820276_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type of Visit: UCompliance Inspection V operation Review U Structure Evaluation V Technical Assistance
Reason for Visit: l316outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: {`7 Arrival Time: :,5'U Departure Time: ;3 D County: �� j�-� Region:
Farm Name: Owner Email:
Owner Name: ,ITG�'"{�; 2-- > 7Phone:
Mailing Address:
Physical Address:
Facility Contact: �/y-� /yJr�p�� Title:
Onsite Representative: �-&-�
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: / `j�IU7y _
Certification Number:
Longitude:
Dische es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [S�_No ❑ NA ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
Design Current
Design
Current'
Design Current
Swine
Capacity 1p.
;a
Wet Poultry
Cc�ty
P
Cattle Capacity Pap.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
eeder to Finish
ffU dao
Dai Heifer
Farrow to Wean
Design
Dry Cow
Farrow to Feeder
D , P,oul
,`Current
Ca `aci P.o .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other Other
Dische es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [S�_No ❑ NA ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
[—]Yes MNo
❑ Yes [L No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA [D NE
Page I of 3 21412015 Continued

Facili Number: - a jDate of Inspection:
1 7
0 No
❑ NA
9. Does any part of the waste management system other than the waste structures require ❑ Yes
Waste Collection & Treatment
❑ NA
❑ NE
maintenance or improvement?
❑ NE
�. 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ER No
❑ NA
❑ NE
a_ If yes, is waste level into the structural freeboard?
❑ Yes
0 No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
M -No
❑ NA
ONE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
Spillway?:
❑WUP ❑Checklists [—❑ Design ❑ Maps ❑ Lease Agreements
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
Designed Freeboard (in): 91— /91 -
❑ Outside of Acceptable Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
❑ Yes
Crop
/
12. Crop Type(s):
❑ NA
Observed Freeboard (in):
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
13. Soil Type(s):
❑ Weather Code
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[3 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes
6. Are there structures on-site which are not properly addressed and/or managed through a
D Yes
E, —No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[RNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ Yes
0 No
❑ NA
9. Does any part of the waste management system other than the waste structures require ❑ Yes
[RNo
❑ NA
❑ NE
maintenance or improvement?
❑ NE
Required Records & Documents
Waste Application
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[No
❑ NA
❑ NE
maintenance or improvement?
[] Yes
® No
❑ NA
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes
M -No
❑ NA
ONE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑WUP ❑Checklists [—❑ Design ❑ Maps ❑ Lease Agreements
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
❑ Yes
Crop
/
12. Crop Type(s):
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
13. Soil Type(s):
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
14. Do the receiving cropsoffer from those designated in the CAWMP? ❑ Yes
®-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes
0 No
❑ NA
❑ NE
acres determination?
21412015 Continued
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
(a No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
[] Yes
® No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [—❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
®. No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ 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
® No
❑ NA
ONE
Page 2 of 3
21412015 Continued

iFacility Number: - L I Date or Inspection: 17
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ygNo
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes ❑ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes CM No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 10 No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below_ ❑ Yes [N No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes nNo
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes EE�No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes E -No
❑NA ❑NE
F] NA E] NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[:INA ❑ NE
Coyrime.' c;#a.quesfton'; . rE larn any :YES answers andlo� aQy addittoual,Mommendations or:any,'other conamen#"s jrs'
uts refs
� II L,�. r I. .an.,l� i rx.:,+, I,I'�..I: ar i1.6:P li39a'��:.
lase drawings of facility -to better ixplain situatrans'6'' additional'pages`as necessary,)_ ��, .
%mac
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412015

ivi'sion of Water g—
n
Facility \umbe®Division of Soilrand Wateonservatio
® Other Agency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: D-' fp Arrival Time:'t7 c'� Departure Time: County: Region: (7
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: /x'1-1'_Cj122/`C- Title:
Onsite Representative:
Certified Operator: o
n
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: / 9�-p 7 f
Certification Number:
Longitude:
Dischar es 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 CE�No ❑ NA ❑ NE
❑ Yes
Design Current= -:._
Design
Current
Design Current
❑ No
❑ NA
Swine ..
Capacity Pop. WejOPoultry Capacity
Pop.
Capacity Pop.
„
�m R
„Cattle
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Fccder to Finish
Dairy Heifer
Farrow to Wean - Design Current
Dry Cow
Farrow to Feeder D�Poult aci P,o ;
Non -Dairy
Farrow to Finish
La y ers
Beef Stocker
Gilts
Boars
Non-LaVers
Pullets
Beef Feeder
Beef Brood Cow
- Turkeys
fur ys,r+,r
Other
Turkey Poults
OtherOthers
:.
Dischar es 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 CE�No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ 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 Lg_No
[:]Yes U4No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/2015 Confinued

[Facility Number: f2- Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2� Structure 3 Structure 4 Structure 5
Identifier: / E
t 1 No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in): t 2
Observed Freeboard (in): 33
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
®,No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement'?
❑ Yes
[0 No
❑ NA
❑ NE
8_ Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[&No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0�[No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
JZ No
❑ NA
❑ NE
maintenance or improvement?
11 _ Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
allo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraalic Overload ❑ Frozen Ground ❑ Fleavy 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 App/roved
Area
12. Crop Type(s): __4C,2 In �lrf ;h-'� ����/ /�'/i2Gt / �9
r✓zt�P'
13. Soil Type(s):
14. Do the receiving crops di r from those designated in the CAWMP?
❑ Yes
[!�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
gNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
R No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
5INo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E3 -No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'?
❑ Yes
�No
E] NA
E] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
allo
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:1 Soil Analysis ❑ Waste Transfers
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes IK No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? [] Yes ,®_Vo
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/412015 Continued

