820064_INSPECTIONS_20171231

- Division of Water Resources
Facility Number -�i-2- H i O Division of Soil and Water Canservation
equeneyAl
ency
Type of Visit:�.,o�mpliance Inspection Operation Review 0 Structure Evaluation Technical Assistance
Reason for Visit: (?(Routine Complaint O Follow-up 0 Referral O Emergency 0 Other 0 Denied Access
It
Date of Visit: I Arrival Time: t 71 Departure Time: ' vp County:s iZ d
Farm Name: ` r�'����L`r�� y �`( 0+1me-(- i r W1 Owner Email:
Owner Name: �" / a k, K t� L� !k�(ss y Phone:
Mailing Address:
Physical Address:
Facility Contact: A v--t-t s 13 ,rv W (re Title:
Onsite Representative:
ff
Certified Operator:tier^ 6z'
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Region:t _1Z d
Integrator: tV-S
Certification Number: T�� 0
Certification Number:
Longitude:
Discharees and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
E] Yes Eg-<o E] NA ❑NE
❑ Yes
Design .Current
Pl'A
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pali.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Nan -La er
1
Dairy Calf
Feeder to Finish
g $'0 a-
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , P,ault
C•a —8c i
P,a
Non -Dairy
Farrow to Finish
Layers
I
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turks s
othe_
ey Poults
Other
Other
Discharees and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
E] Yes Eg-<o E] NA ❑NE
❑ Yes
❑ No
Pl'A
❑ NE
❑ Yes
❑ No
C3 NA
❑ NE
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 [�J< ❑ NE
E�Ies ❑ NA I] NE
❑ Yes 0' lqo ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facilit Number: - Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E]-Nry❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ZO
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2<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
ED No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement'?
❑ Yes
['Ifo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[f"'10
❑ 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
IJ<
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
4 o
❑ NA
❑ NE
maintenance or improvement'?
11. Is there evidence of incorrect land application'? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Approved Area
12. Crop Type(s): o f W 1060 fil r
13. Soil Type(s): W a A10
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Quo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �lo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ID''"" ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes [3'I o ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes 2<0 ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'? [] Yes o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? Ifyes, check ❑ Yes [;I<o ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes []�o [] NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the Facility fail to install and maintain a rain gauge? ❑ Yes Q No ❑ NA ❑ NE
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes ❑,110m ❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facili 4Number: Date of Inspection: 2
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E>d-�❑ NA ❑ NE
25 Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative'?
34. Does the facility require a follow-up visit by the same agency'?
❑ Yes 0>cr— ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes ❑ A}o ❑ NA ❑ NE
❑ Yes Ui ` o ❑ NA ❑ NE
❑ Yes [Ej`5_o ❑ NA ❑ NE
[:]Yes ❑']Vo ❑ NA ❑ NE
❑ Yes E]'�fo ❑ NA ❑ NE
❑ YesNom❑ NA ❑ NE
[:]Yes [ �i o ❑ NA ❑ NE
Comments (refer to question #) Explain any YES answers and/or.any additional recommendations or any other comments.
Ilse drawing`s of facility=to'better explain,�s'ituations (use"additional pages as necessary).
C,eA 1(0-30g- 6 f -s(
slodr- -7 0, 7—l7
Reviewer/Inspector Name: Tis i V �t� Phone io- 03-33
Reviewer/Inspector Signature: i � � (JAjj�a Date: -Z
Page 3 of 3 2/4/2015

Type of Visit: ice,,, mmpliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: &1ioutine 0 Complaint t) Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: I 12A3a W County: s'� 0.1 Region:t )ZD
Farm Name: r e-wwH ►�k L1L:dq -y rw t,
Owner Name: tet✓ L[ I 'v1
Mailing Address: Z 5 6z) �Pc� Gt5 Y _ 1��� ✓ Ci 1 ,•
Owner Email:
Phone:
tri If,
Physical Address: o L) G 1101 �-41,1
Facility Contact: ' 61S 6-ajaeck �, _,h (I yitlr Phone:
Onsite Representative: t
Certified Operator:
Back-up Operator:
Location of Farm:
Integrator: fn 13 L LG
Certification Number: sr 7 oet
Certification Number:
7 m i F
Latitude: 5 03 / Longitude: 7 e0
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
DesignCu
Capacityrrent'
Pap.
ft
Design Current
Cattle Capacio
ty Pp.
Dairy Cow
Wean to Feeder I
INon-Layer
I
Dairy Calf
Feeder to Finish
❑ Yes
�o
❑ NA
Dairy 11cifer
Farrow to Wean
[D,,`es
Design
Current
Dry Cow
Farrow to Feeder
Dr. .P.oultr
Ca acit
Pao ._
Non -Dairy
Farrow to Finish
Lavers
❑ No
"❑ NA
Bee!' Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
1'
tQther
Turk PouIts
7
Other
Other
s
r,
Discharves and Stream Impacts
1. Is any discharge observed from any part of the operation?
M es
❑ No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field [!3-6thcr:
a. Was the conveyance man-made?
❑ Yes
�o
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[D,,`es
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
60011-
001-
d.
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
es
❑ No
"❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ED No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ETes ❑ No ❑ NA ❑ NE
of the State other than from a discharge'?
Page 1 of 3 21412015 Continued

Facili Number: oL - Date of Inspection:— 11A D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? es o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 6�d � [-]NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Gg�lro ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a [] Yes [! No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes 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)
71WE
Required Records & Documents
9. Does any part of the waste management system other than the waste structures
require ❑ Yes ❑ No
❑ NA
❑ NE
maintenance or improvement?
❑ No
❑ NA
[J -NF,
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ❑ No
❑ NA
E] NE
maintenance or improvement?
the appropriate box.
1 1. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ NA
2N
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure
to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of 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 �E
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA E3 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes ❑ No ❑ NA �3
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑-NE
IS. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
71WE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
[J -NF,
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
❑ No
❑ NA
0 E
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ N A [a-lgl
❑ Weather Code
[:]Sludge Survey
❑ NA [31N E
❑ NA E:fNE
Page 2 of 3 2/412015 Continued

