820519_INSPECTIONS_20171231

wm
NORTH CAROLINA
Deparbnent of Environmental Qual

im
Type of Visit: Q<ompliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: (3riTo-utine 0 Complaint O Follow-up Q Referral Q Emergency O Other Q Denied Access
Date of Visit:
/1 Arrival Time:
Departure Time:
County: Region:
Farm Name:
���; �/�-y-�L'7 �Qd�i�
Owner Email:
Swine Capacity Pop.
Wei Poultry
Capacity
Owner Name:
Eattle Capacity Pop.
,may
Phone:
to Finish
Layer
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: S' Integrator: vd
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Dischar es and Stream Impact
1. Is any discharge observed from any part of the operation?
Discharge originated at. ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2_ Is there evidence of a past discharge From any part of the operation?
3_ Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page I of 3
[:]Yes J&No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
[-]Yes ❑No
❑ Yes Jallo
❑ Yes L No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
2/4/2014 Continued
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wei Poultry
Capacity
Pop.
Eattle Capacity Pop.
to Finish
Layer
Dai Cow
to Feeder
Non -La er
Dai Calf
er to Finish
Dai Heifer
w to Wean
[Farrow
Design
Current
Cow
to Feeder
D . Pouf
Ca aci
P.o
Non -Dai
w to finish
La ers
Beef Stocker
HNon-I a ers
BeeF Feeder
s
Pullets
Beef Brood Cow
Teske s
t?ther
Turkey Poults
Other
10ther
Dischar es and Stream Impact
1. Is any discharge observed from any part of the operation?
Discharge originated at. ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2_ Is there evidence of a past discharge From any part of the operation?
3_ Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page I of 3
[:]Yes J&No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
[-]Yes ❑No
❑ Yes Jallo
❑ Yes L No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
2/4/2014 Continued

Facility Number: - / `j' jDate of Inspection:
4 Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes V5 -No © NA ❑ NE
a. If yes, is waste level into the structural freeboard? Q 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 ofthe structures observed? ❑ Yes C,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
Q Yes
[2,No
❑ NA
❑ NE
waste management or closure plan?
M No
❑ NA [-]NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DVM
7. Do any of the structures need maintenance or improvement?
❑ Yes
[a No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[ZNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minutc Inspections [:]Monthly and I" Rainfall Inspections
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
n No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
® No
[] NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN 0 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): X -r -'s
13. Soil Type(s):
14. Do the receiving crops differ from those designate in the CAWMP?
❑ Yes
FX, No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[2�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
J&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
M No
❑ NA [-]NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
M 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.
D Yes
�R(No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minutc Inspections [:]Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[a No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No ❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Facili Number: - Date of Inspection: Q:— •—/1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes MNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes CK 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 NJ No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 2[No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
F] NA E] NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
[:]Yes ® No
[:]Yes ® No
[—]Yes No
❑ NA ❑ NE
E] NA E] NE
❑ NA ❑ NE
Phone:
/d ,;70 `" &
Date:
V4/2014

Type of Visit: ompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: routine O Complaint O hollow -up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: p Departure Time: : O o County: S� 0s Region: fZ
Farm Name: [,� n V�r� r—. �—
Owner Name: }�� ryi r D c yC
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
697rrc i%11JB �r Title: 74,•:dos-�
Integrator: lxueA4 ay-oLcrw-
-e /
Certification Number: lgD78'
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number:
Latitude: Longitude:
Discharges 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 DWQ)
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes [E,No ❑ NA ❑ NE
[:]Yes ❑ No
Q Yes ❑ No
❑ Yes ❑ No
❑ Yes LM No
[:]Yes allo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 2/4/2011 Continued
Desi n�Current°
j 41
� I Design Current
Desi Current `*w`r:fDa
Swine
CapactyPop
_-
Wet Poultry
I
Capac�tyP pCCapacity Pop.
_:::...
Weto Finish
La er
Dow
Feeder
p pa
Non—Layer
Daalf
Weto
Feeder to Finish
, . Daeifer
Farrow to Wean
Design Curieiit ,tr Dw
Farrow to Feeder
D : P,oult .
Ca aci . Po w' N'
Farrow to Finish
Layers
Beocker
Gilts
Non -Layers
.. Beeder
Boars
Other
i�
`�
Pullets
Turke sTM.,
TurkeyPoults
Beood Cow
Other
Other
Discharges 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 DWQ)
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes [E,No ❑ NA ❑ NE
[:]Yes ❑ No
Q Yes ❑ No
❑ Yes ❑ No
❑ Yes LM No
[:]Yes allo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 2/4/2011 Continued