` Facility Number: jDate of Inspection:
— to
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
§a.No
DNA ❑ NE
,i
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
gLNo
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a FOA 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
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 the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
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 [;� No ❑ NA ❑ NE
❑ Yes fRLNo ❑ NA ❑ NE
❑ Yes 2.No ❑ NA ❑ NE
❑ Yes 0,No ❑ NA ❑ NE
❑ Yes E_No
❑ Yes [j� No
❑ Yes 10 -No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better. explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone: 90 —3 03—D rr1
Date:
2/4/2015

ivi"sion of Water Resourc
es
Facility Number' ®- 7� O Division of Soil and Water Conservation
Type of Visit: (a'Compiiance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: erl routine O Complaint O Follow-up O Referral 0 Emergency Q Other Q Denied Access
Date of Visit: / Arrival Time: //9)!V0 I Departure Time: 1 County. rte- Region: l�
Farm Name: 11_.�j11'Ec�f lcZ l ri- Owner Email: T�
Owner Name: f}d"�, �- j'j�-t r� G Phone:
Mailing Address:
Physical Address:
Facility Contact:
Lr folJ+� Title:
Gc Phone:
I
Onsite Representative: S G'� Integrator:
Certified Operator: Certification Number: 9
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharees and Stream Imnacts
1. Is any discharge observed from any part of the operation?
Design Current
[a No
Design
Concent
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
wine
Capacity PaWet
Poultry
Capacity
Pop
M'6H0—.'Rq-
CattleCpaity Pop.
Wean to Finish
❑ NA
La er
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
Dai Cow
Wean to Feeder
c. What is the estimated volume that reached waters of the State (gallons)?
on -Layer
Dai Calf
Feeder to Finish
❑ No
='-
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
Dai Heifer
Farrow to Wean
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Dry Cow
Farrow to Feeder
❑ NE
'D Uy .
Ca aci
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharees and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[a 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 DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�allo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
G, No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 214/2014 Continued

Facili Number: Date of Inspection:
• Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
gj-No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: it G
Spillway?:
Designed Freeboard (in): 7-
Observed Freeboard (in): 17117� 1�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
FM No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
Ca-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
[S-No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[E�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�]C
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ,® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �'f}.^,1 //t r S /� / ��d/�.�•� /I v�SCY�
13. Soil Type(s): A(I--
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes En No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[:]Yes 0,No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 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 E] Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes E�'No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 124 Minute Inspections p Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes 01 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [E No
❑ NA ❑ NE
❑ Weather Code
❑ S]udge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/412014 Continued

Facility Number: jDate of Ins ection:--
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [3,No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑.No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of fust survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a pbosphorus 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
E] No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
IS 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
Pa No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
allo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ffg No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
ELNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
CE�No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any.additional`recommendabons or any other comments �, L
Use drawings of facility to better explain situations;(use>"adi it 6iiji pages as necessary). ..L
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
01- /'�z - 9-- /'6-
Phone: 21—P
Date: ZztL—/_5--
2/4/2014

Date of Visit: Arrival Time: F5F,_'Q__5__j Departure Time: p; oro County: 4�k
n
Email:--7�—
Farm Name: ie.�yG' / G��r Owner Email:
Owner Name:4y/� /i III �' /74P Aloz--y Phone:
Mailing Address:
Physical Address:
Facility Contact: L,mt// Tide:
Phone:
Region:
Onsite Representative:
__r.4k�
Design
Integrator: 'Op '9 jaw i. -
/%
Certified Operator:
lle/!%r & S }�g:...
.
_ Certification Number:
Pop.
Cattle Capacity Pop.
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Curreat
❑ Yes
Design
Current
Design Current
Swine Capacity' Pop.
Wet Poultry
Eapacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
❑ No
❑ NA
Dai Cow
Wean to Feeder
Non -La er
[M -No
❑ NA
Dai Calf
eeder to Finish
❑ Yes
FNo
❑ NA
Dai Heifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
Ca aci
P,o
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
s
Beef Feeder
Boars
r7Layers
Beef Brood CowOther
ults
ll 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?
[:]Yes E.No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[M -No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
FNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3
2/4/2014 Continued

]Facility Number: - Date of Inspection:
Waste Collection & Treatment
,4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
N No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[K No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
[:]Yes
KNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
.® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
10 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Appr red Area
12. Crop Type(s):L—
13. Soil Type(s):
14. Do the receiving crops di from those designated in the CAWMP?
❑ Yes
allo
❑ NA
D 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
[S No
❑ 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
13 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
J2 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
I. No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes .tel 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 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes allo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/412014 Continued

j Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes �K`No
+� 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes &No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey E] Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or 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?
tom"' �r Yv � ! �� f �L- �j,Ar [ 71i)`^�� L'ia►i/ `7r
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes O No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes 10 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 0 No
❑ Yes ® No
❑ Yes �. No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone:
Date: fG13-� J1(
21412014

Date of Visit: I I p-- v 7LA Arrival Time: : Da Departure Time: j ; County: Region: F�
FarmName: 7�Gt/m 4
Owner Name: �✓"✓r s�J�gr �y� `—
Mailing Address:
Physical Address:
Facility Contact:
rx-r-f ad T 1� Title: r
Integrator:
Certification Number:
Owner Email:
Phonc:
Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
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 C@�No ❑ NA - ❑ NE
❑ Yes
C rent Design,f Current
Design Current
ISDesigng
'
Ca ty� PopWetPoultry
Capacrty� P
Cattle Capacity Pop.ore
❑ NE
Wean to Finish
ILayer
Dai Cow
Wean to Feeder
Non -La er I
Calf
Feeder to Finish
f
Dai Heifer
Farrow to Wean.
`�
� k Design Current
Cow
Farrow to Feeder
_
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
-
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
_
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 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 C@�No ❑ NA - ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[] Yes
❑ No
❑ NA
❑ NE
[:]Yes ❑ No
❑ Yes RNo
[—]Yes Lallo
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 2/412011 Continued

Facie Number: 77T 7(v Date of Inspection:
— / D —/3
[a No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
EgNo
❑ NA
❑ NE
'4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[aNo
❑ 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
❑ NA
Identifier: /"9W g'4kr-
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspections
Spillway?:
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
5a No
❑ NA
Designed Freeboard (in):
Observed Freeboard (in): {a _
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
D�_No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any pan of the waste management system other than the waste structures require
❑ Yes
J9 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
� No
❑ NA
E] NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
CEI-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
y
12. Crop Type(s): _�Gti11•�J/ir/ ,���-f�./� / 13t�1�%lu�ee / ;9
lirr^S�r�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
C,No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[g No
❑ NA
❑ NE
acres determination?
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
allo
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[a No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
EgNo
❑ 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
[d 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
5a No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes � No ❑ NA [:]NE
Page 2 of 3 214/2011 Continued

