820305_INSPECTIONS_20171231

�.dim
NORTH CAROLINA
Department of Environmental Quaff

Type of Visit: tyMortlpHance Inspection U Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: t&aLLjKArrival Time: If"Z717 Departure Time: D County: Region:
Farm Name: 141A pb f e, Owner Email:
Owner Name: 1 L Phone:
Mailing Address: Z ,v 0`((k4I (]X O(mC L.p',r? , — 7` 7 n
Physical Address:
t
Facility Contact: t; VVA `(- G16 `(2,t Title: Phone:
Onsite Representative: Integrator:` ��rs
Certified Operator: .l Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
t
❑ Yes
Design
Cnrrent
-
Desiurrent
Mile
wine
ltry
Capacity
Pop.
Cattle...
CapaPop.
[]3 NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
DNA
Wean to Finish
c. What is the estimated volume that reached waters of the State (gallons)?
La er
Dai Cow
❑ Yes
Wean to Feeder
i
NA
Non -La er
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[D -No
Dai Calf
❑ N E
Feeder to Finish t{ �fi
❑ Yes
E14o
-' `
❑ NE
Dai Heifer
Farrow to Wean
©esign
Cnrrent
D Cow
Farrow to Feeder
D `kP.oul
.0 aci
P,o i
Non -Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
=
Beef Feeder
Boars
jPulletsBeef
Brood Cow
Turke s
Other
Turkey Poults
Other
LL
10ther
t
Discharp-es and Stream Impacts
I _ Is any discharge observed from any part of the operation?
❑ Yes
D<o —❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[]3 NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
DNA
❑ 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
i
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[D -No
❑ NA
❑ N E
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
E14o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

FaciliNumber: Date of Inspection:
tV
[✓f No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
[ /(No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
EZ>A
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
No
Identifier:
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�To
Spillway?:
❑ NE
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[�
Designed Freeboard (in):
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
Observed Freeboard (in): 3 Z.
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑.M
❑ 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 o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
�o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
0 o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes/[�-�do
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[t'No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes [J�N�[D NA 0 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): cls c.• c t [�r�y,r4 5' [, C,�
13. Soil Type(s): L, CJ
t
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[✓f 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
Eg/No
❑ NA
❑ NE
acres determination?
❑Other:
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�To
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
EE No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[3No
❑ 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
dNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis, ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[�
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3 2/412015 Continued

FacWl Number: =2- - 30 5 1 1 Date of Inspection:
24. Did,Qe facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑<o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ YesNA ❑ 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 provide documentation of an actively certified operator in charge? ❑ Yes E3 -go' ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [ 'Po ❑ 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.
34. 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.
p 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 lo— ❑ NA [] NE
❑ Yes B-fNo ❑ NA ❑ NE
❑ Yes Lid""' ❑ NA ❑ NE
❑ Yes 0<0�­❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes VNo
N ❑ NA ❑ NE
❑ Yes❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Iry j,17
l
qto
Reviewer/Inspector Name: L� y Phonef
Reviewer/Inspector Signature: Date: GLS 1.
Page 3 of 3 2/4/2015

Type of Visit: 0 Compliance Inspection V Operation Review V Structure Evaluation V Technical Assistance
Reason for Visit: Cr routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1 Arrival Time: l f Departure Time: County: -S ►"t Region: [ 1
Farm Name: i s o -f r--, Owner Email:
Owner Name: R o V1 K t l Woo 1�411% Phone:
Mailing Address:
Physical Address:
Facility Contact: 12vt4t,� ; .e_ t�v�`Gv� Title:
Onsite Representative: 1
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone::
Integrator: irm1? " s
Certification Number: C1f�
Certification Number:
Longitude:
Discharp,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? (1f yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes -No ❑ NA ❑ NE
❑ Yes
❑ No
[fNA
❑ NE
❑ Yes
❑ No
Dp ign Cur nt
C esign
Current
Design Cur rent
Swine
Ca actty Po
p
Wet Pof r3 p ty
uit a act
1'a p,
Cattle Ca act Pop.
p ty
-
Wean to Finish
La cr
Dai Cow
Wean to Feeder
g
Non -La er
Dairy Calf
Feeder to Finish
c9 -
��
" '
Dai Heifer
Farrow to Wean
Design
Cur ent
. D Cow
Farrow to Feeder
�; _
� " D : PouIt � 1.Ga aci
Ro -.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
_
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
" -
Qther
_
Turkey Poults$.
Other I
10ther
Discharp,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? (1f yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes -No ❑ NA ❑ NE
❑ Yes
❑ No
[fNA
❑ NE
❑ Yes
❑ No
E]�1VA
❑ NE
Page I of 3
❑ Yes ❑ No
❑ Yes allo
❑ Yes ff No
[3�NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
2/4/2015 Continued

