820107_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual
2 Vn

Type of Visit: (#Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: Koutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency O Other 0 Denied Access _
Date of Visit: Arrival Time: Departure Time: l .c,1 County: SO Region: f C
Farm Name: /, Owner Email:
Owner Name: �l�Te� t�.aC.��Gz�'Vty Phone:
Mailing Address:
Physical Address:
Facility Contact: D &V %� Z_ -O 12ti Title:
Onsite Representative: `t
Certified Operator: it
Back-up Operator:
Location of Farm:
Phone:
Integrator: -Ar _ s
Certification Number:
Certification Number:
Latitude: Longitude:
DischarEes and Stream Imoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at:. ❑ Structure ❑ Application Field
a. Was the conveyance man-made?
❑ Other:
i
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated voiume 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 �c ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
[] Yes allo
❑ Yes J�fNo
2-1q_A ❑ NE
F].#A ❑ NE
[]IA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued
Design
Currents'
'� `Design
�•
Cur
Design Current
"Wet
rent
Swine
Capacity
Pop. a Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
"''„
La er
Daia Cow
Wean to Feeder
=
Non -La er
Dairy Calf
Feeder to Finish
1?67Z
-0. _
°:
Daia Heifer
Farrow to Wean
Design
Crtrrent
Dry Cow
Farrow to Feeder
D eFou!#r.
@a aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
_•
Turkeys
Other*
Turkey Poults
Other
Other
H
DischarEes and Stream Imoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at:. ❑ Structure ❑ Application Field
a. Was the conveyance man-made?
❑ Other:
i
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated voiume 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 �c ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
[] Yes allo
❑ Yes J�fNo
2-1q_A ❑ NE
F].#A ❑ NE
[]IA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

IFaci4ty Number: - 6 Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No fEJ" A_A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes 0-N-6— ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes R -Ko_
❑ NA
❑ NE
waste management or closure plan?
L_kKo
❑ 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 _E 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 E3'1'To-
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance altematives that need
❑ Yes E!J'No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes []110 ❑ 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): �C.f, yC �i �S lc V
13. Soil Type(s): 1 V C
14. Do the receiving crops differ from those designated in the CA WMP?
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
[a-1Qo
❑ NA
❑ NE
❑ Yes
L_kKo
❑ NA
❑ NE
❑ Yes
Cg 1"_o
❑ NA
❑ NE
❑ Yes [l1To 0 NA ❑ NE
❑ Yes [214o ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [11<o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [9 -No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EJ -No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [3No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes F�rNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA 0 N
❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

LF acEy Number:,},- Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑.W ❑ NA 0 NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes FTN -6 ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes
E ' o
❑ NA
❑ NE
❑ Yes
fo
❑ NA
❑ NE
❑ Yes
[2>o
❑ NA
❑ NE
❑ Yes E3 No ❑ NA ❑ NE
❑ Yes [21 o ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
iswe
c"X 5 � Gv' c�-[ L' ,3 `� bow
[] No
❑ NA
❑ NE
[2'No
❑ NA
❑ NE
[J -No
❑ NA
❑ NE
[3'No
❑ NA
❑ NE
Reviewer/Inspector Name: t C) U e1no Phone:«
Reviewer/Inspector Signature: 300Date: b .
Page 3 of 3 21412015

Lpe or visit: v uompuance inspection v Uperauon xe"ew V naructure r.vaivanon V recdmcaI Assestance
ason for Visit: (Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ! Arrival Time: ; 3 Departure Time: D County:
Farm Name: Owner Email:
Owner Name: �GZ F— [{ a Phone:
Mailing Address:
Physical Address: [
Facility Contact: �Gty (4 Lo L-,{ `an G Title:
Onsite Representative: f c
Certified Operator: 1(
Back-up Operator:
Phone:
Integrator: Iti " s
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Region:
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?
❑ Yes EfNo ❑ NA ❑ NE
❑Yes
C] No
C3--N-A
E] NE
[—]Yes
❑ No
Ej,�tA
❑ NE
Design Current 'l
Design
Current
Design Current
Capacity Pop.
u� r
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
rFinish
TFeeder
La er
Dai Cow
Non -La er
Dai Calf
b"`'
Dairy Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D : Paul
Ga aci
P,o .
Dairy
Farrow to Finish
LGilts
La ers
Beef Stocker
Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkevs
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify 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?
❑ Yes EfNo ❑ NA ❑ NE
❑Yes
C] No
C3--N-A
E] NE
[—]Yes
❑ No
Ej,�tA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes Q'No
[—]Yes [TNo
[3 -'NA ❑ NE
F] NA ❑NE
❑ NA ❑ NE
Page 1 of 3 2/4/2015 Continued