FaciliNumber: Date of Inspection: — p—/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structurc(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? []Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ® No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[k 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
[Z No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
EZ No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
L2�,No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[&No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[0,No
❑ NA
❑ NE
Comments (refer to question-#): Explain any YES answers and/or any additional recommendations or'any other ommentgij
Use drawings of facility -6 better explain situations (use additional pages as necessary).
Q
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9/p .- jr-33 go
Date: lQ —lo -1-3
2/4/2011

Type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Time: c7 Departure Time: ! oaa 1 County: —Region:
Farm Name: y CLa'q?�- Owner Email:
Owner Name: 1-f Get/ r _ S•-rG�u Phone:
Mailing Address:
Physical Address:
Facility Contact: y� r !Yi �r�_ Title: ^��ire Phone:
Onsite Representative:<�'_� Integrator: r
Certified Operator: ,�/"V f Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
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 jQ'No ❑ NA ❑ NE
❑ Yes
DesignCrrrentMAO
❑ NA
Design Current
Design Current
Swine I
Capacity° 'PapWetxPoultry
❑ NE
Capacity -Pop.
Cattle C•apaci#y Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
I
INon-Layer
IDairy
Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
ID . Poul
P_ P. I?o
Non -Daffy
Farrow to Finish
I
Layers
I 113eef Stocker
Gilts
I
Non -Layers
Beef Feeder
Boars
Pullets
I 113eef Brood Cow
Qther
—Turkeys
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)?
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 jQ'No ❑ NA ❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes ❑No
[:]Yes RNo
[] Yes E[No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 214/2011 Continued

Facility Number: jDate of Ins ection: —
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
L&No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
e
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: L-ow
�7—
Spillway?:
Designed Freeboard (in): r lo
Observed Freeboard (in): 33 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
g No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
C?�No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
r_-1 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
M%/ 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
[ANo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
RNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application'? If yes, check the appropriate box below.
❑ Yes
JE-No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):----
14. Do the receiving crops di4r from those designated in the CAWMP?
❑ Yes
IG No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E� No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[Et No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[VI No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Pq No
❑ NA
❑ NE
Required Records Documents
_&
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
fallo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
5� No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists [:]Design p Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ENo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ZI No
23. If selected, did the facility fail to instatl and maintain rainbreakers on irrigation equipment? ❑ Yes 9 N
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: -726 1 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes a No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 6'No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes RNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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.
[5§ -Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes [R No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes W No ❑ NA ❑ NE
RLYes ❑ No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
(Z'No
❑ NA
❑ NE
additional recommendations-.6t.6-y'-fotljer comments..""'"
Use draw drawings of facility to better explain situations use dditro ala a es as necessary). t
facility P ( p g
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:'JD 4 f3 -35 y o
Date: l/—//-/
2/412011

Date of Visit: r%%—/ Arrival Time: Departure Time: County: Region:
Farm Name: ry �f' �c� at S _ Owner Email:
Owner Name: _h/ �-� j� �� p' -L Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: ,
Integrator: %�Ivle
Certification Number:
Phone:
Onsite Representative: 521r�
Certified Operator:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
'� !�
Destga Cur�r�ent��� �� - Destga 'Current
r Com' i r -+$ '.. ti -s s. -''�,
CapacttyPop Poultry CapacttvYPop
Design Current
rM�gapacine
Cattlety Pap.
.t
swWet
Wean to Finish
y* La er
Dai Cow
Wean to Feeder
Non La er
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
D : }Poul Ca aci
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Boars
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes WNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:)Yes ❑No
[:]Yes �0 No
❑ Yes D4 -No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 214/2011 Continued

Facility Number: 7-77,7_(v Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
rM No
—] NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ 3/
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
R)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?
a Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
[Z No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
W No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
5�_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 ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
Window
12. Crop Type(s): �^�71111�L Tis 'r-e't JWA �15�1
13- Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
C.T10
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E&No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
RNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
O 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
S -No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
2S No
❑ NA
❑ NE
the appropriate box.
❑WUP c❑Checklists ❑ Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes gNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 9 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: L Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [0 No ❑ NA 0 NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes a 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
[2 No
❑ NA
❑ WE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[,No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
C] Yes
JR1 No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
®;Yes
❑ NA
❑ NE
V, Application Field p Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
®No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[B No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
RNo
❑ NA
❑ NE
Comments:(refer to question ft Explain any YES answers and/or any additional recommendations fmny other comments. 9�
Use drawines of facility to better explain situations (use additional pages as necessary). ,_"'
1-'Pir 0/'V6>L7_ 01-t- g'z-h
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �j¢-lff 33Dn
Date: —jj/
2/4/2011

t
Ik -io
Type of Visit til -B mpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: L Arrival Time: O Departure Time: County: Region:
Farm Name: ,fi�D%l�v�uGto'IsL Owner Email:
Owner Name: �te"'V i e- /! Phone:
Mailing Address:
Physical Address:
Facility Contact:,&�� Title: 13��U/7�� _ Phone No:
Onsite Representative: Integrator: 0WurW
Certified Operator: Gs'"'V; i< -7 � Operator Certification Number: Z
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o =A
❑ u Longitude: 0 ° ❑ I ❑
Design Current
Design Current
❑ NA
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ an to Finish
JE1 Laver
❑ Daizy Cow
❑ Wean to Feeder
ILI Non -Layer
❑ NA
El Dairy Calf
Feeder to Finish fi-b
�= ==-El
Dairy Heifer
❑ Farrow to WeanEl
Dry I'oUltry _ -_
Dry Cow
❑ Farrow to Feeder
No
El Non -Dai
El Farrow to Finish
E] Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Turkey Poults
Number of Structures:
❑ Other
❑ Other
Discharges & Stream lmgacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes KNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
EINE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
EINE
❑ Yes
❑ No
❑ Yes
No
0 NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 12/28/04 Continued

