820405_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

-- ---- - _ . -:,*, . 4 _ .
4'.
Type of visit: i�ompliance Inspection V Vperateon Review V Structure Evaluation V Technical Assistance
Reason for Visit: 940utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Q' Departure Time: 30 County: �',�,`_ Region:
Farm Name: l,[j�,� _ r/J----' Owner Email:
Owner Name: ctitf:m ; Phone:
Mailing Address:
Physical Address:
Facility Contact: fl��� r /,(/� %�`�s- Title: fJ7,�i7�/` Phone:
Onsite Representative: Integrator:
Certified Operator: %/ Certification Number: p21�/SJ3
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes allo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
Design Cnrrent
Design Current
Design Carrent
Swine
, i Capacity Pop"
Wet Poultry
Capacity =:'Pop.
Cattle Capacity Pop.
Wean to Finish
❑ YesUZ21kNo
Layer
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Dairy Cow
No
Wean to Feeder
❑ NE
of the State other than from a discharge?
Non -Layer
Dairy Calf
- Feeder to Finis
Dairy Heifer
Farrow to Wean
gn Current
D Cow
Farrow to Feeder
D P,oultct
wryc1?0
Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
on -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
s.
N
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes allo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
[] Yes
❑ No
❑ NA
[] NE
2. Is there evidence of a past discharge from any part of the operation?
❑ YesUZ21kNo
❑ 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 2/4/2015 Continued

[Facility Number: -Date of Ins ection:
[:]Yes
® No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
FVI No
❑ NA
❑ NE
'. 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[Z 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
Stricture 6
❑ NA
Identifier:
the appropriate box.
Spillway?:
Designed Freeboard (in): %
Observed Freeboard (in):a
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Wo
❑ 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
[allo
❑ 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
ta No
❑ NA
❑ NE
8. Do any of the strictures lack adequate markers as required by the permit?
❑ Yes
[KNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[�, 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 [S 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):2=11rK> �'T
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ YesNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [&No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[:]Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
FVI No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
allo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
UNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes [&No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard [:] Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [—]Yes M No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E&No ❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

" Facility Number: - t7 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
D Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [ZI No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the faci lity? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[:]Yes ®.No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
[:]Yes [0 No ❑ NA ❑ NE
0 Yes ® No
[:]Yes ❑ No
[:]Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question:!!):. Explaio, any YES answers andfor any additional recommendatioos`or auy other comments.
Use drawings of facility to better explain situations (ase additional pages as 1necessa
U ry): '
f�t� lfr3 �i S -9 I f�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:��'/
21412015

Division of Water Resources
Facili •Number � . O Division of Soil ,and Water Conservation
®Other Agency
Type of Visit: Compliance inspection n Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: eRoutine O Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: ' Q Departure Time: County: gS 4 l
Farm Name: w., -P `eq #Z Owner Email:
Owner Name: a+'l e- k'1%4 F aU Phone:
Or
;Mailing Address:
Physical Address:
Facility Contact: _*1'0 �'+1� I✓ r u Er4-L,%3 Title:
t[
Onsite Representative:
Certified Operator: %C
Back-up Operator:
Location of Farm:
Latitude:
Region:FICD
Phone:
Integrator: W 6
Certification Number: `t ' 150
Certification Number:
Longitude:
f _
� Design Cetrreat� Destgn� Current
Design Current
Swore �
_
Ca act 'Po Wet Poultry
p �' p`
3 - a
eapactty Pop:
Cattle Capacity P.
y
Wean to Finish s , La er
DaiEX Cow
Wean to Feeder
© O' Non -La er
I
Dairy Calf
Feeder to Finish's
Dairy Heifer
Farrow to Wean
**
� ,
D
_ estgn 'Curren tI
Dry Cow
Farrow to Feeder
D . P,oult ,
Ca act n-
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
3 Turkey Poults
Other I
I Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If'yes, notify DWR)
?. 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 i o ❑ NA ❑ NE
❑ Yes ❑ No [VIVA ❑ NE
[] Yes ❑ No [EJIA ❑ NE
❑ Yes ❑ No
❑ Yes �No
❑ Yes ENo
C:fNA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 2/4/2015 Continued

t
F'acilit Nu ber: - Date of Inspection -
,L -,3 jE�
V
Waste
ns 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
Identifier:
Spillway?:
[✓]'-5'o 0 N ❑NE
❑ No 0 -TTA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Designed Freeboard (in):
Observed Freeboard (iri}:
5. Are there any immediate threats to the integrity of any of the structures observed?
large trees, severe erosion, seepage, etc_)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes [�J<oo ❑ NA ❑ NE
❑ Yes [r]'No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
Ea"No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
g3"No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ Yes
[ff No
❑ NA
❑ NE
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[J`No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
oe
0 No
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
[31No
❑ NA
❑ NE
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes 6 No [DNA ❑ 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 �%J ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
Y�4a
12. Crop Type(s): 6, rJ & 'eV
13. Soil Type(s): co &V—V y�
14. Do the receiving* crops differ from those designated in the CAWMP? ❑ Yes �o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [frNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑14o ❑ NA ❑ NE
acres determination.'
17. Does the facility lack adequate acreage for land application?
❑ Yes
ZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[a"No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ff No
❑ NA
❑ NE
20_ Does the facility fail to have all components ofthe CAWMP readily available? If yes. check
❑ Yes
[21<o
❑ NA
❑ NE
the appropriate box.
❑WUP []Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement'? If yes, check the appropriate box below.
❑ Yes
[31No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
[] Waste Transfers
❑ Weather
Code
ti ❑ 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'No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'?
❑ Yes
[f No
❑ NA
❑ NE
Page 2 of 3 2/4/2015 Continued