Facili Number: - Date of Inspection: /0-10-13
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [SNo ❑ 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): Ct ��_ �g
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes S 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
5g No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
f@ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ELNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
J�A No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground Q Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN,> 10% or 10 lbs. ❑ Total Phosphorus [] Failure to Incorporate Manure/Sludge
into Hare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAW MP?
❑ Yes
[R No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
0 NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
4 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
JRJ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
R 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.
❑ YesLai
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[4 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
LR No
❑ NA
❑ NE
Page 2 of 3
2/412011 Continuer!

IFacWty Number: - Date of Inspection: --(p
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below. T
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32_ Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[j No
[DNA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes [M No ❑ NA ❑ NE
❑ Yes E4 No ❑ NA ❑ NE
❑ Yes © No ❑ NA ❑ NE
❑ Yes No
❑ Yes ® No
❑ Yes JEJ No
❑NA [j NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer:to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawin' L of`fati ty`to better explain situations (use additional sages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: gyp - 3301'
Date: /Q /0 -..,2a0
2/412011

d V Z ob 0 :1q�,_
Type of Visit: ompliance Inspectiou 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: D Departure Time: I 1 County:Sa,.ngRegion:
Farm Name: LA, ry � ✓ er– 5 Owner Email: �'—
Owner Name: z�- r ✓ S 0.ti,--4G,3"e__ Phone:
ir
Mailing Address:
Physical Address:
Facility Contact: ,t / /lit'r--r— Title:
Onsite Representative: S�
Certified Operator:�!`d,
Back-up Operator:
Location of Farm:
Latitude:
r• Phone:
Integrator: �
Certification Number:
Certification Number:
Longitude:
Swtne
Wean to Finish
Design Curren �a g z rrent '
Ga aci Pin _+W t ult °, Cae ac CPr
P ty P rY P P ,
Layer �,
Design Current
C attle Capacity Pop.
Dairy Cow
Wean to FeederNon-La
er
Dai Calf
Feeder to Finish
Farrow to Wean
- -
D .l',oul@a
Design
aci
°'
Current
P,o
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars Pullets
Beef Brood Cow
Turkeys
ME_ ...
Other
Turkey Poults
Other
r Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes CZ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
[:]Yes No
[:]Yes No
❑ NA ❑ NE
[DNA ❑ NE
❑ NA ❑ NE
❑ NA [] NE
❑ NA ❑ NE
Page I of 3 2/4/2011 Continued

Facility Number: ,'�2— - / `j Date of Ins ection:
allo
❑ NA
❑ NE
❑ Yes
Waste Collection & Treatment
❑ NA
❑ NE
❑ Yes
allo
j 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[2�No
[:INA
❑ 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): I t i 19
Observed Freeboard (in): (e, Q
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
E0 Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[g Yes
Lff'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
[E[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): I7? l_�"j
13. Soil Type(s): `56
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
XLNo
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ Yes Eg-No ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
[:]Yes ENo ❑ NA ❑ NE
❑ Yes ,ES No ❑ NA ❑ NE
❑ WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
.21. Does record keeping need improvement`? If yes, check the appropriate box below_ [:]Yes M_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 ANo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑N
Page 2 of 3 2/4/2011 Continued

