820043_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental dual

Type of Visit: E0 Compliance Inspection U Operation Review U Structure Evaluation Q Technical Assistance
Reason for Visit: 01troutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 'U- Arrival Time: Departure Time: I W,'00County: Region- (—
Farm Name: _ ��GYtlY1S Owner Email:
Owner Name: may' Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: [�CIJ/7`�d` Phone:
Onsite Representative: S' .e� I— Integrator: j r'
Certified Operator: �sa�--�� Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ®,No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [] No
[-]Yes JaNo
❑ Yes R No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 2/4/2015 Continued
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Pointry
@apacity
Pap.
Cattte Capacity Pop.
Wean to Finish
La er
I I
I Dairy Cow
Wean to Feeder
F
jNon-Layer
I I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to WeanDesign
Current
Cow
Farrow to Feeder
D . P,oul
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
13oars
Pullets
Beef Brood Cow
Turkeys
Other
ITurkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ®,No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [] No
[-]Yes JaNo
❑ Yes R No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 2/4/2015 Continued

. Facility Number: Date of Ins ection:
❑ Yes
[3 o
❑ NA
Waste Collection & Treatment
15. Does the receiving crop and/or land application site need improvement?
-No
Q`No
❑ NA
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
El
❑ 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
[r]IN'.
Identifier -
dentifer:Spillway?:
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E No
Spillway?:
❑ NE
Designed Freeboard (in):_
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Erl�o
0 NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
E!fNo
❑ 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 DVM
7. Do any of the structures need maintenance or improvement?
❑ Yes
0-<o
❑ NA
❑ NE
8. Do any of the structures tack adequate markers as required by the permit?
[:]Yes
E]14o
❑ 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
to
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[3]No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Q-3'do ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload [❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window /❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): _ Q
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[3 o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Q`No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑'No
❑ NA
❑ NE
acres determination?
21. Does record keeping need improvement? If yes, check the appropriate box below.
[—]Yes
[31 o
[] NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[r]IN'.
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[E] No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Fe—I'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
[31 o
[] 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
�o
❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 5No ❑ NA ❑ NE
Page 2 of 3 214/2015 Continued

.[Facility Number: Date of Inspection:
p --
No
24, Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
CI !"O
DNA ❑ NE
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
To
❑ NA ❑ NE
the appropriate box(es) below.
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ FaiIure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ NA
❑ NE
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
eo
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
4?1'-No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[-]Yes
[D"No
❑ NA ❑ NE
Other Issues
No
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑
❑ 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
I�o
❑ 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
eo
❑ 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.
0 Yes
/
E31Vo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
❑ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[2�<
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
[r3`T,lo
❑ NA
❑ NE
Comments (refer to question ft 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).
/CQ�,v1 f�da( ivo.1 ce.` ja•-`�`fz-� 3Tiwt..
Reviewer/inspector Name: Sire
Reviewer/inspector Signature:
Page 3 of 3
Phone: 9& 3o 3-01S7'
Date: /d —�
2/4/2015

J —/
Type of Visit: O Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: y} -J Arrival Time:E�Departure Time: ;/ County: Region: F a
Farm Name: /W Gr- 9 F�r/izfj
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: dcy-r- Title: ©�/T Phone: -�—
Onsite Representative: Integrator:
—� —
Certified Operator: _ Certification Number: 7g
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
_Discharees and Stream Impacts
. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3_ Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 5�1_No ❑ NA ❑ NE
❑ Yes
❑ No
_
0 mi 04 10.9
❑ NE
❑ Yes
a*�DestgnA.Current
❑ NA
Desigp
Current
Design Current
Swine �Capactty��. Pop.
Wet Poultry
Capacity
Pop.
Cattle Gagacity Pap.
r
Wean to Finish
La erI
Dairy Cow
Wean to FeederI
jNon-Layer
I I
Dairy Calf
Feeder to Finish
F '4.
Dairy Heifer
Farrow to Wean'
gin
Current
Cow
Farrow to Feeder
D , I;oul .
,C�E�a'ca'c
P,o P.
Non -Dai
Farrow to Finish
Layers
jBeef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Turkey Poults
Other
Other
_Discharees and Stream Impacts
. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3_ Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 5�1_No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
[] NE
❑ Yes ❑ No
❑ Yes S No
❑ Yes Ej No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA [] NE
Page 1 of 3 2/4/2015 Continued

Facili Number: - Date of inspection:
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No ❑ NA ❑ NE
Structure 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
F] NE
waste management or closure plan?
❑ Yes
No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify 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
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
p Waste Transfers
❑ Weather Code
9. Does any part of the waste management system other than the waste structures require
[] Yes
[ No
❑ NA
❑ NE
maintenance or improvement?
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Waste Application
❑ NA
❑ NE
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
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 p 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 ® 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?
Required Records & Documents
[]Yes 2 No ❑ NA ❑ NE
❑ Yes ®. No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
JZ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below_
❑ Yes
® No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
p 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
[3 No
❑ NA
❑ NE
Page 2 of 3 2/4/2015 Continued