Facili Number: - Date of Inspection:
❑ Yes
Q No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
fNo
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
D-1�❑
NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
LSJ
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
p Weather Code
Spillway?:
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[] Yes
Designed Freeboard (in):
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
gt
Observed Freeboard (in): 3
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Q'&o
❑ NA
❑ NE
. (i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[ rNNo
❑ 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
ETN_
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
0-9-o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Flo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes []-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift E] Application Outside of Approved Area
12. Crop Type(s): C1:O j9 13 e-,lM.[,�.r Ct 'PaS�U'e S(, iJ
13. Soil Type(s): — NO
.
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ffNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes D -No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes EJ N -o ❑ 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 I R1V o ❑ NA ❑ NE
❑ Yes [}'1`Io ❑ NA [] NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
fNo
❑ 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
[?7rNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
p Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[] Yes
[:]NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
gt
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - I Date of Inspection: 3 -7
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �lo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes B`go ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
�o
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[g No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[.]'1'Jo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 I. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
[] Yes
[Ko
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
bM-N-6
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
�o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[ -7K4o
❑ NA
❑ NE
Caxnments (refer,to:quesoon;#): ExplainYESanswers and/or,Of
a©y, }#. L, any, additional romrnendahons or auy e
atherleommna
Use drawrngs' ot�
f faclhty to better eapiain situations (use additional pages as necessary)= y� .
Cr
Reviewer/Inspector Name: b il
Reviewer/Inspector Signature:
Page 3 of 3
Phone: n 33 39-�
Date: � Aux,, i -7
2/ /2015

I Al s
tb &D
Type of Visit: aCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance j
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access J
i�r.�wr�rr -rr
Date of Visit: Arrival Time: Departure Time: County: s4Y4Region:
Farm Name: _ DQVc�C.[� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: D Title:
Onsite Representative:
,4 (
Certified Operator: u
Back-up Operator:
Location of Farm: Latitude:
Phone:
Phone:
Integrator:
Certification Number: d
Certification Number:
Longitude:
Discharges and Stream Imoacts
1. Is any discharge observed from any part of the operation? ❑ Yes Q,?T__0 NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [] No NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[:]Yes
DesignCurrent
216
Design
Current
Design Current
Swine
Capacity_ Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
❑ NE
Wean to Finish
❑ Yes
La er
❑ NA
❑ NE
Dairy Cow
❑ Yes
Wean to Feeder
❑ NA
on -Layer
of the State other than from a discharge?
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dg Cow
Farrow to Feeder
Farrow to Finish
Gilts
Boars
D . Poul
La ers
Non -Layers
Pullets
Turkeys
Ca aci
Y,o
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Other
Turkey Poults
Other
F
Other
Discharges and Stream Imoacts
1. Is any discharge observed from any part of the operation? ❑ Yes Q,?T__0 NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [] No NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[:]Yes
❑ No
216
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E310
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Q No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2015 Continued

Facili Number: Date of Ins ection:yj lbuaft
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
o
❑ NA
[D NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
Fj_NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes
[2'�'Io
❑ 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
Ej/No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
PNo
❑ NA
❑ NE
maintenance or improvement?
1 l . Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload p 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 o Wind Drift ❑ Application
Outside of Approved Area
12. Crop YP T e(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
to
❑ 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
FeeNle
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[2/No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
D<0
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[7'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
F2<0
❑ 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 Ji]''No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E!fNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [2fo ❑ NA ❑ NE
Page 2 of 3 2/412015 Continued

FacW Number: - rri Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ff' r�o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes IJ-'s"O ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes �o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [J o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[�J'M
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[2<o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑"IV'
❑ 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
El"No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pend ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EJINo
❑ 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
�CNo
❑ NA
❑ NE
Eommei3ts (refer toiaesbon # Explain'any YES sa �orany .additional recommendations or�auy otherZcommeiifs�.
-
Reviewer/Inspector Name: \ r i Phone: 43s�-
ReviewerAnspector Signature:E)UA4V Date:
Page 3 of 3 2/4/2015

(Type of Visit: QrCompHance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access J
k1f
Date of Visit: OG Arrival Time: Departure Time:`, CountyS
A ^ Regionl�
Farm Name: ELM,
a•.-, Owner Email:
Owner Name: �J 4U a t^U�-x _ Phone:
Mailing Address:
Physical Address:
Facility Contact: L tj Z­0�116 � Title: Phone:
Onsite Representative: Integrator: K 9
Certified Operator: l Certification Number: 20 OS _
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design
Gnrrent
Swine Capacity Pop:ffdintry
Capacii}
Pap.
Cat#le Capacity
Pop.
Wean to Finish
Da' Cow
Wean to Feeder
a er
I I Dairy Calf
Feeder to Finish
Da' Heifer
Farrow to Wean
Design
Gurrept
D Cow
Farrow to Feeder
P■onitr
Ca _aci
P■o
Non -Dairy
Farrow to Finish
]rNon-Layers
Layers
Beef Stocker
Gilts
Beef Feeder
Boars
ts
Beef Brood Cow
Turkeys
Other
Turkey Poults
M
Other
Other
-J.—
M—.--
. I
Discharges and Stream Impacts �..,
1. Is any discharge observed from any part of the operation? ❑ Yes D-111` ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No 0NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes [] No LTd4A ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR) ❑ Yes ❑ No EKA ❑ 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 [3<o ❑ NA [] NE
of the State other than from a discharge?
Page I of 3 2/4/2014 Continued