Facility Number: Date of Inspection: E2-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes RNo ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes EZ[ 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 stmeture(s) and date of first survey indicating non-compliance:
25. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes RNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes fa No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
LL �
f411
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes IXC No ❑ NA ❑ NE
❑ Yes EQ No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes IQ No ❑ NA ❑ NE
❑ Yes qNo
❑ Yes JR No
❑ Yes [3,No
Phone:
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Date:
2/412011

f.S
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Q) Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ; 3 Q Departure Time: County: Region:
Farm Name: 61,nL� y rwef7--
Owner Name:yz
Z'rl�1
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
t Title: ;;;,:;kl
Integrator:
Certification Number:
Phone:
Onsite Representative:
Certified Operator: Y447r /iG
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes EE�No ❑ NA ❑ NE
❑ Yes
Design Current . Design
Current
Design Current
Swine
Ca aci Po�� -„
p ty p Wet Poultry Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
can to Feeder
Nan -La er
Dairy Calf
eeder to Finish
Dai Heifer
Farrow to Wean�"��'
Design
Current
Dry Cow
Farrow to Feeder`
-
D Poultry -�Caaci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
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 EE�No ❑ NA ❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
[:]Yes ®„No
[:]Yes allo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 2/412011 Continued

' Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfal)) 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
❑ NA
Identifier:
15. Does the receiving crop and/or ]and application site need improvement?
❑ Yes
® No
Spillway?:
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Designed Freeboard (in): 19
❑ NA
❑ NE
acres determination?
Observed Freeboard (in): � 1( 3 _?y &ro
5. Arc 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.)
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[2 No
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
0 No ❑ NA
❑ NE
waste management or closure plan?
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
eat, notify DWQ
7. Do any of the structures need maintenance or improvement?
.Yes
t2rlVo ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
0 No ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
6No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance a]tematives that need
❑ Yes
A No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below, ❑ Yes LEkNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
S No
❑ NA
❑ NE
15. Does the receiving crop and/or ]and 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
[Z No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
F No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[2 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
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 ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" 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
E] NA 0 N
❑ Weather Code
❑ Sludge Survey
❑NA E] NE
0 N ❑NE
Page 2 of 3 2/4/2011 Continued

t Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Ig No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 55r—yes 1:1 NA [:]NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [3 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
[:]Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
[:]Yes
® No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
Comments
.frefer to question ft Explain any YES answers and/or any additional recommendations or any other commeuts F;. "
Use drawings.of facility to better explain situations (use additional pap -es; as necessary). .. A . ;
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: L�-3'Dp
Date. A) F //
2/4/2011

14'
Type of Visit OFC-o—mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date or Visit: Arrival Time: Departure Time: // r PO County: Region:
Farm Name: ,t 17 . V �fr5j�! iv��k�� _ _ _ Owner Email:
Owner Name: 'C`Ui E= �;S _ 1l'P�,.yCcc�7� Phone:
Mailing Address:
Physical Address:
Facility Contact:���!/i r 1 <<'/ `TitleC/IT �� Phone No:
cam'
Onsite Representative: v 4 r ntegrator:
Certified Operator: r Operator Certift tion Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =o =. 0 Longitude: =° =' ="
Discharges & Stream Impacts
1. is any discharge observed from any pan of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 Zj No ❑ NA ❑ NE
❑ Yes
Design Current
Design C+nrrent
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
C►attle Capacity Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feeder p
❑ Non -Layer
❑ Dairy Calf
❑ Yes
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Ponitry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non-Daiix
❑ Farrow to Finish
❑ Layers
❑ Beef Stucker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
Brood Co
❑❑Beef
Turke s
Other
❑ Other I❑Other
❑ Turkey Poults
Number of Structures:
'"#�
Discharges & Stream Impacts
1. is any discharge observed from any pan of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 Zj No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes P?No
❑ Yes X[No
❑ NA ❑ NE
El NA ❑NE
Page 1 of 3 12/28/04 Continued