4
Facility Number: fp Date of Inspection
Soil type(s)
Waste Collection & Treatment
14.
Do the receiving crops differ from those designated in the CAWMP?
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[IYes J�jNo
❑ 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?:
❑ Yes
No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ YesInkNo
Designed
Designed Freeboard (in): /
[:1NA
EINE
18.
Observed Freeboard (in): "-7 to 4� Z
❑ Yes
;RNo
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes Wo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes J,No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes ®,No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes UNo El 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 MNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes WNo ❑ NA ❑ NE
main tenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes JR -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) fjzti7s ��/,e /® l,•�s✓S r,�.,/ �Gp rrt
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
allo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
;9 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?
❑ YesInkNo
[:1NA
EINE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
;RNo
❑ NA
❑ NE
SCommeuts (refer to`question.#): Explain any. YES answers andlor anv recommendations or#any�otner comments
Use drawtngs,of facility to better explain situations (use addtttonal pages as necessary)�s�
Reviewer/inspector Namet
Phone:
iv
Reviewer/Inspector Signature: Date: /f jJJ
rube Z uj -)'

L
Facility Number: -- Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ANo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes CE�No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists
❑ Design El Maps C1 Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ;5 -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 [2[No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes C,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
KNo.
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
®.No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[,No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
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
E&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
DkNo
❑ NA
❑ NE
General Permit? (fel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
;5.&
❑ NA
❑ NE
33_
Does facility require a follow-up visit by same agency?
❑ Yes
CgNo
❑ NA
❑ NE
Additional GommezEts aq oKi1 rawings
i
H
Page 3 of 3 12/28/04

j3�144S /z o 9
Type of Visit 'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit U"Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /2 `� -b Arrival Time: //: Zd Departure County: Region:
Farm Name: G'�-�'' Owner Email:
Owner Name: yeY� it%+ e- fob.A Je- 4 Phone:
Mailing Address:
Physical Address:
Facility Contact:
G rte✓ l�-v r�
Title: %tea • zpe_'C_- • Phone No:
Onsite Representative: 6 &-C-e_y— 964-v<-- Integrator:
dao
+ls`A�A" k
Certified Operator: Operator Certification Number:
'�';: p
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ED n EDI = " Longitude: = o =' = u
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Current
DesignIf
rret
esigI11uH
F
DesignC•arrentSwine
❑ NE
C+opacity Population
Wet"Poultry apacpulaton
Cattle Capacity Papulation
❑ Wean to Finish
❑ Layer
a. Was the conveyance man-made?
❑ Yes
❑ Dai Cow
�-,!
3 wA
❑ Wean to Feeder
❑d1Non-La er
❑ Yes
❑ No
❑Dai Caif
❑ NE
Feeder to Finish
❑ Dai Heifer
Farrow to Wean
Dty Poultry
❑ D Cow
[:1E No
❑ Farrow to Feeder
❑ NE
❑ Non -Dai
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
2. Is there evidence of a past discharge from any part of the operation?
❑ Gilts
❑ Non -La ers
ElBeef Feeder
❑ NE
E]Boars
❑ Pullets
El Brood Co
Turkeys
❑ Yes
CTNo
Other
❑ Turkey Poults
❑ Other
Number of Structures:
❑ Other
12/28/04
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
8 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
�-,!
3 wA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[?<A
❑ 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)
[:1 Yes
[:1E 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 adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
CTNo
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

f
FO-ility Number: 62- —27( Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ,I, EIIN'�o'
El NA [INE
a. If yes, is waste level into the structural freeboard? ❑Yes l�'ivo El NA ElNE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: AKAVA (P-�� %op
Spillway?:
Designed Freeboard (in): 2 -
Observed
Observed Freeboard (in): Z %
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
D -g ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
_
6_ Are there structures on-site which are not properly addressed and/or managed ❑ Yes
10 ❑ NA
[I NE
through a waste management or closure plan?
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify
DWQ
7. Do any of the structures need maintenance or improvementYes
`? F -1E<
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[J'N'o ❑ 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
��
2 o ❑ NA
❑ NE
maintenance or improvement?
❑ NA
❑ NE
Waste Application
Is there a lack of properly operating waste application equipment?
❑ Yes
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
,�,�
LTNo ❑ NA
❑ NE
maintenance/improvement?
1 l . Is there evidence of incorrect application? If yes, check the appropriate box below, ❑ Yes
U'No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
[:]Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) tea[ c.� t�ii -, 3�r� �� S Cl G. , i �✓ l . S —) tiCs
cJLC
13.
Soil type(s) UA46
_
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
7I�o
El NA
[__1 NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'❑ Yes
ET o
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
B"go—
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
Q -Ko
❑ NA
❑ NE
, ,Phone: 33Reviewer/Inspector Name /G o a
Reviewer/Inspector Signature: Date: —zoo
12/28/04 Continued

17- y- a 91
Facility Number: 6'�:Z — Date of Inspection
❑ Yes
G?Ko
❑ NA
❑ NE
Rouired Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
FrNo
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[�
❑ NA
❑ NE
No
the appropirate box. ❑ WUP ❑ Checklists ❑ Desi Maps Design ❑ ap ❑ Other
❑ NE
and report the mortality rates that were higher than normal?
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E io
❑ NA
❑ NE
❑ 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
EWo
❑ NA-
❑ NE
Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
Yes
El�
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
CrNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E� Imo
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
t�f`No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Ef o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
G?Ko
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Et No
❑ NA
❑ NE
f
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
R<01
❑ 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
El,_3Yes
,
I'No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
Yes
El�
o'
EK
o'
❑
Ll NE
33. Does facility require a follow-up visit by same agency?
El Yes
,__,
0<0 ❑ NA
❑ NE
Comments and/or Drawings:
1228/04