lFacifity Nu ber: h5Z7 - jDate of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EElNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes , L_!d'<o ❑ NA ❑ NE
the appropriate box(es) below.
❑
Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge Ievels
❑ 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 F, -4<o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ErNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
E3 -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
ONo
❑ 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
%[ fNo
❑ 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
[2 -No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ErNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[/-No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[l'No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
'�� �-�-
16 3,�
2 (0-
Reviewerllnspector Name:
Reviewer/Inspector Signatur
Page 3of3
Phone: q 3 33 f f
2 �.T
Date: J
2/4/2015

j S �� /y7a• !d b V
Division of Water Resources
Facility Number [� - ® 0 Division of Soil and Water Conservation �
Q Other Age_cy
Type of Visit: ompliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: GtIftoutine O Complaint C) Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: !� Departure Time: County:�i Region
Farm Name: Owner Email:
Owner Name: �L���f't_ S Phone:
Mailing Address:
Physical Address:
Facility Contact: izoNt" t t t+f 6pt vlt5 Title: Phone:
Onsite Representative: 11 Integrator: Y,
fs3
Certified Operator: Certification Number: a K
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr. Poultr
Ca aei
Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
iiillliill 11111111. 111 'li lid
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [] iMo ❑ NA ❑ NE
❑ Yes [—]No WA ❑ NE
0 Yes ❑ No [f—NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No El"NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ff No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ENo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2014 Continued

Facili Number: ,L - s Date of Inspection:
❑ Yes
[ J�No
❑ NA
❑ NE
. Wash Collection & Treatment
❑ Yes
[2'14
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yeses
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
J2'<A
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
❑ NA
Identifier:
the appropriate box.
Spillway?:
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
Designed Freeboard (in):
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
Observed Freeboard (in): �{
[:]Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes
&3*rNo
[DNA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
14<0
❑ NA
❑ NE
waste management or closure plan?
21412014 Continued
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
g2rNo
❑ NA
[] NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
J3'No
E]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
[TNo
❑ 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 El"`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 D�/
Drift �❑ Application Outside of Approved Area
12. Crop Type(s): �/ 9 Gcr �C//-._ �'_() V
13. Soil Type(s): GO fX"y ittA O Wet
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes g�rNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes [k<o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ J�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[2'14
❑ NA
❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Ea
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Vo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
[:]Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
[❑ Rainfall ❑ Stocking p Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
© No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

acili Number: - U IDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [3No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E!No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes�No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes � 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:
❑ Yes [✓"No ❑ NA ❑ NE
E] Yes [BN"o [D NA F] NE
❑ Yes Eff"No ❑ NA ❑ NE
❑ Yes [3No ❑ NA ❑ NE
32_ Were any additional problems noted which cause non-compliance of the permit or CAWMP? [—]Yes %TNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes fff�No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes �No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
4-7
Reviewer/Inspector Name: c Phone: '�"l 3. 33 J
Reviewer/Inspector Signature: Date:A"
L "
Page 3 of 3 214/2014

Type of Visit: 0-Eompliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: (2rfioutiue O Complaint 0 Follow-up O Referral Q Emergency Q Other O Denied Access
1
Date of Visit: Arrival Time: Departure Time: County: cS Region:
Farm Name: �(,.r�" �-� Owner Email:
Owner Name: `S ��w� LIZ, Phone: ,eA C -.n-"
Mailing Address: IV CLJ O L.y`(-'r_[ L`f _ /1, J a
Physical Address: v
`
1
Facility Contact: o A m_' c.,tilc [/Ir &4_j Title: Phone:
Onsite Representative: _ �{ _ _ Integrator:
Certified_ Operator: t l Certification Number: P_YS,3
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Wean to Finish
Wean to Feeder
Design Current
Q -�,7Qe
La er
m"Pty
rrent Pop.
Cattle Capacity Pop.
Dai Cow
Non -La er
Da Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
D . Poni
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes �o ❑ NA ❑ NE
a. Was the conveyance man-made? [—]Yes ❑No ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No [}A ❑ 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 []-N [] NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [ o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [f' oto ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 214/2014 Continued

Facili Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [D-Ne—E] NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ©.N< ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
[] NA
Identifier:
I& Is there a lack of properly operating waste application equipment?
❑ Yes
[J,11-0
Spillway?:
❑ NE
Required Records & Documents
PKYes
Designed Freeboard (in):
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Observed Freeboard (in):
o
❑ NA
❑ NE
5_ Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
es❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
the appropriate box.
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
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
[Biso ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
F l"o ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�o ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes []'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): , � if V -4t il? S 0
13. Soil Type(s): Ct #"U!4 'A
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes UIo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes U3140 DNA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ffNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
fNo
[] NA
❑ NE
I& Is there a lack of properly operating waste application equipment?
❑ Yes
[J,11-0
[] NA
❑ NE
Required Records & Documents
PKYes
d
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
EZj'<
❑ 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 Q -<o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and V Rainfall Inspections❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ElYes D/ ❑ 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