Facili Number: - 1 Date of Inspection: 3�
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �Q No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes .S] No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ED 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
Q No
❑ NA
❑ NE
Other Issues
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes JEJ No
❑ NA
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
ja 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
J;j 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 Z 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 ENo
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes JEJ 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 e
Reviewer/Inspector Name:
Reviewer/Inspector Signator
Page 3of3
Phone: �).-1[7 j 1)-3'--V 0—/
Date: 2--"l 3 _ (
21412015

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: Arrival Time: ® Departure Time: County: - L Region: 6
Farm Name: Owner Email:
Owner Name: 1'1 (�nG� %�Gdar�� _ Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
f
I
Onsite Representative: A..:C�1 a e.�v�lQ[ rS
Certified Operator: /�,"C�Q�/ A?0i%et1
Back-up Operator:
Location of Farm:
Wean to Finish
Wean to Feeder
17 Feeder to Finish $
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Latitude:
Non -
Layers
Non -La ers
Pullets
Turkeys
Turkey Poults
Other
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
Phone:
Integrator:
Certification Number: 1'7 $ cyi
Certification Number:
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:
Cow
Cy alf
y Heifer
Cow
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [2/No ❑ NA ❑ NE
❑ Yes [—]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 210
❑ Yes �o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: Date of Inspection: Jol,2;0 677
Waste Collection & Treatment /
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ 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: I—
Spillway?: mil
Designed Freeboard (in): / G //
Observed Freeboard (in): -:33 // _
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �o ❑ 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
E24o
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
Q 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?
❑ Yes
Wo
❑ 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)
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
9. Does any part of the waste management system other than the waste structures require
❑ Yes
11d4o
❑ NA
❑ NE
maintenance or improvement?
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
B -<o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application'? If yes, check the appropriate box below. ❑ Yes E2'�o ❑ NA ❑ NE
❑n ing ❑ HydTan}ie-Owrload ❑ Ftuzetrrund ❑ He u, n, etc.)
❑ PSV ❑ PAN ->-t - 3t l0 lbs. ❑ Total Phospho Fai ge m o are oil
❑ indow ❑ E ❑ Appli"ion-Outsi pprove ea
12. Crop Type(s): S Ov e
13. Soil Type(s): 6-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Q o
[] NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�To
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ ' oo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[�Io
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
lDA<'o
❑ NA
❑ NE
the appropriate box.
❑ WH'P ❑ Q;c^r.�lr� ❑ DLsign Qhs ❑ e greemen ❑ Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes �o ❑ NA ❑ NE
❑ E1wrukry7rz6ftfd ❑ ❑ ❑ ❑ W e,�
04&n-f�m [jSlocLnrE_1 emp7-im ❑ s ❑ s ❑ gwte sora
22. Did the facility fait to install and maintain a rain gauge? ❑ Yes D<o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes DNo ❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

• Facility Number: - q I I DoInspection: V
Q'No
❑ NA
ONE
❑ Yes
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E2'<o
❑ NA
❑ NE
25. is the facility out of compliance with permit conditions related to sludge? if yes, check
❑ Yes
[Dl<0
❑ NA
❑ NE
the appropriate box(es) below.
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
[a<o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
LSI o
❑ NA
[ r
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
❑ Appheation-Field ❑ bageep.19temge-Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WM P?
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
Q'No
❑ NA
ONE
❑ Yes
EK
❑ NA
❑ NE
❑ Yes
2- o
❑ NA
[] NE
❑ Yes
E?4
❑ NA
❑ NE
❑ Yes DIN' 0
❑ Yes Q'No
❑ Yes [3No
NA ❑ NE
�NA C:]NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better explain situations (use additional eases as necessarv).
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 210- !�- 33 (JQ
Date: l d _ R!Z -16
21412015

Date of Visit:/� / Arrival Time:7j Departure Time: j� '_3 C CountySswRegion: F9 V
Farm Name: A 4-_1Z, Fa
Owner Name: rn; r_/7Q
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: X2zLr Title: 42[r-�n r_ r— Phone:
IV
Onsite Representative: .5 Integrator:
s
Certified Operator: ,,:' '� Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
- en
Pop.
11
Wet Poultry
La er
JUMgn
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
B8D
%ry/fl
= ° �,,`
- -
D . 1'oultr.
La ers
=
Design
Ca aci
Current
PioX
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Turkeys
Turkey Poults
Other
Beef Brood Cow
y —
_
Oth-.er
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes Pq No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of apast discharge from any part of the operation? ❑ Yes MNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Callo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 214/2014 Continued