Facility Number: Date of Ins ection: a
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA [0;4KE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [] No ❑ NA I� "'E
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 O�NV
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes EsJ-�o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes Q<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
Q'Tes
❑ No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, aver -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[] Yes
[!I -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
E11No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
[] Yes
Q'IQo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
Yes
❑ No
[] NA
❑ NE
�4% eA-d 0 ivtLf�a �C4
QbowC` S�YGµ s -f—, e, I6oL) ff,,,1 (ANk
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tcrc.-. Ytc,c� Y
(� ��C���t-��-�c �,.v►,� � ��'�..5 lvi;,(,t�k1���'7ru� �(� I j1-]
#3o IVCDel�dis►��, P� ot 7rt�U V�
Gc r1 �/` Vlr c 1S ` '� '-�'' o � p 1 x -f Q Q S 100 fel ' � al -> k.. { Z QI �l o V eve r•
3 0, �� J'�` r✓t L�,r •F (, n!
A. 17 SOu%-� �3 �isc��µ�t (�jcs KIIGJtl+l 1, '1� �dallIQI.CrtfLvrj "�trs'Ort�41`'� i"� S�I`f
tz rM wl-�' ' C✓/i A
Uf ,� It' {_'to cvev 'A (ttv J
Reviewer/Inspector Name: ' �4
Reviewer/ Inspector Signature: tMin —
Page 3 of 3
Phone:
Date:
3
2/4/2015

9 S M5 i SfJ
OrDivision of Water Resources
�Facfflty Number I� - ® O Division of Soil and Water Conservation
O Other Agency
Type of Visit: Cj.E pliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: difoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: Ma�Owner Email:
Owner Name: J Phone:
Mailing Address:
Physical Address:
Facility Contact: C k 19,eVUWA Title:
Onsite Representative: q
Certified Operator: A 'lt1 •
Sack -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
10 her
Latitude:
Phone:
Region
Integrator:
T
Certification Number: l gb
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
L
ayer
llry roultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance than -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 DW It)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heiler
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑Yes rZo E] NA ❑NE
❑ Yes [] No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ®"No
❑ Yes Zf No
E? -RA ❑ NE
Z NA ❑ NE
Cj*'NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NF
Page I of 3 21412015 Continued

Facili Number:- Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ['T No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No Q"NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[;? Ro
❑ NA
Spillway?:
Required Records & Documents
Designed Freeboard (in):
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
q?0SNo
❑ NA
Observed Freeboard (in):_
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check
❑ Yes
[;KNo
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
20'N_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
�No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement'?
❑ Yes
ErNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[E>o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
ErNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
KNo
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes C!T*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 F-1 Evidence of Wind Drift ❑ Application Outside of Approved Area
4.
12. Crop Type(s): A", S( C) Ad
13. Soil Type(s): d
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Q o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [!No ❑ NA ® NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑'No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[;? Ro
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
q?0SNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check
❑ Yes
[;KNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below, ❑ Yes ZNo
❑ 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 tail to install and maintain a rain gauge? ❑ Yes 1No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes allo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facllit Number: - q D jDate of lns ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes -EI'No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes C 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 [�+Io
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [ 0No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes 0No ❑ NA ❑ NE
❑ Yes [, �o ❑ NA ❑ NE
❑ Yes [X -No ❑ NA ❑ NE
❑ Yes [2/No ❑ NA [] NE
❑ Yes �No
❑ Yes dNo
❑ Yes ["No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question #): Explain any YES answers_ and/or any,addltlonal recommendations or any: other'comments.
Use drawings of facility to better ex Iain situations.{use additionah ages as necessary).
' &4 ° 6
,�Io�
�
5C.
C:.f( (o-
Reviewer/Inspector Name:
Reviewer/[nspector Signatur
Page 3 of 3
Phonelo -1(3 3: 13733L(
Date: 11
21A015 S

I VA- .Jr 75-u ►v r? U
A vision of Water Resources
'Paellity Number - 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: OCompliance Inspect€on 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (3 Etoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: LSJ Arrival Time: Departure Time: County: �^ RegionM—e)
Farm Name: o CWqt �a Owner Email:
Owner Name: Lr4 s Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: L�
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Title:
Latitude:
Phone:
Integrator:
Certification Number:
Certification !Number:
Design Current
Wet Poultry Capacity Pop.
La er
Non -La er
0
Non -Li
Pullets
Other
Poults
Design Current
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes EE�1P ❑ NA ❑ NE
a. Was the conveyance man-made?
❑ Yes
❑ No
[] 7 A
❑ 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
[RI�A
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
�o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes dNo [] NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2015 Continued

4t
Facili umber: -Date of Inspection:
N c
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
N�aste Collection & Treatment
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes rlo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E3-55�❑
NA
❑ NE
a. If yes, is waste level into the structural frecboard?
❑ Yes
❑ No
NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NE
Identifier:
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
Spillway?:
❑ Yes No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Designed Freeboard (in):
❑ NA
❑ NE
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
IrJ Ko
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
Q<
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
2<o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
C. o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2< 7"'D NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window
indo_ww` ❑ Evvidence of gW/indVDft'Application Outside of Approved Area
12. Crop Type(s): v+�[,U�C3� �C7 o rel Cr
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [ o
❑ Yes No
❑ Yes C3<0
❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes ETNo ❑ NA ❑ NE
❑ Yes EE <o ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes Ea -Ko
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes rlo
❑ 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 13<0
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes �(No
❑ NA
❑ NE
Page 2 of 3 2/4/2014 Continued

Facility Dumber: - Date of Inspection:
24". Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Lam° ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [e]�iCo'— ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes []�< ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Io
❑ 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
❑'Ko'
❑ 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
IS' o
❑ 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
[:�o
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 1 No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes [ r o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes eNo ❑ NA ❑ NE
Comments (refer t6,que9tidn.#): Explain.anyYES answers and/or -any additional recommendations or any other comments.
Use drawings of:facility io'better explain situations: (use additional pages as necessary).
4��[ % f , , —
slwuye5.�y-�l-2-1,�s 6 s.a PS,( �S�
Reviewer/lnspector Name:
01
Reviewer/inspector Signature;
Page 3 of 3
Phone:
Date:
2/4/2011