rPacgity Number: EK- Date of inspection: gor
IH "'o
❑ NA
❑ NE
❑ Yes
' Waste Collection & Treatment
❑ NA
❑ NE
[:]Yes
'o
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[curia—❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
E. -14A
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
S. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
.�Io
❑ 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
[� oo
❑ 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
[Ado
❑ 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�<o❑
NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Cg-N—o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below_ ❑ Yes Q o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): CV' N'"
13. Soil Type(s): No
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ®'K -o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [31 -Ko— ❑ NA ❑ NE
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?
Re uired 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
IH "'o
❑ NA
❑ NE
❑ Yes
to
❑ NA
❑ NE
[:]Yes
'o
❑ NA
❑ NE
❑ Yes E3 No ❑ NA [] NE
❑ Yes No ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements []Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections p Monthly and 1" Rainfall InspectionsSludge 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 F!f/No ❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Facifl Number: Fj- 0 Date of Inspection: 'S'.0
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ o— ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes II 1 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [g. -Ko ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or'document ❑ Yes 2-55 ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air duality concern? ❑ Yes D -Nu ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes []' ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑153
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[�r �o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
�o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
BITo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additionaf.recammetidations or any other, comments.
Use drawings of facility to better explain situations (use additional pages as necessary). , r-
�l
7- 3 � 5
[
-o
` &C)
i
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �M- 33(�
/ rr�
Date: j4h r 15
2/4/2014

Type of Visit: OrCompliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance I
Reason for Visit: routine O Complaint 0 Follow-up O Referral 0 Emergency 0 Other O Denied Access 11
Date of Visit: Arrival Time: Departure Time: � County: 19"f% I-,— Region: r_90
Farm Name: L M7`L Rv to Owner Email:
Owner Name: `to tothett4lPhone:
Mailing Address:
Physical Address:
t
Facility Contact:u l{,�t Title: Phone:
Onsite Representative: Integrator:
Certified Operator: it Certification Number: z -o d 3 f
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Carrent
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Non -Layer
Design
Capacity
Design
Current
Pop.
Current
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non-Dairy
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feede
Farrow to Finish
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
a. Was the conveyance man-made?
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Boars
Other
Other
b. Did the discharge reach waters of the State? (If yes, notify DWR)
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
❑ Yes
Ea>o'
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
C A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
[] No
[l TKA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[:]Yes
❑No
NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
allo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [—]Yes El"No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 214/2014 Continued

Facifi Number: - Date of Ins ection: 50
� 4
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Vl 1
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
n Ndt1❑ NA ❑ NE
❑ No BNK❑ NE
Structure 6
❑ Yes L+>d' ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
I__I o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
0 ,
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
['yo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
[]Xo
❑ NA
❑ NE
acres determination?
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E4<o
❑ NA
❑ NE
maintenance or improvement?
[�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
Waste Application
C3,9'o'
No
❑ NE
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
C
❑ 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 0 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 C] Eviden;VCC?'_'
Wind Drift Application Outside of Approved Area
12_ Crop Type(s): �Cd` W �' ct,Ge
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes [ j o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check [—]Yes Q'No ❑ NA ❑ NE
the appropriate box_
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes E No ❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�io
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[R,<o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[]Xo
❑ 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
C3,9'o'
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes [ j o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check [—]Yes Q'No ❑ NA ❑ NE
the appropriate box_
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes E No ❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Other Issues
Facility Number: - Date of Inspection; '
[—]Yes
�No
❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E&i<o' ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
(];. [DNA
❑ NE
the appropriate box(es) below.
[:]Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Yes
EfNo
❑ Non-compliant sludge levels in any lagoon
permit? (i.e., discharge, freeboard problems, over -application)
List structure(s) and date of first survey indicating non-compliance:
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
O21go
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
&2,<o ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[r'No ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[—]Yes
�No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
[—]Yes
Ej"No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
EfNo
❑ 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
O21go
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[fNo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[� o
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[�fNo
❑ NA ❑ NE
Comments (refer to question #i): Explain any YES answers: and/or any additional recommenf atrons or. any other�comments.'i
Use drawings of facility to better explain situations (use addttional:pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
o- 3•Y
Phone:
Date: 0 L
2/4/2014

Type of Visit: ®'Compliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint O Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Timer County�� Region: -t
�q
Farm Name: Owner Email:
Owner Name: t a, Phone:
Mailing Address:
Physical Address:
Facility Contact:i
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
7R,W� S E0,_41 NMY �,_
Title: Phone: q_5 36
Latitude:
Integrator: 'go _
Certification Number: Y 0
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes effNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [:]Yes ❑ No ErT4A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) [:]Yes ❑No NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes dNo
❑ Yes �No
01A
Design Current
Design Current `
Design Current
Swine
Capacity Pqp.
Wet Poultry
Capacity ;Pop ;Cattle Capacity Pap.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
JiDUfflR575h"7005pacity-�
.
Dai Heifer
Farrow to Wean
uTrent�F
D Cow
Farrow to Feeder
Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
5%
Other
_ _ _„
Turkey Pouits-
Other
Other"
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes effNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [:]Yes ❑ No ErT4A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) [:]Yes ❑No NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes dNo
❑ Yes �No
01A
0 N
E] NA
F] NE
F] NA
0 N
Page I of 3 2/4/2011 Continued