Facility Number: - I Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[allo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): f'?
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
10 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
(RNo
❑ 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
[R 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
FLNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Z No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes R-1 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [E No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes JZ No ❑ NA ❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes L0 No ❑ NA 0 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 [M No [3 NA ❑ NE
❑ Yes ja No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes a 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 allo
❑ Waste Application ❑ Weekly Freeboard []Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes allo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
E] NA ❑NE
❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Facility Number: - Date of Inspection: — =/
• 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [,No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
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 fait to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes E[ No ❑ NA ❑ NE
31 . Do subsurface tile drains exist at the facility? if yes, check the appropriate box below. ❑ Yes No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP? ❑ Yes ® No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes ® No
34. Does the facility require a follow-up visit by the same agency? [:]Yes No
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone:,22233:�3aa
Date:
114%2014

i'�Z31-'--7e/Y
- Divi'sion of Water Resources
Facility Number ®- jf 3 Division of Soil and Water Conservation
�• Other Agency
Type of Visit: ompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: OlFroutine 0 Complaint Q Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: t+ !1J Arrival Time: 00 1 Departure Time: 1149.1 043 County: c��fd� Region:
Farm Name_lj'j�f �a�/ns Owner Email: `�'—�
Owner Name: /�', s!L p� - . Phone:
Mailing Address:
Physical Address:
Facility Contact: /%i;c dr! p x.11 Title: 67 Phone:
Onsite Representative: f<4-�_ Integrator: z
40,
Certified Operator: ����_. Certification Number: 12X2}
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Discharees and Stream Imnacts
1_ Is any discharge observed from any part of the operation?
Design Current
[RNo
Design
Current
Design
Current
Swine
Capaty Pop..
Wet Poultry
Capacity
Pop.
Cattle Capacity
Pop.
Wean to Finish
b_ Did the discharge reach waters of the State? (If yes, notify DWR)
La er
❑ No
❑ NA
❑ NE
Dai Cow
Wean to Feeder
Non -La er
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
❑ No
Da' Calf
❑ NE
Feeder to Finish
❑ Yes
12 No
...
❑ NE
Da' Heifer
Farrow to Wean
[gNo
❑ NA
Design
Current
Cow
Farrow to Feeder
D . P,uW
Ca H.,
P,o .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharees and Stream Imnacts
1_ Is any discharge observed from any part of the operation?
❑ Yes
[RNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b_ Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
12 No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[gNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2014 Continued

Facility Number: - Date of Inspection: —/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 10 No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
Spillway?:
Reed _Records & Documents
Designed Freeboard (in):
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
0 No
❑ NA
Observed Freeboard (in): ��-
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[�[.No
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
14 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
JqNo
❑ 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
Eg.No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
®No
❑ NA
[]NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
jo No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes V 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 ❑ 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 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ZLNo ❑ 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
Eff No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
Reed _Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[�[.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 [?j No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [—]Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA D NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Facility Number: - 4 3 1 Date of Inspection: —/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [[No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to'develop a POA for sludge levels
❑ 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)
❑ Yes
54 No
❑ NA
❑ NE
[:]Yes
Callo
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes ,8 No ❑ NA ❑ NE
[:]Yes D�-No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
No
❑ NA
❑ NE
No
❑ NA
❑ NE
®No
❑NA
❑NE
[RYo
D NA
❑ NE
Comments (refer to question # ).- Explain any YES apswerS and/or anyjadditional recommendations or�anykotlier�eomments.'
Use draw�ags of:facility:to:better explain situations {use addit,onal:pages as;necessary).; �
Reviewer/Inspector Name:F���
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 5�0-if-r—�Zrl*p
Date:
2/4/2014

K
Type of Visit:-0`Comptiance Inspection O Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit- J 3 Arrival Time: D Departure Time: •QD County:
Farm Name: +�`�!/y16 Owner Email:
Owner Name: 1W U 4 zez Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: g9-gW-1.--- Phone:
Onsite Representative: integrator: ''z�/a3,✓
Certified Operator:S-� Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Region: ?_ _
Design Current
Design
CurrentDesign
Y Current
* ,.}-
Swine _:. .,Capacity Pop.
��Wet Poultry
L Ca aci
' p ty
Po p.
a Capacity Pop.
Cattle :
,
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish /
r
Dairy Heifer
Farrow to Wean`
'- � Design
•
Current
Dry Cow
Farrow to Feeder
D ;Poul ' Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layer
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Poults
Other
—,Turkey
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ® No ❑ NA ❑ NE
[—]Yes ❑ No
[—]Yes ❑No
❑ NA ❑ NE
❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [—]Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [—]Yes allo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

Facility Number: Date of Inspection: /
—6-2-- 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 33
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E] No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public
health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
J;a 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
.g 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?
I I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Z[No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® 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?
Required Records & Documents
19. Did the facility fail to have the 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_
[ ] Yes ® No
❑ Yes No
❑ Yes ® No
❑ Yes No
❑WUP ❑Checklists [—]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [5No
❑ 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 QNo
❑ NA ❑ NE
[:INA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[] Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [0 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 25 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 ,®-No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑Yes 2]No ❑NA E] NE
❑ Yes gNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes 0 No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes JR 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 pates as necessary).
Revicwer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: �j'o/,j 3-33vo
Date:
21412011

Type of Visit: QCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: GeRGutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: M Arrival Time: ` OO Departure Time: I tf.*00 County: Region
Farm Name:rIl W7 Owner Email:
Owner Name: t (,��/ d �` Phone:
Mailing Address:
Physical Address:
Facility Contact: 41firAa -e / Ro jfLs Title: &2,0 tj� Phone:
je
Onsite Representative: �G�•- - ^
Certified Operator:
Back-up Operator:
Location of Farm:
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current
" Design `Current
Design Current
Swore Ca ac� Po
Wet�Po Ca acr Po
ultns� P� h',,p•
Cattle Ca aci Po
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
eeder to finish
,
Dai Heifer
Farrow to Wean
DesignC rrent
Cow
Farrow to Feeder
D , P,oul , �rn',Ca aci _Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
-
Turkeys
Mher"�r
Turkey Poults
Other
Other JE
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 4Q No ❑ NA ❑ NE
❑ Yes [—]No
[]Yes ❑No
❑ Yes [:]No
[:]Yes ® No
[-]Yes ®. No
❑NA C:] NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 2/4/2011 Continued