'apol ivision of Water Quality
Facility Number . :- 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: CFCompliance 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:
Departure Time: ' $
County:'4— Region:
Farm Name:
❑ No
Owner Email:
❑ NE
Owner Name: M.r.
k� ��l �(�,C� j`�t
Phone:
Mailing Address:
Physical Address:
Facility Contact: ��f;vcvL�� Title:
C(
Onsite Representative:
Certified Operator:
Phone:
Integrator: VU–S
CertificationNumber:-- [ 0 Lt
Back-up Operator: Certification Number:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Other
Other
Latitude: Longitude:
Design Current
Wet Poultry Capacity Pop.
La er
Non -Layer
Dry rouary
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
AIM t' th d 1 h 11 47 S 11 1)
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[:]Yes L' —K-5 L❑ NA ❑ NE
❑ Yes
❑ No
�NA
❑ NE
❑ Yes
❑ No
[�NA
❑ NE
C' a is a estimate vo ume t at reac a waters o t e tate (ga ons).
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 rNo
"❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/412011 Continued

Facility N mber: Date of Ins ection: h•
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes o ❑ NA ❑ NE
ra. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 4D-N"A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
identifier:
Spillway?:
Designed Freeboard (in): !
Observed Freeboard (in): 1 s
5. Are there any immediate threats to the integrity of any of the structures observed? D Yes E3 -NT ❑ 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
�°
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E]-ITo--
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ Yes
❑r1q_o_
❑ NA
❑ NE
9. Does any part of the waste management system other than the waste structures require
❑ Yes
ON.
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
[3<o
❑ NA
❑ NE
Waste_ Application
❑ Yes
-d"""
❑ NA
❑ NE
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Flloo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): K -,t �.�/4
13. Soil Type(s):
6
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E -M
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[2 -?46-
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑r1q_o_
❑ NA
❑ NE
acres determination?
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Eg4o'
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[3<o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
-d"""
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[;YNo
❑ NA ❑ NE
20. Does the facility fail to have all components ofthe CAWMP readily available? Ifyes, check
❑ Yes
[ Ko
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Eg4o'
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
[] Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
/
{ F
/,
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�o
❑ NA ❑ NE
Page 2 of
2/4/2011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Cn-R-o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [5-N�o_ ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Nan -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [T -No' ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
F1,Pdo
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
EYNo
❑ 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
L7 '''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
]o
❑ 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
2/No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
[:]Yes
[ji No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes �lo ❑ NA ❑ NE
U(epuQ) p 'n an"y YES answers and/or a'n
additional +recammend ai'ons air. any other J.
comments.
s ingsoffacilito better,e laInuat ( seadditionalages as necessa .a'
'(7Z
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
IL
Phone:
Date:
2/4/2014

�2 1ms
CD
type of visit: gLvu�ance inspection V Operation Review V Structure Lvaluation V l ecnnical Assistance
Reason for Visit: 0 Routine O Complaint 0 Follow-up Q Referral Q Emergency ( Other 0 Denied Access
I Oki Date of Visit: Arrival Time: Departure Time: County:;��'. Region: o` U
1«. �.
Farm Name: ��� T d k 5'y Owner Email:
Owner Name: "( Phone:
Mailing Address:
Physical Address:
Facility Contact: T 5p,�/i {�(JL[/' Title: Phone:
Onsite Representative: r Integrator: /7
Certified Operator: (t �ty �S �'`� Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design CurrentNMI
Design Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity Pip:
Cattle Capaelty Pop.
Wean to Finish
Layer
;
Dairy Cow
Wean to Feeder
Non -La er
I
❑ No
Dairy Calf
❑ NE
Feeder to Finish
❑ Yes
❑ No
Dairy Heifer
❑ NE
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Dr. P,o.ultr,
C•a acit P,o
Non -Dairy
❑ NE
Farrow to Finish
Layers
Q4o
❑ NA
Beef Stocker
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Gilts
Nan -La ers
❑ NA
❑ NE
Beef Feeder
Boars
Pullets
Beef Broad Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[PiA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
FEKA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Q4o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
�o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 1/412011 Continued

Facili Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes C9'1 o_❑ NA ❑ NE
1
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No C3-?V�_ ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Lld'NQ
❑ NA
Spillway?:
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Q.Xb
[] NA
Designed Freeboard (in):
acres determination?
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
Observed Freeboard (in):
17. Does the facility lack adequate acreage for land application?
❑ Yes
g3'<o
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
F ]' o
0 NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes o
[:]NA
[:]NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
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
E&O
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ZpKo—
❑ 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
U No
❑ NA
❑ NE
maintenance or improvement?
I I . Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ N E
❑ 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
t2. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[goKo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Lld'NQ
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Q.Xb
[] NA
❑ NE
acres determination?
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
17. Does the facility lack adequate acreage for land application?
❑ Yes
g3'<o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
21'N'
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes EKo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
2l. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes o
[:]NA
[:]NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
Page 2 of 3 2/4/2011 Continued

Facili Number:of w, 6�
Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by thepermit? DYes 19<0 C] NA NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ;'�o[:] NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey -indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [] Yes io ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes QeKo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes T/ 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 D40,
❑ 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 C! o
❑ 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:
No
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes �
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes[(No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [� No
❑ NA ❑ NE
Comments (refer to question #):, Explain any YES answers and/or any additional recommendations or any other comments..; .
Use drawings of facility to better explain situations. (use additional panes as necessary).
004 1 ktctz tso-^
Reviewer/inspector Name:
#% M, - I if
Reviewer/Inspector Signature: Qin Date:
Page 3 of 3 2/4 I I

L
10141►z
1' 0 Division of Water Quality
Facility Number1, - O Division of Soil and Water Conservation
0 Other Agency
Type of Visit: o Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: ® Routine C) Complaint 0 Follow-up 0 Referral 0 Emergency Q Other Q Denied Access
Date of Visit: Q`'2-'' Arrival Time: ;� . Departure Time: I it: 5'2 rn.— I County: 0t'J Region:
Farm Name: i1 i t Y1 Unaau Rvto Owner Email:
Owner Name: �Y'C�yyk i�'t ier,� Phone:
Mailing Address:
Physical Address:
FacilityContact: Crq
v4 JtU5qu Title: Phone:
Onsite Representative: cl Integrator: /V!(,t:jr pL—&t m
Certified Operator: t" Certification Number: 1q0%
b
Back-up Operator: Certification Number:.
Location of Farm:
Swine
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish I Layer
Wean to Feeder [Non -Layer
Feeder to Finish g p Sb
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Nan -L,
Pullets
Other
Poults
Design Current.
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [P No ❑ NA ❑ NE
❑Yes
❑ No
(� NA
❑ NE
❑ Yes
❑ No
[p] 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 1 of 3 2/4/2011 Continued

Facility Number: Z - &4 Date of Inspection: /0 2 �
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate`? Yes
a. If yes, is waste level into the structural. freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:�-
[0No ❑NA ❑NE
❑ No M NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed'? ❑ Yes T 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
E� No
❑ NA
❑ NE
waste management or closure plan?
[:]Yes
[P No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate puhlic health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement`?
0 YesNo
❑ NE
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
4 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
[] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
17. Does the facility lack adequate acreage for land application?
❑ Yes
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
C] NA
❑ NE
maintenance or improvement'?
❑ NA
T
T
Page 2 of 3
Waste Application
2/4/2011 Continuer!
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 T 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 Ac�:u,sc'1e_ptta�/
ble Crop
Window n❑_Evidence of Wind Drift ❑ Application Outside of Approved Area
u
12. CropType(s): ( U l3-�SS C r.-L�1 sro- �tn.00960 ' � el-
'—
13. Soil Type(s):641k--fijoa,e T
❑ Yes
No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes
[P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E] No
❑ NA
❑ NE
acres determination?
❑ Waste Transfers
[] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q9 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ep No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'?
❑ Yes
No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
D Yes
4 No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [] Soil Analysis
❑ Waste Transfers
[] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge'?
❑ Yes
4 No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
`i-' No
❑ NA ❑ NE
Page 2 of 3
2/4/2011 Continuer!

Facithy Number: KZ 61-tDate of Inspection: jo
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
Qa No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
Q 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
[R No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
EQ No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations.or any other comments.
Use drawings of facility to better explain.: situations (tile additional ptiges'as necessary).
Reviewer/inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: ID -q33 -130o
Date:
2/4/2011

49 Division of Water Quality
ty - I
Facili Number 0 Division of Solt and Water Conservation
Q Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: ® Routine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: 1 a. t Departure Time: (' County: 1Yi Sa/V Region: EAD
/
Farm Name: �VL1M� r� 1 hu /rWIYI Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: t% �„WJS2j4 Title:
Onsite Representative: it
Certified Operator: 0
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Non -L
Pullets
Other
Poults
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes
� No
F-1NA❑
NE
❑ Yes
❑ No
E; NA
❑ NE
❑ Yes
❑ NoUP
NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) []Yes ❑No MNA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [] YesNo E]NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes o E]NA E]NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

ifaacili "Number: Date of Inspection-
Waste
ns ection-Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes -_0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
® No
Identifier:
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes]
No
❑ NA ❑ NE
Spillway?:
❑WUP ❑Checklists [3 Design [] Maps ❑ Lease Agreements
Designed Freeboard (in):
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Observed Freeboard (in): `� 4
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
5. Are there any immediate threats to the integrity of any of the structures observed?
[]Yes
[5 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�,No
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
`E] No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
17`f No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
!
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
[] NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
Q 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 f Wind Drift Application Outside of Approved Area
12. Crop Type(s): 5P r
13. Soil Type(s): � 4A
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
[n No
❑ NA
❑ NE
acres determination'?
17. Does the facility lack adequate acreage for land application?
❑ Yes
� No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ftl LP No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes]
No
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists [3 Design [] Maps ❑ Lease Agreements
[]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
W No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�,No
❑ NA ❑ NE
Page 2 of 3
2/4/2011 Continued

-Facili 'Number: 917 - jDate 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 T� 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.
PApplication Field ❑ Lagoon/Storage Pond ❑ Other:
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ONE
❑ Yes
No
❑ NA
❑ NE
[] Yes
[ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Yes
❑ No
❑ NA
❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
[DNA
❑ 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? 0 Yes [A No ❑ NA ❑ NE
Comments (refer to question#): Explain any YES answers and/or any additional recommendations or any:other comments���
Uscadrawings''of facility to better: explain situations (use.. additional pages as necessary)..
;..
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q/0-43 '3 7-4-1Date: 8 lR ( t
2/4/2011

* Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation.
�— 0 Other Agency 11
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: a O Arrival Time: I�% .,,, Departure Time: //•` County: Od Region: F'0
Farm Name:
Owner Email:
Owner Name:L%\Ads!�!., Phone:
Nailing Address:
Physical Address:
Facility Contact: Ct. M t& b..J Sq=:3 Title:
Onsite Representative: tt
u
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
/�
Phone No:
Integrator: M y t i •stn C __.
Operator Certification Number: ` F Dd/
Back-up Certification Number:
Latitude: [=O =g
Longitude: =0=1 °=1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
Other
❑ Other
Dry Poultry
❑
Layers
❑ Non -Layers
❑ Puilets
❑
Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design 'Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy I
❑ Beef' Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: �J
K 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)?
Ad. 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 Mlo ❑ NA ❑ NE
❑ Yes
❑ No
N NA
❑ NE
❑ Yes
❑ No
tNA
❑ NE
aNA
❑ NE
❑ Yes
❑ No
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
PNo
❑ NA
❑ NE
Page I of 3 12/28/04 Continued

Facility Number: — Date of Inspection
I
P No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
Waste Collection & Treatment
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
�] No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes P No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
NA
❑ NE
Struct re 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
maintenance/improvement?
[�No
❑ NA
Spillway?:
[PNo
❑ NA EINE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
Designed Freeboard (in):
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Wind w ❑ Evidence of Wind Drift ❑ Application Outside of Area
Observed Freeboard (in):
12. Crop f�i✓ Srnr �M))
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
P No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
P?No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
�] No
❑ NA
9. Does any part of the waste management system other than the waste structures require ❑ Yes
QTNo
❑ NA ❑ NE
maintenance or improvement?
❑ NA
❑ NE
Waste Application
❑ Yes
TNo
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[�No
❑ NA ❑ NE
maintenance/improvement?
[�No
❑ NA
11. Is there evidence of incorrect application? If yes, check the appropriate box below. []Yes
[PNo
❑ NA EINE
❑ 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 Wind w ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop f�i✓ Srnr �M))
type(s) S QL�Q
13. Soil type(s) A4.4 k`A)a
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
(PNo
❑ 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
1� No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
TNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[�No
❑ NA
❑ NE

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Q:No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �allo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists❑ Design g ElMaps [IOther
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes F No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
rNo
0 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
M No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
�NA
El NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30, At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
1p No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
tfl No
❑ NA
❑ NE
'mm"cri'ts'fandlri•`Drnwln s����r " � ���� � � �R � i � ��������: � ���_����'��: •�,�`A
A�ddtt»anal Co g 1 :. e� 4. + .b r �, .
�t
Fuge 3 of 3 12/28/04

t
0 Division of Water Quality
I ± —6- —0— 1 Facility Number �� O Division of Soil and Water Conservation
O Other Agency
Type of Visit • compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit • Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 6 ZO D9 Arrival Time: Departure Time: County: SftY"`'S S61J Region: EL
Farm Name: — fican i P, )LrJ�2" ra^pA _ _ _ Owner Email:
Owner Name: C= FI inn [ �"^5 Phone:
Mailing Address:
Physical Address:
Facility Contact: k U s Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No-,
Integrator: MIL�_024__ "okn.9 ac
Operator Certification Number: 71V
Back-up Certification Number:
Latitude: =0 =
c=i=61 Longitude: =0=d
0=d 0
��Vv &J, i
4� I�jtl
w
Design Current
swine C.flpacity Population
❑ Wean to Finish
❑ Wean to Feeder
54 Feeder to Finish WOW
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other—
Design Current
Wet Poultry Capacity Population
❑
Layer
❑ Non -La er
Dry Poultry,
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dai Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes Nallo ❑ NA ❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
I�No
[INA
❑NE
❑ NA
❑ NE
❑ Yes
OpNo
❑ Yes
M No
❑ NA
EINE
❑ Yes
(VNo
❑ NA
❑ NE
12/28/04 Continued

or
Facility Number:
Date of Inspection la 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes C�ONo
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
&NA ❑ NE
Structure 6
❑ Yes [�]Vo ❑ NA ❑ NE
❑ Yes [�bNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [�?No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Q No [INA ❑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 &I No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes®No ❑ NA C1 NE
maintenance/improvement? 11
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
PNo ❑ NA
❑ NE
T
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
Reviewer/inspector Signature: Date: /0 Zo
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptafble Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) � � i,�f`� Ccas 4e, �g4,., Q SS L/�r'oa- w �\l Sri , r i.1�el�.o�
�
13.
Soil type(s) AIW k - !t/Dr�t'_ (114-rO_rla G✓a� -: ,:.::;::..;_
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
EP No ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? Cl Yes
T 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
[FNo ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
qNo ❑ NA
❑ NE
coommi:nts (reterto gtie titin #}I Fzplain an�y�YES answer"i/or anrecomm nduti�bns or any other'camments,
' r N� 'k #f* :'.✓ y'r:ix°�x'b'b'F'a"r:J,; 1�3
Use drawings of facility toibettcr eeexplam sity1uagnoi y{use . addittonanpages nsg tgzecessary) ��
,-: -._d]Mw4 '. �i'c•h3N1i.l�tPiYL�K.' ICiCZ-. e:A.rP� s.�`,�..i �'4}a 9C. ",;'�;_.m6,. a-�.� .... ..'Ei. v.—,:;_ ':-: -=-. ,�.
i
T
Reviewer/inspector Name Phone: 910 '�3QrJ
Reviewer/inspector Signature: Date: /0 Zo
12/28/04 Continued

Facility Number: — Date of Inspection �o
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists
❑ Design ❑Maps [I Other
[:]Yes
[�No
❑ NA
EINE
❑ Yes
;fjjNo
❑ NA
EINE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
[$No
❑ NA
❑ NE
❑ Yes
[V No
❑ NA
❑ NE
❑ Yes
V No
❑ NA
❑ NE
❑ Yes
$3 No
❑ NA
❑ NE
❑ Yes
IS No
❑ NA
❑ NE
❑ Yes
�%o
❑ NA
❑ NE
❑ Yes [P No ❑ NA ❑ NE
❑ Yes [ft No ❑ NA ❑ NE
❑ Yes [ANo ❑ NA ❑ NE
❑ Yes
T, No
❑ NA
❑ NE
❑ Yes
IR No
❑ NA
❑ NE
❑ Yes
q& -No
❑ NA
❑ NE
i e u•� _"
Addltionaldgommen#sand/orDrawings:��"r�,
MZ
7
12/28/04

Type of Visit • Compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: � Arrival Time: '� Departure Time: .' County: �S4TWQSOIS Region: FPX
Farm Name: FP izyl F -a ✓� V�'►O� $Cita rlwm Owner Email:
Owner Name: Pmiri ki i i.r Phone:
Mailing Address:
Physical Address:
Facility Contact: _ _ (l' Title: Phone No: DD
Onsite Representative: Integrator: r" t7rC.1t..J
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
U Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Back-up Certification Number:
Latitude: = e =I=,, Longitude: =0=4 0 11
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ La ers
❑
Non -Layers
❑ Pullets
❑ Turke s
Other ❑ Turkey Pou Its
❑ Other 1LJ Other
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)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dai Heifer
❑
Dry Cow
❑ Non -Dairy I
❑ Beef Stocker
❑ 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?
0
❑ Yes tpNo ❑ NA ❑ NE
❑ Yes ❑ No [�,NA
❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes ❑ No r NA
❑ NE
❑ Yes �?No ❑ NA
❑ NE
❑ Yes Iq No ❑ NA
❑ NE
Page 1 of 3 12/28/04 Continued

Facility Number: (3;E---EFJ Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
4tructnre 1 Structure 2 Structure 3 Structure 4
Identifier: I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 306(
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
Structure 5 Structure 6
❑ Yes
(P No
❑ NA
❑ NE
❑ Yes
toNo
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public stealth or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [�bNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [PNo [INA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes *No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
V
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes
o
❑ 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
r.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
E�No
❑ NA
❑ NE
4 f:
Reviewer/inspector Name w Phone:3
Reviewer/Inspector Signature.eWXL-AADate:
Page 2 of 3 12/28/04 Continued

Facility Number: — Date of Inspection I y
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA EINE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check Cl Yes No ❑ NA ❑ NE
the appropriate box. ❑ WDp ❑ 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
y No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E�No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�bNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ONo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
EpNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes *No [:INA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CA WMP? ❑ Yes Q No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes k�No ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes No ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes No ❑ NA ❑ NE
Page 3 of 3 12/28/04

Division of Water Quality
Facility Number QDivision of Soil and Water Conservation
`Other Agency
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: f j blI rii Arrival Time: Departure Time: /O County: ✓ T S0
Farm Name: tkn UnAam Ft4,1'h Owner Email:
Owner Name: �rchk� �''� �'St Phone:
Mailing Address:
Physical Address:
Facility Contact: M ll '2 Title: Phone No;
Onsite Representative: li Integrator: rl
t
Certified Operator: t Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Fecde.
Farrow to Finish
Gilts
Boars
Back-up Certification Number:
Latitude:
n°
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑
Non -Layer
Other
❑ Other I
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?
Region:
Longitude: =0=' ❑
Design Current
Cattle Capacity Population
❑ Dai Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �No ❑ NA El NE
❑ Yes
❑ No
ONA
❑ NE
❑ Ycs
❑ No
NA
❑ NE
(YNA
❑ NE
❑ Yes
❑ No
❑ Yes
[]�No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
12/28/04 Continued

f Facility Number: 6 Date of Inspection Q d
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes M No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
1► NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): L 324
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 [:INA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'? ❑ Yes [P No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement'?
H. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [� No [--INA ❑NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ FAN > 10% or 10 lbs []Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) C"s L_ r1Yt
,5r". 6fn r^
ii
13, Soil type(s) Noir Wa
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 15 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes N No ❑ NA EINE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes MNo ❑ NA ❑ NE
❑ Yes [Po ❑ 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:
Reviewer/inspector Signature: Date: /a / Q�
12/28/04 Continued

Facility Number: Date of Inspection I D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes T No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check []Yes Q�jNo ❑ NA CINE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ISNo ❑ 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 0 No ❑ NA ❑ NE
23. If selected., did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P No ❑ NA ❑ NE
24,
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
f3 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
DNo
❑ 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
QNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
1W No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
1� 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
ED 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
[P 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?
El Yes
VNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
1P No
❑ NA
❑ NE
Comments and/or Drawings:
!2/28/04

Type of Vislt @ Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Oe Arrival Time: /!5V M Departure Time: 2: ZO r• County: 2472050') Region:
t
Farm Name: Frixo � iyi b4aq Fvwm Owner Email: nn �� � f� � f
Owner Name: aK In 1... l Phone: C�f 0 5-6 i � �1
Mailing Address: tit C���►�o�, ��- o183a8
Physical Address:
l �
Facility Contact: _ EM N �`I� Sct�., Title: Phone No:
Onsite Representative: Fra.41 �Lk- aL Integrator: A' PL
Certified Operator: rrrMV1'VN L.�'d sa"i Operator Certification Number: 11096
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0
=I
=16 Longitude: = ° = I = 11
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 [4 No ❑ NA ❑ NE
❑ Yes
Design Current
Design Current
Design Current
Swine
Capacity Population
Wet Poultry Cap- acity Popuuffflon
Cattle Capacity Popu�nation
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Yes
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish
Q
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
'
❑Beef Stocker
❑ Gilts
❑Non -La ers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Pouits
❑ Other
❑ Other
Number of Structures:
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 [4 No ❑ NA ❑ NE
❑ Yes
❑ No
P NA
❑ NE
❑ Yes
❑ No
EPNA
❑ NE
NNA
❑ NE
❑ Yes
❑ No
❑ Yes E�No
❑ Yes PNo
Page 1 of 3 12/28/04
❑NA El NE
❑ NA ❑ NE
Continued

Facility Number: — rp
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: I
Spillway?: Q
Designed Freeboard (in): +"
rJ�f I
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No Pc7i"NA ❑ NE
Structure 5 Structure 6
❑ Yes [P No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes V No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes KI 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 9 No ❑ NA ❑ NE
maintenance or improvement?
Waste ARplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E�No ❑ NA EINE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
�] No [INA
❑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 OulItside of Area
12.
Crop type(s) e0aSW &ernA" CP0 t SMC ({ �✓t �U�I St7'Gf � l ! eT
—
13.
Soil type(s) Oa& 4 A
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
1p No ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
[P No ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
f� 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 bettenezplam;situations: (use add tionalpages as;necessary):.
Da vi, (e� L1As ✓hadi recor-w..a.Jed cka_-�es -r- `Vyn
P,,wj'o Ks r S�P v►
l �
Reviewer/Inspector Name ,n P Phone: [phone]
Reviewer/Inspector Signatu
Page 2 of 3
Date: /o
12/28/04 Continued

. ,. ,,-�—�----jjam�--,,
Facility Number: Date of Inspection
Required Records & Documents ����
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes GSNo ❑ NA EINE
20. Does the facility fail to have all components of the CAWM.P readily available? If yes, check ❑ YesNo ElNA [:1NE
the appropriate box. ElWUP ElChecklists
[IDesign E:1 Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [P No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge`? [--]Yes P No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes W 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
fp No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
�g No
[:INA
❑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
P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
15No
❑ 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
SNo
❑ 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
1p 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
UNo
[__1 NA
[INE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
N No
❑ NA
❑ NE
AdditianaiComments` and/or, Drawings.,77771
Page 3 of 3 12128104

t .
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of ViAl: Arrival Time: O: 7 Departure Time: County: -S"&.5an_ Region:
Farm Name: F�Qnk�,en L:,,,150fV Fa/ Owner Email:
Owner Name: F/"An/IA L�.,r�pr�, Phone: 1/0- 5-6 `/- y09/
Mailing Address: •'2S-6 D F,'Le Q�.d .e &_o C-�,�, air N4.— •?83 8
Physical Address:
Facility Contact:
Title:
Onsite Representative: Fra,71eZ,
Certified Operator:
Back-up Operator:
Phone No:
Ccu/ o/� S /►itir�p 4 /own
Integrator: 7y
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =0 =I
=41 Longitude: =0=1
o=1 = !f
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder ❑ Non-Layet
[9-reeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑
Turkey Poults
❑ Other
Discharges & Stream Impacts
1, Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑ Dairy Calf L�_-____J
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: F'
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?
11
❑ Yes 9 -Ko ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Cl NA
❑ NE
❑ Yes
❑ No
❑ Yes
e-00MXF-1NA
❑ NE
ElYes
,
L�}'
NA
❑ NE
12/.28/04 Continued

Facility Number: ,;? —1, At
Date of Inspection
2 No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
Waste Collection & Treatment
4. Does any part of the waste management system other than the waste structures require
No
[-fo
❑
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[T
❑ 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: f!r
!e
11. Is there evidence of incorrect application'? If yes, check the appropriate box below.
❑ Yes
[5"&o
Spillway?: /t
❑ 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
Designed Freeboard (in):
Area
�3f
12. Croptype(s) __BP/rr✓r�..�'�lG� .Sr.,a%� (r.�a,rf
Observed Freeboard (in): -
13. Soil type(s) Wa, A1,0 4
14. Do the receiving crops differ from those designated in the CAWMP?
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
3No
❑ NA
❑ NE
(ie/ large trees, Severe erosion, seepage, etc.)
❑ NA B -NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`
❑ Yes
❑ No
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
2No
❑ NA
❑ NE
through a waste management or closure plan?
El Yes
, ,
Le
❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental
threat, notify
DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
2'No
❑ NA
❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
2 No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
[-fo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2"No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application'? If yes, check the appropriate box below.
❑ Yes
[5"&o
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Ev Snce of Wind Drifl Application Outside of
Area
�3f
12. Croptype(s) __BP/rr✓r�..�'�lG� .Sr.,a%� (r.�a,rf
13. Soil type(s) Wa, A1,0 4
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[;•ado
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA B -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 [}'KE
18. Is there a lack of properly operating waste application equipment'?
El Yes
, ,
Le
❑ NA ❑ NE
poleas, Ph co'l411r ed^ YG�aa%- base aee-s op, /a5veo, pan le
G3 A�CC�tSa/�.�
Reviewer/Inspector Name Phone: 91n-41�G-/S4/r�%�To
Reviewer/Inspector Signature: ae4Date:
12/28/04 Continued

Facility Number: 8.-
.� — Date of Inspection �•d�
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2io ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑mss El No [3 NA ❑ NE
the appropirate box. []>W11_ [:1Chec [a^�si n ❑sts g s ❑ 9Ker
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [--]No ❑NA ❑ NE
❑ Waste-4pplieefieE 0 Vieeki�,�vtl ❑ te Atmlysis ❑ Seil.As� ❑ ❑ r n
❑Rainfall ❑ Stooking [9-6rop Yield ❑ 124++inute1Tmj t -Sons ❑ ons ❑ uVeetfter'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
9 -Ko
❑ NA
❑ NE
❑ Yes
Flo
❑ NA
❑ NE
❑ Yes
[9 -No
❑ NA
❑ NE
❑ Yes
G; -mo
❑ NA
❑ NE
❑ Yes
ElNo
❑ NA
❑ NE
❑ Yes [<o ❑ NA ❑ NE
❑ Yes E;Ao [INA ❑ NE
❑ Yes 21� o ❑ NA ❑ NE
❑Yes 3'o [INA ONE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes
El NA
[INE
El Yes
,L��J,/No
LTJ No
❑ NA
❑ NE
- s•y ►'t+ ?Frtk- " t r - - - a - -r 9 1. g f i'1: e f:-�' ..
Addit€oral Comments;anaj/or',Drawln s t��a; `l - -
4t '20
IGuSC t<onAarif ,Sa��Oton IV/>'LS Try o�7�ar'n 6t Gd� v7F �rov1'
14gdd�
�'S'yh ��t! �0�!•Ajc r�f4ct G�/y 6vr�r+Y ><arfi /ecOrp�j�
Pl[ G SC %'! a v[ � A n � u •' Ipr G hc� �( d,,,. W a
f'o a 4 S c.r
9 c.sa�.
c7n t /
cc {•C, G�c.� {�i t 1C.3�t• /o �°� � S 4"""q
S 7o y.,'N
�n9en AP.A
12/28/04

IType of Visit • Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit 9 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: G /S o Time: ! z
Q Not Operational Q Below Threshold
Permitted 0 Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ..... _..................
Farm Name: �.. lapl ��.... .r.n.,P`,fa ......1 otRe�Lc_k �{.ra.,,� County:... arxi.�t?.�Ce7..............................FR.o.......
Owner Name: .........< P..�{`!r.`.�........,r!.,`.u�.P`..�........................./ Phone No:...�'11...:..t %.�f.:..0 �t�...................................,
MailingAddress:..:ZF4 ...........,5 .....al r.:rd .e ............Rd ............... �an............ �(:........... .? 3.. .................... ..........................
Facility Contact: ...... ft. r'.h.I :.....`.... L :�a.N�r��.............. Title:................................................................ Phone No:.p................................................
Onsite Representative:....... �C �r.nl.��i.,a.......... :.r!' sp...................................... Integrator:..... �x,Rti�yc.......cgg"? ...............................
Certified Operator: .........1 i.....................L ►. s.a: Operator Certification►...............
y�............................
Location of Farm:
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� ��� Longitude �• �� �«
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [3'1-fo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes aKo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) Yes [3 -No
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes [allo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes [No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 9 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes GNU
Structure I Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier:.......................................................................... .......... I........................ ........................ I.......... ...................................
..............................
rr
Frecboard (inches):
12112103 Continued

Facility Number: G Ll
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 maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal W
14, a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
❑ Yes MNo
❑ Yes ❑-Ko—
❑ Yes E Vo
❑ Yes
❑ Yes �o
❑ Yes Q -No
❑ Yes [,JNo
Management Plan (CAWMP)? ❑ Yes
GAla
❑ Yes
B -No
❑ Yes
0 -Ko
❑ Yes
9 No
15. Does the receiving crop need improvement? ❑ Yes 9 No
16. Is there a lack of adequate waste application equipment? ❑ Yes [J 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 P -No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ wo
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 UNo
Air Quality representative immediately.
:.1:: ':'i?'.:u}:"'.,F, .illi•••rN!!^ ,fir' �h,'i!h -;XL :=€'i"`}€:;TlIfMN".�hs£Y"` :`t`=fail}ti,ik'rtL;iS?4€::€;HJ;_••3'.4. 3Lii4.`::i:' .'!., .JE s".e?S.a',t'«p:.'�.� •:'F:I�!N'si "3.. t:J:f.:
Cotiunents {refer, to;, uestaon #)•. F.yc lana ain ,YES answers and/or=an ,:recommendattoos*o hfiy other'cotnments '
r€. ;:, 11 fu € ,<L„,, . ; ::€+LI ;,:; p ?�:;^€ r ;f :rc 'r:! ' ;moi an Y£. ,tu;-li,tt �r :. ,.a m,.,a, 3:..,13 ..=,x=,�L;au='.. ,.I:..b ,. } k .,..
-- ' € I iN.” 3i ltil Iitir;t al q- 91_ a dfr Yr 1 d L ' "', '-
IUse drawt>igs;of.i�ciLtyuto better lainsitisagons.�{use addrhonal pa a `=as<necessary)°:1,� iel F' _ �_ ' '
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Reviewer/Inspector Signature: Date: G -15
12112103 Continued

Facility Number: g— Date of .inspection
Required Records & Documents
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
Ly'No
22.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
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(ie/ drsigrt; maps, etc.)
❑ Yes
SNo
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
O -NO
❑ Wasie Application ❑ FreeUoaard ❑ Was rs ❑ ��pling
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑-1 o
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
[;-Nb
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ -discharge, freeboard problems,-ovew�ti+on)
ElYes
E -No
27.
Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
L INcr
28.
Does facility require a follow-up visit by same agency?
❑ Yes
[INo
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑'lq'o
NPI)ES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
&- es
❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Q -No'
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[9-14o
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
Q -Nb
34. Did the facility fail to calibrate waste application equipment? ❑ Yes O -Ko
35. Does record Ikeeping for NPDES required forms need improvement? If yes, check the appropriate box below. El Yes ❑ No
❑ d&kinj- o rrm ❑ Crop Yield Form ❑Reirt€sll ❑ o
❑ 120 Minute Inspections ❑
Q No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
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I2/I2103

Site Requires Immediate Attention: No
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITAInON RECORD
DATE: 7uiv9X , 1995
Time: 10 %:5 -
Farm Name/Owner: L
Mailing Address:-� ,t gt a. _ Citi Sftk_ i1C, _2,
,County: 6g Pc % R,Sor�-
Integrator: C!,,�=lb's F_me]s Q__^r._ Phone:
On Site Representative: A,,-, lib .#,Jj,' Phc
Physical Address/Location: sR 'ai I YA F.iAAa
M
Type of Operation: Swine X Poultry Cattle
Design Capacity: Number of Animals on Site:.,. 5 -S&O _
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3s-' _C&_" Longitude: ° .q'_EL"
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Yes or No Actual Freeboard: Z Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Zrop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or No ts6-
Is animal waste discharged into water of the state by man-made ditch, flushing system, of -other
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes ar No "Deb. -0, \.4"
.Additional Comments: zPecV-te*j
TT -'-b us Al ---
Inspector Name 'Drs"N cskv„tte. Na� .braMCCl o �Signature
Sv+ k -PM �1aft-&v-A r3t&
t=� ,y eg-let-41e NC a83o f
cc: Facility Assessment Unit Use Attachments if Needed.

...._ _ . _ ....PLAN.OF ACTEON(Poa).FOR-HIGH-FREEBOARD.AT_ANIMAL. FACILITIES
Facility Number:
82-64
County: Sampson
Facility Name: Franklin Lindsay Honeycutt Farm
Certified Operator Name: Chris Gainey Operator Number:
988058
1. Current liquid level(s) in inches as measured from the current liquid level in the lagoon to the
lowest point on the top of the dam for lagoons without spillways; and from the current liquid level
in the lagoon to the bottom of the spillway for lagoons with spillways.
Lagoon Name/1D
Spillway(Y or N):
Level(inches):
Lagoon 1 Lagoon 2 Lagoon 3 Lagoon 4 Lagoon 5
1
N
1s
2. Check all applicable items
Liquid level is within the designed structural freeboard elevations of one or more structures.
Five and 30 day Plans of Action are attached. hydraulic and agronomic balances are
within acceptable ranges.
X Liquid level is within the 25 year 24 hour storm elevations for one or more structures. A
30 day Plan of Action is attached. Agronomic balance is within acceptable range.
Waste is to be pumped and hauled to off site locations. Volume and PAN content of waste
to be pumped and hauled is reflected in section III tables. Included within this plan is a list
of the proposed sites with related facility numbers, number of acres and receiving crop
information. Contact and secure approval From the DWO prior to transfer of waste to a site
not covered in the facility's CAWMP.
Operation will be partially or fully depopulated.
*Attach a complete schedule with corresponding animal units and dates fro depopulation
*if animals are to be moved to another permitted facility, provide facility number, lagoon
freeboard levels and herd population for the receiving facility
3. Earliest possible date to begin land application of waste: 9/2112018
I hereby -certify that I have reviewed the information listed above and Included within the
attached Pian of Action, and to the best of my knowledge and ability, the Information is
accurate and correct.
Franklin Lindsay Phone:
Facility Owner/Manager (print)
Date:
Facility Owner/Manager (signature)
910-564-4091
9/21/2018