Facility Number:—� Date of Inspection /D
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
Waste Collection & Treatment
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes M No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA EINE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier,
Spillway?:
Designed Freeboard (in):
12.
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes §9 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
13.
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes CRLNo ❑ NA ❑ NE
through a waste management or closure plan?
14.
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 IS No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
Cl Yes ® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ NE
9. Does any part of the waste management system other than the waste structures require
W yes [:]No ❑NA CINE
maintenance or improvement?
17.
Waste Application
9No ❑ NA
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 'LNo ❑ NA ❑ NF
maintenance/i mprovcment?
f,No ❑ NA
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
C&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)
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CA WMP? ❑ Yes
No ❑ NA
❑ NE
15_
Does the receiving crop and/or land application site need improvement? ❑ Yes
No ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ yes
No ❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
9No ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
f,No ❑ NA
❑ NE
Reviewer/Inspector Namey. C
Phone:` 20 =69133ee
Reviewer/Inspector Signature: Date:
Page 2 of 3 12/28/04 Continued

a
Facility Number: / Date of Inspection
Reciuired 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 ER No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [Z 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
CZ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
10 No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EffNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
allo
❑ 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
10 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[4 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
0 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
R Yes
❑ No
❑ NA
❑ NE
Additional Comments andlar Drawings:
w 6z u, _ Fb r loin—ul� 7 '0"
Page 3 of 3 12!28/04

z — 16,— ZOd i
Type of Visit (oTompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit erfoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: /D.,30 Departure Time: County: Saa/
Farm Name: 61AI/ Owner Email:
Ownor Namr- /j1GY V! L /� n/U/L*117�� phnnP-
Mailing Address:
Physical Address:
Facility Contact: G/Lt_r- 461 -e --Title: Sp��' �J_� Phone No:
Onsite Representative: Integrator:
K X51 P car K.
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Region: /540
Location of Farm: Latitude: [=O
=4
=66 Longitude: = ° 1—_1' =
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry C►apaclty Population
Cattle Capacity Popul2non
❑ Yes
❑ Wean to Finish
❑ Layer
I I
iry Cow
i Calf
Wean to Feeder d$55 1/08575 110 Non -Layer
El Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Giits
❑ Boars
Dry Poultry
❑ Layers
on -Layers
Pullets.
❑Pullet
❑ Turkeys
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Cow
Other
❑ Other
❑ Turkey Poults
❑Other
Number of Structures:
[INo
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
EINE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
/
a. Was the conveyance man-made?
❑ Yes
❑ No
,LJ—M"AA
[INE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
ElYes
[INo
M'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
El NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes❑
VNo
NA
❑ NE
other than from a discharge?
12/28/04
Continued

6 b
Facility Number: gZ - J6 j9
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structurco Structure 4
Identifier: Lrc�' /� ?_f 4l3 rNs�d y
Spillway?:
Designed Freeboard (in): `` Ncf uttd
Observed Freeboard (in): 26-
5.
6-
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes Nom ElNA ElNE
EJYes BIgo ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 2 o ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ErNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? L_f No
(Not applicable to roofed pits, dry stacks and/or wet stacks) ❑Yes 3< F-1 NA El NE
9. Does any part of the waste management system other than the waste structures require ❑ Yes D tvo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes' �No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P'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. Croptype(s) f�e�it(��a. (6�-01.� �i�+4�! Gr�e'�/ a!D.S•J �r/V
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yeslamo ElNA ElNE
15. Does the receiving crop and/or land application site need improvement? ElM Yes o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, F1 Yes E No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes Doo [:1NA
ElYes D o ❑ NA
❑ NE
❑ NE
Reviewer/inspector Name :/�� j Phone 9/19 ' 5CR3 . 336-0
Reviewer/Inspector Signature: Date: Z -/4$r Zl��
12/28/04 Continued

Facility Number: —.5 q Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes CjNo ❑ NA ❑ NE
the appropirate box. ❑ W LJP` ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Et"5o_❑ 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
�io
❑ NA-
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
R56
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
OZ
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
10
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[��, m
El NA
El NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
Ivo ❑ NA
❑ NE
Other Issues
� �
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
%?fo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
2<"❑
NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
El Yes
��
o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
CrNo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

t3.i s- 0 8 -- 0 9 - --
Type of Visit &Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: /i. /S!i¢, Departure Time: //; f' County: pi,/ Region:
Farm Name: _ !u; V r tri, & f -r r.,.r. Owner Email:
Owner Name: /7'14 Phone:
Mailing Address:
Physical Address:
Facility Contact: _. f� e— it 1U _Title: Phone No:
Onsite Representative: �� a Integrator: V,
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: =0
= ="
Longitude: =0=4 °=4
F/20
> esrgn * C rreot
_` Desigq -
lg ry .n
Current
�
SwineCapacrty Popuiarion
jEftpurrent
We# Poultry Ca�aty Po matron
Cattle Ca aci Population
p
Ea<
❑ Wean to Finish
❑ La er
2<A
❑ Da' Cow
❑ Yes
❑ No
® Wean to Feeder d
3<o
❑Non -La er
❑ NE
❑ Da' Calf
0-r1o'
Feeder to Finish
_; rw .. __,_.
Da�y Heifer
❑ Farrow to Wean
'-
Dry Poultry
❑ Da Cow
El Farrow to Feeder
.
'' `'`
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
-
❑ Turkeys
Other s
❑ Turkey Poults
❑Other
❑ Other
Number tsf Structures:
Discharges & 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 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'?
[I Yes 9< El NA El NE
❑ Yes
❑ No
�A
❑ NE
❑ Yes
❑ No
Ea<
❑ NE
2<A
❑ NE
❑ Yes
❑ No
❑ Yes
3<o
❑ NA
❑ NE
❑ Yes
0-r1o'
❑ NA
❑ NE
Page I of 3 12128/04 Continued

Facility Number: irz— /
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: sc r of 1Z :;f- 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2 i
❑ Yes �B<o ❑ NA El NE
❑ Yes L7 Ro ❑ NA ❑ NE
Structure 5 Structure 6
27 33
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes eo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) ��
6. Are there structures on-site which are not properly addressed and/or managed El Yes [I o ❑ 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? [3 Yes B No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes U oo ❑ 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 21o ❑ NA [--IN E
maintenance or improvement?
Waste Application ,--,�
10. Are there any required buffers, setbacks, or compliance alternatives that need [I Yes l_TNo [INA ❑ NE
maintenance/improvement?
IL . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑'go' -_0 NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc,)
❑ FAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [I Application Outside tof Area
12. Crop type(s) ze-y � �G r�� �� �✓w+-f/I CSM C Q 0 COrAj _
13. Soiltype(s) B&B fLA
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes O Noo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes D No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [ �o ❑ NA ❑ NE
❑ Yes Ll No ❑ NA ❑ NE
tiCoaaments (refer to ueshon # Elatn an answers
q } p y YE3° any reco men�dations or any other coiin�nents.
Ute drawings of facility to bet#erexplata�sttuahons. (usdditional pages asnecssary,):
qV
Reviewer/inspector Name Phone;/Q. X33.3330
Reviewer/inspector Signature: Date: 1Z ya —Zoo 8
Page 2 of 3 12128/04 Continued

4 R
Facility Number: ?Z j/�j Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes B<o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes L1 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design [:1 Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ffNo ❑ 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 B o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Lao ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
L"I' o
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
B<o
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes LsNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes E oo ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
E3<o
❑ NA
❑ NE
❑ Yes❑'lgo
❑ NA
❑ NE
❑ Yes
L"1 iso
❑ NA
❑ NE
❑ Yes L7 iso ❑ NA ❑ NE
❑ Yes 21'To— ❑ NA ❑ NE
[:]Yes L- 1t o ❑ NA ❑ NE
AddzbonalkComnlents andlar Drawings t*<EM.
.z�r.
AL
Page 3 of 3 12/28/04

if - - .T1fj-! � 1Z -/y- 4,90 7
G Division of Water Quality
Facility NumbergZ .J / 9 O Division of Soil and Water Conservation
O Other Agency 11
Type of Visit 0 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: J2 -//'d% Arrival Time: p Departure Time: 20 County: S4±149tc/ Region: Z -Q
Farm Name: dtl;yxsi lam,_ )ea k A ^� Owner Email:
Owner Name: 1�%r Vie �wcwr:, ., Phone:
Mailing Address:
Physical Address:
Facility Contact: Gam'-Sc+r AAa cnr jr-_ Title: ` -� r Phone No:
Onsite Representative: Uu ne!- _. Integrator: .A nJ
Certified Operator: e-rui t_ deNf y e-ti-0.�- Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: Eo =11 =4 Longitude: =o=, =v
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑
Layer
& SSD ❑ Non -Layer
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?
b_ Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heife3
❑
Dry Cow
❑
Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
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
M No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[jNo
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes El No ❑ NA ❑ NE
11/28104 Continued