Racili Number: TZ- 'O Date of Ins ection: 9,1 ; u fl e!-/
Wste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [3-N ---❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [] Yes [] No E3 -14-A ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):,
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [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 []'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 [D"�o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ffyNo ❑ NA ❑ NE
maintenance or improvement? P
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [�b ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes [2No ❑ 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): 12 tti 3 cv-yLtc,_d, S & 0 Fe -ye -c, e
13. Soil Type(s): L ti b
❑ Yes
E3<o
❑ NA
❑ NE
14. Do the receiving crops diffe from those designated in the CAWMP?
❑ Yes
[3'1�4o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[] Yes
ED -go
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
O'lg0
❑ NA
❑ NE
acres determination?
❑ Yes
❑'1 o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[q -go
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[5No
E3NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E3<o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
[2-1qo
❑ 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
❑'1 o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
[fNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0 No
❑ NA
0 NE
Page 2 of 3 21412015 Continued

lFacillity Number: Z - 3 65 Date of Inspection: AJ t
24 ' Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [315o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes {2-1qo_ ❑ 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 [3 -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
❑ 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 anon -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Vo ❑ NA ❑ NE
❑ Yes [;No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes C3 No ❑ NA ❑ NE
❑ Yes / No
❑ Yes [�No
❑ Yes &No
❑NA ❑N
❑NA ❑N
❑ NA ❑ NE
C A(refer to quesh#) }plain any.`YES'answe#d/oray addEtional recomrr�ddatioosor airy other romments. t
i,.
Use drawn. on
ueceasmH
t
_suoas aeadiettanala eas L A
Reviewer/Inspector Name:
Reviewer/Inspector Signatu
Page 3 of 3
,31reL '3- DvPhone: 5f c — q,31—
'C:
: Date: p1� etc, vl r[
21412015

I&I Pil s 2K Ito V I I
Type of Visit: O-Compl' nee Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit:' outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: G_0 . Departure Time: County: SAYX� Region:
Farm Name:�Owner Email:
Owner Name: Phone:
I
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
h+�tG tjA Title:
�C
Latitude:
Phone: [�
Integrator: " J
Certification Number: F9 76)"ff-7
Certification Number:
'266)9
Longitude:
Design Current_ _ Dgn Current M Design Current
Saiae Capacity Pop. Wet �ou[try�nCapacity Pop$ Cattle Capacity Pop.
Wean to Finish Layer Dairy= Cow
Wean to Feeder Non -Layer Da Calf
Feeder to Finish '�+ Dai Heifer
Farrow to Wean
_ °Design Currents D Cow
Farrow to Feeder D , P,oult.-`Ca achy I'a Non -Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non -Layers Beef Feeder
Boars Pullets Beef Brood Cow
Turkeys '
Turkey Poults a _
Othera Other IM
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 E&N6— ❑ NA ❑ NE
❑ Yes
❑ No
BNA
❑ NE
❑ Yes
❑ No
Ejo%'A'
❑ NE
❑ Yes
❑ No
E]�<
❑ NE
❑ Yes
[307o
❑ NA
❑ NE
❑ Yes
ET -No
❑ NA
❑ NE
Page I of 3 2/4/2011 Continued

Facility -Number: y Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes NA ❑ NE
a, If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [�3<A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): t+
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [f 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 [ T_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 environ me �tal 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 [fNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) `
9, Does any part of the waste management system other than the waste structures require ❑ Yes [ff No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [?(No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes ff 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): f3G e 'g6 0 ~— 4 t" _ F Coro )&S�
J� 13. Soil Type(s): (-->
J 14. Do the receiving crops differ fro those designated in the CAWMP?
0 Yes
ErNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[ f No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
allo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
C2rNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ YesNo
E] NA
E] NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
No
E]NA
E] 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 EfNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking [:)Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yeso [:]NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? [:]Yes No ❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Facility;lumber: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
B;�d ❑ NA ❑ N E
[A4 ❑ NA ❑ NF
❑ Yes
�o
❑ NA
❑ NE
❑ Yes
[iia
❑ NA
❑ NE
❑ Yes
E?lNo
❑ NA
❑ NE
❑ Yes E34 ❑ NA ❑ NE
❑ Yes []�10 ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. 0 Yes EA
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?es E o
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes [�rNo
34. Does the facility require a follow-up visit by the same agency? [:]Yes E�No
c'Le„�.��—
� 32
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑NA ❑NE
0 N ❑NE
❑ NA ❑ NE
NA ❑ NE
3P7
otcc�+'r" k t (-Z*C"_P/
Phone: 3 3:i;
Date:
214120J]'