Facility Number: - Date of Ins ection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [![<o ❑ NA 0 NE
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Structure 5 Structure 6
E] Yes �o ❑NA 0 N
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes ED"'N'o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [:]Yes [&filo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ®'K'o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [a No ❑ NA ❑ NE
maintenance or improvement?
Waste A13plication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes M Xo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. [:]Yes G2 -Ko ❑ 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
p Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [] Application Outside of Approved Area
12. Crop Type(s):f, ai�1A . fes' �w��t'-r _ .•G*r�st-�Ca7
- r
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 [!'<0 ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [�o ❑ 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 Q�Xo ❑ NA ❑ NE
❑ Yes [Vo ❑ NA ❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Ek<
❑ 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
❑'Po
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
[]Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections p Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
02 -No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Bio
❑ NA
❑ NE
Page 2 of 3 2/4/2011 Continued

Faci Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes I rJ No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes CTNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge Ievels 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 ETIN10 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [L lL ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes fo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes LS''`'o [DNA ❑ NE
❑ Yes Lam' o
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below. es ❑ No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP? ❑ Yes EKO
33. Did the Reviewer/ rispector fail to discuss review/inspection with an on-site representative? ❑ Yes [G 40
34. Does the facility require a follow-up visit by the same agency? ❑ Yes F,34o
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments(refer to quesrion #j: Explain any YES answers and/or any. additional recommendations or any other comments.
Use drawings_ of facility to better explain situations (use additional' pages as necessary).
c"4 4".
C(Jy�y _ o- ?. � f - 3 2-3
Reviewer/inspector Name: V Phoney' �3V
� f
Reviewer/Inspector Signature: Date: .,DGL Na
Page 3 of 3 214/2011

/ok a -
I
Type of Visit: QrC_�ompliance Inspection U Operation Review Q Structure Evaluation U Technical Assistance
Reason for Visit: CLAoutine 0 Complaint O Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: LJdqgpLvjJ Departure Time: alb` County: oSA� n Region: M
Farm Name: �� L 'EM -=6 Owner Email:
Owner Name: 0 . tL\ . Libe YC PtY•J Phone:
Mailing Address:
Physical Address:
Facility Contact: 0""Mp j4W_x'gt,, 4 Title: [� ,fiy 2 _ Phone:
Onsite Representative: Integrator: �LttZD•tR1o(� 14
it
Certified Operator: �p►M� Certification Number: �1C7o`3�
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 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 M No [] NA ❑ NE
[—]Yes []No
❑ Yes ❑ No
[—]Yes
Design Current
[—]Yes
Design
Current
Design Current
Swine
Capacity Pop.
Wet 1?oiiltry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Layer
Dairy Calf
Feeder to Finish
24co
jDairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
OEM, gP,o_Wt ,
Ca aci
P,o P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes M No [] NA ❑ NE
[—]Yes []No
❑ Yes ❑ No
[—]Yes
[]No
[—]Yes
dNo
[::]Yes
[E(No
[] NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

FaciliNumber: a - to Date of Inspection l0
Waste Collection & Treatment
❑ Yes
&No
❑ NA
❑ NE
4. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate?
❑ Yes
[g'�o
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
�Vo
❑ NA
❑ NE
St,uc e 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:}►`j.
17. Does the facility lack adequate acreage for land application?
❑ Yes
q/ No
❑ NA
Spillway?:
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E� No
❑ NA
Designed Freeboard (in): — t --
Required Records & Documents
Observed Freeboard (in): _ r
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
16 No
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[��No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc_)
the appropriate box.
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[yNo
❑ 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
ENo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ZNo
❑ 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
ff No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
[V(No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes dNo ❑ 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 WindowEvidence of Wind Drift ❑ Application Outside of Approved Area
(rN A {
12. Crop Type(s): 7LZAMU44 { CC]4UO
13. Soil Type(s): NO A
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
EXNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[6 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
q/ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E� No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
16 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
g 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 &v No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall inspection U1 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [—]Yes A] No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [,7 No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: Date of Inspection: 101a
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes dNo ❑ 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 [v](No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes dNo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ff No ❑ NA ❑ NE
❑ Yes [2rNo ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
&(No
❑ NA
[] NE
[(No
❑ NA
❑ NE
u
No
❑ NA
❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
Date: , [� L / 1
2/4!2011

ivisioii of Water Quality ?����
Facility Number -O Division oPSoiiandI
ater Conservation S�fG
© Qther Agency
Type of Visit: ompliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral Q Emergency 0 Other O Denied Access
Date of Visit: / Arrival Time: / - ,ja Departure Time: jU County:. Region: is
Farm Name: L -+L r—.4e,91,5 Z7/74, Owner Email:
Owner Name: q�j�p� fit �DG�-s+r� Phone:
Mailing Address:
Physical Address:
Facility Contact: ,t/_; d Title: �/,/�y�,!l Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number: C�l1SL�
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
.e
Design C►urreut
@urreut
Design Current
S wine Capacity Pop.
Wet Poultry
,Design
-sem
Capacity aPop:
Cattle "' Capacity Pop.
Wean to Finish
La er
Dai Cow
can to Feeder
Non -La er
Da' Calf
Feeder to Finish* =''Wt
Da' Heifer
Farrow to Wean
:..
-* Desi n *Current
Dry Cow
Farrow to Feeder
Dr:Poultry.
.- Ca acr ,_ Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
-Layers.
Beef Feeder
Boars
Pullets
I 113eef Brood Cow
`= Turkeys
a
Other 2'_ Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes PLNo ❑ NA ❑ NE
[:]Yes ❑No
❑ Yes ❑ No
❑NA ❑NE
❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Cj�No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

