820722_INSPECTIONS_20171231

NUH I H LAHULINA
Department of Environmental Qual
II

Type of Visit: UComp!' ce Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: OrRoutine O Complaint O Follow-up O Referral O Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: County: , y� Region:
Farm Name: j�j;� �GU/ Owner Email:
Owner Name: /97p ✓ Y Phone:
Mailing Address:
Physical Address:
Facility Contact: z tom' Title:
Onsite Representative: F1.r %,,—is,Alwrr
Certified Operator. 'Woo s' r
Back-up Operator:
Location of Farm: Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
q M
sl�`gn Current =
Wet Poultry ii,acity Pop. Cattle -
4141i'
Design Current
Capacity Pop.
Wean to Finish
er
Rn-La er
Dai Calf
Wean to Feeder
Feeder to Finish
Farrow to Wean"Me
Farrow to Feeder
Uri`+'
f
MY D sign
D , P,ou! I:; °FTTT:
a �aci „I
"`l' Dai Heifer
Cuurrent D Cow
1�9� P !�
,, ,o Non-Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
"'FI i
Farrow to Finish
Layers
ults
10ther
Gilts
Boars
Other I
Discha es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
0Yes EE o ❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
d. Does the discharge bypass the waste management system? (if yes, notify DWR) ❑ Yes [—]No [:]NA [:]NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes No [] NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes E31 ❑ NA [:]NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

V
Facility Number; - Date of Inspection: J,;;Z r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Identifier.
❑ NA ❑ NE
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Spillway?. -
Designed Freeboard (in): /
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes [a o ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7_ Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
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
E] ryo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
©' o—o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA 0 NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): _ AZZ&""1
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
0 N
[] 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
Q'l l�o
❑ NA
❑ NE
Required
19.
Records & Documents
Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20.
Does the facility fail to have ail components of the CAWMP readily available? if yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21 _ Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes D-lq-o-- ❑ 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 [3-N-o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [�j No❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: _ Date of lns ection:
* 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
to
❑ NA [] NE
the appropriate boxes) 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
to
❑ 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_ Al 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
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
0 Yes
[-No
❑ NA
❑ NE
[:]Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[l] No
❑ NA
❑ NE
❑ Yes
[]'N�o__
DNA
❑ NE
Comments (refer to question #):.Explain any YES answers and/or any additional recommendations or any other comments.
iJse drawings ty P ( P g ry) ' of facili ' to beffer explain situations use additional a es�as necessa " '
l rr bed �,t
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone: q%� __11Z9'3LS1
Date:
21412015

( r3 —
i
Type of Visit: Q Co Hance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance J
Reason for Visit: Routine Q Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: L C� Arrival Time: .�t� Departure Time: , County: Region:
Farm Name: �{�t� I c'-ddr� Owner Email:
Owner Name: Ud [. /pD/Z- Phone:
Mailing Address:
Physical Address:
Facility Contact: /Voorc— Title: �c
Onsite Representative:
Certified Operator: tdrt7fJ f°
b
Back-up Operator:
Location of Farm: Latitude:
Phone:
Integrator,
Certification Number: A,Z-'100
Certification Number:
Longitude:
Design
,Design
urrentti
Design
Curre©t
Swine Capacity �Pop.
Wetlll'ouftHu ry
Capacity
Pop.
p,
C Capacity
Pop,
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -I a er
Dairy Calf
Feeder to Finish
Dairy Keifer
Farrow to Wean,'
rl;
Design
Current
D Cow
Farrow to Feeder
rr
D P.oul
Ca aci
pop.
Non-Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
on -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
I
;
Other
Other
I,
Discharses and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. 1s 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 [3-No ❑ NA ❑ NE
❑ Yes 0 No E] NA NE
❑ Yes ❑ No ❑ NA NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
2ZNo
❑ NA
❑ NE
❑ Yes
JEI_No
❑ NA
[] NE
Page I of 3 21412015 Continued

Facility Number: - Date of Inspection:
Waste Collection & "Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ;K No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ONE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /47-_
Observed Freeboard (in): ,3 7
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes " No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[&No
❑ NA
0 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
allo
0 NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
0 Yes
(2],No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
SO No
❑ NA
0 NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[KNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑Q Evidence of Wind Drift ❑ Application Outside of Approved Area
12.Crop TYpe(s):>�'�©��'sSr�'J
13. Soil Type(s): Via:
14. Do the receiving crops differ from those desi&mated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[allo
❑ NA
❑ NE
❑ Yes
[ij No
❑ NA
❑ NE
❑ Yes
Ea'No
❑ NA
❑ NE
❑ Yes &I No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [. No ❑ NA ❑ NE
20. Does the facility fait to have all components of the CAWMP readily available? If yes, check ❑ Yes Q No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21 _ Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ED No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P�J_No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: A'-'7— Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes P,No ❑ NA ❑ NE
r
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [Z'No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ®, No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® 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 r7lNo ❑ NA ❑ NE
❑ Yes E3,No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes Lallo ❑ NA ❑ NE
❑ Yes No
[:]Yes No
❑ Yes 23-No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Continents (refer to question #): Explain any YES answers andfor any additional recommendatioas`or any otber comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
ReviewerAnspector Signatur
Phone:
Date: /----7- /., --�O J
21412015
Page 3 of 3

/;:'— - v /6
n
Type of Visit: 0D _Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
(Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: O County: Region: r9L
Farm Name: 5_, W 1 Jam" Fa t'Owner Email:
Owner Name: ll,,'e3 G iN-DD a -r Phone:
Mailing Address:
Physical Address:
Facility Contact: r j %���r�- Title:z /,tv—z.
Onsite Representative: i 4?7Inj ODt�
Certified Operator: p/ 2--
Back-up Operator:
Location of Farm:
Latitude:
G Phone:
Integrator:
Certification Number-
Certification Number:
Longitude:
Design Current Design..- Current Design Current
Swine Capacih Fop. Wet i'outtry Capacity Pop. Cattle C►apathy Pop.
JUDWean
to Finish
La er
DairyCow
Wean to Feeder
3�on-Layer
Dairy Calf
Feeder to Finish
_
" `=`
De dig Current
Dr. P,oultr. Ca aci Po
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stucker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Turkeys
Turke Faults
-
��-
Other
Other
Discharaes and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes fg]_No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gaIlons)?
d. Does the discharge bypass the waste management system? (lf ycs, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence ol'a past discharge from any part of the operation?
❑ Yes
C2dNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Qq_No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Faci.lih• Number: Q' - Date of In ection:
Waste Collection & Treatment
t 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
2[ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Cq�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 4-66 were answered ,yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
T Do any of the structures need maintenance or improvement?
❑ Yes
E&No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
,P9-No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
r'-1 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 &No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 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):/9rZ
13. Soil Type(s):i
14. Do the receiving crops differ from those designated in the CAWMP?
IS. 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'?
Rectutred Records & Documents
14. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
F�jNo
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
ICl No
❑ NA
❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes [J,No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes [gNo ❑ NA [] NE
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes U[ No
❑ Waste Application ❑ Weekly Freehoard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall D Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes LKNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [Z No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection: — L
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 3 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ®_No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [a No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Pg-No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [] Yes [&No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes FA No [] NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30_ Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes JKJ No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ELNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [No ❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signatw
Phone:
Date: Z22 _z��—_Afl/ 4
21412015
Page 3 of 3

i ype or visit: ty-comppance inspection v vperanon xeview C.1 arructure r vaivanon tV i ecnnwill Assurance
Reason for Visit: 01 routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: '3a Departure Time: o County: Region:
Farm Name: way 7" ✓<� �a�ys^ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: C r
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: 1/i lff
Certification Number: / 913Y3
Certification Number:
Longitude:
Design Current INWHOesigi. Current
Swine Capacity Pap. Wet Poultry Capacity. P,op.
Design Cnrrent
Cattle Capacity Pop.
Wean to Finish
Layer
IDairy
Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish t30
Farrow to Wean
Design Current
D . P,ou1 Ca aci = P,o
Dairy Heifer
rhy Cow
Farrow to Feeder
Non -Da'
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
_
=
Pullets
Beef Brood Cow
Other _
Turke s
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 gLNo NA NE
[] Yes
[] No
NA
[] NE
Yes
[]No
[] NA
NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Yes []No
[� Yes No
Yes No
[] NA NE
NA NE
NA NE
Page 1 of 3
21412014 Condnued

Facili Number: - 7 Date of Ins ection:
Waste Collection & Treatment
1 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Q2� No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in); -
Observed Freeboard (in):--
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
MNo
❑ 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
RA No
D NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
& 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
Fg-No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
q No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E,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): �'/'ri1 �../ U`c'�'e �r-d
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CA WMP?
❑ Yes
[0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[:]Yes
RNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
allo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
12 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
JR No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? 1f yes, check
❑ Yes
JR No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements [-]Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes Lallo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
[:]Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes Z3 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

FacHi Number: - Date of Ins action:
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 R9_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 ❑ Yes 13No ❑ 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, fi-eeboard 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 KA No ❑ NA ❑ NE
❑ Yes [3 No ❑ NA ❑ NE
❑ Yes MNo Q NA ❑ NE
❑ Yes No
❑ Yes No
[:]Yes [allo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:7p—�
Date: Z /S
21412014

Type of Visit: (j)'Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: 91foutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Ill Arrival Time: ,' p Departure Time: 1,2,1 _ „ County Region:
Farm Name:„ �i ✓ r-/ 52r _ 4 Owner Entail:
Owner Name: -)'� i d ?-.~ / 1 G Phone:
Mailing Address:
Physical Address:
Facility Contact: Cj 111 MLbi a Title: ' L
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: &y,, j,4
Certification Number: 'Z;L lj as _
Certification Number:
Longitude:
Design Current
Design
Current
Design C►nrrent
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity ON
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
X4Feeder
to Finish
D
D E)
—
-
Dairy Heifer
Farrow to Wean.
Desi
Dry Cow
Farrow to Feeder
D F Foul
Ca ac'i
Pao
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
'
Turke s
Other
Furkey Poults
Other I
:' ' airay.�.:.---:.mow. :::..:ueu:�.:—a.,.::..�,�-s.:w ...:��..,.
- ..
FTOther
wasaea.a+.,v��:ww:...:..:."•
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes K No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes gLNo ❑ 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 21417014 Continued

Facility Number: - Date of Inspection:
- /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
(N No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
0 NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 1
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
E�No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
Q No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0 No
0 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? 1f yes, check the appropriate box below. ❑ Yes [R] No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ TotaI Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window] [] Evidence of Wind Drift ❑ Application Outside of Approved Area
/ a 12. Crop Type(s): Zel-I 014L p v z-. Sr-rel
13. Soil Type(s):
14. Do the receiving crops differ frotri those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q No
❑ NA
❑ NE
❑ Yes
RA No
[:3 NA
❑ NE
❑ Yes
[No
❑ NA
❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes [K No 0 NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes [SNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes ®,No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E4 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge'? ❑ Yes [allo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [::]Yes I& No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

Facili Number: f Date of Ins tion: f-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EZ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ONo ❑ NA ❑ NE
the appropriate box(es) below-
0 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 [4 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [] Yes ® No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately_
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond 0 Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[j�No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
54 No
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: //'/��yZ���/
21412014

A
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ( K utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: fl Departure Time: County:. Region:
Farm Name:_ ��jf u lj1 i t/I-A— Owner Email:
Owner Name: _Mm e-k -, V ro0"' Gz ✓Ert j -- /l G Phone:
Mailing Address:
Physical Address:
Facility Contact: Q J-rn/- DD-1`Cr Title:
Onsite Representative: Gr`r"r &a0e,e j n /7'lOvr�
Certified Operator: 1! 1 p/r—
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: Atf ems'
Certification Number: 'A 2Jlyo _
Certification Number:
Longitude:
Design Current _ Design Current
Swine Capacity Pap. Wet P,oultry;.Capacity Pap.
Wean to Finish La er
11
Design Cnrreat
Cattle Capacity Pop.
DairyCow
Dairy Calf
Dai Heifer
DEy Cow
Non -Dairy
Beef Stocker
Beef Feeder
Wean to Feeder
iNon-Layer
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
a
Design Current
D . 1?onit • Ca aci P,o .
Layers
Gilts
Non -La ers
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
--
Discharges and Stream Impacts
. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a, Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes allo [] NA ❑ NE
❑ Yes [] No
D Yes ❑ No
[:]Yes [:]No
[] Yes [gNo
[:)Yes [Q No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page l of 3 21W2611 Continued

Facili Number: - % Date of Inspection:
�!
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[g 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): 1
Observed Freeboard (in): _7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
JKNo
❑ 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
EZ 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
M No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Upo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
O_No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
MNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Q3-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): 0;Vm41e6r 1,P-
13. Soil Type(s): lip If, f't,A0
14. Do the receiving crops differ from (hose designated in the CAWMP?
❑ Yes
[g No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[Z No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[&No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L)4-No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
gNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
RNo
❑ 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 �gNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No
❑ NA [] NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection: --7 3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes O No ❑ NA ❑ NE
'R 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ELNo ❑ 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 [g No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ® No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
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 RL No ❑ NA ❑ NE
❑ Yes Gff-No ❑ NA ❑ NE
❑ Yes f&No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP? ❑ Yes
[, No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
MANo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
Q�LNo
[DNA
❑ NE
Reviewer/Inspector Name
Phone: 9—�3`�'
A /
Reviewer/inspector Signature: Date: 13
Page 3 of 3 21412011

Type of Visit: ompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: J v Departure Time: `p7 County: - Region: rT
Farm Name: Owner Email:
Owner Name: ,%� �[ ; ✓r �/ �a/�� 11 G Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: �,.� rjp�� , Phone:
Onsite Representative: pgr—t__ Integrator:
Certified Operator: _ IwoCertification Number: NCO
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop
Designx, Current
Wet Pou try "'Capacty Pop.
T Design Current
Cattle Capacity Pop.
Wean to Finish
La er
Da' Cow
Wean to Feeder Non -La er
Dairy Calf
eeder to Finish...,
Farrow to Wean
Farrow to Feeder
'`- ' .:
` Design Current
D . Pou :..Ca aci Pao .
Da Heifer
Dry Cow
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Othe
urkey Poults
Other
. . . . .
Other
Discharnes and Stream Impacts
1. Is any discharge observed from any part of the operation?
[] Yes
[-3 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
[0 No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Z[ No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - Date of inspection:
//—
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
[] No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure
4 Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 1
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
[3NA
❑ 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
M No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2[ No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [] Application Outside of Approved Area
12. Crop Type(s): ► a{ '. Pc"e r6 k7 r d
13. Soil Type(s): _—Lar,.n.M,
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?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP [—]Checklists ❑ Design []Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes M No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes 9 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
DNA ❑NE
Page 2 of 3 21412011 Continued

Facili Number: - Ds ection: / - / /-
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 Iagoon
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 ®, No ❑ NA ❑ NE
❑ Yes D No ❑ NA ❑ NE
❑ Yes EZ No ❑ NA ❑ NE
[:]Yes ® No
[:]Yes No
[:]Yes 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).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9y�-y33 �330�
Date:
21412011

I
Type of Visit: ompliance Inspection 0 Operation Review p Structure Evaluation 0 Technical Assistance
Reason for Visit: er, outioe O Complaint C) Follow-up d Referral 4 Emergency Q Other p Denied Access
Date of Visit: Arrival Time: :3 D Departure Time: D County Region:
Farm Name: 9'° ✓e" -- P500n Owner Email:
Owner Name: /n",,.{C ; ,,-.er 1��r/rn� L, t G Phone:
Mailing Address:
Physical Address:
Facility Contact: ✓r�r ��� Title: Phone:
Onsite Representative: �9/'�.,�/ Q01� f Z11•Ay /1T P Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current ._� Design Currentx . , {
Design Current
Swine
.
Capacity Pop. ,WetiP,oullry.Capacety Pop
=..-.
Fettle Capacity Pap.
Finish
La er
Dai Cow
Feeder
Non -Layer
DairyCalf
o Finish
pD - =�
DairyHeifer
o Wean
- Design :Current
D Caw
to Feeder
D . IPoult ` , Ca act Po
Non-Dai
to Finish
PGilts
La ers k+
Beef Stocker
Non -Layers +
Beef Feeder
Pullets
Beef Brood Cow
Turkeys
Turke 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 (gations)?
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 R No ❑ NA ❑ NE
[-]Yes [-]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 1Q No
❑ Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA []NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

IFacility Number: - Date of Inspection:
— f
Waste Collection & Treatment
1A 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[—]Yes
0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
0 No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): t9-
Observed Freeboard (in):. Q
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
M 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
1171 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
❑ Yes
[g_No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[KNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop TYPe(s)=
13. Soil Type(s): Ca 7 dh ry
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [a No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® 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 & Pen -nit readily available?
[—]Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[—]Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Z 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 Q No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: - Date of Inspection: --%
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [:]Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA [] NE
❑ Yes � No ❑ NA 0 NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes [K No ❑ NA ❑ NE
❑ Yes (� No ❑ NA ❑ NE
[:]Yes ® No
❑ Yes (I No
[:]Yes 0 No
❑ NA ❑ NE
0 NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional., recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
•� ,� was /`�' �—� : �Gcl 3 ►'�- C�%�" �,�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: !?`— ��r~,33 DD
Date:
21412011

Onsite Representative:
Certified Operator: _57IZ4� _
rv"ission of Water Quality
Facility Number Lc��J - ® ® Division of Soil and Water Conservation
® Other Agency
Type of Visit: Gruompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint O�Vollow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Timer Departure Time: County:. Region: /-4712
Farm Name: kv Owner Email:
Owner Name: �i W ; 6eM,3 . �— G Phone:
Mailing Address:
Physical Address:
Facility Contact: G/J&22r�_Title. 1WTr-�
Integrator: Iit�/V
Certification Number:
Phone:
Sack -up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Design Current Design Current
WefPoultry Capacity Pop. Cattle Capacity Pop.
;,
an to Finish
La er
Dai Cow
an to Feeder
der to Finislt
-Layer
K�
a'��
D , 1'6titr,F.,�Ca
La ers
"'-
Design Current
aeity P,o
Dai Calf
-
k
Dai Heifer
ow to Wean
ow to Feeder
!IFarrowto Finish
D Cow
Non -Dairy
Beef Stocker
s
Non -I a ers
Beef Feeder
rs
Pullets
Beef Brood Cow
er lTurke
Turkeys
Pouets
_-..
er
Other
Discharges and Stream Impacts
1, is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b_ Did the discharge reach waters of the State'? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system`? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
0 Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes [:]No
❑ Yes ❑ No
❑ Yes ro No
[—]Yes Co No
❑ NA [] NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes []No ❑ NA [A NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [:]NA ONE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA
NE
(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
[S NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ No
❑ NA
NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ No
❑ NA
NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
® Yes
❑ No
❑ NA
01
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0Yes [:]No ❑ NA
❑ Excessive Pending ❑ 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 ❑o Evidence of Wind Drift 10 Application Outside of Approved Area
12. Crop Type(s): '�,a� �s1T�� _ - -
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
[N. 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
Eg No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[] No
❑ NA
[$ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
2r No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists El Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes [0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? 0 Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

IFacWty Number: = I 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 provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
❑ No
❑ NA
® NE
❑ Yes
❑ No
❑ NA
§9 NE
❑ Yes
❑ No
❑ NA
fo NE
❑ Yes ❑ No ❑ NA jo NE
❑ Yes M No []NA ❑ NE
❑ Yes ❑ No ❑ NA [5,NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Mlvu ❑ NA UNE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 0 No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ® No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary). -
le a NVrMd5"7�
-x�— 7-29 Lee his7f,
- - J
Reviewed]nspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone:lfl
Date: e-"g r ! 1
21412011

Facility Number: — Vate of Inspection
AddihonalCommeut5 and/or Dirawengs
r y UA(P.
1-9
`jam �mo I 11 we�'/,�5 ry a per% a�
� � r
f rL
r
w
7125/97

p,.��,�y ���,. �% �/ I ime !n _ Time Out t - �O Date
�—
Farm Name Integrator
Owner Site Rep
Operator No
Back-up No.
COC Circle: General or NPDFS
Design- -
Current
--Design
: -Current
Wean — Feed _ '
Farrow — Feed -
--
Wean —Finish
FarroW —Finish
Feed — Finish
Gilts 1 Boars
Farrdw — Wean
Others -
FREEBOARD: Design
Observed --
Sludge Survey
Calibration/GPM
1 _
Crop Yield
,
Waste Transfers
-_ -
Rain Gauge
Soil Test
7.
, :
PLAT
Rain Breaker
Wettable Acres
WEekly.Fn_eboard
©wily Rainfall
14n Inspections
4
Spray/Freeboard Drop
Weather Codes
120 min Inspections
Waste Analysis:
Date
Nitrogen (N)
Date
Nitrogen (N)
MIMIL
■ ■
■
_r
i�9'111
a

rC3%Mky 110U. I;me In Time Out Date
Farm Name Inlegrator
Owner Site Rep
Operator No -
Back -up No. -
COC Circle: General or NPDES
Design
Current
Design
< < -Current
Wean — Feed-'
Farrow— Feed
Wean — Finish
Farrow— Finish
Feed — Finish
Gitts / Boars
Farrow —Wean
—
Others
,
FREEBOARD: Design
Observed
Sludge Survey
Calibration/GPM /
Crop Yield
Waste Transfers
Rain Gauge
Rain Breaker
Soil Test
PLAT
Wettable Acres
Weekly Freeboard
Daily Rainfall
1-in Inspections,
Spray/Freeboard Drop
Weather Codes
120 min Inspections
Waste Analysis:
Date
Nitrogen (N)
Date 'Nitrogen (N)
PulIIField
Soil
Crop
Pan
'Window
•rp-a :
-

Type of VISit 04'6mpliance inspection O Operation Review U Structure Evaluation O Technical Assistance
Reason for Visit otstine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: % D Arrival Time: Departure Time: ,2; 00 County: Region: lfZZ)
Ar
Farm Name: // r arri^-�' Owner Email:
Owner Name: ililr�: �� 1i G G Phone:
Mailing Address:
Physical Address:
Facility Contact: M00�- Title: Phone No:
Onsite Representative: Zvi Mx ,� Integrator:
Certified Operator: Operator Certification Number: ��i-
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =' =' ❑ ., Longitude: = ° =' =
Design Current
Design-"- Gurrent
Design Current
a a ity Population
Cattle Capacity Populatio
Finish
M
❑ La er
❑Dai Cow
Feeder
❑Non -I a er
❑ Dairy Calf
Feeder to Finish a fl
-..yt;=` _
Dai Heifer
❑ Farrow to Wean
Dry Paulfry� -
❑ D Cow
❑ Farrow to Feeder
El Non -Dairy
❑ Farrow to Finish
La ers
❑ Beef Stocker
❑ Gilts
❑Non -La ers
❑Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Co
MOM
❑ Turkeys
= -
Otl
❑ TurkeyPoults
❑ Other
❑Other
Numla'er of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[INo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
9LNo
❑ NA
❑ NE
b- Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
e. 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
IRNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
WNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

- Facility Number: — Date of Inspection
t
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
EffNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): l
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
[] Yes
® No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
&4,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
U3,No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
RkNo
❑ 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
CELNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
M 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 > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop types).-
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CA W MP? ❑ Yes IgNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
[9 No
❑ NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[,No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
0,No
❑ NA
❑ NE
I "- /��ccl /i/Bua � •Q/r"��Jsr``�.,�f�ui hf l
i%D /ce p 01,0s-frr
Reviewer/Ins ector Name L� } Y
I Phone:
Reviewer/Inspector Signature: Date: / D
Page 2 of 3 12128104 Continued

Facility Number: — 7 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the approprrate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 91 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
19 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
D� No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JqNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
J9 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
JR.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
WINo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
K-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
DINo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 1 .
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
Z_No
❑ NA
❑ NE
General Permit? (iet discharge, freeboard problems, over application)
32_
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
allo
❑ NA
❑ NE
33_
Does facility require a follow-up visit by same agency?
❑ Yes
[ANo
❑ NA
❑ NE
Page 3 of 3 12128104

` S 12-zZ-Zo0k
Type of Visit (r;Routine
m Hance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit O Complaint 0 Fallow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: 12�17-De% Arrival Time: Departure Time: j{,�a0 „, County: Sa_P5e..j Region: FQU
Farm Name: So'k4N i :%yer Fare, Owner Email:
Owner Name: S l ac.LC Wt j ey- F:a`r"^ L L. Phone:
Mailing Address:
Physical Address:
Facility Contact: G re e_t— M Od 1rG Title: Te c. SPA Phone No:
Onsite Representative: `i t r"`r-.nj e r
Certified Operator: �OO''r- 3a.,,�c s C.
Back-up Operator:
Location of Farm:
Integrator:
Operator Certification Number: 27-400
Back-up Certification Number:
Latitude: 0 0 = 6 Longitude: = ° = 6
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
%Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ La er
❑ Dai Cow
❑ Dai Calf
❑ Non -La er
® Feeder to Finish
240D
Z "
❑ Dai Heifer
, Dry Poultry
❑ Lavers
a ers
❑ Pullets
❑Pllets
❑ Turkeys
E]Turkey P ults
❑ Other
❑ D Cow
❑ Farrow to Feeder
❑ [don-Dai
❑ Farrow to Finish
❑Beef Stocker
❑ Gifts
❑ Boars
El Beef Feeder
ElBeef Brood Co
Other
❑ Other
Number of Structures:
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 rnan-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 ETNA ❑ NE
❑ Yes
❑ No
L"I NA
❑ NE
L3 NA
❑ NE
❑ Yes
❑ No
❑ Yes
��No
❑ NA
❑ NE
❑ Yes
[2 o
❑ NA
❑ NE
12128104 Continued

-- 1
Facility Number: 82-- 7Z2
Date of Inspection /2-/7709
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: La 1
Spillway?:
Designed Freeboard (in): / 9
Observed Freeboard (in): 30
5. Are there any immediate threats to the integrity of any of the structures observed'?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes M No ❑ NA ❑ NE
❑ Yes E7 No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes ErNo ❑ NA ❑ NE
if any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes L'J iVo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes C3 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks an(/or wet stacks) , �/
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 IJ ]Vo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑Yes ffNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ]0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) (H410, 5Tp—t ( 4/0. 5 . �
13. Soil type(s) Cal N h D
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
ETNo
❑ NA
❑ NE
Z'*N o
❑ NA
❑ NE
BNo
❑ NA
❑ NE
��No,
❑ NA
❑ NE
LNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any�recommenda4ions or any oth'e�eomments
Use drawings of facility to better explain situations. {use additional pages -as necessary:)
Reviewer/inspector Name i cIC -
Phone: %V. �33.3300
Reviewer/lnspeetor Signature: Date: /2 -17 - Z 00 9
12128104 Continued

4r -
Facility Number: $2 —72Z Date of Inspection �Z'►�'�
Renuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes L'I No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Cl/No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes LI N El NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes V ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the pernvt? ❑ Yes 7Nq ❑ NA ❑ NE
25. Did the facility fail to have an actively certified operator in charge? ❑ Yes L No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes 2 No ❑ NA ❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
3 No ❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
B 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
ONo ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No ❑ NA
❑ NE
General Permit? (iel 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
12128104

j>> _re- S I- c e -0 9 RiL-
Type of Visit (Compliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit Erkoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: /2 -!6 -01 Arrival Time: x :0 • - Departure Time: Z 7_t7 County. TT a ^lRegion: ) o
Farm Name: SortlTln R"J17u + Owner Email:
Owner Name: %1G c k- R i u c.r Foul - V. LLC. Phone:
Mailing Address:
Physical Address:
Facility Contact:
Gr ee-y Akuur- c—
Title: Sn,*-A
Phone No:
Onsite Representative:
G r0_cv- Moan
Integrator:
At-wl�7 �^l
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = = « Longitude: = ° = 1 ❑ u
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry
Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑Laver
❑ Dai Cow
❑ Wean to Feeder
❑Non -La er
❑ DairyCalf
(� Feeder to Finish ' 00
si
DairyHeifer
❑ Farrow to Wean
D . Point
❑ D Cow
❑ Farrow to Feeder
❑ Non-Dai EZ
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
El Gilts
❑ Non -Layers
❑Beef Feeder
El Boars
❑ Pullets
❑ Beef Brood Co
❑ Turke s
F11 ism
Other
❑ Oiher
❑ Turkey Poults
❑ Other
Number of Structures �1
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[ to
❑ NA
❑ NE
Discharge originated at_ ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
[3 A
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
[<A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
9 A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
B<o
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
D-i�o
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: F2 --7ZZ
Date of Inspection 16 'D $
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes IK tvo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes D-No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier. ka aj
Spillway?: N(7
Designed Freeboard (in): j
Observed Freeboard (in): 2 r
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
[IE Yes
�
No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
Q No
❑ NA
❑ NE
S. 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
,,,.,.,.,,//
B o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
,�/
lam" No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Pond ing ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s) CY!�' � S�II Gran! L/O.S.J
13. Soil type(s) CIA
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes LI No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes l_SNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:) Yes
[go
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
[3'Ko
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
Gl o
❑ NA
❑ NE
t•omtuents (refer to question #): Explain any YES answers and/or any recoaemendatiatts or auy other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
•r
Reviewer/Inspector Name .. S Phone: �}r0, y33 �33Q
Reviewer/Inspector Signature: Date: %7r11' — ZOOS
Page 2 of 3 12128/04 Continued

Facility Number: gZ —7,Z7 Date of Inspection
Required Records & Documents ��//
19. Did the facility fail to have Certificate of Coverage & Permit readily available`? ❑ Yes En. ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAW"W readily available? If yes, check ❑ Yes l' No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other ��
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes B o ❑ 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
["No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
["No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
El NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,['To
U No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[I NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElLI Yes
,�No
tvo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
T,,/
LNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
dNo
❑ 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
2 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
r
IJ No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
2fgo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
B' o
❑ NA
❑ NE
Additional Comments andlor Drawings:
12128104

-. I31n(S rjkve4 01/0v/zoos
ivision of Water Quality
Facility Number gZ 7 Z Z 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0<0-mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit tD-1to'utine 0 Complaint 0 Follow up Q Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /2-/2-07 Arrival Time: 2:00 Ns Departure Time: Z:3S n„ County: 5Gi+MSoJJ Region: FRO
Farm Name: S©'w,t-�. �i v ur -a "-M S Owner Email:
1
Owner Name: 1Z� Vw 1-s<y�..S LLC Phone:
Mailing Address:
Physical Address:
rtc r o
Facility Contact: �7 M �' �- Title: Phone No:
OnsiteRepresentative: Integrator: M�L"L:t; - grow..j
I
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = • = •• Longitude: = o = • =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Weanto Feeder
Feeder to Finish 124t00
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Lavers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any pan of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Curr
Capacity Piipula
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: F
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 [IINo ❑ NA ❑ NE
❑ Yes
[9 No
❑ NA
❑ NE
❑ Yes
[`a No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
© No
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
[p3 No
❑ NA
❑ NE
12128104 Continued

7i
Facility Number:-72z Date of Inspection t2- 12-07
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier: 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 r
5_ Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes `f' No El NA El NE
(ie/ large trees, severe erosion, seepage, etc.}
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [� No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [� No ❑ NA ❑ NE
8_ Do any of the stuctures lack adequate markers as required by the permit'? ❑ Yes [ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement? r
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 50 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu. Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift Elre Application Outside of Aa
12. Crop type(s) � C_rr' tA_cl A. t wIia..j _:�
13. Soil type(s) Ca—Z '
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
M 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
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
,®pNo
117 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
r
Reviewer/Inspector Name tiG� �e.J e t Phone:
Reviewerllnspector Signature: �Z e_.�Date: 1 Z ' z - 2,60-7
12128104 Continued

Facility plumber: gZ 7ZZ Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes EX No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [� No ❑ NA ❑ NE
the appropirate box. ❑ wup ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes (4 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
fil No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
18 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
1P No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
rim 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-campliance of the permit or CAWMP?
❑ Yes
IF 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
1� No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[, ?No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[�j No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Type of Visit 0 Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /4 /p-O Arrival Time: 4r1jr—J1 Departure Time: ! 3j County: EQA44OS0w! Region: G120
Farm Name: So �4Rive-io— EcLv w.5 Owner Email:
Owner Name: !?>10.C_k R ti cj� Fn ty'< _ �L C. Phone:
Mailing Address:
Physical Address:
Facility Contact: w hcet� Moort— _ Title: /GCLr . Q14! Phone No:
Onsite Representative: 66-cc...tr Ntol�t2 ����r•+.i /�oyi-� Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = I = " Longitude: 0 ° 0 I 0 "
Design
Swine Capacity
Current
Population
Wet Poultry
Design
Capacity
Current
PopulaEa
Design C►arrant
Cattle Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Layer
iry Cow
❑Non -Layer
ily Calf
Feeder to Finish
2 p0
J::
`°-'=;
Dry Poultry Y.._:_ .
❑ Layers
❑ Non -La ers
Pullets
❑ Turke s
❑ Turke Poults
' ❑ Other
# ❑Dai Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ BeeFFeeder
❑ Beef Brood Cowi
Number of�Structure`s:
❑ Farrow to Wean
El Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
❑ Yes
[M No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
[,2 No
❑ NA
❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
❑ Yes
WNo
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
El Yes
14 No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ONo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
PRNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

gz - 7z z-
Facility Number: gZ7a Date of Inspection 1pYCY�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [21 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [9No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �—
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in): , -2
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ yes
oNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
C9No
❑ 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
�gNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
0 No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes
[�f No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[ZNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
WNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [--IPAN > 10% or ] 0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) is.e vj., w.C`c. _ R z, S 1'4 c._ 1 % CS' vtt i nl [ 0. S
13. Soil type(s) C
14_ Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
(:YNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
� No
El NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
0 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�gNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
PNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name r per/ Phone:
Reviewer/Inspector Signature: �Lc .a�Q�� Date: /O�/p — Zop
Page 2 of 3 12128104 Continued

Facility Number: Z --7z Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes EgNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes &No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes p No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[j No
❑ NA
❑ NE
23,
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
13 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
PfNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�YNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
;A No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
R(No
❑ NA
❑ NE
Other Issues
28,
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ONo
❑ NA
❑ NE
29.
Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑ Yes
PrNo
❑ 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
VNo
❑ 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
allo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did ReviewerAnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
';YNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
%No
❑ NA
❑ NE
Additiorial'Comments and/or Drawings:
Page 3 of 3 12128104

w
rAn f r1 e2v-6T�
Type of Visit ®Compliance Inspection O Operation Review O Structure Evaluation U Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑Denied Access
Date of Visit: �% O Arrival Time: Departure Time: '� County: k_'% !►+ISO.- Region:
Farm Name: �� ��.� u av %`a v..1 Owner Email:
Owner Name: ?) l R e-k e . vL- 1 I r,N s. A Phone: fl&
Mailing Address: Pig "�_40 gVLVLr,_ UV
Physical Address:
Facility Contact: A t1 ►r A o oi-et Title:
Onsite Representative: &eeeE Moor-- �i w, Mao -'ie
Certified Operator: .Sa.ia-L a 3 M—aa gyp_
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:.22 SfaoD
Back-up Certification Number:
Location of Farm: Latitude: = o = I 0 {1 Longitude: = ° = 1 = u
Design Current
Design Curren#
'" r F Design V Current
Swine
Capacity Population
Wet Poultry
'CapacityR Populatton".
; Cattle ' 1 , .v Capacity Populafion
❑ an to Finish
❑ La er
❑ an to Feeder
❑Non -La et
Feeder to Finish
dG
.;
❑ Farrow to Wean
D Poui
❑ Farrow to Feeder,
'
❑ Farrow to Finish
❑ La ers-'
❑ Gilts
❑Non -La ers
❑ Boars
❑ Pullets
"
Turkeys
_- z
Other
❑Turke Poults
❑ Other
❑ Other
z'
m ery Stru N of` cEl
❑ Dairy COW
❑ Dairy Calf
❑ Dairy Heifer
❑ D Cow
❑ Nan -Dar
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
PTo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[UNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[�Vo
❑ NA
❑ NE
other than from a discharge`?
12128104
Continued

r- •
Facility Number: Date of Inspection L1lC'�I
Required Records & Documents �
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes Yes LP ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 2'No ❑ NA ❑ NE
the approprrate box.
❑ WUP El Checklists ❑Design [I Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Wxzkly-eebetzrd ❑-WaUa.Analysis ❑ Soil -A ftiysis ❑ Waste Transfers ❑
AaauaLUdifizatim-
EIR,aip"i ❑ Steal4ag ❑ CmpX-ield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ w_es�ds
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
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
EKNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
91 E
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
,04.
UNo
❑ 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
❑ 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
Add,ti'nnat;Caitttneutstaudly Ur wEig
:Z S ; lic als e .t r t#-7doe ., a 0 v h . /
Ile'l/ '1 P'W f a Lv 01�>/ 0 n. 5 ! /-,t
12128104

Facility Number: aDate of Inspection�D
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): f
Observed Freeboard (in): =�
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes YNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
[]Yes [g No ❑ NA ❑ NE
❑ Yes EJd No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes E�No ❑ NA ❑ NE
8. Do any of the stuctures tack 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 allo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VNo ❑ NA ❑ NE
maintenance/improvement?
. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes LJ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) w�4et✓a t -r si•.t ��.,,.�.ir�
13. Soil type(s) f-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes QNO ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[INo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[]
Yes
EYNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�ZNo
❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L� No
❑ NA
❑ NE
Comments refer to, uesiion # : Explain an YES. ( .4 ) p � y .answers aud/orany recommendations or, any;utlfrer comrttents..,,
Use drawings of facility to better ezglain situations: (use additional. pages as necessary): "
Reviewer/Inspector Name ,� �< -z Phone: 9/0— /f5�
Reviewer/inspector Signature: Date: -a7d —ej
12128104 Continued

of Visit *Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit • Routine O Complaint O Fallow tap Q Emergency Notfication d Other © Denied Access
D�'s•re
Facility Number Date or visit: 'G� Time: 9' a,F- ca j; yD'dy
O Not Operational Q Below Threshold
'[Permitted G/Certified 13 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: .........................
Farm Name: ...... 50{! f' ...�✓1 r ... FCrr ......... .......... .._. County: __.Q£�� ..... W �W
Owner Name:......art►ry....... LL.�........................... Phone No: ..9���.. .. ix�...... tL �.........
'_►Mailing Address:.... . C9�, - - B a- .....1.....-- --....... � 1 CC��f ..............V C .......2k ......... .._........ _...
Facility Contact: .. nSS1- _ ...�gICG........._ -..... Title: Phone No: _ -
Onsite Representative: frf�>PC ..Q2%C. _ l 't.....U�z�C>w .......__.. integrator--,e�l��� ......!`'!,2
Operator Certification Number:.
Location of Farts:
94w"ine ❑ poultry ❑ Cattle ❑ Horse Latitude " 4 44 Longitude • 4 64
Discharges , Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes [319o_
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes Elgo
c. If discharge is observed, what is the estimated flow in gal/min? _r
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes QM
2. Is there evidence of past discharge from any part of the operation? ❑ Yes EKo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes LI-vo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier
Freeboard (inches):
12112103 Continuer•

Facility Number: — ?
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes To
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes 2-go
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes 21To
8. Does any part of the waste management system other than waste structures require maintenancefimprovement? ❑ Yes Di
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes E31q-o
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes G?14o
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes G144o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type 1310 PM aCIA — HlJv Sm a // 6�rn Q .r /, )L/ct
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 9-N6
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes [}wo—
❑ Yes 93Wo—
❑ Yes gwo—
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ff No
❑ Yes ETf4o
❑ Yes Ef<o
MQ Field Copy ❑ Final Notes
Reviewer/Impector Name
a .,k rQrr
Reviewer/Inspector Signature: Date: /7 d Ll
12112lu l [:ormnuea

Facility Number: — �1 Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes B-Ko
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ cbec�, de�rt�ap's, etc.) ❑ Yes O_Ne-
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 90
❑��mnliance
❑ irreel�eerd�❑ Wass ❑ Soil Sampling
24. Is facility with any applicable setback criteria in effect at the time of design? ❑ Yes EMq
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
M2!id-
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
U.No
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[-info
28.
Does facility require a follow-up visit by same agency?
❑ Yes
Bl o
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
9-No
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
El -No
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 fortes need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Farm ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

t.-
10 Routine V Complaint 0 Follow-up of DWQ irtVection 0 Follow-up of DSWC review V Other
Facility Number z 7z Date of Inspection
Time of Inspection /' 24 hr. (hh:mm)
13 Registered M Certified ® Applied for Permit Permitted 10 Not Operational Date Last Operated:
Farm Name: .,......_o-cam .Z .�'!Eic....�'` County:.......,.F`;".r:�-..�./.............................._......
Owner Name: ................11..�'', ........................................... Phone No9f �..SZ�..7 ..7i�j......................
FacilityContact: ............. ��......�.................... Title:....................................................."-------... Phone No:...................................................
MailingAddress: ....... - �../ x_ ,, . r yc....l..1!.. ......F '......•....................................»............................... .........................
Onsite Representative:.,,,,,,,,.,,,, ...... Integrator- ------
------'. ......
Certified eralor:......... ,rr _ .. � Op._........�......................................... Operator Certification Number.........................................
Location of Farm:
A
........................................................ .........................................---...................I...............
.............................. ...............................'
Latitude 0 =' =11 Longitude =' 0` ="
�:. rwtya WYP.J — t--O
__ _�.!Vii�rnt`s �.rI.IG�LL�
vGl^Y M.,dy
Capacity.:"Poptilahoii ..{P Alf
,j
CapaCEty, Piipula#ion , Cattle w Capacity Ptrpulatxon ``
❑Layer
Genera
1. Are there any buffers that need maintenancelimprovement? ❑ Yes �j No
2. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes �No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) El Yes ® No
c. If discharge is observed, what is the estimated flow in gallmin? A1/4
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes ffNo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes M No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ® No
5. Does any part of the waste management- system (other than lagoons/holding ponds) require ❑ Yes CS] No
main ten an c el i m p ro ve rnen t?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes k9 No
7. Did the facility fail to have a certified operator in responsible charge? ❑Yes ®No
7I25197
Continued on back

Padlity Number: e2 -- 720
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (LagoonsZolding Ponds. Flush i'its, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier.
Freeboard00:.._...... � ._....... _ ........ - _ _ ...w .........
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environrnental threat, notify DWQ)
❑ Yes KNo
❑ Yes CZNo
Structure 5 Structure 6
❑ Yes No
❑ Yes No
[5tYes ❑ No
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes JONo
Waste Application
14. Is there physical evidence of over application? ❑ Yes ANo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type �... .a arc•+ ... ,s be ..%vt� ��' - ......Y_.--------•---_-
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes No
18. Does the receiving crop need improvement?
❑ Yes
PU No
19.
Is there a lack of available waste application equipment?
❑ Yes
kfNo
20.
Does facility require a follow-up visit by same agency?
❑ Yes
fR No
21.
Did Reviewer/Inspector fail to discuss reviewrnspection with on -site representative?
❑ Yes
Q'Nq
22.
Does record keeping need improvement?
❑ Yes
0 No
Eor
Certified or PenWtWd Facititim5 Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
ONo
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP.
❑ Yes
EfNo
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
❑ No
0-No. violationsot deficieitcie's.wereitoted-during this; visit:, You:wiU rkei ive•nafurther ;
e6rres'po6dence
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: 'y�� Date: /// /l