rM_9 S'Aw, 15 3b
IType of Visit: ( f Com 'ance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: I A9 t�Lo Departure Time: County: �J4rn Region:��
Farm Name -LJ o nJ ►1� Owner Email:
Owner Name: f\amtlll woo Phone:
Mailing Address:
Physical Address:
Facility Contact: {� D�1rl� W004`'k Title: Phone:
Onsite Representative: . Integrator:
Certified Operator: Certification Number: ! r
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharmes and Stream Impacts
1. Is any discharge observed from any part of the operation?
Design Current
t.&X ❑ NE
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Cagacity
Pop.
Cattle Capacity Pop.
Wean to Finish
b. Did the discharge reach waters of the State? (If yes, notify DWR)
Layer
❑ No
NAVE
Dairy Cow
Wean to Feeder
I lNonlLayer
I
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
Dairy Calf
❑ No
Feeder to Finish
2 LL(q
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
io
Dairy Heifer
Farrow to Wean
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Design
Current
Dry Cow
Farrow to Feeder
D . P.oul
Ca aci
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Keys
OtherRoil
Turkey Poults
Other
Other
Discharmes and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
t.&X ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
EKA
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
NAVE
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
io
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/412014 Continued

Facil' Number: 9 T - Date of Inspection: 12
Waste Collection & Treatment 17
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes -N-6 -❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No Q-1 AA❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes e'No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes LJ fZ
❑ 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 EJ - f90
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure
to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): L,vV c� 4 v
tN
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
l9. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
[EI No
❑Yes
[5No
❑ Yes
[d"No
❑ NA ❑ NE
E] NA ❑NE
❑NA ❑NE
❑ Yes [r]'No ❑ NA ❑ NE
❑ Yes 6 -No ❑ NA ❑ NE
❑ Yes
[" No
❑ NA
❑ NE
❑ Yes
Vo
❑ NA
❑ NE
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements C] Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ZZ
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [—]Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 6"No ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: e Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ET -No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑fq'o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
❑ Yes EjNo
❑ Yes �o
❑ NA ❑ NE
❑ NA ❑ NE
❑ YesX10 ❑ NA ❑ NE
❑ Yes io ❑ NA ❑ NE
30_ Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes L 'moo
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? 0 Yes [D No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes �)
34. Does the facility require a follow-up visit by the same agency? ❑ Yes FJNo
Reviewer/Inspector Name:
Reviewerllnspector Signature:
Page 3 of 3
i[k
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Phone: G
Date: 417 1-5
2142014

Type of Visit: tD'Com fiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: VRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other Q Denied Access
Date of Visit: 131 9G Arrival Time: l Lf eparture Time: DU.. County: Sa►MAft Region:n
Farm Name: J VI A I •C w t? ofer, r ry-(_*7 Owner Email:
Owner Name: j`0ku il-t Le'e- 000' r L' Phone:
Mailing Address:
Physical Address:
Facility Contact: t20vt+t tc C LJO0 Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
I(
t(
Phone:
Integrator:
Certification Number: �00 i G
Certification Number:
Location of Farm: Latitude: Longitude:
0,11,P fVr-w4-r-. Gl---,eo--,. tu—, 5S e,1A z Z
Discharaes and Stream Impacts
1. Is any discharge observed from any part of the operation?
Design Current
Q-1115
Design
Current
Design Current
Swine
Capacity Pop.
Wet Pqultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
NA
Layer
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
Da' Cow
Wean to Feeder
p
Non -La er
Da' Calf
Feeder to Finish
Z t{
❑ Yes
[:]No
NA
Da' Heifer
Farrow to Wean
❑ Yes
�rNo
Design
Carrent
Dry Cow
Farrow to Feeder
E To
D . P.oM
Ga aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turke Poults
Other
Other
Discharaes and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Q-1115
❑ 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
4!� ""
❑ 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
�rNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
E To
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 214/2014 Continued

PF
Facility Number: -S2 jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 1 -Ko lJ NA
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Q 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 8-1qo_ ❑ 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 23-iffo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑Yeso ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [2-ao ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 1V V ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes:
M o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[T -No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
/j No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Ek<o
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
[DIffo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[aXo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
I
❑WUP ❑Checklists []Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [-]Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [-]Yes [[j'<o ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [54o ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: - Date of Inspection:
24, bid 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 Ea -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 [a-Xo ❑ 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.
❑ 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?
CC4�d�,�.-
sW�r' sem, -
Reviewer/inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
0-3f12-,,
P __S4
❑ Yes O.Na— ❑ NA ❑ NE
[:]Yes a b, o ❑ NA ❑ NE
❑ Yes [j;.X6 ❑ NA ❑ NE
❑ Yes
Lg-VU
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[�Vo
❑ NA
❑ NE
Phone: J
-31�li
Date:
2/412011

