820075_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental QuA

W
ti
l'ype of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 42 outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: D Departure Time: / County: Region:
Farm Name: /Zn/f;,r 5wr}1�//7!�i��. Owner Email:
411
Owner Name: ; +f a ,,1 Phone:
Mailing Address:
Physical Address:
Facility Contact:
1 f i!2; tLUD /Y�_ Title: r, /--- Phone:
Onsite Representative: s'en.
Certified Operator:
Back-up Operator:
Integrator: 3Fe.5_2 _
101,
Certification Number: e g`99-'lfl
Certification Number:
Location of Farm: Latitude: Longitude:
Discharees and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Q N ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑NA ❑NE
❑ NA ❑ NE
❑ Yes
[] No
❑ NA
�� {�
[::]Yes
�Current�
❑ NA
❑ NE
Design
Current
❑ NA
Design
Design Current
Swine
Capacity
Pap
Wet Poul try E
!
Capacity l Pop ; !'
Cattle Capacity' Pop.
Wean to Finish
La er
Dai ry Cow
W an to Feeder
Non -Layer
-
Dairy Calf
eeder to Finish
/ /U
/
k
Dairy Heifer
Farrow to Wean
Design
Cur, t'..
Dry Cow
Farrow to Feeder
'' D ,P.onl
Ca aci
'
Non -Dairy
Farrow to Finish
Layers ers
Beef Stocker
Gilts
Non -Layers.
Beef Feeder
Boars
Pullets
c
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Q N ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑NA ❑NE
❑ NA ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
[::]Yes
No
❑ NA
❑ NE
❑ Yes
` to
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facilit Number: - Date of Ins ection:
Waste Collection & Treatment
• 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes D<o ❑ NA ❑ NE
. a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: _
Designed Freeboard (in):
Observed Freeboard (in): 27 3- _
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage,,etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
Structure 5 Structure 6
[:D Yes D116 ❑NA ONE
❑ Yes [lNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
0 o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
0 Yes
[3'<lo
❑ 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 No
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
❑1T
❑ NA
❑ NE
Waste Application
No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[l
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes
[ No
❑ NA
ONE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > I0% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidenceof Wind Drift E]Application Outside of Approved Area
12. Crop Type(s): /'n"V4 / 4evt-'d� -rd( .
—
13. Soil Type(s): Late
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
[�J<
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
IT 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'go'
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[J -No
❑ NA
❑ NE
20. Does the facility fail to have all components ofthe CAWMP readily available? If yes, check
❑ Yes
❑1T
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements❑Other:
21. Does record keeping neeZeekly
ovement? if yes, check the appropriate box below. Yes o ❑ NA ❑ NE
❑ Waste Application [ Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfal I ❑ 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 �No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �No❑ NA [] NE
Page 2 of 3 2/4/2015 Continued

Facility Number: - Date of Inspection: j
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
ffNo ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Ea'<o ❑ NA
❑ NE
and report mortality rates that were higher than normal?
--No
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[I ❑ 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
ONo ❑ 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
ETNo ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ETNo ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[a'No ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Ld'< ❑ NA
0 NE
or
Al
�` r f/ _14/111 1 1
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: &o-303
03
Date: /a e`
2/4/2015

ivisian of Water Resources
Facility Number ®- 7® ®Division of Soil and Water Conservation
Q Other Agency
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: s} Departure Time: County: Region
Farm Name: ,/�� .zg �fQr'%���/7C. Owner Email:
Owner Name: / ; /J, %�Ql�,�� ,. Phone:
Mailing Address:
Physical Address:
Facility Contact: J� Title: Gui7 ori`
Integrator:
Certification Number:%g% a
Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharses and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [5_No ❑ NA ❑ NE
[:]Yes ❑No
❑ Yes ❑ No
❑ Yes [] No
❑ Yes �No
[:]Yes [&No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 11412015 Continued
Design Current
Design
Current
Design Currop.ent
Swine
Capacity Pap.
Wet P,auliry
Capacity
Pop.
Cattle Capacity P
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Q
'
Dai Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D .P,oul
Ca aci
P,o
Non -Dalry
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
-
Turke s
Other
Other
I
EffurkeyPoults
10ther
Discharses and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [5_No ❑ NA ❑ NE
[:]Yes ❑No
❑ Yes ❑ No
❑ Yes [] No
❑ Yes �No
[:]Yes [&No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 11412015 Continued

" [Facility Number: - r Date of Inspection:
❑ Yes
(R No
❑ NA
❑ NE
Waste Collection & Treatment
[:]Yes
[Z No
❑ NA
❑ NE
`• 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[:]Yes
RNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
10 No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
18. Is there a lack of properly operating waste application equipment?
❑ Yes
®,No
❑ NA
Spillway?:
Required Records & Documents
Designed Freeboard (in):
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
Observed Freeboard (in):�
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�No
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
R No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
L No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
CE 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
[S No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[�!kNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [&No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
(R No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[:]Yes
[Z No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
ER No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Z No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
®,No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [3 No ❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facility Number: - Z= Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No
25. is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes 21 No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey F—) 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 El No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes [MNo ❑ NA ❑ NE
❑ Yes [a No ❑ NA ❑ NE
❑ Yes tZ� No
❑ Yes [,No
❑ Yes CEI.No
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Phone:
Date:
2/412015