Q:21 0 1 634 Id
Facili Number: - 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)
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?
©fid ❑ NA ❑ NE
[q-N'o ❑ NA ❑ NE
❑ Yes E j,?,ro ❑ NA ❑ NE
❑ Yes P o ❑ NA ❑ NE
❑ Yes O No ❑ NA ❑ NE
❑ Yes [vf'�o ❑ NA ❑ NE
❑ Yes [ Ko ❑ NA ❑ NE
❑ Yes ❑'NO ❑ NA ❑ NE
❑ Yes []�!o
[—]Yes 13 No
[:]Yes F
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better exulain situations fuse additional oaRes as necessarvl.
jQ CcOAe^ � l
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: l�"'1��]J� f
Date: fttylti
2141244

Type of Visit: ®'Com ance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergencv O Other O Denied Access
Date of Visit: K Arrival Time: Departure Time: 4ori CountyiS
Farm Name: Owner Email:
Owner Name: �Lit+�Y'� CV Phone:
Mailing Address:
Physical Address:
Facility Contact: O N N -s" lQue:
Onsite Representative: !/(
Certified Operator: l t
Integrator:
Phone::
U('9 `
('9
Region: �—t--"
Certification Number: �_1.53
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other_
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
Design Current
❑ NE
Design
Current
Design Curren64 t
❑ NE
Swine
Cap Pop.
Wet Poultry
Gapacity
Pop.
Eattle Capacity Pap.
Wean to Finish
---0
La er
Dai Cow
Wean to Feeder
._ nI
INon-Layer
I
alf
Feeder to Finish
"'
Dai Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Farrow to Finish
D , P,o_ul
La ers
Ca acity
Pyo .
Non -Dairy
Beef Stocker
Gilts
Boars
Non -La ers
Pullets
Beef Feeder
FTBeef Brood Cow
Turkeys
Other
Other
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other_
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
2<A
❑ NE
❑ Yes
❑ No
;.rA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes
❑ YesNo
E2'<A
❑ NE
❑NA
❑NE
❑ NA
❑ NE
Page l of 3 2/4/2011 Continued

�r
Facili Number: X - Date ofInspection: 3 -
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [] Yes [tea ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No � ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [- I`o NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[""
❑ NA
❑ NE
waste management or closure plan?
❑ NA
❑ NE
the appropriate box.
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E;p4u❑
NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes I1 N
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[D l�o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
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 [ t ❑ 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_ l ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): � -P""k k S & y
13. Soil Type(s): 60 M a _V -V V 1/` U GL
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?
Reauired Records & Documents
[:]Yes ff No
❑ Yes [] No
❑ Yes Ej"No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes [3No D NA ❑ NE
[:]Yes ErNo❑ NA [] NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes [�Ko
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes u 1Vo
❑ 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 []5 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
[] Waste Transfers
❑ Weather
Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes I1 N
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
Page 2 of 3 214/2011 Continued

0-5
Facili Number: - Date of inspection: 10
14. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes e' Vo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes EJ'No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes Io ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes 1 No ❑ NA ❑ NE
Other Issues
2$. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑filo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes VTNo ❑ NA ❑ NE
❑ Yes io ❑ NA ❑ NE
❑ Yes To ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
ENom
❑ NA
[:]NE
044
❑ NA
❑ NE
❑ No
❑ NA
❑ NE
Comments (refer to question 9): 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).
— /o - �S- 12
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
11 OVA
u
Phonj.f 0 433 3 3 3 y
Date: 3V.r
IV
1/4/2014

ivision of Water Quality
Facility Number ®- ® © Division of Soil and Water Conservation
Q Other Age icy
Type of Visit: &tomptiance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: (DIoutine Q Complaint 0 Follow-up 0 Referral 0 Emergency Q Other 0 Denied Access
Date of Visit: Arrival Time: t:9 �f' /rl?eparture Time: ounty: ! ` Region: FW
Farm Name: �� £ �i w� ty C= aRm Owner Email:
Owner Name: LL e, Phone:
Mailing Address:
Physical Address: ?)3�l Un0up"" Q RA, RQ5LSQ20 fuc
Facility Contact: 9onnTi' \, . k\sA4ry�,5 Title: Phone:
Onsite Representative: a A m E_ _ Integrator:
Certified Operator: (4E_P:7y U A2Q tin Certification Number: Ic
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current _ = Desiga Current
Design Current
Swine
Capacity -*PoP Wet Poultry Capacity. Pap.
m
Cattle Capacity Pop.
Weish
.
Layer
Da Cow
Wder
Non -La er
Dai Calf
Feeder to Finish
Da Heifer
Farrow to Wean
Design. Current
Cow
Farrow to Feeder
!D : 1?oult : Ca ac P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
F Beef Brood Cow
Turke s
Other
Turke PouIts
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 ycs, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [;] No ❑ NA ❑ NE
[::]Yes
❑No
�] NA
❑ NE
❑ Yes
0 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 No
[:]Yes No
® NA ❑ NE
[� NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: - D Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 5Q No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No � NA E] 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
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
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
❑ YesNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [jQ 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): �t;�t�yC �PR u{i�� ,G • O , Qd4k , bt ; Q0+fQ1J
13. Soil Type(s): r -.o 4 A C [, )AA. 11),06
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
_Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design [] Maps ❑ Lease Agreements
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ® No ❑ NA [] NE
❑ Yes [A No ❑ NA ❑ NE
[]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes q No [] NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes 15Q No ❑ NA ❑ NE
❑ Yes Dg No ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