Type of Visit: Compliance Inspection V Operation Review U Structure Evaluation O Technical Assistance
Reason for Visit: (]�outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: MA fily UArrival Time: Departure Time: l/ U(" County• Region:F71( �b
�r
Farm Name:'P, pi�J� �i �jl%Rj p ���-. �(/ti Owner Email:
Owner Name: Rdb o('( �� ��� _ Phone:
Mailing Address:
Physical Address:
Facility Contact: 12 a Wa Title: Qy Phone:
�%
Onsite Representative: l`�S/�,i�' Integrator: Of
Certified Operator: C Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
.'` Design,Cu�eot<
❑ Yes
Design
Current
Design Current
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Swine Capacity Pop '^
Wet Poultry
Cap ity
Pop.
Cattle Capacity Pop.
❑ No
gal�A
❑ NE
w A.,
❑ Yes
❑ No
[—&1GA
Wean to Finish
Cow
Wean to Feeder
Non -La er
❑ No
C]RXA
Dai Calf
2. Is there evidence of a past discharge from any part of the operation?
Feeder to Finish
[J;�No
❑ NA
❑ NE
Dairy Heifer
❑ Yes
Farrow to Wean
❑ NA
Design
Current
DEy Cow
Farrow to Feeder
D , P,o_ult .
Ca
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
...:.
Turke s
.
Other
Turkey Poults
Other
Other
Discharges and Stream ImnaCtS
1. Is any discharge observed from any part of the operation?
❑ Yes
�No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
gal�A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[—&1GA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
C]RXA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[J;�No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[0'&o
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

FltciliPlumber: - Date of Ins ection: "
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
�10 ❑ NA ❑ NE
C <- ❑ NA ❑ NE
Structure 6
❑ Yes Q�LNo ❑ NA ❑ NE
6_ Are there structures on-site which are not properly addressed and/or managed through a [:]Yes [9'1�o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes EU_Na ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E; 7M ❑ 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 [L-]Xo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes F71,No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [!TN. ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
g6'No
U NA
U NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[] o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
©�1t5
❑ NA
❑ NE
acres determination?
TT//
17. Does the facility lack adequate acreage for land application?
❑ Yes
[j�'<o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E o
�/
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q1Vo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Q�Xo
❑ 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 ER"No
r
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis p 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? ❑ Yeso
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes f�o
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 2/412011 Continued

Fhcili Number: - Date of Inspection: /1' AJVUU 131
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 FR]o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[:]Yes
03X0
❑ NA
❑ NE
❑ Yes
[ZIo
❑ NA
[] NE
❑ Yes [�o ❑ NA ❑ NE
❑ Yes Q�Ko ❑ NA ❑ NE
❑ Yes To ❑ NA ❑ NE
❑ Yes 0?/No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes `f>' ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes [jlo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes Q/0 ❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
PhUb " { a
,� - -3 3A
D"Q
ate:
.2/4/2011

Type of Visit: 0 Compliance Inspection V Operation Review U Structure Evaluation O Technical Assistance
Reason for Visit: (Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Arrival Time: Q pt+,
Departure Time: R County:
Farm Name_
1 \OLXQ oo
J.JQ04EtA V7Attf,\
Owner Email:
Pop.
Cattle - C•apacity Pop.
Owner Name:
q
Phone:
Mailing Address:
Physical Address:
Region: ERO
Facility Contact: C3 (\A 0D \,�)CcAf_90 Title: W t%j t R Phone:
Onsite Representative: 5 -q" Integrator: mi 1QOhY agowro
Certified Operator: pr.sq_ Certification Number: A`QU j(n
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity W^ Pop.
Wet Poultry
Capacity
Pop.
Cattle - C•apacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
I jNon-LayeT
I
Calf
Feeder to Finish
airy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dry P,oultr,Y
Ca achy
P,o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
113eef Brood Cow
Turkeys
Other
Turkey Poults
Other
I 10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 [yNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
[:]Yes ❑No
[]Yes R3"No
[:]Yes [!(No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 214/2011 Continued

[Facility Number: $ - Date of Inspection: ti���
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [gNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No E3 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ��
Spillway?:
Designed Freeboard (in):�
Observed Freeboard (in): L41
❑ Yes
[!�No
❑ NA
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[9"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
[2No
❑ NA
❑ NE
waste management or closure plan?
[:]Yes
allo
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[gNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[]Yes
[2'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
D"'No
[DNA
❑ NE
maintenance or improvement?
Waste Application
No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes �Io ❑ 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): Vp—su,Q—t 943-tuggr
> 1C_ t��J ! R"i P_
t �
13. Soil Type(s): N As 60 ac
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [EI'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 [VrNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[!�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ "No
D 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
allo
❑ 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 [2 -No D NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [g No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [ No ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: jDate of Inspection: 'B�jj
112
g No
[DNA
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[g"'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.
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge
levels
❑ Non-compliant sludge levels in any lagoon
® Yes
❑ No
❑ NA
List structure(s) and date of first survey indicating non-compliance:
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: 'A1ZA43t_Er\
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
Cg'$4o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
ER"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?
❑ Yes
d No
❑ NA
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
g No
[DNA
❑ 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
EdNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
® Yes
❑ No
❑ NA
0 NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: 'A1ZA43t_Er\
_
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
1 No
❑ NA
❑ NE
33. Did the Reviewer/inspector fai l to discuss review/inspection with an on-site representative?
❑ Yes
d No
❑ NA
0 NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
dNo
❑ NA
❑ NE
Reviewer/Inspector Signature: ,,k� Date: 26' 1 t --"V
Page 3 of 3 2/4/2011

Type of Visit: erCiomphance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: O�outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ® Arrival Time: : OCA Departure Time: a v CountyRegion:
Farm Name: %7 a_11� /C r/11 Owner Email:
Owner Name: tirl<G,C__ r:!-- Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Title: ��i1� Phone:
Onsite Representative:. Integrator:
Certified Operator: ,S . _ Certification Number: w2na&
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
ii' j Destgn Current Design @urrenti Design Current
Swtne- Wet Po11lt . Ca act -Pa
Capacity Pop 3= ;ry p Catt1%le Y C►K==Pop.
Wean to Finish µ Layer s„ Dairy Cow W
Wean to Feeder Non -Layer Dairy Calf
eeder to Finish " Dai Heifer
Farrow to Wean - DesignCtirrent Dry Cow
Farrow to Feeder D Poplt , Ca act Non -Dairy
Farrow to Finish " Layers x Beef Stocker
Gilts Non -La ers '� Beef Feeder
Boars Pullets Beef Brood Cow
Turkeys
11 1r+ a
;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)?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
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 W No
❑ Yes J4 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/2011 Continued

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

Facili Number: - 3 Date of inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Z No ❑ NA ❑ NE
25. Is the facility out of compliance with permii conditions related to sludge? If yes, check ❑ Yes R No ❑ NA ❑ NE
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 provide documentation of an actively certified operator in charge? ❑ Yes ER No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Ej No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Yes
[:]No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:�rf.
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
[:]Yes
tj� No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
C' No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2011

Type of visit 'Compliance Inspection V Operation Review V Structure Evaluation U Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral 0 Emergency O Other ❑ Denied Access
Date of Visit:%973-19I Arrival Time: CQ Departure Time: !� County: �'—J Region:
Farm Name: 7iQ Lq �I!�QD_FeN` rarer- / Owner Email:
Owner Name: ^IF11b,"aai I— er _1.(J Phone:
Mailing Address:
Physical Address:
Facility Contact: ; UU>W`A' Title: Phone No -
Onsite Representative- Integrator: ur 4
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [=O =6 =it Longitude: = ° = f 0 a
n Current
_ P g
;est n
'g
"' Design Curre
Current ��acity
Po ulahon�'�'et
PQn1try Caci
Population�Cattle Capacity Population
•_.
a
Po Finish
rSW�
❑ La er
❑Dai Cow
o Feeder
❑ Non -La er
❑ DaiCalf
to Finish —v —
�
P'�' ❑Dai Heifer
Farrow to Wean
DryxPoultry ' }
❑ D Cow
❑ Farrow to Feeder- - `-y Non -Dairy
1:1Non-Layers
❑ Farrow to Finish
El Beef Stocker
❑ Gilts
❑
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
z =
❑ Turkeys
�.:.
❑ Other
❑Turke Poults
❑Other
Number of Structures:
-
❑ NA
--
Discharges & Stream Impacts
1- Is any discharge observed from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
C&No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
J&No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128/04
Continued

F,
Facility Number: Z-1 Date of Inspection
Waste Collection & Treatment
( 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes ®.No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes .® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes ® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes klNo ❑ 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) fir" ,ria -1 Car, % lr- T2e/c
.S ��T/' V y� �t`.JC.LC �p I Y ! '� SGiF 1G I �Ctc
�� ' • _7 �l/ �r
13.
r�
Soiltype(s) �ylr�l2/aury �Dl�Lbnra
10
of r5 dep9a_j r -V r mays. F -D r
14.
Do the receiving crops differ from those designated in the CAWMP?
KYes
EjNo
C]NA
[INE
15.
Does the receiving crop and/or land application site need improvement?
ELYes
ff o
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
ff No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
59.No
❑ NA
❑ NE
Comments {refer to question #,}: Explain any YES answers anr any recommendations or any other comments.
Use drawings of facility to better explantsitua#ons. (use additional pages as necessary).:
.S ��T/' V y� �t`.JC.LC �p I Y ! '� SGiF 1G I �Ctc
�� ' • _7 �l/ �r
10
of r5 dep9a_j r -V r mays. F -D r
Reviewer/Inspector Name y, �_ r�,y
Phone: gllT—�J-33a�
Reviewer/Inspector Signature:
Date: —13 dAd/o
Page 2 of 3 .1 12128104 Continued