FacilityNumber: - Date of Inspection:
l
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): li
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
allo
❑ NA
0 NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
fo No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
1 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
51 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes Vg -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): )'Jo't _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes JQ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes N[ No ❑ NA ❑ NE
16. Did the facility fail to secure andlor operate per the irrigation design or wettable ❑ Yes ®, No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes L, No ❑ NA ❑ NE
❑ Yes [� No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists [—]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard [] Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
p Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fait to install and maintain a rain gauge? 0 Yes No
23_ if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [&bio
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ONE
❑NA ONE
Page 2 of 3 2/4/2011 Continued

IFacWty Number: Date of ins eetion:
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 permii conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? C] Yes MNo
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?
❑NA ❑NE
[DNA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes �a No ❑ NA ❑ NE
❑ Yes rRNo ❑ NA ❑ NE
❑ Yes f No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes E4 No ❑ NA ❑ NE
❑ Yes L.No ❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: �-���4�%�
2/4/2011

Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit &f utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: / Arrival Time: // : Q l7 Departure Time: County: Region: I -r -Am
IV
Farm Name: �' 1—��y'1-�i� c: Owner Email:
Owner Name: �.wf �aL Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: 0 IN I^ w #— Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number: 6;7-oa 3`
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o ❑ ' ❑ Longitude: =0
❑ ` ❑
it
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
J9No
Design Current
Design C*urrent
Design Current
Swing Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Yes
❑ Dai Cow
❑ Wean to Feeder
❑Non -La er
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
11 Dairy Calf
Feeder to Finish j 721
❑ NA
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
❑ Non -La ers
❑ Beef Feeder
EEIBoars
❑ Pullets
El Beef Brood Cow
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Turke s
allo
Other
❑ Turkey Poults
El Other
Number o€ Structures:
El Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
J9No
❑ 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
5kNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
allo
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes [Z No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / g
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes ® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ® Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? 54 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 allo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes (a No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes k]C .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 ❑/ Evide/nce of Wind Drift ❑ Application Outside of Area
12. Croptype(s) l:`t�?•_� ��r..� /D�`t'r�—J
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[&No
❑ NA
❑ NE
15. Docs the receiving crop and/or land application site need improvement?
❑ Yes
10 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[9 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[9 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question #): Explain any Y.E�S, 2nsWer5 and/or any recomnendahon5a6r any Other COmtIten�tS
sUse,,drawings of facility to better.'explam sitaati6ns (Pk ddtteonal pages as necessary)
Reviewer/Inspector Name
Phone: �%0-e133- 33y a
Reviewer/Inspector Signature:
Date: /,;z— 3—j O
Page 2 of 3 12/28/04 Continued

Facility Number: — Date of Inspection 3� D
's
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [9 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes RNo ❑ 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
[,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
E.No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
NNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern'?
❑ Yes
19 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[RNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/]nspector fail to discuss review/inspection with an on-site representative?
❑ Yes
f@ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Addit>onalComments'audlor Drawings '��
Page 3 of 3 12128104
Page 3 of 3 12128104

I
Type of Visit UCompliance Inspection Q Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit &, routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: : 0o I Departure Time: County: Region: / 0
dv
Farm Name:_ �Ctl'IJIS �yl C Owner Email:
Owner Name:; +r %n —LQ c A et Lnw Phone:
Mailing Address:
Physical Address:
Facility Contact: D aiyi d c7e: h 0 f=,Z Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator: iloe�, _
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [=o =' = Longitude: =o❑' =
Design Current
Design
Design CurrenCapacity
Population
Ncre'ntu
et Poultry Capacity Puiation
Cattle Capacity Population
❑ Wean to Finish
❑ La er
I
❑ Dairy Cow
❑ Dairy Calf
❑ Wean to Feeder ❑ Non -Layer
Feeder to Finish I j •
❑ No
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ NA
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowl
❑ NE
❑ Turkeys
❑ Yes
Dther
❑ Other
❑ Turkey Poults
❑Other
dumber of Structures:
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
Discharges & Stream impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
5d No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
JR
12/28/04
Continued

Facility Number: Date of Inspection % g
' Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
ZNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes
❑ No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
® No
❑ NA ❑ NE
(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
"0 No
[:]NA C1NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
54 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
(A No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[XNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Aff^ Q`iff r --I-
13. Soil type(s) ,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
RNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
EX No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
[, No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
,M No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[&No
❑ NA ❑ NE
Comments (refer to gitestion ft Explain any YES ani m ers and/©rran recommendattons or any other c mments.
y �
_
. _ ..
Use drawings of,fa to better explaip situations. (use addtbo"dial pages as necessary.) � _T
:.
J� S r r_ t;(J .S-1���-•r ��^ +'`rn %`� C'wc. yG' �' ��
i/�jL�
..�--.
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: Z/__ Z�L__ A K) Cie
12/28/04 Continued