8
)k -)v
6
Type of Visit QkM6mpliance Inspection 0 Operation Review O'Ttructure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency JEWAher ❑ Denied Access
Date of Visit: �% �% D Arrival Time: Departure Time: ; pp County: &' Region: rT, o -
Farm Name: Q Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:/T C�j [ L`trl�� �_ Title: Cl//7y �� _ Phone No:
Onsite Representative: e er /nen _ �,y� Integrator: .104
Certified Operator: n�rlC� - > > 19"1'-V 6"�y Operator Certifecatian Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 00 =. = Longitude: =o =' = u
Design Current
Design C*urrent
Design Current
Swine Capacity Population
Wet PouEtry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑Dai Cow
❑ Wean to Feeder
❑Non -La er
❑ NA
❑Dai Calf
❑ Feeder to Finish kD
❑ No
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ La ers
❑ Non -Dai
❑ Farrow to Finish
ersPullets
❑ Beef Stocker
Gilts
❑Beef Feeder
PE113oars
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ Turkey Points
(dumber of Structures:
❑Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: — Date of Inspection
Soil type(s)/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[9No ❑ 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:
[,9 No
❑ NA
Spillway?:
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
Designed Freeboard (in): 4 1 g`
R No
❑ NA
Observed Freeboard (in): b r,97
17.
Does the facility lack adequate acreage for land application?
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
C.No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
18.
Is there a lack of properly operating waste application equipment?
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
J.No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
A 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
7LNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
14 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
Cff-No ❑ NA EINE
❑ 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) d , ,.,/ / vt
y►r--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
[,9 No
❑ NA
❑ NE.
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
R No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
V[No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
[RNo
❑ NA
❑ NE
Guo
tin �,� ��d !1 H-i'�r� o� /`a�-t_ ; •� �� I'�r�rs s
`J
T/l �y lra� 1 Irv" 3-I-0 10 7- o
Nil
Reviewer/inspector Name
Reviewerllnspector Signature:
Page 2 of 3
Phone: '7'7A9 "7,( 33 —33
Date: /!7
12/28/04 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 9[No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists
❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNo ❑ 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 ZNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[.No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
P No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
§?[No
❑ NA
❑ NE
Other Issues
/r,�l ur; /[ /-rte► �jD t! ��►�ur� D a m L��v�� 1����1,
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ANo
❑ 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
9No
❑ 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
EgNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[,No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[ No
❑ NA
❑ NE
Addetional Camments�and/_or Drawings: ,
�9 Gv�rz:-
/r,�l ur; /[ /-rte► �jD t! ��►�ur� D a m L��v�� 1����1,
Page 3 of 3 12/28/04

✓ 3Tp.s i -a8-0? R12-
Z7&
2
z7&
Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 112 -/* -40131 Arrival Time: Departure Time: County: San/ Region: /C�0
Farm Name:'�/fiV /r S Owner Email:
OwnerName:tyGi—V e-� Phone:
Mailing Address:
Physical Address:
Facility Contact: lie 4_y htcZyrt Title: - Phone No: pp ,
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0
=1 = Longitude: [� o = d ❑
Sd
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Design Current ,Design Current _....
_.. .
Design Current
Swine.. ,
Capacity Population Wet PoultryjCapacityPopulahon
Cattier y Capacity Population
❑ Wean to Finish ❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ No
B<A
❑ Dairy Calf
❑ Feeder to Finish
❑ Yes
❑ Dai Heifer
❑ Farrow to Wean
"
Dry P� Itry
❑ DEY Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
El Beef Stocker
❑Gilts
❑Non -La ers
El Beef Feeder
❑ Boars:
- ❑ Pullets
❑ Beef Brood Co
ow
❑Turke s
Other• .
�.
❑ Other
❑ Turke Poults
El OtherDer
Num of Structures: 2—
❑ Yes
L7No
❑ NA
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
2<o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
B<A
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
DIVA
❑ 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
B<A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
B o
❑ NA
❑ NE
3- Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
L7No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

Facility Number: f —Z
Date of inspection
Waste Collection & Treatment �,/
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes LT No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ErNo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 7119 // f
5. Are there any immediate threats to the integrity of any of the structures observed?
El Yes 'Ll' No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) �
6. Are there structures on-site which are not properly addressed and/or managed El Yes H,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
[R<o ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?❑Yes
15. Does the receiving crop and/or land application site need improvement?
L7No ❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ NE
9. Does any part of the waste management system other than the waste structures require
❑ Yes
��
0No ❑ NA
❑ NE
maintenance or improvement?
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application`?
Waste Application
ffNo
❑ NA
❑ NE
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
vo ❑ NA
❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
G 1qo ❑ 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/�
�,� �� 49-1�o'
� S��lr,iAJ COrS.&4- Ars V./
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
B<o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
2 o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
CTNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application`?
❑ Yes
ffNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2<o
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name 91,c Phone: �'/U. 3.3, 3 S
Reviewer/inspector Signature: Date: / Z "o -- Z44a8
1212SIU4 Continued

Facility Number: Z —�7(a Date of Inspection1/2-0-991
Required Records & Documents ,_�
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes B Ngo ❑ NA El NE
20. Does the facility fail to have all components of the CAWM P readily available? If yes, check El Yes E No ❑ NA ❑ NE
the appropirate box_
❑ WUP El Checklists [:1 Design [:1 Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes B5o ❑ 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
[:1 NA
[INE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElB Yes
�B<o
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Plo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
9<6
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
2<o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
0'11o-
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ YesNNoo
El NA
[INE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
D o
❑ 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?
El Yes
,—,�
t_Two
❑ 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?
El yes
_/
[9<o-_ El
ElNE
33.
Does facility require a follow-up visit by same agency?
ElYes
9 -?03o
LJ NA
EINE
.. 'ILS
Addttianil Comments andlor Drawings rw
_ _ `_ '� a4 E
Page 3 of 3 12/28/04

,S_t7aWs 6v 4 j e d 11o,11 z Jo g
0 Division of Water Quality
11 Facility Number $Z Z 7 iv 0 Division of Soil and Water Conservation
0 Other Agency 11
Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit ®Routine 0 Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 1Z -//'D7 Arrival Time: 2: Departure Time: 3;Zp County: Sgt..Esa.-j Region: "'Ro
Farm Name: A.6i✓e y G Ae gocz d- d_4 _ Owner Email:
Owner Name: f>k+"iJi� - .Jc Cs.�L Phone:
Mailing Address:
Physical Address:
Facility Contact: C'e-4r Mo-arL Title: 5 e-; -• Phone No:
Onsite Representative: Co oc-s-c, Integrator: AA UJC� G� &r-nw &f
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0 =g = Longitude: ❑ ° = i ❑
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
I I I ❑
Layer
-El Non -Layer
Dry Poultry 12�
❑ Layers
❑ Non -Layers
❑ Pullets
❑
Turk
e s
❑
Turkey Poults IEEE]
❑ Other
Discharizes & 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 Capacity1'opiulation
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: RD
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 [A No ❑ NA ❑ NE
❑ Yes
© No
❑ NA
❑ NE
❑ Yes
[ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
No
❑ Yes
a No
❑ NA
❑ NE
❑ Yes
IM No
[INA
[:1 NE
12128104 Continued