Facili ° Number: - 3 Date of Inspection: 4 —
Waste Collection & ,rreatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
[2jNo DNA ONE
❑No ❑NA 0 N
Structure 6
Spillway?:
Designed Freeboard (in):
❑ Yes
® No
❑ NA
❑ NE
Observed Freeboard (in): (r
❑ Yes
No
❑ NA
❑ NE
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.)
❑Other:
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[S No
❑ NA
❑ NE
waste management or closure plan?
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield p 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
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
[Z No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
© No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[Z No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes g�No [DNA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): /0
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [S No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement'? ❑ Yes [K No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [K 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 RNo ❑ NA ❑ NE
❑ Yes [N 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 ail 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 p 120 Minute Inspections ❑ Monthly and I" 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
gNo
❑ NA
❑ NE
Page 2 of 3 2/412011 Continued

Facilitv Number:- Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes ® No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes [ No
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 CA WMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes [MNo ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [X[ No ❑ NA ❑ NE
❑ Yes EFNo ❑ NA ❑ NE
❑ Yes ®No
[—]Yes ®,No
❑ Yes Eg-No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question: Explain any YES answers and/orrany additional recommendations o"r
many other,eotnmeiits.�
Usc drawgs:of�facilityJo better explain situations {use ada onal pages as necessary). - g
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2011

KM
Type of Visit: erComptionce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: , oo Departure Time: fit] County: Region:
Farm Name: M Gl-- f2 arm S Owner Email:
Owner Name: jJ7; G A cls � S `/�1 �� Phone:
Mailing Address:
Physical Address:
Facility Contact: %}'f ; c fj / af�_ Title: %}Gc.//r Phone:
Onsite Representative: �'��,�` Integrator:
Certified Operator: ,�'c..�� Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes a No ❑ NA ❑ NE
[] Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d_ Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ®No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ® No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 214/2011 Continued
DestgQCurrent
DesignCu.rent-
Design Current
Ca act Po -
Wet Poul
Ca acttV�'r l?o �' � �
Cattle Ca aci Po
Finish
r[Wean
La er
Dai Cow
Feeder
Non -La er
Da' Calf
o Finish
Dairy Heifer
harrow to Wean
Design Cierent% I
Dry Cow
harrow to Feeder
D . P,ou!
Ga act
Non -Dai
Farrow to Finish.:
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
w:
Pullets
Beef Brood Cow
a
Turke s
Other_
: .�-::
Turke Poults�
Other
her
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes a No ❑ NA ❑ NE
[] Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d_ Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ®No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ® No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 214/2011 Continued

FaciliNumber: - = I Date of Inspection:
Waste Collection & Treatment
1 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [] Yes [3 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
18. is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
Spillway?:
Required Records & Documents
Designed Freeboard (in): C7
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'?
❑ Yes
® No
❑ NA
Observed Freeboard (in): _ 4116-
16-
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�C No
❑ NA
5.
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
0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[& No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
14 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes allo ❑ NA r] 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):c
13. Soil Type(s): .
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes FA No F] NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes R' No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
1p 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
�C 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 0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
[:]Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes (& No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [0 N
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
No
❑ NA ❑ NE
Page 2 of 3 2!412011 Continued

Facili Number: - Date of inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ 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 0 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[—]Yes
® No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P] 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
0 No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations oriany�other�commeli
Use, drawings _of facility:to better explain situations (use additionalvages as necessary.).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of
Phone: 9A9._'//:0__j37 0 0
Dater
214/2011

Type.of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 9<utine 0 Complaint O Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date o1 Visit: - —[D Arrival Time: pp Departure Time: ® County: Region:
Farm Name: s Owner Email:
Owner Name: 171 ;"C, /I a r _! S /'� aQ -ee3 Phone:
41
Mailing Address:
Physical Address:
Facility Contact: %'j1 i Cit Sye: n
re -Phone No:
Onsite Representative: s — Integrator: 'az-.
99,
Certified Operator: sem" Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = = Longitude: =o=&
o0& =6t
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
DesignC►urrent
Design Current
Design Current
Swine Capacity Population
We# Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dai Cow
❑ NA
❑ Wean to Feeder
❑ Yes
❑ Non -Layer
❑ Da' Calf
CR No
Feeder to Finish
�j �'� J 1�
j
❑ Da Heifer
❑ NA
❑ Farrow to Wean
ry Poul#ry
❑ D Cow
❑ Farrow to Feeder
L1 Non -Dairy
La ers❑
ow to Finish
r[E--J]'Non-Layers
Beef Stocker
❑ Beef Feeder
s
Pullets
❑ Beef Brood Col i
61EIGitts
Turke s
Turke Poults
Numtter of Structures: �/
❑ Other
r
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
Cl NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
CR No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
Page I of 3 12128/04 Continued