Facility Number: 3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes `RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes C3No ❑ NA ❑ NE
the appropirate box_ ❑ WUP ❑ Checklists
❑ Design El Maps [:1 Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EgNo ❑ NA [--IN E
❑ 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 {5No ❑ NA ❑ NE
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 CA WMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
1� No
❑ NA
EINE
❑ Yes
&No
[JNA
❑ NE
❑ Yes
19 No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
[3 No
❑ NA
❑ NE
❑ Yes
I& No
❑ NA
❑ NE
❑ Yes
[5No
❑ NA
❑ NE
[__1 Yes
®No
El NA
0 N
❑ Yes V[No ❑ NA ❑ NE
Additional Comhtents.a�dlor Dravmgs: - �.r�
Ae°N+ 1.
i
7
Page 3 of 3 12/28/04

i
� - ivision of Water Quality
iFacility Number ��— - 3 0 Division of Soil and Water Conservation
Q Other Agency
Type of Visit (6*16o—mpliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit C7tioutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other [I Denied Access
Date of Visit: rArrival Time:Departure Time: % O6 County Region:
Farm Name: _Z%11 a f _ L, Q01 can AIC Owner Email:
Owner Name: _R,& ✓a h : C I"! __ Y Phone:
Mailing Address:
Physical Address:
Facility Contact: 0 ✓l h `� 'I,�U12 Title: n e'" Phone No:
Onsite Representative: .S Integrator:
Certified Operator:Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0
=6
❑ it Longitude: ❑ ° ❑ , E_—] "
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation'?
❑ Yes
LK No
❑ NA
❑ NE
Design Current
Design C«urrent
Design •urreut
Swine Capacity Population
Wet Poultry
Capacity Papulation
Cattle
Capacity Population
❑ Wean to Finish
❑ La er
❑ No
❑Dai Cow
❑ NE
❑ Wean to Feeder 10 Non -Layer I
❑ Dairy Calf
Feeder to Finish Q
❑ Dairy Heifer
El Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Layers
ElNon-Dairy
❑ Farrow to Finish
❑ NA
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Turkey Poults
12128/04
❑ Other
❑Other
Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation'?
❑ Yes
LK No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
ON E
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
IgNo
❑ 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?
12128/04
Continued

Facility Number: --3 Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 12
Observed Freeboard (in):
5_ Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[)q 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
[9 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
KNo
❑ 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
[&N0
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
MNo
❑ NA ❑ NE
mai ntenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
;Z No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12. Crop type(s) G9Pn f t2 Y y 1 �'CSr�[
13. Soil type(s) 617
14. Do the receiving crops differ from those designated in the CAWMP?
R Yes
❑ No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
® Yes
o
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA ❑ NE
18, Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA ❑ NE
Comnnen#s refer to uestton # Ex IaEn an YES answers and/or an recommendations or an other co h Y
Use.dra*.sings of faciliw�a better explain situat,on%: (use additional pages asfnecessary)
j) 11 L / - 1 IQ
1qi ciG pact ]'a�CT�r,ti+^a(iY/r tf /�/rt(�'�'a- � Wl9D�`�/� (AJf tri L`
a4 AVe_
)1 7 1�• tf C1 j V [� [ �lJ �i//�f—�?!� y%Lo�✓ ��- /L
/ c�6,cu
Reviewer/inspector Named Phone: �U-�'—,�; e?O
Reviewer/Inspector Signature: Date:
»n:cinl

Facility Number: — Date of Inspection i
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes M No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EgNo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ]aYes eNo❑ NA ❑ NE
n_wl�ste 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?
21 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 F�`No
❑ Yes �INo
❑ Yes KNo
❑ Yes No
❑ Yes No
❑ Yes E No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
�LVo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
[�[No
❑ NA
❑ NE
❑ Yes
R[No
❑ NA
❑ NE
Additional Comments and/or Drawings:
a� 3
1 MS104

_ Division of Water Quality
Facility Number �'� �� O Division of Soil and Water Conservation 3H e.
O Other Agency
Type of Visit 6-tornpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 6 rcoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: , �D Departure Time: !,q v County: -5 � Region: �ZO
Farm Name: �g..r�� Gt/DD�Owner Email:
Owner Name: s-iy"Phone:
Mailing Address:
Physical Address:
Facility Contact: >~JitlZGu�J�rt� Title: Phone No:
Onsite Representative: .sd°-L Integrator: �irrD
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0
=g
0 Longitude: =0=, =
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
❑ Layer
❑ on -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heilei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: ETJ
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 DINo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
CR No
❑ NA
❑ NE
12/28/04 Continued