11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
99 No
Facility Number: gZ —2-7&1 Date of Inspection
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
M No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
® No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: E4ge / 40'"«
13.
Soil type(s) i,cj , Vin/ ,. r /"��'✓rflL �v 11,vS
Spillway?:
14.
Designed Freeboard (in): /
[�'No
❑ NA ❑ NE
i
Observed Freeboard (in): 2-7
Does the receiving crop and/or land application site need improvement? ❑ Yes
1�9 No
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.)
❑ NA ❑ NE
17.
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
21 No ❑ NA ❑ NE
through a waste management or closure plan?
Is there a lack of properly operating waste application equipment? ❑ Yes
P No
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
EjNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[;?No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0 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
99 No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
ReviewerAnspector Signature: Date: /Z r%/— Zd,3 7-
❑ 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) _ j3Sr 61 (64?;�-
13.
Soil type(s) i,cj , Vin/ ,. r /"��'✓rflL �v 11,vS
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
1�9 No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
V1 No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
Vj No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
P No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name t G e-.0 _ Phone: ql0. X33..330 O
ReviewerAnspector Signature: Date: /Z r%/— Zd,3 7-
12128104 Continued

7
Facility Number: SZ -Z7 Date of Inspection 111-11-V71
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [ No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes y No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes MNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[�No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[31 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
0 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
M No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
V3 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[9No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[XNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® 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
W1 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
1 Comments and/or Drawings:
12/28/04

Type of Visit QD-£6mpliance Inspection 0 Operation Review U Structure Evaluation 0 Technical Assistance
Reason for Visit 4:�i�outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
SEDDate of Visit: /LLL Arrival Time: 1129.'3 0 1 Departure Time: .' D D I CountyRegion: L�
Farm Name: tTOyi� r 1�1`/%ts Owner Email:
Owner Name: ' &gfl-Ali e _ ' drag 3�u Phone:
Mailing Address:
Physical Address:
Facility Contact: ,%Zig zzDovrs.[ Title: Phone No:
Onsite Representative: ��,•� Integrator:
Certified Operator: j.� Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: E= o =, El a Longitude: =0 =, = W
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
[—]Yes
Design Current
Designurrent
Swine
Capacpulation
!NC
Wetaxpa ty pulation
M
Cattle Capacity Population
❑ Wean to Finish
ID Layer
❑Dai Cow
❑ No
❑ Wean to Feeder
❑ NE
❑ Non -Layer
❑Dai Calf
❑ No
14 Feeder to Finish
�� / a�
— ,�
❑DairyHeifer
El Farrow to Wean
D Poult �� �a
❑ Dry Cow
❑ Farrow to Feeder
P9 No
❑ NA
ENon-Dai
❑ Farrow to Finish
❑ Yes
ers❑
Beef Stocker
❑ Gilts
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
FLa
on -La ers
eder
❑ Boars
❑ NE
Pullets
❑ Beef Brood Co
Other
3:-
❑ Turkeys
❑Turke Poults*
Page I of 3
❑Other
Continued
❑ Other
,
Numbervf Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
[—]Yes
O No
[INA
❑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
P9 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 adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
;.No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

Facility Number:
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 [q No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ✓ <✓
Spillway?:
Designed Freeboard (in): 1 4'' - g
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ;R No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
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 CR No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes KNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes J.No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) B�-rm�bra -Z �G' �� )Ae-
3. Soil type(s) WlZr r' --� /G`f `±A r- ;& 11 ttJ&✓t i 1e / /
Lrf9jr15 - - -
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
W No ❑ NA ❑ NE
RA No C3 NA El NE
No ❑ NA ❑ NE
ELNo ❑ NA ❑ NE
gNo ❑ NA ❑ NE
�a U-bb,$`aivrl
t utas �7 Thi ern � . Ife f r�vTf J 1 ` ` �5 300 rL c6 Z Cot" �P7 a;Y ff r�-
`t3 IytAP n r.t� f -C `rS U1 �'P rA-1 P �Owh ✓t -/r �r du r rta -.5
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3
12/28/04 Continued

r
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes F4 No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ELNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
n 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
IN No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
U No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
t9 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[3No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ER 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
0 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
UNo
❑ 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
W No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
C,No
❑ NA
❑ NE
Additional Comments and/or Drawings: r
T'�✓i1 Dt~ �t�i is S� r� ng-
i vL For k3
r4On-'"�m�5 i ►'`ctrnti i�"�co�'3,
Page 3 of 3 12/28104

Facility N�umber�
❑ No
❑ NA
�
❑ Yes
--__
❑ NA
❑ NE
Type of Visit 0 Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit • Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: r7 I3 -o Arrival Time: l�.'3� Departure Time: County: , 49!T aoi Region: 6E9
Farm Name:�Qee�C.cr / Owner Email:
Sia-
Owner Name: �Xeellle S Phone: : dr9/0 ; _t9� 'gig
,Mailing Address: X2&6 /1?os 1 ve ! - -- - C •n r Ale
Physical Address:
Address:
Facility Contact: Title:
Onsite Representative: NU✓�e Nena�.�Nl`7/
Certified Operator: ___H_ e_r, _..e__
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
neder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Ce fl sf
Phone No:
Integrator: ew�s
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ 0 =4
Longitude: [� ° ❑ 1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
T I' ❑ Non -La er
Dry Poultry
❑
Layers
❑
Non -Layers !
❑ Pullets
❑ Turke s
❑ Turke Poults
❑ Other
Dischar2cs & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy, Cow
❑ Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: ®,
b. Did the discharge reach waters ofthe State? (if yes. notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Docs 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 040 ❑ NA EINE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[INA
- ❑ NE
❑ Yes
❑ No
❑ Yes
0' NNo
[INA
El NE
❑ Yes
BIN'.
❑ NA
❑ NE
12/28/04 Continued