Facility Number: Date of Inspection
is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
® No ❑ NA
❑ NE
Waste Collection & Treatment
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
jo 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:
Wo ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
Spillway?:
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
®. No ❑ NA
Designed Freeboard (in):
17.
Does the facility lack adequate acreage for land application? ❑ Yes
M -No ❑ NA
❑ NE
Observed Freeboard (in): q,'�
Is there a lack of properly operating waste application equipment? ❑ Yes
gjs!o ❑ NA
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
[:1 Yes
® No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc_)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
J] No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
9No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
C4No
❑ 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
9 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance/improvement?
11.
is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
® No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s)�rn.,��---
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
Wo ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
J,No ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
®. No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
M -No ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
gjs!o ❑ NA
❑ NE
Explain a
explain situ!
Reviewer/Inspector Name K„
Reviewer/Inspector Signature:
Page 2 of 3
Phone: 5ac7
Date: t)
12128/04 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes R No ❑ 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 ERNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers 09-Aimual 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
9,No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[KNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
C,No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
54 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
IR No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P9No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
C.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
5aNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3l. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
E,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
allo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12/28/04

Type of Visit EMompliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint Q Follow up O Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: ��'i�J Arrival Time: �' (% Departure Time: County: Region: r 0
Farm Name: [n CL }j,_,_ oaf iws __ Owner Email:
Owner Name: J14.,<4 ' j2 wl Phone:
Mailing Address:
Physical Address:
Facility Contact: X iC 2 r Z f2_122 Q Title: Phone No:
Onsite Representative: integrator:V/'r�
10,
Certified Operator: S' -- Operator Certification Number: 7 �
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 E--]' 0 u Longitude: = 0 0 t =
16
Design Current
Design Current
Design C*urrent
❑ NA
❑ NE
Swine Capacity Population
Wet Poultry Capacity Papulation
Cattle Capacity Papulation
❑ Wean to Finish 1
10 Layer
❑ Dairy Cow
El Wean to Feeder
❑ Non -Layer
[j Dairy Calf
❑ Feeder to Finish
❑ Yes
❑ Dai Heifer
El Farrow to Wean
Dry Poultry
❑ D Cow
El Farrow to Feeder
--
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
El Beef Brood Co
❑ NA
ElTurkeys
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
Other
❑ Other
❑ Turkey Poults
❑ Other I
A Structures: ELI
❑ NE
other than from a discharge?
Discharees & Stream ImRacts
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
Cl NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
(KNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
P9 No
❑ NA
❑ NE
other than from a discharge?
12128/04
Continued

i
Facility Number: — Date of Inspectiou / `a
Waste Collection & Treatment
WNo
[INA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
f .No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
RNo
❑ NA
❑ NE
Stnucture I Stnicture 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): f G%
Observed f=reeboard [in):
5. Are there any immediate threats to the integrity of any of the structures observed?ElNA
❑ Yes
KNo
El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
[4No
❑ NA
❑ NE
through a waste management or closure pian?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
9(No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes KNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes (ANO ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes XNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 5i.No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
[:]Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s)
13. Soil type(s) 4r— p A--
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes D§,No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
WNo
[INA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
VNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
64No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: 33 UZI
Reviewer/Inspector Signature: Date:i�J
12128/04 Continued

' Facility Number: — Date of Inspection / �o
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes QNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 2L& ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes QNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[&No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
&No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
9No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
gNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
allo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
E] Yes
[KNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
RNo
❑ 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
KNo
❑ NA
❑ NE
General Permit? (id discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
QZNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
NNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
12/28/04

Type of Visit Compliance 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: Arrival Time: i 3 C� Departure Time: : 3 County: O` Region:
Farm Name: 2 Owner Email:
Owner Name: m:r ha e.) Phone:
Mailing Address:
Physical Address:
Facility Contact: _�,'j�: r_YtQ,_Q� f!5 Title:
V
Onsite Representative:
Certified Operator:s�*
Back-up Operator:
Phone No:
Integrator: ` -CS i
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ u ❑ I ❑ 1
4 Longitude: ❑ ° =
Discharp_es & Stream Impacts
I . Is any discharge observed from any part of the operation?
Design Current
Design Current Design CuOMAN rrent
Swine
Capacity Populret;Po uiltry
Capacity Population" Cale Capty Population
ElWean to Finish
❑ Layer
El Dairy Cow
ElWean to Feeder
Feeder Finish
❑ Non -Layer
'
❑ Dairy Calf
" El
to
_
Dairy Heifer
El Farrow to Wean
Dry; Poultry
El Dry Cow
ElFarrow to Feeder
❑ NE
❑ Non -Dai
Farrow to Finish
El Farrow
Layers
� ❑Beef Stocker
❑ Gilts
❑ Non -Layers
� ❑Beef Feeder
El Boars
El Pullets
❑ Beef Brood Ca
2. Is there evidence of a past discharge from any part of the operation?
_.::. ❑ Turkeys
RNo
Outer
❑ Other
❑ Turkey Pou Its
El
'Number Structures:
❑ Yes
Other
of
Discharp_es & Stream Impacts
I . Is any discharge observed from any part of the operation?
❑ Yes
U[No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
RNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
® No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