[iypeoi visit: t uompuance inspection U uperanon ttevrew V structure tvaivation V iecnmeat Asststaince
Reason for Visit: tine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
� --IYIPY�1 II
Date of Visit: Arrival Time: !7 Departure Time: ' 3y� County: Region: e—Ro
Farm Name: Z!p// rr� er�y Owner Email:
a
Owner Name: B. d Phone:
Mailing Address:
Physical Address:
Facility Contact: _,�F;Z4,y Title: jje,./ Phone:
Onsite Representative: g�
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator: c -
Certification Number: _/,9
Certification Number:
Longitude:
_
Swine
n to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design Current
Capacity Pop.
Design Csarrent
Cattle Capacity Pap.
Dai Cow
n to Feeder
Non -La er
Dai Calf
er to Finish
w to Wean
w to Feeder
t
I D
D 1 $onitr
Design
Ca aei
Current
Eo
Dai Heifer
Cow
Non -Dairy
w to Finish
La ers
Beef Stocker
Non -Layers
Beef Feeder
El Boars
Pullets
Beef Brood Cow
Other
..
Turkeys
Turkey Poults
Other
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes [allo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
[:]Yes ❑-No
❑ Yes 0 No
❑NA ❑NE
❑ NA ❑ NE
❑NA E] NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: jDate of Inspection:
d
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
D Yes
[S No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
ONE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ "3 G 3�
5. Are there any immediate threats to the integrity of any of the structures observed?
O Yes
M No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
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 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)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Q No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
_g No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. [:]Yes J2�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): r
13. Soil Type(s); Z1 TTdl1�..
el
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E -No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ff[ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [Z No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes S No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes S 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. 0 Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [Z No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 12 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 2/4/2014 Continued

FacW Number: - Date of Inspection: & — /6
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [&No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below_
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
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 CAWNP?
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 [3 No ❑ NA ❑ NE
C] Yes 0 No ❑ NA ❑ NE
❑ Yes [, No ❑ NA ❑ NE
❑ Yes Cg No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes La No
❑ Yes No
[—]Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Name: Phone:
Reviewer/Inspector Signature: , Date:
Page 3 of 3 2/4/2014

ti
Type of Visit:ompl' ce Inspection 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: c7 Departure Time: County: Region:
Farm Name: /�; n,� o, >Fa rrrrsh c. Owner Email:
Owner Name: WjTtQ�/}H /c,or77� Phone:
Mailing Address:
Physical Address:
Facility Contact: 137/17 PD/1; ," Wp?t4 Title: &Ik4 i7 Phone:
Onsite Representative: S`Ar.�, Integrator:
IV
Certified Operator: Certification Number: g
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes [:]No
❑ Yes [:]No
❑ Yes (No
[:]Yes Ej�No
[:INA ❑ NE
[:INA ❑ NE
❑ NA ❑ NE
E] NA ❑NE
[DNA ❑NE
Page l of 3 2/4/2014 Continued
Design Current
Design
Curreut
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle -C&apacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
1 o pp
Da" Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D , P,oul
Ca aci
IP,o ,
Non -Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
_
Turkeys
Other
Turkey Poults
Other
10ther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes [:]No
❑ Yes [:]No
❑ Yes (No
[:]Yes Ej�No
[:INA ❑ NE
[:INA ❑ NE
❑ NA ❑ NE
E] NA ❑NE
[DNA ❑NE
Page l of 3 2/4/2014 Continued

Facifi Number: - Date of inspection.
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): /9
Observed Freeboard (in):�-
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Structure 5
[RNo ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes �,No ❑ NA [:]NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[S No
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
[—]Yes
EL No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
9. Does any part of the waste management system other than the waste structures require
❑ Yes
MNo
❑ NA
❑ NE
maintenance or improvement?
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[.No
Waste Application
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E4 -No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ®..No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 1J9_k;e4'V4 yr-'-
13. Soil Type(s): �L[f � , A f p; 6 J f C
14. Do the receiving crops iffer from those designated in the CAWMP?
[:]Yes
D9,No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application`?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[.No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E4 -No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? if yes, check the appropriate box below. [—]Yes S No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ONo
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes aN
o[:]NA ❑ NE
❑ Weather Code
❑ Sludge Survey
E]NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: - Date of Inspection:
T 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [&No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(es) below.
❑ failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes D❑ 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
❑ Yes No
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
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes ® No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ;,No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes ® No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ® No
0 N 0 N
❑NA 0 N
❑NA ❑NE
0 N 0 N
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA 0 N
❑NA 0 N
E] NA ❑NE
( 9 ft p Y Y y othercomments
Comments refer to question Explain an YES answers and/or an additional recommendations or an o
Use drawings:;of faciliity to. better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 0 D
Date:
2/4/2011