Facility Number: — Date of Inspection -/ •a
L'No
❑ NA E]NE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes
D No
Waste Collection & Treatment
(Not applicable to roofed pits, dry stacks and/or wet stacks)
Io
❑ NA
9. Does any part of the waste management system other than the waste structures require 0 Yes
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
EKo
❑ 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: 1 - D
LNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
Spillway?: h0 .70
❑ 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
Designed Freeboard (in): �Y '
1; f I— mg, lt3' IGV !� �`►G 111r�ay1
1�i
7ao 'r°+
l2. Crop type(s) sMa//►,' D&Q r.,.
Observed Freeboard (in):^
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E o
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
[a N
❑ 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
L'No
❑ NA E]NE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes
D No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
Io
❑ NA
9. Does any part of the waste management system other than the waste structures require 0 Yes
D'No
❑ NA ❑ NE
maintenance or improvement?
❑ NAL�_�,,//NE
Waste Application
❑ Yes
❑ No
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
ErNo
❑ NA ❑ NE
maintenance/improvement?
D'�o
❑ NA
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
LNo
❑ 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
1; f I— mg, lt3' IGV !� �`►G 111r�ay1
1�i
7ao 'r°+
l2. Crop type(s) sMa//►,' D&Q r.,.
13. Soil type(s) Woe..._ 6 r4,o_. k_%_ ,
v /I,—,,C`
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
E3 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Io
❑ NA
El NSE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[]
Yes
❑ No
❑ NAL�_�,,//NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
LT NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
D'�o
❑ NA
❑ NE
Mr. /-/ "#- h a,s
a-1 16a11 I.yP "7 allot 4uv
Av C auce- 0/'ea.
Reviewer/Inspector Name
Phone: rl/0 �18G'IS`ll e,r{ X30
Reviewer/Inspector Signature: %f Date:
12/28/04 Continued

Facility Number: SL, . —]r] & 1 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 9< ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes NA ❑ NE
the appropirate box. ❑ ❑ Che
c s ❑ D ❑ M,w<-❑ Othef__ ,
21. Does record keeping need improvement? If yes, check the a pro riate box below. L,—yes El No El NA E] NE
6'-r1 -40 ';� -10-7 1.17
aste Application �e��,, ekkl/ly Freeboard El "rte,- sto Amis (I £Se�F is- El[-�infall [�}�teeieirtg E] rop Yield QDA-fi5 Minute Inspections onthly and 1" Rain Inspections [3-W�eather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑Yes qK8' ❑NA El NE
❑ Yes
❑ No
❑ NA
U -NE
❑ Yes
❑ No
❑ NA
GIKE
❑ Yes
❑ No
❑ NA
❑f1E
❑ Yes
EKo
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA UNE
❑ Yes 2 o ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes ErNo ❑ NA ❑ NE
❑ Yes [(No ❑ NA ❑ NE
❑ Yes
-Mb
❑ NA
El NE
El Yes
,D,
Leo
❑ NA
❑ NE
Ad`tiittonai Comments and/or,l)rawings.
- y' + :
1fr.-r
� !Pleos a t/SC "r/ rfJVrba,ee_
k I' A-,eei,W
c�dP r�
re [orU//
S i
��U M,nu t
44 r!oJe
Co/u,rr�
'V d Frrs �oorU r e -t o rds
6 4 le .
ce
R Cn w � �j ISe f�ro�
12128/04

Type of Visit ® Compliance Inspection Q Operation Review '0 Lagoon Evaluation
Reason for Visit ® Routine O Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
wine El Poultry ❑ Cattle ❑ Norse Latitude ' ° " Longitude a I
Design Current
Swine Caoacih• Ponnlation
❑ Wean to Feeder
�eeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons
Holding Ponds / Solid Traps
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Laver ❑ Dairy I
❑ Non -Laver ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Subsurface Drains Present J[LJ Lagoon Area !LI Spr2v Field Area
No Liquid Waste Mnna eiment Svstem
Diseharraes & Stream Impacts
I. Is anv discharse observed from am• pan of the operation? ❑ Yes O M
Discharge orizinated at: 0 Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑Yes [,]
b. If discharge is observed, did it reach 'Nater of the State? (If yes, notify DWQ) ❑ Yes B -90—
c. If discharee is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes. notify DWQ) ❑ Yes E[No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes Dwo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ yes D -M
Wage Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑-+io-
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: / o�
Freeboard (inches): G
A
05103/01 Continreed
Dateof)"iot:
—/ `a Time: /4;_,R 5
Facility Number
� 1_ _ 7 7 L 1
it
=Not erational 0 Below Threshold
-- --
-
Milermitted mortified
[3 Conditionally Certified
M Registered
Date Last Operated or Above Threshold:
Farm -Name: "o ,o,ce
F rte+ S
County: _SQn,Drf"i 6f a
Owner -Name:
ye'e,
Phone No: =J //J - ?
Mailing Address: — /� d 0
�� «/�� /�.�
C 1,'_�t*�
_ N L _-2 F2
Facility Contact: _ _ Hcr-
e - _ Ht- e-yL4-
Title:
Phone No: Gi/U - 9>U- k/ 3 �
Onsite Representative:
Hier L, e Hailex clfIntegrator:
Ayr tY
Certified Operator:
He, -,I. . e Hd., o„
Operator Certification Number: I a+'7ki
Location of Farm:
wine El Poultry ❑ Cattle ❑ Norse Latitude ' ° " Longitude a I
Design Current
Swine Caoacih• Ponnlation
❑ Wean to Feeder
�eeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons
Holding Ponds / Solid Traps
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Laver ❑ Dairy I
❑ Non -Laver ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Subsurface Drains Present J[LJ Lagoon Area !LI Spr2v Field Area
No Liquid Waste Mnna eiment Svstem
Diseharraes & Stream Impacts
I. Is anv discharse observed from am• pan of the operation? ❑ Yes O M
Discharge orizinated at: 0 Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑Yes [,]
b. If discharge is observed, did it reach 'Nater of the State? (If yes, notify DWQ) ❑ Yes B -90—
c. If discharee is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes. notify DWQ) ❑ Yes E[No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes Dwo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ yes D -M
Wage Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑-+io-
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: / o�
Freeboard (inches): G
A
05103/01 Continreed