V02
Facility Number:—
yl
Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes 1,2[ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): /9
Observed Freeboard (in): 3 Co
5_ Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes [Z 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 tgNo ❑ NA ❑ NE
VMS
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes C0 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 ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN> 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) �,�SGr�sr / 6'htr 6QZirtr I ;?ye
13.
Soil types)
Reviewer/Inspector Name Phone: !210—
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
(XNo
❑ NA
El NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
J29.No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
W No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
2&No
❑ NA
❑ NE
18.
Is there a tack of properly operating waste application equipment?
❑ Yes
Q9_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):
-P r re ! n� L—Qc7+�•
Reviewer/Inspector Name Phone: !210—
Reviewer/Inspector Signature: Date:
- r 11/28/04 Continued

Facility Number: -3 Date of Inspection F
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 JZ No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
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?
Comments and/or Drawings:
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
14 No
❑ NA
❑ NE
❑ Yes
$4 No
❑ NA
❑ NE
❑ Yes
0No
❑ NA
❑ NE
❑ Yes
JR No
❑ NA
❑ NE
❑ Yes
CA No
❑ NA
❑ NE
❑ Yes
4 No
[INA
❑ NE
❑ Yes
K No
❑ NA
❑ NE
❑ Yes
(PrNo
❑ NA
❑ NE
❑ Yes
JKNo
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
fR No
❑ NA
❑ NE
12/28/04

E
5rvision of Water Quality
FaCllilyUiI1bCI �j t7E0 Division of Soil and Water Conservation
— —�0. Other Agency
Type of Visit
ompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
0 Routine 0 Complaint
0 Follow up Q Referral Q Emergency
0 Other ❑ Denied Access
Date of Visit, `Arrival Time: 0 Departure Time: 1101-3-151 County: Region:
Farm Name: �Zems Owner Email:
Owner Name: n zy L / LU t n—hf ►ti- Phone:
Mailing Address:
Physical Address: f
Facility Contact: ���e�1 yJTA1-n Title: Phone No:
Onsite Representative: Sri Integrator: la
Certified Operator: ___ Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0 =1
=46 Longitude: =0=,
°0, =
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
11 ❑ Layer
❑ Nan -La cr
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non-Dairy—
F-1 Beef Stocker
❑ Beef Feeder
❑ Beef Brood Coy
Number of Structures: F
K Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
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 [RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
EJ NA
0 N
El Yes
El No
❑ Yes
DkNo
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
12/28/04 Continued

` Facility Number: 87L— Date of Inspection :3D
❑ Yes
0 No
' Waste Collection & Treatment
❑ NE
15. Does the receiving crop and/or land application site need improvement?
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
SNo ❑ NA EINE
a. If yes, is waste level into the structural freeboard?
❑ Yes
21 No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
❑ Yes
5kNo
Spillway?:
❑ NE
18. Is there a lack of properly operating waste application equipment?
Designed Freeboard (in):
f[No
❑ NA
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7_ Do any of the structures need maintenance or improvement?
❑ Yes
K No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
RLNo ❑ 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?
,3
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No ❑ NA ❑ NE
mai ntenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[51No ❑ 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) 6zv eA.V xo1G Ov-e=S r-.,-�. / C V e rx— 1
13. Soil type(s)
v
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
X Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[]
Yes
DU No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
5kNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
f[No
❑ NA
❑ NE
0 C Lea -►1 Fe-.gc 14 r. 1 T rU &7--- LL)1-C:L
Reviewer/inspector Name ]�� L 1 ,'fff+�a Phone:
Reviewerl[nspector Signature: Date:
12/28/04 Continued

Facility Number: Date of Inspection (�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 9 No ❑ 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 appropirate box. ❑ WUP ❑ Desi Maps ❑ Checklists Design ❑ p El 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
2 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[3 No
E.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
KNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
21 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
O NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
A No
❑ NA
❑ NE
29.
Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑ Yes
M 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
MNo
❑ 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
ED 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
Z No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
M No
El NA
El NE
AilditionahComments:and/or Drawu'gs ; , > y 1
1�,c rn��Yr- K��p c� v� %` rZ�s ,�-L-s�c S� url�� �f— �,�� % �-•�- A1C
12/28/04