Facility Number: — 0 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ®.No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): '10
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes KNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes E.No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
® Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
®,No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ NE
9. Does any part of the waste management system other than the waste structures require
❑ Yes
q No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
®,No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below, ❑ Yes ,iQ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) �b,lt-&rj 6 -rod
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWIvIP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
fRYes ❑ No [INA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
RNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
® No
❑ NA
❑ NE
1$. Is there a lack of properly operating waste application equipment? ❑ Yes
N No
[--INA
❑ NE
%'t-
'C"--nAl ue
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 2 of 3
Phone:
Date: (Q-�"�v{CJGd
12128/04 Continued

Facility Number: — Date of Inspection 1 6��V
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JgNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WIJP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Ryes OPiKEl NA ❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAW MP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal'?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (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
[4 No
❑ NA
EINE
❑ Yes
19 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
EINE
❑ Yes
MNO
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
El Yes f@No 0 N [:1 NE
❑ Yes ER No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 9No [INA ❑NE
:.
Additional::CommeoEsandlor Drawings:
vv t°r` C -e W 5 R', I ��� 7h �y 171alaA , : `t W06 oL- We�mk f'r,%J d--
wazW r i r r w�'ra�� r%�e� 14— yf m vte.,14-E> F:- jOa.--*- fi�pjo�'�� Tp
ea ckPu / 1 v Fr a F j U +r"" b r /-V- 2 u pia .
r,l o -+c. ubG n.a Int o -c 'Thaw 3 b3 aF 114 wA.", ypck K 11 y60 r—
&Jd Tate TI}e l3rnt>u���:r� D�� pr-_rAe Nom+
Page 3 of 3 12/28/04

1
Division of Water Quality
Facility Number3 0 Division of Soil and Water Conservation 7 a
0 Other Agency
Type of Visit 0<ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:'
Farm Name: 2GW►'riS Owner Email:
Owner Name: �2c�� n r° L Phone:
Mailing Address: -Vd v Arne /& /J C.
Physical Address:
Facility Contact: Title:
Onsite Representative: - —
Certified Operator:
Back-up Operator:
Phone No:
Integrator: ^tr
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o ❑ I = Longitude: = o =, =
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 Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
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'?
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: a]
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
El Yes
❑No
El NA
El NE
❑Yes
0 N
El NA
El NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes BNo ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
12/28/04 Continued

Facility Number:A:;,__ Date of Inspection �a;"
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes Fq No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
Identifier:
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
®No
❑ NA ❑ NE
Spillway?:
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
Designed Freeboard (in):
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
Observed Freeboard (in):
12.
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
JZ No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
14.
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
,4 No
❑ NA ❑ NE
through a waste management or closure plan?
® No
❑ NA ❑ NE
16.
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
Z 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
j+ No
❑ NA ❑ NE
maintenance or improvement?
WasteAvolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
[--]Yes
ERNo
❑ NA [:INE
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 CropWindow❑ Evidence of Wind Drifl ❑ Application Outside of Area
12.
Crop type(s)
13.
Soil type(s) 19X
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
Ad No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
® No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
® No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
&No
❑ NA ❑ NE
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:/[Y _.3.3-33
Reviewer/Inspector Signature: Date: '5='V7-7 — dyo
12/28/04 Continued

1
Facility Number./1,,7-- Date of Inspection p
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JgNo [:INA ❑NE
20. Does the facility fail to have all components of the CAWW readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box. ❑ Wup 0 Checklists ❑ Design ❑ Maps ❑ Other
21- Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [9 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[9 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
14 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
J,No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
XNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
RNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
C9 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
N 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
ZNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency'?
❑ Yes
0 No
❑ NA
❑ NE
AdditionafComments °and/or Drawings: v ,� 5Z. .
Page 3 of 3 12/28/04
Page 3 of 3 12/28/04

Type of Visit O'Lrornpliance Inspection O Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit G�ffoutine 0 Complaint 0 Follow up 0 Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: t�.1-fLJ County 27• Region:7�-
Farm Name: %yi i w'R P�ze M� _._ Owner Email:
Owner Name i Li Li a t`� Phone:
Mailing Address: 1��5� 'Oelfaa 4!�te/�/[S /IAC-� 4�?4�'qq
Physical Address:
Facility Contact: %h�G L It Oa,� ' Title: Phone No:
Onsite Representative: _��.�..�— _ Integrator: y 2; -,
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: ❑ o ❑ J ❑ 11 Longitude: ❑ ° ❑ ' ❑ u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑
Layer
❑ Non -La et
Dry Poultry
❑ Lavers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkev 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 Curr.0nt
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ _Dairy Heifet
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
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?
J
[D Yes ANo .0 NA EINE
❑ Yes
4 No
❑ NA
❑ NE
❑ Yes A�' No
❑ NA
❑ NE
❑ Yes
4 No
❑ NA
❑ NE
❑ Yes
PR No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
12/28/04 Continued