Facility Number: — Jp Date of Inspection / 5'
Re uired 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 J9No ❑ NA ❑ NE
the appropriate box. ❑ W`UP ❑ Checklists ❑ Design ❑Maps El Other s�
21. Does record keeping need improvement? If yes, check the appropriate box below. [a Yes No ❑ NA ❑ NE
9 Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAW MP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewcr/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
19 No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
®,No
❑ NA
❑ NE
aYes Mom❑ NA ❑ NE
❑ Yes IN No ❑ NA ❑ NE
❑ Yes [9 No ❑ NA ❑ NE
❑ Yes
E,No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
2 No
❑ NA
❑ NE
❑ Yes
&No
❑ NA
❑ NE
❑ Yes [*No ❑ NA ❑ NE
Additi6iW'Commei ts�audl Drawings
AL
12128/04

1
Type of Visit compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint Q Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: —11 ,rival Time: Departure Time: = County: Region:
Farm Name: _ l�L 4-h L< < Owner Email:
Owner Name: �Qil/I �DL-/t crs+�F1 Phone:
Mailing Address:
Physical Address:
Facility Contact: 1DII - 1_49LI4 Title: Phone No:
Onsite Representative: ��Gur�C _ Integrator:'
A601 -
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =10 Eli ="
Longitude: = ° = d =
is
JDFsign
" Curient�
Design Currentilia Design Current
Swine
Capacity Pop latton.
Wet.Poultry
Cap qty Popeilahon Cattle Capacity Population
El Wean to Finish
❑ La er El Dai Cow
ElWean to Feeder
❑ Yes
❑ Non -La er
❑Dai Calf
Feeder to Finish
p
f...11111.
❑ Dairy Heifer
-11
Farrow to Wean
❑ NE
-
I�.ry Poultry
❑ D Cow
❑ Farrow to Feeder
A -
❑ Non -Dairy
❑ Farrow to Finish
❑ No
❑�La Layers
❑ Beef Stocker
❑ Gifts
❑ Yes
❑ Non -Layers
Beef Feeder
El Boars
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑Pullets
❑ Beef Brood Co wl
- - -
El Turke Is
other than from a discharge'?
Other}:
❑Turke Poults
❑ Other
12/28/04
=' ❑Other
_
Number of Structures:
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
4 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
,R No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
,k] No
❑ NA
❑ NE
other than from a discharge'?
Page I of 3
12/28/04
Continued

Facility Number: Date of inspection lL_L�L
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not property addressed and/or managed
through a waste management or closure plan?
❑ Yes E.No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes Callo ❑ NA ❑ NE
[:]Yes 4No ❑ NA EINE
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 [S5 No ❑ NA ❑ NE
8_ Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
RNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ yes
EkNo
❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
rM No
[INA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes
J4 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 types) _
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
ANo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
QNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
f, No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
® No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
JRNo
❑ NA ❑ NE
Reviewer/Inspector Name I phone:
Reviewer/Inspector Signature: Date:%�—
Page 2 of 3 12/28/04 Continued

Facility Number: — p Date of Inspection
Required Records & Documents
t9. 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 LR 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 W 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
E& No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
5kNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
gNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
RNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[9No
❑ NA
❑ NE
29.
Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
RNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31 _
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
M No
❑ NA
[:1 NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
JKNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
W No
❑ NA
❑ NE
Additional omments�and/ur Drawtn s �....... ........
Page 3 of 3 12/28/04
Page 3 of 3 12/28/04

El
ti
vision of Water Quality i_____
acility
FNumber p/
� , �Q% � Division of Soil and Water Conservation
O Other Agency I
Type of Visit k)Co—mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: F-7-110-0-1 Departure Time: County:
Farm Name: �L /�dr"/� _ Owner Email:
Owner Name:Phone:
Mailing Address:
Physical Address:
Facility Contact: a Title: Phone No:
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
Boars
Other
❑ Other
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = 6 ='
= Longitude: = ° =' ❑ u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑
Layer
❑ Non -Laver
Dry Poultry
❑ La ers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkev Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: P-1
b_ Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
jjjNo
❑ NA
❑ NE
[:]Yes
K,No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: — j If Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
El Yes ®No [-I NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Crop type(s)l�f�fiL
Spillway?:
Designed Freeboard (in):
Soil type(s)��
Reviewer/Inspector Signature: Date: D
Observed Freeboard (in):
14.
5_ Are there any immediate threats to the integrity of any of the structures observed? [❑ Yes
0 No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
EINE
15.
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
JO No
❑ NA ❑ NE
through a waste management or closure plan?
❑ NE
16.
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
C4 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
14 No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ NA
❑ NE
9. Does any part of the waste management system other than the waste structures require ❑ Yes
C,No
❑ NA ❑ NE
maintenance or improvement?
❑ NA
❑ NE
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
EK No
❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
64 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)l�f�fiL
IL
13.
Soil type(s)��
Reviewer/Inspector Signature: Date: D
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ZNo
❑ NA
EINE
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
RNo
❑ 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
q 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):
IL
Reviewer/Inspector Name Phone:,go
Reviewer/Inspector Signature: Date: D
12/28/04 Continued

Facility Number:— Q Date of Inspection / D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage &Permit readily available? Yes No [:INA ❑NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 9 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Docs record keeping need improvement? If yes, check the appropriate box below. JO Yes ❑ No ❑ NA ❑ NE
19 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
14 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[R No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
9 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
J@ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E[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
ERNo
❑ 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
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12/28/04