Type of Visit
ompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
0 Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Z' Arrival Time:k_'!
: X70 Departure Time: ' County: _5T- Region:
Farm Name: A �" Owner Email:
Owner Name: tt -Q�X �.L� ��'f �,''L— Phone:
Mailing Address:
Physical Address: �-�
Facility Contact: _ U)Qr2 I a r;-- Title: Phone No:
Onsite Representative: s6 -��—" Integrator: /
Certified Operator: „ c �'�� Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 1=1 e E__1 I = u Longitude: =0=A
0=A
r
Design Current �� `. Design Current
Design Current
Swine
Capacity Po ulation Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish5
❑ Layer
Dairy Cow
❑ Wean to Feeder
❑ Non -Layer I
Dairy Calf
[ eeder to Finish
.:
❑ Dairy Heifer
❑ Farrow to Wean
t Dry":Poultry
❑ D Cow
❑ Farrow to Feeder
El NE
❑ Non -Dairy
❑ Farrow to Finish
El Layers
❑ Beef Stocker
❑ Gilts
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Beef Feeder
❑ Boars
[INA
❑ Beef Brood Co
2. Is there evidence of a past discharge from any part of the operation?
Turkeys
KNo
Other
z�: Turkey Poults
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Other
El Other
Number of Structures:
El NE
other than from a discharge?
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
El Yes
El Non -Layers
[INA
El Pullets
Discharge originated at: El Structure [I Application Field ❑ Other
❑
❑
El Yes
1. is any discharge observed from any part of the operation?
El Yes
® No
[INA
[:1 NE
Discharge originated at: El Structure [I Application Field ❑ Other
a. Was the conveyance man-made?
El Yes
El No
[j NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
El No
El NA
El 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
El No
[INA
[:1 NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
KNo
❑ NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[0 No
El NA
El NE
other than from a discharge?
Page I of 3
12/28/04
Continued

Facility Number: — Date of Inspection
1
❑ Yes
($No
Waste Collection & Treatment
❑ NE
15. Does the receiving crop and/or land application site need improvement?
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�3 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
allo
❑ NA
Spillway?:
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�y
Designed Freeboard (in): I
❑ NA
❑ NE
Observed Freeboard (in): c3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
C4 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
V) No ❑ NA ❑ NE
through a waste management or closure pian?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
V1 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
RNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:1 Yes
[9 No [INA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
C9 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below_
❑ Yes
Jallo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
r3' -
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?
Myes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
�. o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
allo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
tallo
❑ NA
❑ NE
Reviewer/InspectorName k $•-`- Phone: D 0
Reviewer/inspector Signature: Date:
Page 2 of 3 72/28/04 Continued

S
Facility Number: Date of inspection —
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box.
❑ WUP El Checklists [:1 Design (3 Maps E] Other
❑ Yes
t.No
❑ NA
❑ NE
❑ Yes
g.No
❑ NA
❑ NE
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?
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
Z No
❑ NA
❑ NE
❑ Yes
C&No
❑ NA
❑ NE
❑ Yes
®.No
❑ NA
EINE
❑ Yes
KNo
❑ NA
EINE
❑ Yes
®.No
❑ NA
EINE
❑ Yes �jl No [INA ❑ NE
❑ Yes
R No
[:INA
❑NE
[-]Yes
CRNo
[:INA
❑ NE
❑ Yes
[&No
❑ NA
❑ NE
❑ Yes
nNo
❑ NA
❑ NE
❑ Yes
ED No
❑ NA
❑ NE
❑ Yes Kio ❑ NA ❑ NE
Page 3 of 3 12/28/04

Site Requires Immediate Attention: N
Facility No. • U 30�
DIVISION OF ENVIRONWENTAL MANACADYMN'i
ANMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 1 o Av �St, 1995
Time: lD
Farm NweelOwner: - W rt W V AQ•ihS
Ma HM Address: 51-17, ` 'v-,v,ot\A� o a f � U A11U , 1�J •L• ZSR 33''4
Coanh+: _ i5 fz) N _
Lrtegrator: u �'� h FAtZ-w�S zN phone;
On Site Representative: rRo�ti� ¢- 1�Jh oot �� phone: qto - Sb1 -- SS 32
Physical Address/Locatiow. �,ac.F S -&- 5 'WI -`AL -b (W w► rli.wtD r13 G2aUU
on 5 S %V%eAaL�d. WV -6k- .
'type of Operation: Swine Poultry _ Cattle
Design Capacity: Z4 4 Number of Animals on Site. ZA4�
DE.1►1 Certification Number: ACE DEM Certification Number. ACNEW_
Latitude: Longitudc: �
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately l Foot + 7 inches a or No Actual Freeboard: —4 -L -Ft. Inches
Was any seepage observed from the lagoon(s)? Yes o No Was any erosion observed? Yes No
Is adequate land available for spray? es r No Is the cover crop adequate? es No
t iR 2 F �.5 U
Crop(s) bung utilized: JAS L CA �. 5Z AC. S
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellios? r No
100 Feet from Wells? Yes No
16 the animal waste stockpiled within 100 Foot of USGS Blue Line Stream? Yes 0&
1s animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes MQ
Is animal waste discharged into waters Vo
e state by man-made ditch, flushing system, or other
similar man-madc devices? Yes or If Yes, Please Explain.
Does the facility maintain adequate waste management recordsvolumes of manure, lead applied,
Way irrigated on spe ' c acreage with cover crop)? Yes o
Additional Comments,, �n rh►� ,n �., 1� AseAv1 A Q, Q.�C �sL �,S
a. ZJ 9-.C- vkvi
vLkL-
Inspector Name Si
cc: Facility Awmrnent Unit Use Attachments if Needed.