,r
Facility Number: a - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes] No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately_
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative'?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes M No ❑ NA ❑ NE
❑ Yes 14 No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
VV
❑ Yes M No ❑ NA ❑ NE
[]Yes No
[-]Yes [�] No
❑ Yes No
❑NA E] NE
[DNA C] NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better explain situations (use additional naQes as necessarvl.
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �` iC3' 3dFS" Ca_ FS S 1
Date: up� kl\1 l
2/4/2011

Type of Visit: Compliance inspection U Operation Keview U Structure Evaluation U Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up Q Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: j-�-ff] Arrival Time: Departure Time: , QO County: —_�q'wp 1,01 Region: FA10
Farm Name:Sq W Sjg.{� Fig/M Owner Email:
Owner Name: s(tW S1-1he. LLC_ Phone:
Mailing Address:
Physical Address: a Vidfr, Pose baro
Facility Contact: Roan j Ivt !`A�r�' Title: Phone:
Onsite Representative: 11 bjlpj Integrator:
Certified Operator: 6, Hope„ Certification Number: 1 Q(yr
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
-
�gn Current=� l
Design
Current
Design Current
Swine
Capacity Pop. .. Wet.Poultry
Capacity
Pop.
Cattle Capacity P.
Wean to Finish
s Layer Dairy Cow
Wean to Feeder
Non La er
I
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Dairy Calf
Feeder to Finish
❑ NA
�' :
it, . Poultr,
`* -''
Design
:Ca aci
Curren#
P,o ,
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Wean
Farrow to Feeder
Farrow to Finish
[:]Yes
❑ No
Layers
❑ NE
2- Is there evidence of a past discharge from any part of the operation?
Beef Stocker
Gilts
❑ NA
❑ NE
Non -Layers
❑ Yes
® No
113eef Feeder
Boars
of the State other than from a discharge'?
Pullets
lfleef Brood Cow
t
Turkeys
Other
Turkey Poults
Other
I 10ther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation'?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[:]Yes
❑ No
❑ NA
❑ NE
2- Is there evidence of a past discharge from any part of the operation?
❑ Yes
N No
❑ NA
❑ NE
3- Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
® No
❑ NA
❑ NE
of the State other than from a discharge'?
Page 1 of 3 2/4/2011 Continued

Facili Number; %D, - Lj QE jDate of Ins ectiow
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ®" No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: --
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �3 0
❑ Yes
® No
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
E:] Yes Callo
E] NA
E] NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes [5] 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?
El Yes [] No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
Yes ❑ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9_ Does any part of the waste management system other than the waste structures require
❑ Yes [ No
❑ NA
❑ NE
maintenance or improvement?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
Waste Application
❑ NE
the appropriate box.
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
I. 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_)
❑ Waste Transfers
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
[]Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [] Application
Outside of Approved Area
® No
12. Crop Type(s):
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
10 Yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
E] Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑Yes
12 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
[]Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
[RNA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: - jDate of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes N No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No [RNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [a 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?
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 CAW MP?
33. Did the ReviewerlInspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes CRNo ❑ NA ❑ NE
❑ Yes �;[No ❑ NA ❑ NE
❑ Yes E- No ❑ NA ❑ NE
❑ Yes ®'No
[:]Yes ER No
[:]Yes [c No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES'answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Please— mow inside a,e� oL�s d� �a �cr, r woczl y iyko s, P leas� rvcrk o-1
bar poi -i a, o� 1 a ooi - ad d -�`� sr P i "0) ' 1' / , eon vs e o l d -
�(b MA nay ba Ifs -"( M 1,(Ch,
g, Please_ rqmt reed- rar ho,) of- rna4en
NO p [-ea1e- post -he Cx(ei+ eAm i+ )"n h Dk boo fit. 7he COC jS grips-en*1
s I Vd �sjatjrce? tovA+ vo/Vm e_ - w'I I n,c � -d_c 104444 ►r,�A
CAW yew,
Reviewer/[nspector Name: 3-o 11 n h pi& Phone: TD -931-33 �Q �
Reviewer/Inspector Signature: Date: _�evl a4, a Dl I
Page 3 of 3 0 2/4/2011

Facility No. Ta -q& -T - Farm Name _Sh/Srvfh�- Dateqj)qjjj
ftk
Permit U�4�- COC ✓ OIC NPDES (Rainbreaker PLAT Annual Cert )
Pop. I Design I Current
MM . g.. . K
7�i MDOjryTol
Lagoon 1 2 3 4 5 6 7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft ►�,
Liquid Trt. Zone ft �t
Ratio Sludge to Treatment Volume
Calibration Date 1 Lg 2 3 4 5 6 7 8
Design Flow
Actual Flow
Design Width
Actual Width
Soil Test Date 111311p
pH Fields
Lime Needed 5*o4�110
Lime Applied
Cu -I Zn -I
Needs P
Croo Yield
Wettable Acres
WUP
Weekly Freeboard
1 in Inspections
120 min Insp. _
Weather Codes
Transfer Sheets!T} r
RAIN GAUGE
Dead box or incinerator
Mortality Records
- ' r iIAA}�L'I��� ,' viii■ n��l��r
111
Verity PHONE NUMBERS and -ffiliations
Date last WUP FRO Ll j 11)3 Date last WUP at farm
FRO or Farm Records
Lagoon #Top
ke
Stop Pump S'�fr'�a'i4rj
Start Pump 5+`
Conversion- Cu -I 3000= 108 lb/ac; Zn -I 3000= 213 Ib/ac
n } fid ti% i�
Cq K r,, r, rul I
App, Hardware
G (OAAd N
r
� 1
Verity PHONE NUMBERS and -ffiliations
Date last WUP FRO Ll j 11)3 Date last WUP at farm
FRO or Farm Records
Lagoon #Top
ke
Stop Pump S'�fr'�a'i4rj
Start Pump 5+`
Conversion- Cu -I 3000= 108 lb/ac; Zn -I 3000= 213 Ib/ac
n } fid ti% i�
Cq K r,, r, rul I
App, Hardware
G (OAAd N

Type of Visit QMompliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit erR6Gtine O complaint O Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: j0~/O Arrival Time: Departure Time: S; /O County: �..�5d.✓ Region:
Farm Name: E W SwrivC_ a&'�"' Owner Email:
Owner Name: S FI Gil Phone:
Mailing Address:
Physical Address:
Facility Contact: �a^'N��- WAl S Title: 1CMV'­ Nlf►-ras.Ag-� ..��`/PhoneNo: �}
Onsite Representative: Integrator: /Ui, N" ,BV& -.JA/
I If
Certified Operator: Qv"+Ail, C IrV_S Operator Certification Number: 2'1//53 -
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o E�]' =" Longitude: =0=' ❑ "
Design C•�trrent
Design Current
Design C►anent
ine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
Wean to Finish
❑ Layer
ElNE
airy Cow
VNo❑ NA
Wean to Feeder
[E]
❑ Non -Layer
airy Calf
Feeder to Finish
Dairy Heifer
CR Farrow to Wean Z S�
Dry Poultry
❑ D Cow
Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
on -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowl
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
Number of Structures:
❑ Other
Dischames & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ['No ❑ NA ❑ NE
❑ Yes ❑ No Li'J NA ❑ NE
❑ Yes
❑ No LTJ NA
❑ NE
❑ Yes
❑ No ltd NA
❑ NE
❑ Yes
❑ NA
ElNE
ElYes
VNo❑ NA
❑ NE
Page I of 3 12/28/04 Continued

Facility Number: 8 — 49D,S
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
Identifier: IPI
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 e74 _
Structure 4
❑ Yes�1:1NA ElNE
El Yes YN',o ❑ NA ❑ NE
Structure 5 Structure 6
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 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 t at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes(N9
El NA [3 NE
8. Do any of the stuctures lack adequate markers as required by the permit`? Yes L[INA [INE
(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 [:INE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ YesNo [:INA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) �G r -z �c..� t-br`,�� (D• S •, Corx-w - 6 -•.vs C 7 oAi
13. Soil type(s) &0 /Q /4aa 0
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
7ElNA ❑ NE
El NA 0 N
No ❑ NA ❑ NE
-Comments (refer to question : Explain any YES answers and/or any recommendations orrany other comments..
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name I �Le.trifS wv,_.,r_
Phone: 910.45'33.3300
Reviewer/Inspector Signature: Date: g /0 —Z 0/0
12/28/04 Continued

Facility Number: — Date of Inspection ID-!O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ YesElNA ElNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists
❑ Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes7'1�0
El NA [:1 NE
23, if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 1:1 Yes El❑ NA NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ElYes [:1NA ElNE
25_ Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes VN0 ❑ NA ElNE
26. Did the facility fail to have an actively certified operator in charge? ElYes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑YesNo ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes VNp
[INA [INE
29. Did the facility fail to property dispose of dead animals within 24 hours and/or document El Yes ❑ 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 2f No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes N ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes7No
E3 NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes ❑ NA ❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12/28/04

i
y V"tBT.4ls I1-23 -2061
Type of Visit 0-150-rnpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Tfo-utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
i
Farm Name: S E W Si"°'•,.1�- t-4rr►a.s Owner Email:
Owner Name: S E Ui S w i wig L. L_ C_ Phone:
Mailing Address:
Physical Address:
Facility Contact: I�iaNNr a G.i:1(r a,.. S Title: FiLw'. _ Mh V Phone No:
Onsite Representative: Integrator:
Certified Operator: Rolf►���C.-W��(1r 6.•:S Operator Certification Number: 29153
Back-up Operator: Gee&14 W4VV1rJ Back-up Certification Number: 191,15
Location of Farm: Latitude: E—]o [::]' E]" Longitude: F]o ED, E::] u
Design Current
Design Current
Design Current
Swine Capaci
Wi
pCapacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder I
1E] Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
��
❑ Dairy Heifer
® Farrow to Wean /2 50 5�0
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ NE
❑ Non -Dairy
❑ La ers
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑ Non-ts ers
El Beef Feeder
❑ Boars
❑ Pullets
ElBeef Brood Cowl
_
❑ Turkeys
ElNE
Other
❑ Other
❑ Turkey Poults
Number of Strueiures:
❑ Other
❑ NE
other than from a discharge?
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
2No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Yes
[:1El,
No
��
El NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[:1 Yes
No
,I-�-� ANANAA
L
❑ 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
El No
EKA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ YesL_1'No
[_1NA
ElNE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El0 Yes
o
❑ NA
❑ NE
other than from a discharge?
12128/04
Continued

l
Facility Number: Z —
Date of Inspection tl-�Oro
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?
❑ Yes EJ No
❑ Yes 21�o
❑ NA EINE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ia_s 1 (�,7s7)
Spillway?:
Designed Freeboard (in): 20r V
Observed Freeboard (in): 125
��
5. Are there any immediate threats to the integrity of any of the structures observed? El,,..._,,
Yes l-'�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 0-110 ❑ 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 O No ❑ NA EINE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes LI 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 El Yes No [I NA ❑ NE
maintenance or improvement?
Waste Aoolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L7 tvo ❑ NA ❑ NE
maintenance/improvement? , --, �evo/
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes L ❑ 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) iG z3'.)
13.
Soiltype(s) G,A M 0
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
[3 NA
El NE
15.
Does the receiving crop and/or land application site need improvement?
ElL7 Yes
,C7
No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
L h!o
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
L'_fNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment'?
❑ Yes
0 No
❑ NA
❑ NE
Comments refer to questionft : Esc tai mments
( q ) naan YES answers and/or anv recommendations or an other co_
Use drawings of facility to better explain situations. (use additional pages as necessary)
Reviewer/Inspector Name .- Phone: goo 33. 3360
Reviewer/Inspector Signature: R Date: //—eo — zao 9
12/28104 Continued

Facility Number: — Date of Inspection //-ZC _-3c]
Rmuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Desi
gn El Mans ❑Other
❑ Yes
B o
❑ NA
❑ NE
❑ Yes
B o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
B o
❑ NA
❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ErNo ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections El Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
E,No ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Ngo [:]NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
��
L3"No ❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
[:1 NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
,E31400
L� Nom❑ NA
[:1NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
B o ❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
B o
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LZ'I o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
�
31. Did the facility fail to notify the regional office of emergency situations as required by
ElB Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
ETNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
M<o
E3 NA
❑ NE
• Drawings:
AL
12%28/04

o/%y/zoee
® Division of Water Quality
Facility Number O Division of Soil and Water Conservation
011 Other Agency
Type of Visit ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1Z -TJ -b7 Arrival Time: �%:3D Departure Time: 2 :30 ,, County: scx/ Region: cZ7
Farm Name: ' W Swi u e _ Rty&-, Owner Email:
Owner Name: Ge -1X[1 1 _ 00-rVe ll Phone:
Mailing Address:
Physical Address:
Facility Contact: R4 N N i C__ LJ i 1(1*a 1-., S Title: —__ Y!h_ AV, Phone No:
Onsite Representative: R''rN i e_- Integrator: Frew 'A.
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =0
= =64 Longitude: =0E_-1, = u
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
El Feeder to Finish
Farrow to Wean /ZSO
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Laver
❑ Non -Lave
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?
Cattle
❑ Dairy Cow
❑ Dairy Calf
❑ Daia Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
Design Current
Capacity. Populatio
ll
Number of Structures: ELI
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?
0
❑ Yes (� No ❑ NA ❑ NE
❑ Yes
[9 No
❑ NA
❑ NE
[71 Yes
P1No
El NA
EINE
❑ NA
❑ NE
❑ Yes
O No
❑ Yes
[R No
❑ NA
❑ NE
❑ Yes
2INo
❑ NA
❑ NE
12/28/04 Continued

1
❑NA
El NE
No
❑ NA
Facility Number: Date of Inspection /2 -
PNo
0 N
El NE
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
14 No
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
[ZNo
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Desigmed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
4 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
[M No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[4 No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?❑Yes
[ No
El NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
EyNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
R1 No
❑ NA
❑ NE
mai ntenancelimprovem ent?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes C' No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hvdraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > I0% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑/Applicattion Outside of Area
12. Crop type(s) _ �jZr,1 LGV4� _ � �r4•N t0. S, J i'ti1 SD /,t% >� Gafi�^l
13. Soil type(s) aoA %1ja� ) jS
14. Do the receiving crops differ from those designated in the CA WMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
I8. Is there a lack of properly operating waste application equipment?
❑ Yes
V1No
❑NA
El NE
No
❑ NA
❑ NE
PNo
0 N
El 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):
A,
1W
Reviewer/Inspector Name 9. -C - KI, envt�g Phone: 9I4, �3j. 3
Reviewer/Inspector Signature: Date: /Z -Z/ - Z4
12/28/04 Continued

Facility Number: 1?Z — Q Date of Inspection /Z -Zi -07
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes O� No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklistsgn ❑ Maps ❑ Desi p ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes UTNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes PffNo ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [RNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
LO No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[4 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[Z No
❑ NA
EINE
Other Issues
2$.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
90 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
P 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
O No
❑ NA
❑ NE
if yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�a No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Comments and/or Drawings:
12/28/04

40
Type of Visit O Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: g ZS O Arrival Time: 1 9%7-4Departure Time: County: Sor/ Region:
Farm Name: S L SWlN �r"`^r Owner Email:
Owner Name: COOL Vr l J W Phone:
Mailing Address:
Physical Address:
Facility Contact: f2_1041j ` �t*�iar,.,S Title: A::;_YN+ AJ-. Phone No:
Onsite Representative: 90A1 Ni L W j ,h gx*--5 Integrator: Aw-f14 A... Ste. ✓�! s
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e =' [=,I
,I longitude: F-10=4 ❑ «
Design Current Design Current; Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish ❑ Layer I ❑ Dairy Cow
❑ Wean to Feeder 110 Non -Layer I ❑ Dairy Calf
❑ Feeder to Finish ft
�t "
Dairy Heifer
:zso z s -x
Farrow to Wean D , Pault � � �` ❑ D Cow
Farrow to Feeder ry 4. r �'� `` Non -Dairy
❑ La ers '�
❑ Farrow to Finish ❑Beef Stocker
❑ Gilts ❑Non -1 a ers 0:1
❑ Beef Feeder
❑Boars ❑ Pullets❑ Turke s Beef Brood Cow
Other ❑Turke Poults @ r a
❑ Other❑Other ersofi$tructtires-
-
Numb
Discharges & Stream Imuacts
1. Is any discharge observed from any part of the operation?
❑ Yes
CgNo
[:INA
❑NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
[�l No
❑ NA
EINE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
No
❑ NA
EINE
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
rid No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
�No
❑ NA
❑ NE
other than from a discharge?
Page l of 3
12128104
Continued

12. Crop type(s)
Facility Number: $Z — Date of Inspection B�
13.
Soil type(s) & p A Ma C 0 8 b a B
Reviewer/inspector Signature: �,.�e.� Date: ZS moa
Waste Collection & Treatment
14.
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[)INo ❑ NA
❑ NE
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:
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[P No
Spillway?:
❑ NE
17.
Does the facility lack adequate acreage for land application?
Designed Freeboard (in):
No
❑ NA
❑ NE
�i
Observed Freeboard (in): 7
Is there a lack of properly operating waste application equipment?
❑ Yes
No
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No El NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc_)
r
6. Are there structures on-site which are not properly addressed and/or managed
❑ YesNo
91 ElNA
❑ 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
El NA
[_1 NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s) & p A Ma C 0 8 b a B
Reviewer/inspector Signature: �,.�e.� Date: ZS moa
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?
❑ YesLP
No
ElNA
ElNE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[P No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (t-efer to question #): Explain any YES: savers and/or any recommendations or any other comments.
Use drawings, of facility to better explain _''d
.Usepages as necessary):..
Reviewer/Inspector Name i�; �„ - —R J - - -- v Phone: 9/0)Y.3 3 - 3330
Reviewer/inspector Signature: �,.�e.� Date: ZS moa
Page 2 of 3 12/28/04 Continued

Y
Facility Number: lg2 —!f Date of Inspection S'
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [.S No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes r8 No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists [I Design El Maps El Other
21- Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VPNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22_ Did the facility fail to install and maintain a rain gauge? ❑ Yes [4 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
(2 No
❑ NA
❑ NE
26Did the facility fail to have an actively certified operator in charge?
❑ Yes
pa No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[;?No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
( No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
PfNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

I
IType of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Deferral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: .' -os Arrival Time: r Departure Time: County: 69, �dl Region: //Pa
Farm Name: S 175d w li.�.:t F�,r.,., Owner Email:
Owner Name:.. Sold It/ -51"1;1 LL - _ Phone: y/0- 061--,97/17
Maiting Address: �,'e4% L -2 75 -7
Physical Address:
Facility Contact: &aa : e �✓ ���^�^ Title:
Onsite Representative: A421711 Ile __ G✓. //,o,«S___
Certified Operator: Gemma/el L✓a��r., __
Back-up Operator:
Phone No:
Integrator: P/t..t,.. S/endo.,
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o [� A [� 46 Longitude: = ° = 4 [� H
Design Current; Destgn, Current Design Current
t
Swine Cap�act�ty Population Wet Poultry Capacity *Population Cattle�Y Capacity PoP anon
❑ Wean to Finish ❑ Layer ❑ Dai Cow
❑ Wean to Feeder ❑Non -La ez ❑ Dairy Calf
❑ Feeder to Finish
F, El Dairy Heifer
arrow to Wean Inj 12 Lf 91D Poultry ❑ Dry Cow
❑ Farrow to Feeder ❑ Non -Dairy
❑ Farrow to Finish ❑ Layers
❑ Beef Stocker
❑ Gilts ❑ Non -Layers
' El Pullets El Beef Feeder
❑ Boars ❑ Beef Brood Cowl
❑
Turkeys € _
Other
❑Turkey Poults
❑ Other❑Other , QNumber,of'Structures: f
� . t _ I
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
[:1 Yes
�,/
L� 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. Docs 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
E3"No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
ErNo
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

i
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):
'r
06 Fr'r�Laa� ,'s moo. y
pleak° �o�l:�.i
a^j rep.,,- beet csrsos r s necce:r.7_
Reviewer/lnspector Name EMGIr Ci/a.�T7�..: Phone: qla-4V( -/c"y/ p„f�36
Reviewer/inspector Signature: Date:
12/28/04 Continued
Facility Number: 8.2 — Ljpr Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[3No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA EINE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?: 40
Designed Freeboard (in): X20, Lf
Observed Freeboard (in): A& r•
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2<o
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
0'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
BANG
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[TNo
❑ 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
[3No
❑ NA ❑ NE
maintenance or improvement?
Waste Annlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[2No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes. check the appropriate box below.
❑ Yes
allo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
-07S 2 $7a SO I ?e r;�- ltyy
12. CroPtYPe(s) B��.r.L�rAC�..� L✓�ies
r ao
�� S
199,
r
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
allo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[2,No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'; El Yes
ON
❑ 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
ffNo
❑ 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):
'r
06 Fr'r�Laa� ,'s moo. y
pleak° �o�l:�.i
a^j rep.,,- beet csrsos r s necce:r.7_
Reviewer/lnspector Name EMGIr Ci/a.�T7�..: Phone: qla-4V( -/c"y/ p„f�36
Reviewer/inspector Signature: Date:
12/28/04 Continued