Facility Namber
tvision of Water Quality
D Division of -Soil and Water" Conservation
D Other. Agency
Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine O Complaint 0 Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: e)County: Region: /? �
o,_2
19 dr
Farm Name: 4 Ct L Fd Owner Email:
Owner Name: +�G�t!r..r:�_ 4oGlC aysv> Phone: _____
Mailing Address: w 12 A/ IZc r- i, ex ��, � ,�rr .ti,4
Physical Address:
Facility Contact: Dg',; d D C vn •� _ _ Title:
Onsite Representative: _ _L%— e _
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
eeder to Finish ,.3 3 D
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Phone No:
Integrator: 42zVjW4
Operator Certification Number: 190 0-3
Back-up Certification Number:
Latitude: = o = Longitude: [:] o ❑ ' ❑ u
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -La yer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: I
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 ol'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 LKNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
tvision of Water Quality
D Division of -Soil and Water" Conservation
D Other. Agency
Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine O Complaint 0 Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: e)County: Region: /? �
o,_2
19 dr
Farm Name: 4 Ct L Fd Owner Email:
Owner Name: +�G�t!r..r:�_ 4oGlC aysv> Phone: _____
Mailing Address: w 12 A/ IZc r- i, ex ��, � ,�rr .ti,4
Physical Address:
Facility Contact: Dg',; d D C vn •� _ _ Title:
Onsite Representative: _ _L%— e _
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
eeder to Finish ,.3 3 D
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Phone No:
Integrator: 42zVjW4
Operator Certification Number: 190 0-3
Back-up Certification Number:
Latitude: = o = Longitude: [:] o ❑ ' ❑ u
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -La yer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: I
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 ol'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 LKNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
12128/04 Continued

9
L
'r

Facility Number: O7 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?❑YesO ❑ NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /9
Observed Freeboard (in): -7(-
5.
(5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes J�jN0 ❑ 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
[9 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
EZ 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
Dd 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
X No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ FAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Applicatioon� Outside of
Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Lallo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
(3No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`s❑
Yes
®.No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
C.No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
54 No
❑ NA ❑ NE
Reviewer/Inspector Name I I
Reviewer/Inspector Signature:
,��'a` ``°s'.•.. f xM Phone:
Date:
12128104 Continued

Facility Number: — DO Date of Inspection6
i Required Records & Documents
a
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 9 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes D4 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EgNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ONO
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
N No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Dg -No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E.No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
R No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
F7 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
�RNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�&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
14 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ANo
❑ NA
❑ NE
A�ddrhbQal'�Can ments.and/or Drawings:
12/28104

#Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation !
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
gate of Visit: ?O -ti Time: d a
Facility Number O
O Not Operational O Below Threshold
M Permitted © Certified 0 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: _
Farm Name: _ �Gr.n _ _ County: 54114 .sun
Owner Name: 0-6 L st ka 310 Phone No: _ �
Marling Address: _w. 10 15- _ a I er f,.f /t'. rd az`
Facility Contact:Jo— e Lot L o JN , Title:. Phone No:
F
Onsite Representative: _L2a.ti s . _. _ �,od%. Integrator. �o r��r /::f4 . w. f
i
Certified Operator: �U v • `a� L e . It awl Operator Certification Number..2002f _�_
i
Location of Farm:
Swine Q Pouhry E3 Cattle E3 Horse
Latitude ' 64 Longitude '
nisdimmes $ Stre m jrn
1. Is any discharge observed from any part of the operation? ❑ Yes 6+ro
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes MNO
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑-No
c. If discharge is observed, what is the estimated flow in galimin? �-
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes B-Ncr
2. Is there evidence of past discharge from any part of the operation? ❑ Yes S -No`
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ONo
Waste Collection & TreatmeQt
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes MW'
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: --
Freeboard (inches): 3 G
12112103 Continued
�ti

Facility Number: — T o '7 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (e/ trees, severe erosion, ❑ Yes EW6-
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or ❑ Yes 0.3'fo
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 [3 -No
8. Does any part of the waste management system other than waste structures require maintenance/nnprovement? ❑ Yes BNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
ONO,, -
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
B No
11. is there evidence of over application? If yes, check the appropriate box below.
❑Yes
d -No
❑ Excessive Ponding ❑ PAN E3 Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
�
la -`4 3 si s`a 3/.�1 )to -,`s` .712 g-ls -s-1� lv/0-.rpiv-29-sr �vr-
12. Crop type Jir 0y,,;ee/j C7C��fVt�QA�4iS r 4nne.l
�f
13. Do the receiving crops differ with those designated to the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
91`T0
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
(Mo
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
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
M -No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge aVor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [RIKo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [-io
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes [f NO
Air Quality representative immediately.
~16. %01/'. L0"��a.y� hat dnt .v�r.� 7��uT
Please TrC r `e /e/ as �tCCCrSSc l y �'rJ
rYWP�1� 7Ftr�vrP p ";61'i' 5
Final Notes
'!mss 7n1tr� CO �°G�•��
Plelis� rfe.�Y1 7�wr A641 e 'sp�� GT[rvnd `ccc� vv � G�►C�` Tr[u� Us rlrce
Ssu'�
/ Y � r►l..��GLj � � GrIN J`-prsarlJ Ur S�o��ay�
,5t'taW 0Ver t re
�' d /° orf e-r-ws•`dh 0o'? rvmc7�_e gr!*ss
Reviewer/Inspector Name Pr
Reviewer/inspector Signature:
Date: 4 - 2
17./I7./U-i Continued

Facility Number: (d 2 - Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/gMP; ehecksts, design; maps., etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ VaS Appy ❑-geeboard ❑ Waste -Analysis ❑ Soil -S
8 -/o ?� S G <V 3.3 3 - YJ-> 3-•r' !- /y 3.5�
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, fireboard problems, over application)
27. Did Reviewer/inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32_ Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? if yes, check the appropriate box below.
❑ Stieekii� ❑ Crop Yield Form ❑Raimbfi ❑ Iagnmion.After-1"Rain--
❑ 1 WMm ta-Inspections - ❑ Arial -,e -Form-
❑ Yes ©-No
X
❑ Yes ❑'No
❑ Yes EaN6'
❑ Yes
❑ Yes Na-
❑ Yes Q N6
❑ Yes B No
❑ Yes BVo
❑ Yes o-
aYes ❑ No
❑ Yes 12 -No
❑ Yes E3 -No
❑ Yes [aN6
❑ Yes P N6
❑ Yes [:]No
113 No violations or deficiencies were noted during this visit. You wM receive no further correspondence about this visit.
I ndlar
_ 1;21 �
33 4./ V.3Ple- S ked
Gtl Cig �C d� l la�.itm �I•e-cor
/
/O Y• G ter'^ 5
Gn -s. /e
G.-. �� 1<Gr/ ecosaf
S
•
12/12/03

Site Requires Immediate Attenem:
Facility No.
DIVISION OF EN'VIRONMENT'AL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD lrP
DATE: August 2 , 1995
Zine: I
, Tk m xamdowner: .,'e3 �a L,
wailing Address• \,County:
'integfWW: Murphy Family Farms lone: [phone]
On Site Representative: Dewey Carter, Murphy Farms Phone:_ Uj Q) S79-169.7
Physical AddresvIocation: ON SQ leia cam_ , NR .,%1�.SML2t OP SP l!i;zs � Se lute
Type of Operation: Swine g Poultry Cattle
Design Capacity: 4t j Gci ;t Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number. ACNEW
Ltltlide: • ,' _4&" Longitude: V • 0, -Ck I•
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) (! r No Actual Freeboard:,'' 4 Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed?Qor NoSeepage Not
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No Evaluated
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Foot from Dwellin s?or No
100 Feu from Wells? = o
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or
Is animal waste land applied or spray irrigated within 25 Feu of a USGS Map Blue Lune: Yes or No Nofvaluated
Is animal waste discharged into water of the state by man-made ditch, flushing system, or4gher
similar man-made devices? Yes o(&) If Yes, Please Explain.
Does the facility maintain adequate waste` management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No Not Evaluated
Additional Comments: This was a very breif inspection, a more thorough inspection will be _
conducted in the future
WInformation noted
If you hays guestions XeizAldin,
Section @ [phone].
r „Blue. Tjnp_'
I; -Ib i s o. �� w i-oe A ; c►� �f o S on �.,..y..+r� .. ! �. � ou p,s i-� G i4�C e1 �. �-aD� S �waJ�C
Inspector Name Signature
CC: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediate Atswfiw:
Faci ty xo-
-t+
MWON OF ENVDtONMNTAL MANAGENEW
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: A•s .L,, ids
Yiare: - - 11.34 -
Farm ' Lc
Nailing Address: ]a& Doge x48 - r. -.P c d b 31 6916)
Intetratar. Murphy Family Farms - - Phone:, o l n ) 2R o_.7j _jo
On Site Representative: Dewey-carjer. muxphY Fates Phone: _(3In) -570-1687
Physical AddressIlLmdon: o.j _%,%2, ie.� 2C._�r� .�[- &s2 LgA�,kQlsal %O%k- d41%.
Type of Operation: Swine ,g Poultry . Caine
Design Capadty: 4 3fdcQ Number of Animals an Site:
DEM Certification Number: ACE, DEM Certification Number: ACNEW
Ltitude:� • �' �• Lantitude: 8 • �'�•
Circle Yet or No
Does the Animal Waste Lagoon have sufficient freeboard of i Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: = A __Ft. �Indws
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or&I Seepage Not
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No Evaluated
Crop(s) beim utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin or No
100 Feet from Wells? or
Is the animal wow stockpiled within 100 Feet of USGS Blue Line Stream? Yes or
Is animal waste lama applied or spray irritated within 25 Feet of a USGS Map Blue Line: -Yes or No Haivalusted
Is animal waste disowged into water of)ie state by man-made ditch, flushing system, o 4&dr
similar man-made devices? Yes or o If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irritated on specific acreage with cover crop)? Yes at No Not Evaluated
Addidonal Comments:_ This was a veEZ breif _inspection, a more thorough insipection will br'
conducted in the future. _.
E of ormation-noted cm zb1a InaReEtIon
if You have auestions relrardL a t i& reRQrt 910*1a_t!o0taCLPAu1_RAMI N,_DEN Hater (Wa i_
Section $ [phone].
gay -Conditions arlsP thatn+ an Imminent loaner rn 81irfaca
"Alm, "
Ilispector Naue S�tllituR
W Facility Assessment Unit Use Attachments if Needed.