Facility Number: Date of Inspection"
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ®No [--INA ❑NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ELNo ❑ NA ❑ NE
Structure 1 p Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): g
Observed Freeboard (in): /
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes CR No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [KNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes U[No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) ,�Lr/'»t jAA ffy / L
/
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q No
❑ 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
5Q No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
91 No
❑ NA
❑ NE
I8. Is there a lack of properly operating waste application equipment?
❑ Yes
KI No
❑ NA
❑ NE
CVV L 1404, -'Ne'EJ) K7-0-
Reviewer/inspector Name - `, Yj �^-MOM Phone: �%!7— 3�1Z
Reviewer/inspector Signature: Date:
12/28/04 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes J,No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 91 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
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
14No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ba No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
J4 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[K No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
P9 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
,4 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
,R No
❑ NA
❑ NE
12/28/04

�'w+� k weir tYd y r W Dlvlslon of Water,QUaI1ty ! i Fjz�
fes} s
5�l
I Facility Nurtiberfi a y3 O`Division of Sotl and'ater Conserratron
air x
I � Other Agency
R
Type of Visit ®Compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ®Routine Q Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: C�.AB/0 Arrival Time: O SDeparture Time: �� County: I r Region: P0-0
Farm Name: R Fair ,+.,s Owner Email:
Owner Name:y ' i� e- cites Phone: �gto _ S3a- `{p 1`
Mailing Address: �_�—�.?.�o�G�9p—e _/!/q of c_Af . jNC PS -1114 _
Phvsical Address:
Facility Contact:
"ritle:
Phone No:
Onsite Representative: Y"'11's C o� R_o�« Integrator:�res Tom_
Certified Operator: P–) ; ce�,4�c, k —Rp.4C.r.s Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: [= e [= 0 Longitude: =0=, °0,
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish 10 Layer
❑ Wean to Feeder 10 Non-Larer
Feeder to Finish I $ Po 4 o
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Lavers
❑ Non -Lavers
❑ Puilets
❑ Turkevs
❑ `furkev Poults
❑ Other
Discharges R 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 HeifelCow Elv
Dry Cov
El Non -Dai
El Beef Stock
El Beef Feede
El Beef Brood
Number of Structures: D]
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 DNN,Q)
2. Is there evidence of a past discharge €rom 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 W No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[ No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12/28/04 Continued

Facility -Number: gA Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes DQ 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: 1'
❑ NE
Spillway?: 6' 10 —4Sf
K] No
Designed Freeboard (in):
EINE
S
Observed Freeboard (in): If
EN No
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes [4 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
[P No
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes ® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [A 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 M No ❑ NA EINE
maintenance or improvement?
Waste Anolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes W No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 93 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or i 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) r (1 r a-._Soelx, Qc s _S
13. Soil type(s) 06
14. Do the receiving crops differ from those designated in the CAWMP? ElYes
W No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
K] No
❑ NA
EINE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination' [] Yes
EN No
❑ NA
❑ NE
IT Does the facility lack adequate acreage for land application? ❑ Yes
[P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
A L',,�.G
b� aer I I< . I h
❑ Yes 10 No ❑ NA ❑ NE
+�"t jp"ti o4 DS/
Reviewerlinspector Name �,� �� Phone:
Reviewer/Inspector Signature: Date: /-v Rf dy"
12/28/04 Continued

Facility Number: +43 I Date of Inspection G /-1Q /as'
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes M No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P0 No ❑ NA ❑ NE
3.1, I . s .t.q
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" 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
P No
❑ NA
❑ NE
El Yes
®No
El NA
[:1 NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
FXI No
❑ NA
[I NE
❑ Yes
R1 No
❑ NA
❑ NE
❑ Yes
5fl No
❑ NA
❑ NE
❑ Yes EQ No ❑ NA ❑ NE
❑ Yes IR] No ❑ NA ❑ NE
❑ Yes 91 No ❑ NA ❑ NE
❑ Yes fB No ❑ NA ❑ NE
❑ Yes •. 10 No ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
Ad'ditioual Cotttmerw#s?andlo°r. DrawIngs: .- x
12/28/04
12/28/04

Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
for Visit a Routine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
F_ Date of Visit: l..l1P� Time: ��� /�
Facility Number 9a
Q Not Operational Q Below Threshold
IX Permitted m Certified [3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: ------. _W.
Farm Name: ..... _-1.17 4 _ �!l!?5.._......_ .... _ - - --- - - County: S e► rr. ,iS7_!u_ _._ ... F R a..
Owner Name: _V-% i .C.� ��. �......... L l&*........ G1 .s�!S.S....... ..... ............ Phone No: Q b.......s. ..".. a. J L .._........_ _.-....._.
Mailing Address: .... 1 S�...... w...1 .G.� .. Cl -- ............ g r �......... C ........
Facility Contact: _ _ ...----------- Title:._ . _— --- __. Phone No: ---------
Onsite Representative..._l^'' ! G4Wa.c��. A� ................... __------- Integrator:
CertMed O erator• ..1._ n 1.................�Operator Certification Number:.. .
.! .....
Location of Farm:
10 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 &6 Longitude • 4 44
Discharges & Streams Impacts
I . Is any discharge observed from any part of the operation?
❑Yes W No
Discharge originated at: ❑ lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) ❑yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/rain? N/A
d_ Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes jc No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes QB No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure fi
Identifier: _. �... ..............
Freeboard (inches):
12112103 Continued

Facility Number: $.I _ y3 IDate of Inspection 6y 7ko%
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, traps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
N'PDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ RainfalI ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes Qj No
❑ Yes ( No
❑ Yes jj No
❑ Yes [O No
❑ Yes ® No
❑ Yes 0 No
❑ Yes M No
❑ Yes No
❑ Yes ® No
EjrYes ❑ No
❑ Yes a] No
❑ Yes W No
❑ Yes C9 No
❑ Yes ® No
❑ Yes [4 No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ddlttonal Comments"and/OV wings _ m' r -
:Lw'r�
Lajoo;+ 1t.►�I. ti.. aoo3 33. 1Y1r, l2oge:r.& s+.+cs P,.ea+cjc 1,as C-bw%AL%
.2. 2 y- a 3
y"►i� Si�ta�g� s�r�/cy y q
3-3-403 t:.��
3-11-03 r`t �� ti �... m Gari a♦
"
-2#P;03 9
l2
l -iaf—O; %S to
51-aI1 -d3 ►�Of
L t
Q6i 7tt1 �.O {Aili
/ �r
setra4f �ro -rOIA-t -1
2 J20 log./ 3. SMb�viTvr e wt
o -� f� c co•l':�.+,t,"f �7au,,scJ a..�oQ rcPa��c
so, l c.4
l.z iS �03 4 n coQ>
l2/l2103

Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ 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?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenanceTmprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Aanlication
❑ Yes 10 No
❑ Yes W No
❑ Yes [T No
❑ Yes P No
❑ Yes Qj No
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ® No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type Jeer r „, rn 05
i
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWW.). ❑Yes P No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes [� No
b) Does the facility need a wettable acre determination? ❑ Yes [jO No
c) This facility is pended for a wettable acre determination? ❑ Yes U No
15. Does the receiving crop need improvement? ❑ Yes (P No
16. Is there a lack of adequate waste application equipment? ❑ Yes 1P No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ® No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ® No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes X1 No
Air Quality representative immediately.
Comme�tts- (refer to gaeshon )� Fatl►�iam an YES answers and/dr airy, rroommertdat oas ar,sny attte C - -
_ tix s r comments r
Use drawwgs'of faa7ity to better euplatn sttuat 6= (use addttiii a pages as nary) COPY ❑Final Notes
�' "�, i
L
Reviewer/Inspector Name__- . _... x ?-z w= y ;
Reviewer/Inspector Signature: Date: -1 0' d
12/12/03 l Continued

Facility Number.--S--Y-3
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Date: r—i -3 - 9�
Time:_- Z,> _cz>
General Xnformati n:
Farm Name:--- County:_�J
Owner Name:_ r c> .r'Ia 79 _ Phone No: 4Q. �- -- Is-(, a-.
U
On Site Representative: Integrator:
Mailing Address:- X ;L, C<a)c
Physical
Latitude: 1 I Longitude: I I
Operation Description: (based on design characteristics)
Type of Swine No. of Animals. T)pe of Poultry No. of Animals Type of Cattle No. of Animals
0 Sow 0 Layer 0 Dairy
0 Nursery 0 Non -Layer 0 Beef
0 Feeder
OtherTjpe of livestock. *:4_ - Number of Animals: -5-2'7C
Number of Lagoons:^ �_ (include in the Drawings and Observations the freeboard of each lagoon)
acility ins:
Lagoon
Is lagoon(s) freeboard less than I foot + 25 year 24 hour storm storage?: ;:f,,
Is seepage observed from the. lagoon?:
Is erosion observed?:
Is any discharge observed?
❑ Man-made ❑ Not Man-made
Cover Crop
Does the facility need more acreage for spraying?:
Does the cover crop need improvement?:
(list the crops which ed improvement)
Crop type: � , Acreage:
Setback Criteria
Is a dwelling located within 204 feet of waste application?
Is a well located within 100 feet of waste application?
Is animal waste stockpiled within 104 feet of USGS Blue Line Stream?
Is animal waste land applied or spray irrigated within 25 feet of BIue Line Stream?
AOI -- January 17,1996
Yes ❑
Nil
Yes ❑
NoO
Yes U
NaI&
Yes U
N6b
Yes ❑
No ❑(5
Yes ❑
NoM
Yes d No W
Yes ❑ ,N..
Yes ❑ Nd�L
Yes ❑ No

Maintenance
Does the facility maintenance need improvement? Yes ❑ NoA-
Is there evidence of past discharge from any part of the operation? Yes ❑ NoV
Does record keeping need improvement? Yes ❑ NAKI-
Did the facility fail to have a copy of the Animal Waste Management Plan on site? Yes ❑ Nop
Explain any Yes answers:
cc Facility Assessment Unit
Drawings or Observations:
Date: z /3 - pG
Use Attachments if Needed
I
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ter - r .. - _',''t: r. ..._.--;: _.- :;-i _`ice .4 r�i• :;
AOI -- January 17,1996