Fapility Number:,q J7
Date of Inspection�(�
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
It immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
S. Does any part of the waste management system other than waste structures require maintenancerimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload [IFrozen Ground ❑ Copper and/or Zinc
❑ Yes
ETNQ_
❑ Yes
CIN -e–
❑ Yes
0 -No
❑ Yes
[No
❑ Yes
DVo
❑ YesJ_
.
❑ Yes
[}No
12. Crop type gP[rrst:r �s �,. 1,✓'r IPL A�ra�r _ _
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes E3 -Nb
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes aO
❑ Yes D - Wo
❑ Yes allo
❑ Yes 9 -No
❑ Yes [3-N
❑ Yes ❑ No
❑ Yes [9 -Ko
❑ Yes Q44a
❑ Yes Q10
'Co(referrto qu�on) F.=plarn any YES answers sadlor anry reoommendabons oraay otlEer oommeats. y_ --
aUse drawings of fae�ty to b�iterercpl u situat:w : (tlse �honal�pages a.nec�ary) eld COPY ❑ F Notes 1 � �.
Ak
Ah`. I�L! enP�.Cv" �u5 SP.ste ��7r�SPo �+��vaC/+ �a,arrl, H
C-
9rat5 ort ThP.� � P,Srgv'IS� 4Oou Gr6SS Ga�•P•' �`U PlPvwi'L �r'as�r�. ��j' �Ai/G
4 Gdc! *o�oro err, So.xe GfPas To �slP c'sia�lsh 5'�ss Co✓Pi;
.
7
Reviewer/Inspector Name �_
}„�„ v i I
•�1-f\e SI I�LLY��L�i.-_ !Y <Fa .%i. .j.. _
Reviewer/Inspector Signature. A Date. '7 —13 _ v
12112/03 � Continued
r. .

Facility Number: —.,77(o 1 Date of .Inspection
Required Records & Document~
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/ Wim; checklists, doigll;.tnaps; etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ V EjF`eeboard ❑ Waste-rteb-sis
s- 7 2 ':2. 9 , 2 - /o21 ]
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
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
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes B -N —o
❑ Yes UM
mss_ 0 No
❑ Yes G -No-
❑ Yes 3­�o
❑ Yes [}-No
❑ Yes Ea W6
❑ Yes [moo
❑ Yes 8. O
❑ Yes O -bio'
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Q No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit_
No Free4�0urd /0 e-, /%ase 'eplo
�eCorc�S Occa�c�1.,9
T
12/12103

r o[] DSWC Animal Feedlot Operation Review* g s{
DWQ Animal Feedlot Operation Site Inspection ta aR d�
d Routine 0 Complaint 0 Follow-up of DNV0 inspection 0 Follow -un of DSWC review 0 Other
Facility Number
C]'Registered F#Certified [3 Applied for Permit E3 Permitted
Date of Inspection
Time of Inspection L 6 QQ J 14 hr. (hh:mm)
© Not Operational Date Last Operated: ..........................
Farm lame Vka 1.County JA?n�..SOn.....................
Owner Name: ....... &CY.fN Gv.... .............................................................. Phone No:.........5� ..............�Oroa ......................
............................:....................................
Facility Contact:........ .... ................ .. Title: .S K ..... rep . . Phone So: S��..�.���.j..........
Mailing Address:........ .....-42 .['d.2 Aut.}......................................... ....i�+ �n �..��.r...................................
Onsite Representative :......... 1-.letxi.t----- 4n.. a ......................................... lntegrator:..--...T.b'.i1.............. ............................................
Certified Operator, ..............- `
. �-.k.�.�....---�..-..o�....................................... Operator Certification Number:............................
Location of Farm:
Latitude • �' �" Longitude �• ��"
Swine
❑ Wean to Feeder
Feeder to Finish 2� O
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current
Capacity Population
a
".Current' Design , 'Current F
Poultry - Capacity.,Population Cattle. Capaci y Population: `.
❑ Layer I ❑ Dairy
❑ Non -Layer I ILI Non -Dairy
❑ Other
.Total Design Capacity ,
Total SSLW
.. ............ .
Numher'or Lagoons l Holdtng•Ponds `© ❑ Subsurface Drains Present ❑ Lagoon Area ❑Spray Field Area
❑ No Liquid Waste Management System w
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes J jNo
2. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed. was the conveyance man-made? ❑ Yes 9,No
b. If discharge is observed, did it reach Surface Water? (tf yes, notify DWQ) ❑ Yes IN No
c. If discharge is observed. what is the estimated flow in �,al/min"? �
d. Does discharge bypass a lagoon system? (If yes. notify DWQ) ❑Yes go No
3. is there evidence of past discharge from any part of the operation? ❑ Yes ® No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes ® No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 10 No
7. Did the facility fail to have a certified operator in responsible charge'? ❑ Yes tfNo
7125197 Continued on back-

Facility Number: 0. — 27 (o
8. Are there lagoons or storage ponds on site which need to be properly closed" ❑ Yes "19 No
Structures (Lagoons.11olding fonds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 10:No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ..................... ......... LJ ..............
...................................................................
.
Freeboard(11): �? , . ls............................................................................................................................................................... .
10. Is seepage observed from any of the structures? ❑ Yes 12'No
11. Is erosion, or any other threats to the integrity of any of the structures observed`! Q Yes ill No
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13_ Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering, waters of the State, notify DWQ)
15. Crop type ...: 1 l!Mi1t........................... .......................................... ............................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21- Did Reviewer/inspector fail to discuss review/inspection with on-site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0- No.violations or deficiencies were noted -during this.visit..You:will receive no further
correspondence a oiit this. visit:
❑ Yes ® No
❑ Yes No
® Yes ❑ No
......................................
❑ Yes iiL\to
❑ Yes +& No
❑ Yes 11 No
❑ Yes ® No
❑ Yes IR No
❑ Yes ® No
❑ Yes 15 No
❑ Yes ® No
❑ Yes No
Q Yes ❑ No
Cortimeni§°{refer ta°question ##); ;Explain any YES ans�ers and/or any recommendattans or an} other coinmeats.
'r,.,rk -'
_. ham" _a.T`k �,
[1se'drawtitgs of facility to';better. explain stttiahons {use additional .pages asrnecessary} {
�x � �'F �,E-�y�, � % y � � y�`;
N w G.
„ �-
Uep
7125197
T
Reviewer/Inspector Name
Q
+
Reviewer/Inspector Signature:
Date: