820426_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Quai

Type of Visit: QDCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Q-1feutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: L.{J Arrival Time: ,'D c? Departure Time: P p County: .,,� Region:
Farm Name: f �d�j,�.t,�t� /sL // Owner Email:
Owner Name: ��s�t— �r/7a. +�- Phone:
Mailing Address:
Physical Address:
Facility Contact: ,�r_� cZ�'`/1a-� Title: �C/7y/ Phone:
Onsite Representative: � r Integrator: / nz,
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Cuent
rr
Design Current
Capacity Pop.
Wet Poultry
Capacity
Pinish
r
La er
Dai Cow
eeder
Non -La er
Da' Calf
Dairy Heifer
Finish
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dr, Paul
La ers
Ca aci
P,o
Non -Dairy
Beef Stocker
Farrow to Finish
Gilts
Non -La Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turke Points
Other
Other
Discharp-es and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes []No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[:]Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Ej No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[a -Now
❑ NA
❑ NE
of the State other than from a discharge?
"- _.. Y _Ir 2 7/,1/7/r1C f nntinnnd

lFacility Number: - jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [—]Yes Io ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 0 No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E3<o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ❑ 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
[3-1No
❑ NA
ONE
8_ Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[D-&o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑`'lglo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[3'N"o-
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN C] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop ❑ Evidence of Wind Drifl ❑ Application Outside of Approved
Area
Window
12. Crop TYPe(s)
�r-
13. Soil Type(s): A4 1�T7�
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
[rNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
[3'N-o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Ej No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑`o
❑ 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 Pwo
❑ 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 Q"1Qo
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
❑ NA ❑ NE
[] Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - jDate of Inspection:--
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes B-No D NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Q o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? Yes 2<0 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
�o
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Ej o
❑ NA ❑ NE
and report mortality rates that were higher than normal?
24_ At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Dl�o
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
ED Z
❑ 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
L`J A"o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
0�o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E2-5o
❑ NA
❑ NE
34_ Does the facility require a follow-up visit by the same agency?
❑ Yes
[2N-o
❑ 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:c�. C� �f /vim— Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412015

t ype of Visit: jl CoZutine
ace inspection U Operation Review U Structure Evaluation U 'Technical Assistance
Reason for Visit: O Complaint O Follow-up Q Referral O Emergency p Other O Denied Access
Date of Visit: Arrival Time: Departure Time: �) �C7 County: Region:
Farm Name: / Z! rZow s Owner Email:
Owner Name: rae- a.' Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Integrator: !�'j->_ z� _
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
- Design Current
Swine_ - Capacity Pap.
Wean to Finish
et
WPoattry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -Layer
DairyCalf
Feeder to Finish OV
I'
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
- Farrow to Feeder
D . Poutt
Ca aei
P,o
Non -Da'
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
H
Turkeys
Other
TurkeX Poults
Other
Other
Discharees and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [N No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes []No
❑ Yes [R�No
❑ Yes VNo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: ZIDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [A 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): 11
5. Are there any immediate threats to the integrity of any of the structures observed? [] Yes [ No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [R(No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes PA No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes RLNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes �No ❑ NA ❑ NE
maintenance or improvement?
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 [_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): ,'J't..
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[R No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
RNo
❑ NA
❑ NE
acres determination?
17_ Does the facility lack adequate acreage for land application?
❑ Yes
B No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
a No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
allo
[] NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
2jNo
❑ 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 [XNo
❑ 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? ❑ Yes 12�No
23_ if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes M-No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facifity Number: Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
1
25. Is the facility out of compliance with permit conditions related to sludge7 if yes, check ❑ Yes 0 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 E3 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [3,No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [aNo ❑ 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
Jallo
❑ 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
[X7No
❑ 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
LE. -No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
33. Did the Reviewer/Inspector Fail to discuss review/inspection with an on -site representative?
❑ Yes
CA No
0 NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[Z�No
[] NA
❑ NE
Comments (refer to question # ): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Phone:
Date:
21412015
Page 3 of 3

Type of Visit: EMomplianee Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ()koutine 0 Complaint 0 Follow-up 0 Referral 0 Eme envy 0 Other 0 Denied Access
Date of Visit: [e,�—/ Arrival Time. �/ [� Departure Time: 'Oct County: `f Region:
Farm Name:✓-�Cf,,t �q,��yt Owner Email:
Owner Name: .r►pl L �l a r� a.4 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: ,,n r,� Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine::
Design Current
Capacity Pop.
Wet Poultry
Design
Capacity
Current
Pop.
Cattle
Design Current
�apaclty Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
jDairy Calf
Feeder to Finish
Farrow to Wean
Va
-
Design Current
.�. D , P�oul Ca aci P,o
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
1 -
Other ` s
r Other
Pullets
Beef Brood Cow
Turkeys
TurkeX PouIts
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 allo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑ 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 [.No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili 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 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
[allo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.) ,
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
®, No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
3 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
[gNo
❑ 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 [a No ❑ NA
❑ 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): rn /Gr/�r �SB-7�c -7 ��r_��ns�a / D U
13. Soil Type(s): /'!)l
❑ NE
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
MNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[KNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[�jNo
❑ 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
La No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
2 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
allo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [a No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
0 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 L3 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes CKNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

Facili Number: &L-J Date of Inspection: b
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes RNo [DNA NE
�25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes [5�No NA NE
the appropriate box(es) below.
Failure to complete annual sludge survey [Failure to develop a POA for sludge levels
rl 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 [5' No [] NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document Yes [3 No NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond Other:
32. Were any additional problems noted which cause non-compliance of the permit or 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
C] Yes [Z No ❑ NA NE
Yes a No E] NA ❑ NE
Yes [ANo
Yes [ No
Yes No
I—] NA NE
E]NA NE
CjNA ❑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:
Phone:
Reviewer/inspector Signature: Date: Zr
Page 3 of 3 21412014

Type of Visit: omplia cc Inspection Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: outine Q Complaint Q Follow-up Q Referral Q Emergency 0 Other Q Denied Access
Date of Visit: Arrival Time: ; av Departure Time: ' 010� County: �',�.,.���s-- Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: �deTitle: �2w'? ✓ Phone:
OnsiteRepresentative: S"r� Integrator: �i►�-y
491
Certified Operator: �j� Certification Number: f�.sr79
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
w esign Currentzu
Design
Cu
Design Current
911-5.apacity Pop.
Wef-Poultry ,Caaciop
DairyCow
Wean to Finish Layer
Wean to Feeder
Non -La er
DairyCalf
4. Feeder to Finish ?
Dai Heifer
Farrow to WeanDesign
'Current
D Cow
Non -Dairy
Farrow to Feeder D : ,Foul . _Ca .aci .Po .
Farrow to Finish
La ers
on -Lavers
Pullets
Beef Stocker
Beef Feeder
Gilts
Boars
Beef Brood Cow
!Other . �
,,.....-
Turkeys
.
-'""
Turkey Poults
�..
Other
Other
Discharges and Stream Impacts
L 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 EINo ❑ 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 Eallo [] NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes E[ No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

FaciliNumber: - Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
C&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
[.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
T Do any of the structures need maintenance or improvement?
❑ Yes
MNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit'?
❑ Yes
LNo
❑ 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
fallo
❑ 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 O-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): �.Y/'hiir ,���r✓_ F G�rh �Gvf r �5���—�- r
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes FZNo 0 NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [-]Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 0 No ❑ NA [] NE
❑ Yes Q No ❑ NA ❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes M No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [2 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 jo No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " 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

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes FA No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes PLNo
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
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other lssues
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 M No ❑ NA 0 NE
❑ Yes Q No 0 NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes JZ[No ❑ NA ❑ NE
❑ Yes �No
❑ Yes [ZNo
❑ Yes ELNo
❑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 additionalpages as necessarv).
Reviewer/Inspector Name-
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: Ca
21412011

x
ivi"sion of Water Quality Faeelity Ntttnber - `JWI;
ion o€ Solt and Water Conserva�On_
er Agency
Type of Visit: , o,mrpl^iance Inspection Operation Review Structure Evaluation p Technical Assistance
Reason for Visit: Ggoutine O Complaint 0 Follow-up 0 Referral 0 Emergency Q Other 0 Denied Access
Date of Visit: © Arrival Time: Departure Time: County:",�5�` Region:
Farm Name: Gt/`jt a - ra., 'rt.j Owner Email:
Owner Name: gz_ 1 L Par- A,, , Phone:
Mailing Address:
Physical Address:
Facility Contact: -0,- - a//�Q .+�� Title: Phone:
Onsite Representative- Integrator:
or
Certified Operator: Certification Number: 7'
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
r
D signreni epsiurge.nt ��
q�. .
Swine
o Cate •aacio
_
„
Wean to Finish
Layer Dairy Cow
Wean to Feeder
41I INon-Layer I Dairy Calf
Feeder to Finish'"°
- Dairy Heifer
Farrow to Wean�
Design Current Dry Cow
Farrow to Feeder
Farrow to Finish
.,
_; D .-,PottE Ca acttyPo Non -Dairy
La ers Beef Stocker
Gilts
Non -Layers sBeef Feeder
B oars
�. Pullets Beef Brood Cow
_2
Turkeys �n ,t
x
Other
Turkey Puults
Other
Other &A,
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ®No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
® No
[] NA
❑ NE
❑ Yes
Fa No
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection: —/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ff 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): V^
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes [Z 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 [gNo
❑ 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 n 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 [LNo
❑ 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): iN�c�sc leuerL �Scy�a� f�tii�
13. Soil T e s
14. Do the receiving crops differ from those designated in the CAWMP? [—]Yes fo 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
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment`?
❑ Yes
U&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 S 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 gNO
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes jg] No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

I%
Facili Number: I 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 to provide documentation of an actively certified operator in charge? ❑ Yes allo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [ZNo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31 _ Do subsurface the drains exist at the facility? if yes, check the appropriate box below_
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
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 Eg No ❑ NA ❑ NE
❑ Yes 5d-No ❑ NA ❑ NE
[] Yes gNo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes
�ANo
❑ NA
❑ NE
❑ Yes
[allo
❑ NA
❑ NE
❑ Yes
[K No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better exDlain situations (use additional Daues as necessarv),
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: trv�r2-�Dl
21412011

Type of Visit: VCompliance Inspection U Operation Review 0 Structure Evaluation p Technical Assistance
Reason for Visit: elkoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 16 Oil UJ' Arrival Time: Departure Time: County: Region: F�
Farm Name:_ L"w1 L-11.1i Owner Email: _
Owner flame; l-- + D:cl-INO-Al Phone:
Mailing Address:
Physical Address:
Facility Contact: V3 �� �a Title: Phone:
Onsite Representative: Integrator: Py` el Lal-�
Certified Operator: I Certification Number: % 2 % f
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design
Current x Design Current
Design Current
Swine
Capacity
M
P,op. �Wetl?oulfry Capacity Pop ` °'
Catfle Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
Nan -La er
DairyCalf
r
. .
s d.Design Cti"Trent
Dai Heifer
Feeder to Finish
Farrow to Wean
D Cow
Farrow to Feeder
D Point"{ Ca acity;P:,o
Non -Dairy
Farrow to Finish
Beef Stocker
Layers t
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke sr
.01mer,
Turkey Points
F'
Other
_�
Other
_T��
max.
- 4 •.
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes INo ❑ NA ❑ NE
Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. hoes 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 (B No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes � No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

t
FacilityNumber: Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Er No [DNA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 02 No ❑ NA ❑ NE
Structure 1 Structure 2 f Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):�
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Q No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
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
UNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[t]'1Qo
❑ 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
U'Ilo
❑ NA
❑ NE
maintenance or improvement?
�: =
Waste Application "uf'
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[ o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[�No
❑ NA
❑ NE
❑ Excessive Ponding n 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): s✓ 5 a C
C/jkr4'�
13. Soil Type(s): vLAG
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
C9 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[P'�o
❑ 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
[0'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[0No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
allo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ff?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
[g No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking [—]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
[!�No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
E No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

FaciliNumber: 41t 7 jDate of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [Lj-tqo
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Eg—o
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 fast survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [Z],Nn
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes C0,1Vo
Other Issues
❑ NA ❑ NE
❑NA ❑NE
DNA ❑NE
❑ NA ❑ NE
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes �lo ❑ 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 R21% ❑ 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)
31. Do surface tile drains exist at the facility? if yes, check the appropriate box below.
Yes
❑ NA
❑ NE
[Application Field ❑ Lagoon/Storage Pond ❑ Other:
32, Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Ct�<o
❑ NA
0 NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[;k90
❑ 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).
Reviewer/Inspector Name: St
Reviewer/lnspector Signature:
Page 3 of 3
` Date: 4-0 ug
21412011

Date of Visit: % Arrival Time: ! D (i Departure Time: County:
Farm Name: �Gt I-xa Pin_ 1 S Owner Email:
Owner Name: La r11�r /j'i Phone:
Mailing Address:
Physical Address:
Facility Contact: Zey1 -pgrit a ►v%- Title: ,Pj V), Yl- Phone:
Onsite Representative: _51r� Integrator: ��'rLg .f
Region: n 0
Certified Operator: Certification Number: / 7 k,7 g
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
r � � Desiga� -.
"' D s gn
Current Design Current
Swine �Curren_t
Capacrty Wet Poultry Capacity
Pop. Cattle Capacity Pop.
Wean to Finish
Layer
DalCow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
/5�7
1l
Desigh Current
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D , P,oul -a aci P,o
Non-Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
I
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other Other
Discharges and Stream Imoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b_ Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [0 No [] NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes [] No
❑ Yes ® No
❑ Yes ® No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

Facifi Number: - 10 Date of Inspection:
,Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [] Yes [a 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): / '7-
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[Z 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
allo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[� No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[D No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[El No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No [DNA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑/Application Outside of Approved Area
12. Crop TYpe(s): Z_zrpjL,//L 16Ucr�Y�of LGarrt lbyI14J_
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
[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
® 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 [3 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 ® 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

Facility Number: - Date of Inspection:
724. 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 2] No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/]nspector 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
❑ Yes [a No ❑ NA ❑ NE
[aYes ❑ No ❑ NA ❑ NE
[:]Yes [$ No
[:]Yes (0 No
❑ Yes RLNo
❑ 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: Phone: c�/0—tf�33D
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412011

type of Visit: (2�omplia Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Oloutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: G /�!� Arrival Time: : �Departure Time: !p County: 51►— Region: /670
Farm Name:G7�h���Q�jyt Owner Email: �—
Owner Name: 6 Z:f,1 i_ BarA F _= Phone:
Mailing Address:
Phvsical Address:
Facility Contact: _;3 rM L tQ(ha_Title: _yL&rr- Phone:
Onsite Representative: sa�,,t� Integrator: -e u-
Certified Operator: Certification Number: /z'rz}
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
,Design Current
"-..
, Design Current ::
Design Current
Swime Capacity Pop.
1Vet Poultrypactty
zt
Pop
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish zzu
Heifer
Farrow to Wean
Design Eurrent a
Dry Cow
Farrow to Feeder
�Ca 'city Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Otheir a.2'
Turkex Poults
Other IOther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at. ❑ Structure ❑ Application Field ❑ Other;
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes. notify DWQ)
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 0,No ❑ NA ❑ NE
Yes ❑ No
Yes ❑ No
❑ Yes ❑ No
❑ Yes �R No
❑ Yes [g No
❑ NA NE
[DNA NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page 1 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 [Z No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Stricture 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 "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 I[ 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 a No ❑ NA ❑ NE
R. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [RNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[] PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): IIt�(o•I Ay�a��i� l C' JI`il IGtJ�te 1IJ"ldCe-n�
' 13. Soil Type(s): J( l,>7T
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ®, No ❑ NA ❑ NE
I5. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ®No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
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.
❑WITP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Rj 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
allo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[Q No
0 NA
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: I 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 permii conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Ej 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 tilt 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 ❑ NE
❑ Yes 10 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
® Yes e@T o ❑ NA ❑ NE
❑ Yes
Q4No
❑ NA
❑ NE
❑ Yes
21 No
❑ NA
❑ NE
[—]Yes
QC 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),
Reviewer/Inspector Name:
Reviewer/Inspector Sigmature:
Page 3 of 3
Phone: • W ;r 33 U a
Date: — ';Zp
21412011

4
;J 0'�1`457010-%6--/oq!�-
Date of Visit: f �� , ,� Arrival Time: r �Q Departure Time: i 1D 1) countyRegion:
Farm Name: _rd/X 43(,O� �_ -f Owner Email:
Owner Name: y5elri-- Phone:
Mailing Address:
Physical Address: 11
Facilitv Contact: d?"t— ���2a'"-� Title: Phone No:
Onsite Representative:"~' Integrator:
Certified Operator: '� ��� Operator Certification Number: t{
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: E__1 e 0' 0 ' Longitude: = ° = I =
11
F­
C►►urreni
Designity
Population
Cattle Capacity Populatio
eanDesign
to Finish
=771❑
Layer
❑ DairyCow
❑ can to Feeder
❑ Non -Layer
❑ Dai Calf
Feeder to Finish D9
❑ Dai Heifer
❑ Narrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
DfY Poultry
❑ N Layers
❑Non -La Non -Layers
❑ Pullets
❑ Turke s
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Other
❑ Ot
❑ Turkey Poults
IEJ Other
Number at Structures:
Discha ges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes FINo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes O-No
❑ Yes C'NO
Page 1 of 3 12128104
❑ NA ❑ NE
El NA ❑NE
Continued

Facility Number: a—dx& Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: 4
Designed Freeboard (in):
Observed Freeboard (in): ,31s—
❑ Yes M-No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Arc there structures on -site which are not properly addressed and/or managed ❑ Yes 29No ❑ 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 9No ❑ 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
❑ NA ❑ NE
maintenance or improvement?
,9[No
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Lallo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
�Pdo
El NA El 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) C &11,e1f1�4�_rw-&L ?!9
13_ Soil type(s) NJ A-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
S-No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
allo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
Q No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Wo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
O-No
Cl 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):
1-3 D c�
Z
ReviewerllnspectorName Phone: %�'o4
l
Reviewer/inspector Signature: Date: % g /D
Page 2 of 3 12128104 Continued

Facility Number: �— ADate of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes j9-No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 9 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists
❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes t5-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
5No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
9No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
2-No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
J No
❑ NA
❑ NE
2T
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
LN-No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
SNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[ANo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
P,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
ONo
❑ 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
V�No
❑ NA
❑ NE
Additional Comments and/or Drawings:
a
Page 3 of 3 12128104

Type of Visit (JrCornpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit C3"Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I
_1_ Arrival Time: ., Dv Departure Time: i t7 O� County: — 0- Region:
Farm Name: TaA11111 /--4r �t_-,S Owner Email:
Owner Name: �zir Lc "�`.�1 Phone:
Mailing Address:
Physical Address:
Facility Contact: �Q A-1 " Title: bI7 r Phone No:
Onsite Representative: -�' z— Integrator:
Certified Operator: Operator Certification Number:.!7P-7 �
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: 0 0 = 6 = Longitude: = ° = d =
Design
Swine Capacity
Current �_U_rrent Design Current
Population wwk&eoultry apacity opulation Cattle Capacity Population
10 Laver ❑ Dai Cow
❑ Non -Layer ❑ DairyCalf
❑ Wean to Finish
❑ Wean to Feeder
i!
Feeder to Finish
❑ Dairy Heifer
Dry Poultry ❑ Dry Cow
❑ Non -Dairy
❑ Lavers El Beef Stacker
❑ Non -Layers ❑ Beef Feeder
❑Pullets Beef Brood Co
❑ Turkeys
❑ Turkey Poults
❑ Other Number of Structures:
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
IA
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b_ Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge`?
[--]Yes ,&No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
j❑NA
❑NE
❑ Yes
P!I­No
❑ NA
❑ NE
❑ Yes
JE�No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: Date of Inspection
f
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes C3,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 G�o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes .91 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
[N 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
[5No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
0-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 Eviidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s) ewry / .dam — :�✓ t-L �flU�-��
13. Soil type(s) /� p
I4. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2.No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Wo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
9 No
❑ NA ❑ NE
17_ Does the facility lack adequate acreage for land application?
❑ Yes
45 No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
O-No
❑ NA ❑ NE
Comments.. refer to question # Explain any, YES answers and/or an 'recommendations or ( q ) p } y any othi:r comments;
Use drawings of facility to better explain situations. (use additional pages as necessary): `
o::,
Reviewer/Inspector Name I Phone: wig 'q'3..3 -73 0"
Reviewer/Inspector Signature: Date:
Page 2 of 3 1212iVU4 Continued

Facility Number-. — Date of Inspection
r
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes f&rNo ❑ NA ❑ NE
1
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box.
❑ W UP ❑Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ERNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ®.No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes K No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes )&No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
[--]Yes J-No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes [.No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[�FNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0,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
CkNo
❑ 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
ANo
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
M No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
D�No
❑ NA
❑ NE
Comments and/or
Page 3 of 3 12128104

Type of Visit EY16ornpliance
Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
E9Koutine 0 Complaint
0 Follow up 0 Referral Q Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival'I'ime: . t7 D Departure Time: County- Region: �r
Farm Name: _I Qr �ri Gl t'►'ni Owner Email:
Owner Name: ��✓`L70_1_� Phone:
Mailing Address:
Physical Address:
Facility Contact: . Afn PQfAO" Title:
Onsite Representative: _ n"'
Certified Operator:
Back-up Operator:
Phone No:
Integrator:;/���
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o = = fl Longitude: = o ❑ , ❑ «
Design Current
DesigMiPopnulafiot
esign Current
city Population
Wet Ponitty Capac
Cattle Capacity Population
rWeanto Finish
❑ Layer
❑ DairyCow
to Feeder
❑ Non -Layer
❑ DairyCalf
Feeder to Finish
El Dairy Heifer
❑ Farrow to Wean
Dry Pointry
❑ D Cow
❑ Farrow to Feeder
❑ Layers
❑ Non -Dairy
❑ Beef Stocker
❑ Farrow to Finish
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Cowl
r.
❑ Turke s
Other
❑ Other
❑ Turkey Pouets
M 10 Other
Number of strueturps:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
'allo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b_ Did the discharge reach waters of the State? (If yes, notify 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
Z. Is there evidence of a past discharge from any part of the operation?
❑ Yes
MNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
,KNO
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

j ["aility Number_ Date of Inspection
1 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 P .No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ �L -
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
4No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6_ Are there structures on -site which are not properly addressed and/or managed
❑ Yes
%[No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
fKNo
❑ 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
KNo
❑ 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/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[LNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn. etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop El Evidence of Wind Drift ❑ Application Outside of Area
Window
l2. Crop types) C/&/-YL �, Gz� r
13. Soil type(s) Jai 0/+
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
99No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EN No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the 'irrigation design or wettable acre determination'?❑ Yes
91 No
❑ NA ❑ NE
IT Does the facility lack adequate acreage for land application'?
❑ Yes
19 No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
9,No
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
A,
Reviewer/Inspector Name Phone:Q— 3 �3AprJ�
Reviewer/Inspector Signature: Date: -;?—.�,Fp O
12128104 Continued

Facility Number: Date of Inspection CJ
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropriate box. ❑ W-UP ❑ Checklists ❑ Desig
n El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Iallo ❑ 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
29 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
M No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
IR No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
J4 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[Z No
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
JR No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
C,No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
RNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
Wo
❑ 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
0No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
%No
❑ NA
❑ NE
12128104

Type of Visit Q'Gompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit eloutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: �_?D Departure Time: : 3 County: Region: tm
Farm Name: _i2/`/ZQ n'L— / LZr/!Zs Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: LO_'ao Title:
Onsite Representative: Certified Operator:
Operator:
Phone No:
Integrator: ��
Operator Certification Number: %ze
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: ED" ET
= " Longitude: 0 ° = I = .1
Design Current
Design Current
Design C*urrent
Swine 4Capacity Population
Wet Poultry@opacity Population
Cattle Capes: ty Populaaon
❑ Wean to Finish
❑ La er
❑ Daia Cow
❑ Wean to Feeder
❑Non -La er
❑ DairyCalf
Feeder to Finish ��O
N.
❑ DairyHeifer
❑ Farrow to Wean
a
Dry Poultry" ' '
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ 1 a ers
❑ Beef Stocker
❑ Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
❑Pullets
❑ Beef Brood Ca
- :.-
Other f -� +uy=
❑ Turkeys
❑Turkey Puults
❑ Other
Ilaother
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
0 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? {If yes. notify DWQ)
Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
A No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
W No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: Date of Inspection
' Waste Collection & Treatment
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
❑ 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
SNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
IM 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
[A 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
ka No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
X No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
El No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13, soil type(s) %U O A `
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
®, No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ZNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
N No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ZLNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Z No
❑ NA
❑ NE
Comments (refer to question #): Explain any .YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name r"d - -r-�� Phone: �0-'3- 33�
Reviewer/Inspector Signature: Date: '0a
/�sJ,G vl .� e�✓�vi v� a..vruuswe�s

Facility Number: Date of Inspection��
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes & No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below_ []Yes 13No ❑ 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 19 No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 14 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
f0 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
$0 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
�@ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
2 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
E+No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
J,No
❑ NA
❑ Nl:
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
J4 No
❑ NA
❑ Nti
If yes, contact a regional Air Quality representative immediately
3 L
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
RM 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
allo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ZNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

i/
Division of Water Quality -
Facility Number— 0 Division of Soil and Water Conservation
Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit outine 0 Complaint O Follow up O Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: _M D7 Arrival Time: /I Departure Time: ' (% County:
Farm Name: ar`ta ,., i--,z r—,n 6 / Owner Email:
Owner Name: Zen �Qr'iia�.n- Phone:
Mailing Address:
Physical Address: cc�''� //
Facility Contact: c&-w `I-6_r/ldTitle: Phone No:
Onsite Representative:
� rB� Integrator:)EJ2 o- s-z�
Certified Operator: Y%_ Farl[ct_sx� Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: = O [ = F Longitude: = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Laver
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
%
(o
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Region:
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
IJ
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. Whatis 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 10 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
Eff No
❑ NA
❑ NE
❑ Yes
®No
❑ NA
❑ NE
12128104 Continued

► Facility Number: Date of Inspection 2 �
Waste Collection & Treatment
1 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ No ❑ NA ❑ NE
a_ if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ® No ❑ NA ❑ NE
through a waste management or closure plan`'
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 14 No ❑ NA ❑ NE
$_ Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes R No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wct stacks)
9_ Does any part of the waste management system other than the waste structures require ;RYcs [:]No ❑ NA ❑ NE
maintenance or improvement?
Waste ARDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes IN No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [Z No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 1bs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Sul] type(s) AtO 71- 11
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
N 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
® No
❑ NA
❑ NE
IT Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
/. r,X )I 5�� �{ �r A u� ; 5F7X AL
X7a
! Q %A CGrLt.
Reviewer/inspector Name .f Cve— ,k" Phone: 21Z} yrt�oI-,
Reviewer/Inspector Signature: Date:p�
! F/LdVY LVr!!lrs"C"

E�
Facility Number: — Date of Inspection 7�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 9 No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists El Design El Maps El Other
21 _ Does record keeping need improvement? If yes, check the appropriate box below. []Yes [SNo ❑ NA ❑ NE
❑ Waste Application []Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ AnnuaI Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[9 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25_
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
9 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
C'No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
EffNo
❑ 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
0 Yes
JZ 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
X 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
W 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'?
IN Yes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
®,No
❑ NA
❑ NE
Comments and/or Drawings:
12/28/P4

- CTt]tvision oflllllWater Quality
LFaeiIj,-
ty 1`urtlber — _M Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit 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 ❑ Denied Access
Date of Visit: �!to rrival Time: i d a Departure Time: ® County7 Region:
Farm Name: ' g ►' 44I.+',_' Owner Email:
Owner Name: en 46& 11WI Phone:
Mailing Address: AZ-3'71 TT_`Szr3 C- kt4ffelkl
Physical Address: LL
Facility Contact:Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator: 's p
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = l = N Longitude: = o= I 0 u
Design Current DestguCurrent Design Current
.,;;Current
Swine ;�fi} � Capacity Pomp la font t Wet Poultry Capactty� Poprulation Cattle Capacity Population
❑ Wean to Finish ❑ La er ❑Dai Cow
❑ Wean to Feeder f ❑ Non -Layer ❑Dai Calf
Feeder to Finish ^ w ❑Dai Heifer
❑ Farrow to Wean D ulhy 1 ' , r=a ❑ DryCow
❑ Farrow to Feeder "`` ' `'r�
❑ Non-Dai
❑ Farrow to Finish ❑ Lavers ❑ Beef Stocker
❑ Gilts ❑ Non -Layers ❑ Beef Feeder
❑ Boars ❑ Pullets
❑ Beef Brood Cowl I
x .H PEJ
Turke s Turke I'O111t5
❑ Other �] Other
Rlumber of Structures'
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
4No
❑ NA
❑ NE
Discharge originated at: ❑ structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
Qk No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
J9 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
rV.(rNo
❑ NA
❑ NF.
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
KNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
&No
❑ NA
❑ NE
other than from a discharge'?
Page 1 of 3
12128104
Continued

Facility Number:A�q Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 9KNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? El Yes aNa ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):Q
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ;RNo ❑ NA ❑ NE
Oe/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 1�jNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7, Do any of the structures need maintenance or improvement? ❑ Yes [K No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
K 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
KNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
ANo
❑ NA ❑ NE
maintenance/improvement?
1. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
P9 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) t' iGJ"tis /�
13. Soil type(s) 1(_/0I
14. Da the receiving crops differ from those designated in the CAWMP? ❑ Yes
U Ne
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
allo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination;❑ Yes
JO No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
9�No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
9No
❑ NA ❑ NE
Comments (refer -to question ft Ezplain.aay YES, answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages asanecessary):' W
Reviewer/Inspector Name �- - ev if - Phone:
Reviewer/Inspector Signature: Date: t!v 42DD�O
12/25/U4 Continued

! Facility Number: — Date of Inspection � 4v
if Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes KNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes XNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers 0 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
;K No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
O No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EX No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
®No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
PINo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Eq No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
N No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ANo
❑ 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 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
2q No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�KNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

g7Ndm ber.21
y
(; Division of Water Quality ,'7 3
0 M'Won.of Soil and Water-Cottservation
O' Other Agency
_. N
Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit B Routine O Complaint O Follow up O Referral Q Emergency Q Other ❑ Denied Access
M
Date of Visit: l�/fQ� Arrival Time: Departure Tinic: County': 5� �_ Region: fPJQ
Farm Name: P0, AQ 1. F rw+ s �/� Owner Email:
Owner Name: /S CN P", 64 Phone:
Mailing Address: �? -3 91 Z t ['as - LJ-e-ea J;A_� 1-1- _ N Cam'_ _ _�T:LAI�
Physical Address:
Facility° Contact: yy�� Title:
Onsite Representative: _ �e ra R, ;tine• , _
Certified Operator: �►+ /"�. „�..r..,
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator: Pea-_
Operator Certification Number: / 78 IT
Back-up Certification Number:
Latitude: Qo = , Longitude: ❑" ❑ ,
Design Current Design Current
Capacity Population Wet Poultq Capacity Population
❑ Laver
❑ Non -Laver
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
1177D
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Lavers
❑ Non -Lavers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Strum Impacts
1. Is any discharge observed from any part of the operation''
Dischar_e orii.,inated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Daia Calf
❑ Dairy lieifet
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: F/ 1:
b. Did the discharge reach waters of the State'' (If yes. notify DWQ)
c. What is the estimated volume that reached Seaters 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
❑ N.
❑ NA
❑ NE
❑Yes
❑No
El NA
❑NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[R No
❑ NA
❑ NE
12128104 Continued

1Facility Number: gA-- 1114 Date of Inspection (o of o0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
V1 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?: _ /4 /091 %
Designed Freeboard (in): J0111- -eA,. <.
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 ero5ion, 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?
NJ 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?
1. 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 Drifl ❑ Application Outside of Area
12. Croptype(s) &tma.C4 &I Z 5G-0..5 f Ce�.•+� beat'. 1��� �. -t.'Fraa� ---
13. Soil type(s) /uca 09
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 acre determination,
El Yes
f No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Comments refer to uckl6n Ei Iain an u� il!
(refer q �- , P Y YES answers.andlor.arty recommendations or any other cammenta..
Use dra% offacili to'better a lain situations: use additional es as necessa
'� ty ,gip ( P� rY)=.
D 1 l h
Mr. !arAa/k ," + r�G is o&L0
F,a"ae Low-�Il�tc. �►��-��aa� Usk 1014 l93 .
7-) 5af...C. 1takCs ir, -4-�.c wait. . t h{�ti ter,
rr T� �v.l a v� K O w �*s CA .._k _ p t s.r •e "k— p� , t s. �. r O
O-r 6•y Ej l
Reviewer/Inspector Name �J A. x, Phone:
Reviewer/Inspector Signature: Sea Date:
Z 12128104 Continued

1
Facility Number: Y� — y,� Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 50 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 El Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
R 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
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
® NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
® NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
®No
❑ NA
❑ NE
29.
Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑ Yes
C9 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
dyes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
B 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
[If No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[9 No
❑ NA
❑ NE
Addit ioiitai Comments and/or Drawin"gs:. n
12128104

lType of Visit • Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit *Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time: �Go AM
Q Not Operational Q Below Threshold
permitted [Kertifi,ed Q Conditionally Certified 0 Registered Date Last Operated or Above Threshold: -------- -------------
FarmName: ..... ........ ».».--------------- ----------------- w».._._.» County: »....-s� y�¢h......».»...........»».......��1.�..........
Owner Name:......_-- -..... ».».» .»». Q.>=__.. _ » .._ .... _»._......... Phone No:....L.10-..533... .....................................
1lai hng Address: ? ..._._ s ✓te�%». t?a .l _Cl�`,l f o� _! __. _ »?d 3
Facility Contact: -- - _..a1 .......... Title:.._ .... ... ........ .......................... -......... ».. Phone No: - -•y/v ..9 y�:..� �. �'?
Onsite Representative:....._. Q�n ... Pp{�G�!t....». _._..._.._..._.�, .._».».... Integrator:..._ ...................... ........... »....»»
Certified Operator:._...,... .de— P� r �� , �, � _ _ _ _ Operator Certification Number:.....%' �,� `�.
Location of Farm:
D- ine ❑ Poultry ❑ Cattle ❑ Horse Latitude ` " Longitude • 4 94
Destgit °
PCurrent Current `Desrg
Swine .Population y :Population CCa 'apanty Po o _.
y n
Wean to Feeder
ceder to finish
jcjo7 s
/ 7 .S
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Number, of
%in A;—rn C-RA -Twrnr
Discha res 8 Stream Impacts
I . Is any discharge observed from any part of the operation? ❑ yes E}No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑yes 0-ISfa
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ©-No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 9 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes BWo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes SNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ».!.................. ............... »....................... ......... ......... .... ............................ ..... ».-.................... ...............................
Freeboard (inches): 33
12112103 Continued

a Facility Number: � -
Date of Inspection •..1'7 •o
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes LJ <o
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes Q-No
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 2- o
8. Does any part of the waste management system outer than waste structures require maintenance/improvement? ❑ Yes 9N-o
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
2-K-o
elevation markings?
Waste Application
10.
Are there any buffers that treed maintenance/improvement?
❑ Yes
❑-Ko-
l 1.
is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
❑"N-6-
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12.
Crop type �.Ra Z a-,, el . �_o . _ Age ram; Sn,� C 4 "a
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWNip)?
❑ Yes
[3-No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
[ No
b) Does the facility need a wettable acre determination?
❑ Yes
9-go
c) This facility is pended for a wettable acre determination?
❑ Yes
UNo
15.
Does the receiving crop need improvement?
❑ Yes
13-No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
[ 0
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes Q-No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 0-No
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 El Yes [J-'No
Air Quality representative immediately_
Comments {refer to gtiesaon #)t Elam auy�YES en and/or atay iuueudattoias or any ofner cntt�enis
y_
Use drawttsgs of facslity to better p sttnattbns (ase addiaoaal pages as Ue essary) teld Copy ❑ Final Notes
Reviewer/Inspector Name Y !'
r .r.,a
Reviewer/Inspector Signature: Q Date: _o y !,^
12112103 Continued

Facility Number: y —cj)4 Date of Inspection:
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
✓ .� 5
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
N! PDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33_ Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form [:]Crop Yield Form ❑ Rainfall [:]Inspection After F Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes
❑ Yes [ o
❑ Yes ErNo
❑ Yes ❑-No
❑ Yes a+- o
❑ Yes QNo
❑ Yes Dilq-o
❑ Yes C -go
❑ Yes B-No
❑ Yes 9Na
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
12112103

Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
FaciliPv Number
Date of visit: ` `G73 Time: 3 ': 3
-• not O erational 12 Below Threshold
Permitted U Certified [3 Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: — P. v V, a rw% ¢ e r•% s County: M=42 s n.-+
Owner Name: LS Q.v _ � hap" - Phone No:
Mailing Address: of 3 9 / j 3 j a C_ W� G Cc.� �• gf l;g, fa v . NC
Facility Contact: S a � c Title:
Onsite Representative: _S c .— ,_„_,. „—•,,,,,•—
Certified Operator: & A-
Location of Farm:
Phone No:
Integrator: /•"re.c 4Q� e-
Operator Certification Number: A Z 7
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' " Longitude '
Design Current
Swine f anariry Pnntdofinn
❑ Wean to Feeder
Feeder to Finish
I I01
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design; Current "Design,' ;:_ Current
Ponhtn. Ca aciitr• Population Cattle Capacity > Po alatton _.
❑ Laver ❑ Dairy
❑ Non -Laver 10 Non -Dairy
❑ Other
Total Design Capacih,
Total SSLW
Number of Lagoons ❑Subsurface Drains Present ❑ Lagoon Area ❑ S rav Field Area
:_.
Holding -Ponds / Solid Traps p ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in galimin?
d. Does discharge bypass a lagoon system? (If yes. notify DWQ)
2. is there evidence of 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?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Freeboard (inches):.`
Structure 5
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
El Yes
❑No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
Structure 6
05103101 Continued

.4
Facility Number: — 5!
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes 0 No
❑ Yes P No
❑ Yes t No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes [P No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes Q No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes Q No
11- Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes Z` No
12. Crop type a,. /, ce 4 -40494 C CZAAes
13. Do the receiving crops differ with those designated to the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 99 No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes EQ No
b) Does the facility need a wettable acre determination? ❑ Yes R] No
c) This facility is pended for a wettable acre determination? ❑ Yes [j5 No
15. Does the receiving crop need improvement? ❑ Yes [D No
16. Is there a lack of adequate waste application equipment? ❑ Yes CR No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
r] No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps. etc.)
❑ Yes
® No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
® No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
® No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
® No
(ie/ discharge, freeboard problems, over application)
23-
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[I No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
(� No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
(P No
[P No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Gamments'(refer. to questions #)w 'Explain any_:YES_attswers aadlor_ any recommeisdatzons:or s>zv. other conirnents. -
..lice draa­sfgs of facdp6to better explain sitnation&" (use addttsonal pages as ueeessar�) _^
-. Field Conn ❑ Final Notes
p) r J 4 g i 0 .. P 10 A J �S t L✓ � e .4+ p 0,F.X �.
�Qrr.r /J �n C�dC9t COhcrQ��ipµj cl ��LP3 FbGdC rc-e-a, J
H.,
Reviewer/Inspector Name
Re-dew-er/Inspector Signature: Date:
0510310I Continued

Information contained in this database is from non agency sources and is considered unconfirmed.
Farm Emergency CaCaU Form
DWQ Facility Number
82 — 26
Date
11/19/2002
Farm Name
Time
3:15
Parham Farms
Owner First Name
Ben
Control Number
1691
Owner Last Name
Pa rl1—am
O Reporting O Complaint
Source
Plan Due Date
Date Plan Date Freeboard
Inches
(? equals blank)
Received Level OK
Breached
O Yes O No Freeboard Lagoonl
111121I2002
I j 111/27/2002
Depopulated
O Yes ONO -
I Freeboard Lagoon2
?
Overflowed
O Yes O No
LQ Issue
Freeboard Lagoon3
O Yes ONE?
?_
Perm issianToPump
Q Yes ONO
Freeboard Lagoon4
?
Inundated
O Yes O Na Freeboard Lagoons
?
Flooded
10 Yes 0 No Freeboard Lagoon6
7
Pumping Equipment
O Yes ONO
Comments
:ailed in 18" freeboard. Indicated that he will be able to lower freeboard level within a
:ee.Is... W..aiting.fln.fields,.1A_dry-.Qut..._..----.._.._.._.-_ -.