Type of Visit: -(Dr-Compliance Inspection O 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: ! p p Departure Time: S a County: -- Region:1�D,
Farm Name:Owner Email:
AF
Owner Name: 1 j ( y D ; r -Ls A/ Phone:
Mailing Address:
Physical Address:
Facility Contact: -B' I { y �`FAlI+ Awa rJlti Title: V w hc—,+r— Phone:
Onsite Representative: Integrator: !err
Certified Operator: Certification Number: 2g:%�"/p
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes allo ❑ NA ❑ NE
❑ Yes
Design
,$
Curent a;�"'
T
Design Curreni
Design Current
Swine
Iapacirvn11
WetPoultry
Capacity
Pop. Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
I Dairy Calf
Wean to Feeder Non -La er
Feeder to Finish
J p
;'"
Dairy Heifer
Farrow to WeanDesign
Cur er nt
Dry Cow
Farrow to Feeder
`D", l;ouIt .
Ga aci
POP...
Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
_- Turkeys
Other
3 Turkey Poults
Other
MOther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes allo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
EINE
❑ Yes
❑ No
[:]NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes �No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes E&No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

Facili Number: - Date of Inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [Z No
a. If yes, is waste level into the structural freeboard? ❑ Yes ® No
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): j Cy 19 _
Observed Freeboard (in):31
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ NA ❑ NE
❑NA ❑NE
Structure 5 Structure 6
❑ Yes Eq No ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
g No
❑ NA
❑ NE
waste management or closure plan?
❑ NA
❑ NE
❑ Yes
® No
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[0 No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
MNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ Yes
0 No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
9. Does any part of the waste management system other than the waste structures require
[] Yes
�, No
❑ NA
❑ NE
maintenance or improvement?
2/4/2011 Continued
Waste ARplication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Ca No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes M -No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 1wMJ0L Lou =,csr-1
13. Soil Type(s):
14. Do the receiving cropediffer 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?
l$. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[Z No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
(3 No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
[] NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
0 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
0 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

I'•
Facility Numher: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3 No
the appropriate box(es) below.
O Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge'? [—]Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Cg No
OtherIssues
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 C, No ❑ NA ❑ NE
❑ Yes g] No ❑ NA ❑ NE
❑ Yes V No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
[:]Yes K No
❑ Yes No
❑ Yes gNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ 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. paaes as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: NP/ #�XY 33DO
Date:S 19
2/4/2011

(Type of Visit: @.6oroutine
nce Inspection Q Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: I Arrival Time: ' [7 Departure Time: O �, ao County: Region:
Farm Name: 14 oil i Fdr,'►',,S
Owner Name: '; I blo I 1i it z S ttunr�
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: 3a 6 I y 14a ( N a;y6 4- Title: D' Wnrd- Picone:
Onsite Representative: S6c .� Integrator:
101
Certified Operator: Certification Number: 21i±' o
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ELNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
Design Current"
a
Design
Current
Design Current
Capacity Pop.
Wet Poultry
Capacity
Pap.
Catkle Capacity Pop.
Finish
reredeErt.o
La er
Dai Cow
Feeder
Layer
Dai Calf
Finish p
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D ,P,oult .
CaPA
P.o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow-
owTurke
Turkeys
s
Other
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ELNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes [] No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes C No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: - % Date of Inspection: - 5- 13
❑ Yes
r ---X No
❑ NA
Waste Collection & Treatment
15. Does the receiving crop and/or land application site need improvement?
❑Yes
� No
❑ NA
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
5g No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[:]Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
[g No
Identifier:
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Pj No
Spillway?:
❑ NE
Re uired Records & Documents
Designed Freeboard (in):
R Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
CR No
Observed Freeboard (in): 30
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[gNo
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[RNo
DNA
❑ 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
E4 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[S 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
r-71 No
El NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
F-11 No
[-]NA
[:]NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): rJ _ f Q V rdle f►� -
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
r ---X No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑Yes
� No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
®,No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[g No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Pj No
❑ NA
❑ NE
Re uired Records & Documents
R Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
CR No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[gNo
❑ 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 [KNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes MNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes N N
o❑ NA [:]NE
❑ Weather Code
ElSludge Survey
E]NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: & -- --r 3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [A No
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes ®-No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, aver -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes D.No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to -question #): Explain any YES answers and/or any additional recommendations or any other commentsrtk_
Use drawrngs of.faciRty to. better explain situations (use additional pales as necessary. ). " ,,
Q NA FINE
❑NA F] NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes EZ No ❑ NA ❑ NE
❑ Yes [K No ❑ NA ❑ NE
❑ Yes Ej� No ❑ NA ❑ NE
❑ Yes (3 No ❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
/� i L ` �/lA Phone: �/�� 5­3CO
Date: /3.
V4/2011

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 10 i) Departure Time: County. Region: t_
Farm Name: ff p%%� h S �,U�� F -W of rc Owner Email:
Owner Name: 9, _ Phone:
Mailing Address:
Physical Address:
Facility Contact: l y //p //;-n ;aS Title: Re,0 ? tpr Phone:
If
Onsite Representative: fcu_ Integrator: &lrL7 ff
IV
Certified Operator: Certification Number: _ZL2_�I/U
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes MNo ❑ NA ❑ NE
❑ Yes
Desi gn
Current �
_
Design
Current
Design Current
Swine
Capacity.
Pop. Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -Layer
Dai Calf
Feeder to Finish
I D
Dai Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dr; 1?oui
Ca aci
Plo
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turke s
Beef Brood Cow
O#her
Turke Poults
Other
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes MNo ❑ NA ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ® No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [E No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 214/2011 Continued

Facili Number: I Date of Inspection:
i 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 I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: q
Designed Freeboard (in): l /`
Observed Freeboard (in):� 311
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
❑ NA
❑ NE
[]Yes
® No
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
K 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 [Z No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window E] Evidence of Wind Drift E] Application Outside of Approved Area
�LJ
12. Crop Type(s): --/1/t/u l Q "I
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
® No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
[]Yes
® No
❑ NA
❑ NE
❑ Yes jZ[ No ❑ NA ❑ NE
❑ Yes El No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 5D 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 p Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [Z No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l " Rainfall inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ® No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection: —/�
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below,
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [& No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below_
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
33. Did the Revicwer/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 [&No ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes 1%No ❑ NA ❑ NE
❑ Yes
[Z No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
�R No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional. recommendations or:any ottieracomiments, ~
Use drawings of facility to better explain situations (useadditionalpages as necessary). t` . p
:. LL _.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ' p y�33v o
Date:
214/2011

Type of visit: ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: `Arrival Time: ! Departure Time: O County:D-� -
Farm Name:a-V r �Qi-ms Owner Email:
Owner Name: % n a" Phone:
Air
Mailing Address:
Physical Address:
Region:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:,z—�.--
100,
Certified Operator: Sv+�� _ _ Certification Number:
Sack -up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design Current
�:
Design
Current
Design Current
Swine Capacity Pop.
WetPoultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Da' Cow
Wean to Feeder
- Non -La er
Da Calf
Feeder to Finish /
' '°
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Tylpoultry
Ca aci
P,o -
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
s F
Turkeys
7 `'
Other
Turke 1'oults
Other Other
Discharges and Stream Im acts
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 the discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes f�;LNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
Yes No
Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 2/4/2011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [&No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [] Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): dy3 - f• [o
®No
❑NA
❑NE
[:]Yes
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ELNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
"No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
01 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[g No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
JQ No
❑ NA
❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
25 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes fo No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground E] 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 l ❑ Evidence of Wind Drift [] Application Outside of Approved Area
12. Crop Type(s): —�Ca� /y`r/�'�i�rA• _ _ _.,., .. _
13. Soil Type(s):
14, Do the receiving crops c fiffer 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?
IT Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑Yes
®No
❑NA
❑NE
[:]Yes
allo
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
[:]Yes No
[:]Yes No
[:]Yes No
[:]Yes ® No
❑ WUP ❑Checklists [:]Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ® Yes [—]No
❑ Waste Application ❑ Weekly Freeboard q Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
DNA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA [] NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

FaciliNumber: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes 10 No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? []Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAVRAP?
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 ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes CK No ❑ NA ❑ NE
❑ Yes [allo ❑ NA ❑ NE
❑ Yes
O No
❑ NA
❑ NE
❑ Yes
[Z No
❑ NA
❑ NE
❑ Yes
S No
❑ NA
❑ NE
Comments (refer to question :#) Eaplaiih any YES answers and/or, any addrtional:t&ommendations or any, other comments.
._..;r
se,drawm s:af.facility to better ezplam situatio..ns (use additional„�pages as necessary} .
Reviewer/Inspector Name:
Reviewer/Impector Signature:
Page 3of3
Phone: �a y 33 Oa
Date: /0 Ll
2/4/2011

Type of Visit i&Tompliance Inspection O operation Review O Structure Evaluation O Technical Assistance
Reason for Visit @Ioutine 0 Complaint 0 Follow up 0 Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: '. Q Departure Time: p p County: Region: r
Farm Name: �_� ; 35 Wflr' ��rr�j Owner Email:
Owner Name: xz Phone:
Mailing Address:
Physical Address:
Facility Contact: D �: N Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator: _
Operator Certification Number: <'L'f?9L'it7 -
Back-up Certification Number:
Location of Farm: Latitude: =o =I
I=" Longitude: 00 =' = "
Design Current
Design Current
❑ NA
Design Current
Swine Capacity Population
Wct Fouttry Capacity Population
Cattle Capacity Papulation
❑ NE
❑ Wean to Finish
10 Layer
❑Dai Cow
❑ NA
❑ Wean to Feeder
JEI Non -Layer
I
i Calf
0,No
Feeder to Finish C)
❑ NE
❑Dairy Heifer
allo
❑ Farrow to Wean
Dry Poultry
apry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
❑ N ers
❑ Beef Feeder
❑ Boars
Mets
El Pullets
❑ Beef Brood Cove
1:1 Turke s
Other
❑ Turkey Poults
Number of Structures
❑ Other
❑
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)
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 QQ ,No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
0,No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
Page I of 3 12128/04 Continued

Facility Number: — Date of Inspection D -9D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 2 N ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): g 19
Observed Freeboard (in): 37 4/O
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ER No ❑ NA ❑ NE
(icl 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 allo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes IllesNo ❑ 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 Na ❑ NA [I NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes DSNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 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)110
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes JS 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 R No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ;KNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes �RNo ❑ NA ❑ NE
mss,= �
Comments {refer to quesian #): Explain any YES.answers and/or any recommendations or any other comments.
Ilse drawings of�facility to better explain sitt ations. {use additional gages as necessary):
Reviewer/Inspector Name� Phone: 9JQ d S�33y�
ReviewerfInspector Signature: Date:
Page 2 of 3 � 12/28/04 Continued

Facility Number: 0;;L— Date of Inspection
:
' Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 43No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 2,No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes KNo ❑ NA ❑ NE
❑ Waste Application [:]Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
®-No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
RNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
� No
[:1 NA
El NE
25_
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
M No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
&�No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
KNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
KNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes�No
El NA
El NE
If yes, contact a regional Air Quality representative immediately
3I .
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
K 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
RNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
U.No
❑ NA
❑ NE
Page 3 of 3 12/28/04

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: Arrival Time:11 u Departure Time: . DD County:
Farm Name: J4D . n tT� �4� r'�"-' Owner Email:
Owner Name: ttbr !liar Phone:
Mailing Address:
Region: ✓ 1W
Physical Address:
Facility Contact: 0 fl; it GUof itle: Y Phone No:
Onsite Representative: S' — Integrator: 1_Szao - -
Certified Operator: - _S- Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ='
=' ="
Longitude: 0 o =, =
Design Current
Design Current
Design Current
Sine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
ID Layer
Non -Layer I
❑ Dairy Cow
❑ Dairy Calf
a_ Was the conveyance man-made?
1110
Feeder to FinishQ O
❑ No
El Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ NA
ElNon-Dairy
❑ Farrow to Finish
Layers
El La
El Beef Stocker
❑ Gilts
El Non-Laers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ NE
❑ Turl<e s
❑ Yes
Other
❑ Other
❑ Turkey Poults
❑Other
Number of Structures:
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
EgNo
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
XNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
59 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
EgNo
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
13. Soil type(s) G j d y r�-s� % N a &
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ER No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
❑ Yes
M No
Spillway?:
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ yes
Designed Freeboard (in):
❑ NA
❑ NE
Observed Freeboard (in): 7L4 '3
❑ Yes
®No
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[R No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
ER No
❑ NA
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
M No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
2 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
RNo. ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[9 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) G j d y r�-s� % N a &
_
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
O�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
M No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
®No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
ER No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspectur Name �-.- �_. , Phone: P--! 33 D0
Reviewer/Inspector Signature: Date: 9--/ i7 -26a91
12128104 Continued

l Facility + b' Number:— Date of Inspection ,�1—fl9
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes tZ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ONo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes (Z No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
UNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[K No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
10 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
RNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
®,No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
29 -No
❑ NA
❑ NE
Addz4onal CammentsiBntllt►1D a,nngS:
a
12/28/04

I.
Type of Visit QWmpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit CASuune 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: C% Arrival Time: Departure Time: County: Region:
Farm Name: flr' Owner Email:
Owner Name: r Phone:
Mailing Address:
Physical Address: f
Facility Contact: zz4` `n r itle:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator• �Z/_49 = _
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =0 = =64 Longitude: = e = L ="
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Mesrgn Current
JZNo
Design Current
Design Current
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
Swine
Capac ty Popolat'on
Wet Poultry
C pas ty lop Khan
Cattle Capacity Papulation
❑ Yes
❑ Wean to Finish
❑ NA
❑ La er
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Dairy Cow
❑ No
❑ Wean to Feeder
❑ NE
10 Non -Layer
❑ Dairy Calf
Dai Heifer
Feeder to FinishEl
❑ Farrow to Wean
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
:..�;�
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Co
❑ Farrow to Feeder
❑ Farrow to Finish
Gilts
PFI Boars
Othete' i
r r
Eir—❑
❑Turke s
❑Turke Points
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
,�
Other
x _
❑ Other
❑ NE
Number of Structures:
Page 1 of 3
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
JZNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation'?
❑ Yes
9 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
(ZNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

Facility Number:— Date of Inspection —a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P,No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
❑ Yes
Spillway?:
❑ NA
Designed Freeboard (in):
15. Does the receiving crop and/or land application site need improvement?
Observed Freeboard (in): Z5
I.No
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
P_No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
EffNo
6. Are there structures on-site which are not properly addressed and/or managed [:]Yes
[INA ❑NE
through a waste management or closure plan?
JRNo
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
,r.0, No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ NA
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
PNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
12 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) 1 �W42L &engnni
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
(XNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
I.No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
EffNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
9No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
®.No
❑ NA
❑ NE
Reviewer/Inspector Name �o Phone: Q
Reviewer/Inspector Signature: Date: `,
Page 2 of 3 12/28/04 Continued

+ Facility Number: 91;z— Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes PINo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes FE No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RlNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard (:]Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge'?
❑ Yes
allo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
®.No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[RNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[2 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
O No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[9 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
R 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
EffNo
❑ 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
RNo
❑ 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
RNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
CKNo
❑ NA
❑ NE
Addtfiona! Comments aridlor Drawin s•
i
T
Page 3 of 3 12128104

d-vivision of Water Quality
Facility Number 0 Division of Soil and Water Conservation
Q Other Agency
Type of Visit
Compliance Inspection
0 operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visitoutine
0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: //"9V Departure Time: 3 D County- Region:
Farm Name:Q±z 2.„rx r_ �a��,s Owner Email:
Owner Name: Phone:(!
Mailing Address:
Physical Address:
Facility Contact: i 4 S _ >Fitle:
Onsite Representative:
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
Boars
Other
❑ Other
Phone No:
2 Integrator: ss
Operator Certification Number: �::M910
Back-up Certification Number:
Latitude: =0
=S
Longitude: =1 o =' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑
Layer
❑ Non -La et
Dry Poultry
Other
Poults
Discharges & Stream Impacts
L is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stoekei
❑ Beef Feeder
❑ Beef Brood Co
Humber 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 ERNo ❑ NA EINE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: —
Date of Inspection
�&No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
�&No
❑ NA
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
XNo ❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure i Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
�To
El NA
[INE
Spillway?:
Designed Freeboard (in): 117
Observed freeboard (in): y
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
N No ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
®,No ❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
P No ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[KNo ❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require❑Yes
X4 El NA
❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
RNo ❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
L.No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�&No
❑ NA
❑ 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
Wo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�To
El NA
[INE
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):
&01
7 -b e
Reviewer/Inspector Name
Phone•
Reviewer/Inspector Signature:
Date:
12/28/04 Continued

Facility Number: — Date of Inspection 07
• Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes allo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. orYes No ❑ NA ❑ NE
95 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?
25. 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
XNo
❑ NA
❑ NE
❑ Yes
[9 No
❑ NA
❑ NE
❑ Yes
[8 No
❑ NA
❑ NE
❑ Yes
[Z No
❑ NA
❑ NE
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
CANo
❑ NA
Cl NE
❑ Yes
[KNo
❑ NA
❑ NE
❑ Yes
J, No
[--INA
❑NE
❑ Yes
1KNo
❑ NA
❑ NE
❑ Yes
[&No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
AdditionalGomments and/orDrawings: 01C� e
Page 3 of 3 12/28/04
Page 3 of 3 12/28/04

Type of Visit 4EMompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit t146utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I�.� Arrival Time: : /Pl Departure Time: :/ County: Bim' Region: >i7
Farm Name: D%1i ;Asi GcJOrtk L +yY-- 6 7-vC /C Owner Email:
Owner Name: H. 1/eXe Phone:
Mailing Address:
Physical Address:
Facility Contact: �1%l; ^ ssGudTitle: Phone No:
Onsite Representative: L Go•�/ Integrator:
Or
Certified Operator: �'CI�Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 e =I = u Longitude: El o='= u
Dign
❑ Yes
flkNo
Current
Design Current
Design Current
Swine Ca 'aci ` Pa elation
Wet Poult "
ry ..• CapacityPoplation
u
Cai#le Capacity Population
❑ Wean to Finish
❑ Layer
❑ Yes
L4No
E]Dairy Cow
❑ NE
❑ Wean to Feeder❑Non
-Layer
51 No
❑ NA
❑ Dai Calf
c. What is the estimated volume that reached waters of the State (gallons)?
CO Feeder to Finish D
-
❑Dairy Heifer
❑ Farrow to Weanz
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Dry Cow
❑ Farrow to Feeder
Dry Poultryi - s
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑Beef Stocker
❑ Gilts
❑ Non -La ers
❑Beef Feeder
El Boars
El Pullets
❑ Beef Brood Covi
-
Others
❑ Turkeys
❑ Turkey Poults
-
❑ Othery
❑Other
Number of Structures
Page 1 of 3
12/28/04
Continued
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
flkNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
L4No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
51 No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
gNo
❑ NA
❑ NE
2" Is there evidence of a past discharge from any part of the operation?
❑ Yes
'VNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

Facility Number: 7 Date of Inspection 6
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 7No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes E&No ❑ NA ❑ NE
_—Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -3j-AY-3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes N No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes ® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes q 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 [Q No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes KNo ❑ NA ❑ NE
maintenance/improvement'?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2!�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) Ct3u c�C.��-rh,wd!/Ci'S�'r.�1 /i�'y ar Gfa
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes (a No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
14 No
❑ NA
❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
W No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
[7No
El NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
IN No
❑ NA
❑ NE
Reviewer/Inspector Name
ReviewerAnspector Signature:
Phone:' 333oZ—
Date: % -7��d
12/28/04 Continued

1.
Facility Number: — s Date of Inspection IZ — D
i. Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? 0 Yes VNo ❑ NA EINE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [3 No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes (3 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Oftual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[ZNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
B No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[9 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[21 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[W No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
5d 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
XNo
❑ 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
29 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did ReviewerfInspector fail to discuss review/inspection with an on-site representative?
❑ Yes
Z No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
allo
❑ NA
❑ NE
Additt g'al�Co m tits'�gnd/or„Draw tilgs
HC
12/28104

Type of Visit 10 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit A Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: SJia/?Arrival Time: Departure Time- County: 5g -12_%0,J
Farm Name: kc, v Owner Email:
Owner Name: L4e_4 + r 01� : e. 1,n�. Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator: --sCctU I� • _ '� r ' a s r.s+L
Back-up Operator:
Location of Farm:
Swine
Phone No:
Region go
Integrator: PIC-4-fcq r~
Operator Certification Number: j !?5Fa2
Back-up Certification Number:
Latitude: [=o =; = Longitude: =°=1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish 10 Layer
❑ Wean to Feeder ❑ Non -La et
® Feeder to Finish LY4O 2.7 aUf
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Lavers
❑ Pullets
❑
Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: [9 Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Cur"ir"ent::
Cattle Capacity Populiatlon
❑ Daity Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
Plumber of Structures:
b. ]lid 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?
DO Yes ❑ No ❑ NA ❑ NE
❑ Yes
®No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
N A
❑ Yes
[93 No
❑ NA
❑ NE
❑ Yes
X]No
❑ NA
❑ NE
El Yes
pi No
❑ NA
❑ NE
12/28/04 Continued

FaUityNumber: $,Z — "y S Date of Inspection
❑ Yes
Waste Collection & Treatment
❑ NA ❑ NE
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
❑ NA ❑ NE
Spillway?: v l91 /D /G ^ 9 7,.
Designed Freeboard (in):
Observed Freeboard (in): 3c5n
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.)
® No
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ® Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [:1 Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 01bs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of
Area
12. Crop type(s) e r rr�,.� o�.� 9 t.c z c� D -s � Se, �•e It
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[� No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`❑
Yes
® 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
M No
❑ NA ❑ NE
iquestion ##) :'Egplau
ciltty:ta i etter eapla"
.':�
. .. :.� "
7- 4ont/!1 y�+e.«t—� A QttJCJ pwir p, tS at/c-k;&%, a to 7 &";-A
f'k t
fojeaa r_ r�PQir :w.r•.c�41������ I
L-c_,Oo" E7 a..k noa yart =pa�'�. I'►'l✓. Sfr:c.��akdL ha.! P�aF►^�teR e�cric�
Reviewer/inspector Name ,[.. q ''� ° Phone:
Reviewer/Inspector Signature: Date: .s -11-k °
121,28104 Continued

Fatility Number: goZ — -� Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes R 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
150 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
F9] No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification'?
❑ Yes
[4 No
❑ NA
❑ NE
Other Issues
pts►{� pisu-
+01 5 SCGFw 'k'a �o� w.pV ���
qWa� ^%tpw.. 4 -LG
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
® Yes
❑ No
❑ NA
❑ NE
A�dc) rtzonal Comments and/or Dra%ings:. {=
-U/1124+4t s+4 %%CZ; +.9 b CAW c cn•
tssQ
wia�'c. wok-ir►-ov► Ca Ks''
pts►{� pisu-
+01 5 SCGFw 'k'a �o� w.pV ���
qWa� ^%tpw.. 4 -LG
ko,.A =Ac,.
.{•o Se,-{4'':1r!J�, PSeasc. rcPC'%V iZr.eQ i'�cti.. edit t -Lia
SusPee.�te�
�e.• icol(ew -kr. LTJO-I+r. u -..P noir
tcp vi'`� �-'L �, k+ c
qhC ,
Pt.c.cza. b
sy�tP_V.%.
12/28/04

Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit *Routine O Complaint O Follow up O Emergency Notification Q Other p Denied Access
Facility Number
— � "7 5,-
Date of visit:
y - G `1 Time: 1; 3 0 P/'i
=Not Operational O Below Threshold
0 -Permitted O -Certified D Conditionally Certified Q Registered
Date Last Operated or Above Threshold: ._._..»»...._...._.
Farm Name*
S;tr �'c /l �a�� F r.►,
County:
Owner Name: _--------- i� ?��e ; c M4
Phone No , ,l o' S 9
Mailing Address:
G 0 �2......Fa.
..
AI g 3� .......... ........
Facility Contact: !�� 7��e// S�-•'c �.,,� Title:
Cc ,�
».... »_. Ph/one No: 2/0
Onsite Representative:...»..
X e ff�e/� 5 +tr , G K`r�.h ..................................
Integrator: ... Pna& <
Certified Operator: _ _
_,��G 1?�! I1....._ S � ; (l4 ui ...... ._.......
Operator Certification Number:
Location of Farm:
[Swine ❑ poultry ❑ Cattle ❑ Horse Latitude " ` " Longitude • ` "
Dischare & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes ENo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes B'90
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes U -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 O.No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [9 -No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 9-96-
Structure I Structure 2 Structure 3 Structure 4 Structure S Structure G
Identifier: .......... ._..1._._............ -Z._.....-- _ --- .......
.----- -- ......... ........
Freeboard (inches): �' LI.;z
121,12/03 Continued

< Facility Number: 8.� —,D 7
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes Q -No
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or ❑ Yes [I No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes 9-No—
S. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes L2'10
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes 21go
elevation markings?
Waste Anulication
10. Are there any buffers that need maintenance/improvement? [:]Yes 0No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes [21fo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type 6e r i , u
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [
14, a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre detetunination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge aVor below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
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
Air Quality representative immediately.
❑ Yes [moo
❑ Yes D -No
❑ Yes QNo
❑ Yes 9 -No
❑ Yes �o
❑ Yes ❑ No
❑ Yes &No
❑ Yes &No
❑ Yes EINo
Comaeeafs (refer to gteeshon) Explain arty YES a sweis and/or a yrvcommenmuons or any other cots" -
Use drawuegs Tof face qty ifl better explain srtuahur (ase`addt anal pages as necessary? [3 -Field COPY [IFtnal Notes
T. Sl(r.ClllGrJ� 15 �J�Gnrl 'rig %0 P�f Tu�,fdil On ��/C �GrC S/4a�S 14. Srr/�So�fi,�
�d�ao,, �Q �S�abt!S�
godc� grass CdVG/",
ReviewerAl ispector Name
Reviewer/Inspector Signature: Date: �` p
12112103 Continued

Facility Number: g 2 Date of Inspection
dd�utinal Cortttnents and/or. -Drawings �..�..:`` Y -: rv-q-� y �:� = __, ` �:.
Had a 5we4// Iec,crravd a `/vsA Ian/l �.�at. M^ 'Zo
83 - '73
/,/s"s
Required Records & Document.~
33 pre.$ rad. P 4s o/o.� II r
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
[x'10
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
&No
❑ Waste Application ' ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling —
24. is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
B No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
9 -Ko
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/discharge, freeboard problems, over application)
❑ Yes
BNo
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
DNo
28. Does facility require a follow-up visit by same agency?
❑ Yes
B No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
M -No
NPDES 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
[ado
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[+ -No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑-No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes O -NO
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes Flo
❑ Stocking Fornf' ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form"
❑ No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
dd�utinal Cortttnents and/or. -Drawings �..�..:`` Y -: rv-q-� y �:� = __, ` �:.
Had a 5we4// Iec,crravd a `/vsA Ian/l �.�at. M^ 'Zo
AL
/,/s"s
wee.(,
33 pre.$ rad. P 4s o/o.� II r
e Sor ✓ey
/LCcOrolS z4 re wG/1
12/12/03

Type of Vlsft (,Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for vises l Routine O Complaint O Foflow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: t g & -rune: lOC�
Q Not operational Q Below Threshold
0Permitted Certified 0 conditionally Certified 0 Registered Date Last Operated or Above Threshold:
s
Farm Name: »....».)) �T � �......fxtKl. .»» �.AM. County: ...
...... ?. s+!►».»-...._.. -
OwnerName: ....... keifM.........................SFLjI.4 ...»...»............................. Phone No:
Facility Contact: ... ! e f�.. sem?» CrS , . » Title:......Q.. stn fr........................... . ».... Phone No: »..... -------
Mailing
........_......–Mailing Address:....... 04 11 ,.......»...
................................. . �It�!i � _nLL
Onsite Representative:.......!' t.r��1._ »STf r`c Integrator:
............................ Int tor: .,...».».......»..»....»»........».................
Certified Operator:,,,._,,, Se��„ ...... a Operator Certification Numbem.•••., ,—
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a ` " Longitude •
Desi�u
--------------
Swlne Ciici - Po , utatioa l
❑ Yes
Wean to Feeder
❑ Yes
Feeder to Finish o
Farrow to Wean
=
Farrow to Feeder
77
Farrow to Finish
-
Gilts
Boars
Desigin Current Design' Cbrresiii
Poaltry Ca a Po ulatron�.. Ca C1 Po aatii
❑ Layer [] Dairy
❑ Non -Layer 1 10 Non -Dairy
Other
Total Design=Capacity:
Nmiber:of.agoons Subsurface Drains Present Lagoon Area 10Spray Field Area
Holding Ponds / Sohd Traps No Liquid Waste Management System
ry �.
Dischanes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ........................................................................
..........................................
❑ Yes 0" No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
[g No
❑ Yes
F -No
❑ Yes F No
Structure b
Freeboard (inches): 44
5100 Continued on baek

Facility Number: 8a — '7_5 Date of Inspection X01
coriiis o dente: abouf this visit. :
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
No
seepage, etc.)
e.
�., 4 k} � eLAJ,
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
... ?rr, a� Sn �� s w; (1 be ac�s{�� 1 �s J: Lrdei
closure plan?
❑Yes
[�No
��
{If any of questions 4-6 was answered yes, and the situation poses an
/
immediate public health or environmental threat, notify DWQ)
Reviewer/Inspector Signature: Date: O 5100
7_ Do any of the structures need maintenance/improvement?
❑ Yes
qNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
9No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
Wo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
[XNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
[f No
12. Crop type I erm�GRfLrc :SmalA Grr,`A 05
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
VNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
C) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
J�No
16. Is there a lack of adequate waste application equipment?
❑ Yes
VNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
VNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
IyNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
Q�[No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
11 Yes
No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
19No
24. Does facility require a follow-up visit by same agency?
❑ Yes
No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
'.*i er dgfcjehe{e ire 00" dixfng this:visit: Your �- i*4 0oj ft�er
coriiis o dente: abouf this visit. :
Comiztents (eefer to quest,oin #) Euplain-anyi answers andlor any recommendations or. any otleet
Use dra - of . �
wrn9s ty
fa�L to baiter. lain srtuatians.
: escp _ (ase addttronal as necessary)
!pages
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baa �oc�n s mta � .� n � a�wJL t eA ,
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: O 5100

Facility Number: a — Date of Inspection
Odor Issues
26. 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?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 1� No
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30_ Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes [ No
32. Do the flush tanks lack a submerged fill pipe or a permanendtemporary cover? ❑ Yes ❑ No
lAOditionai.",C-ommentsandtor-Rswinp:--- - . _
5100