-
Facility Dumber: —L/p pate of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available`? ElYes E< ElNA E]NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
El Yes [lo ❑ NA ❑ NE
the appropirate box. ❑ WP� ❑ Che • "sts ❑ i gn ❑
21. Does record keeping need improvement? if yes, check the appropriate box below. Q'S es ❑ No ❑ NA ❑ NE
2I aste Application ❑ d ❑ ;ua—s—�6 . ,•. ;_ ❑ Wn tc-T ts;ers
pp �_� yrs- ❑ El Annual Certification
❑ ❑ &Q44+rtg. Drop Yield [2~f20 Minute Inspections ❑ BlVeather 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 regnired 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 non -nal?
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?
El Yes
0 o
0 N
El NE
❑ Yes
[ANO
❑ NA
❑ NE
❑ Yes
[?rNo
❑ NA
EINE
❑ Yes
2 -No
❑ NA
❑ NE
❑ Yes
27&o
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA B`NE
❑ Yes 2"No ❑ NA ❑ NE
❑ Yes U -Ko' ❑ NA ❑ NE
❑ Yes I__i No ❑ NA ❑ NE
❑ Yes 2 -No ❑ NA ❑ NE
❑ Yes 9 -No ❑ NA ❑ NE
❑ Yes L, No ❑ NA ❑ NE
755itfona1TCot>;ments d/or brai_U,
P/eUsa slr4r/ !iS%nq Me
l
Gn�il r!ro/v f %'. lrJ
12/28/04

t
I
-� � ..c .�'_'..:: _' sem,. - x -.z= �°.% �^-•
- = Ori Of Water Qaafiity ��
�-
S..:a'�
-- ---�= s �- -� �� _ �--�� �_ of.Sm'l ana �Wster�C[►nservafzoa �� �'� � -� � s.. �
Type of Visit (grCompliance Inspection O Operation Review O lagoon Evaluation
Reason for Visit G4outine O Complaint O Follow up O Emergency Notifi tion O Other ❑ Denied Access
Facility Number Date of Visit: Time:
0 Not Operational 0 Below Threshold
UT?ermitted MCertified r] Conditionally Certified © Registered Date Last Operated or Above Threshold: .........................
Farm Name: Si w -- Sw fi r , .- - County: 5 o N
Owner Name: ../h� oK1 Fes.. -S NJ 4+`� Q^ f+"S Phone No; – Ila) ... _.......� .......
Mail►ngAddress: ..... _... r ......_�"'�+!s�«_.. ;Il _. d _.____.__._._.__... J'���* `rr� �W.NC ��_ !?.7577
Facility Contact: ' �• R"� 1r 3r"'' �t _....... ..._ Title: 9!!tn -'Q Phone No:
.r.�•wi ti
Integrator: Representative:................ ............_...._. ..W1
Certified Operator-. A-"16— S Operator Certification Number:...,.
Location of Farm:
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• ��«
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes [✓f No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)❑Yes -1No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) [jYes E]No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 9*f4o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes G11<I0
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Identifier:
Freeboard (inches):
12112103
Structure 1
I
................. I .................
9q
Structure 2 Structure ;
Structure 4
❑ Yes 91� 0
Structure 5 Structure 6
Continued

Facility Number:
Date of Inspection y1
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any strictures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes ILKlo
❑ Yes G?f,10
❑ Yes M14o
❑ Yes M'No
❑ Yes RNo
❑ Yes gNo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes [3f4o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type L.1,4,1 , R W_ i n t� Avc 41 Ir -r- L-cf'SeeJ,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes GkNo
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor l..sues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes ErNo
❑ Yes [RNo
❑ Yes 9 No
❑ Yes GTNo
❑ Yes UKo
❑ Yes S No
❑ Yes [9'N' o
❑ Yes Milo
❑ Yes ['10
Conuinents (re#er�toyq�uesha�a .#y)� Explau�a a{ny,,YFSanswers and/or any- recarnmendat<ot� or an other comments.:
-Use 4131 bf ficin to YGLIGI c
wings ty c?tF+ rY? [Meld Copy ❑ Final Notes
v _
�y y
f�rsr wdi� h+sys� and 1?br`�IK'�G �p►-� i�
�
Reviewer/Inspector Name =p
Reviewer/Inspector Signature: Date: p
12112103 Continued

• Facility Number: Date of Inspection 9� a
Required Records & Documents
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
22.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
7
(ie/ WUP, checklists, design, maps, etc.)
a<0
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Mf4o
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[IKo
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
RRo
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
(ie/ discharge, freeboard problems, over application)
0140
27.
Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
21� o
28.
Does facility require a follow-up visit by same agency?
❑ Yes
[bio
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
2-96
NIPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
2<0
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I " Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
Er No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
(:altlona} or, wings - x� - ._s• x r x s
_L11 -r- Ao;c j
7
12112103