Facility Number:2—,`j-1
Date of Inspection 77-//-07
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier.
❑ Yes V] No
❑ Yes ® No
Structure 5
0 N 0 N
❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in): 19 g
Observed Freeboard (in): z & 9
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes P No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not property addressed and/or managed ❑ Yes C� No [INA ❑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 7 No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [3 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need []Yes M No [-INA ❑NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [�'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside.of Acceptable Crop Window [] Evidence of Wind Drifi ❑ Application Outside of Area
12. Crop type(s) trs V.
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes %V] No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes VpNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes [ANo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 54 No ❑ NA ❑ NE
❑ Yes ONo ❑ 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 IZr LK We-Ve—f—& Phone: 9/0 , X33. 3300
Reviewer/Inspector Signature: Date: %Z - a2 --D7
12/28/04 Continued

I .. :.
Facility Number: S2 —Sj Date of Inspection
Re aired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [A No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [g] No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes q 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
E�,No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
RNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
q 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
El NA
El NE
Other Issues
r
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility tail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Pd No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
(� No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12/28/04

fA 1r f r
Type of Visit Q Compliance Inspection O Operation Review ® Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:- a6 - o Arrival Time: %/: Z Departure Time: 11.35 County: 7�+�KDS�� Region: ���
Farm Name: Owner Email:
Owner Name: aNy d Int- 11o�yCjt-f _ .... Phone: 7Z' 906T
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ 0 ❑ 1 ❑ 1{ Longitude: 0 0 ❑ ' ❑
Design w . Current
❑ Yes
Design. Current
Design Current
Swine Capacity Population
Wet Poultry
tvt:;�
Capacity }Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
a_ Was the conveyance man-made?
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Laver
NE
❑ Dairy Calf
Feeder to Finish5
❑ No
.:: _._.._�_.
❑ Dairy Heifer
❑ Farrow to WeanDry
Poultry
ry FL
ElD Cow
❑ Farrow to Feeder
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
-
El Non -Dan
❑ Farrow to Finish
❑ Layers
2. Is there evidence of a past discharge from any part of the operation?
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
NE
❑Beef Feeder
❑ Boars
❑ Pullets
❑ NA
❑Beef Brood Co
=-_ -
Other
❑ Turkeys
❑ Turkey Poults
;
❑Other
❑ Other
11/28/04
NumberofStnsetures:
Discharges & Stream Impacts
. Is any discharge observed from any part of the operation?
❑ Yes
❑ No
❑ NA
[XNE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made?
❑ Yes
❑ No
[INA
NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
FINE
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
Im NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
❑ NA
NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ yes
❑ No
❑ NA
NE
other than from a discharge'?
Page I of 3
11/28/04
Continued

Facility Number: Date of Inspection
Waste Collection 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 Structurco Structur& StructurAo
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 25-
5.
S5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement'?
Waste Application
14. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes. check the appropriate box below. ❑ Yes ❑ No ❑ NA [�d 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)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
19 NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
P NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?
❑ Yes
❑ No
❑ NA
IP NE
IT Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
I31oNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
P NE
Com.ments,(refer to question #): Explain any YES answers and/or any recommendations or any other comments
Use drawings of facility to better explain situations.use a4wo' nal pages as necessary)
74 %5 %A%>�o t 4fr'.O-✓ w� s ' !fes,.. /�L•�l s,. t4disS.
Reviewer/Inspector Name I i' �vc� '� -- — ] Phone:
Reviewer/Inspector Signature: Date, j —fJ e, -Zoo
Page 2 01-3 11/18104 Continued

Facility Number: f j/ 1 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA �tNE
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 ❑ Desi Mas 1
Design ❑ p ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes ❑ No ❑ NA P NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
C 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
R NE
27.
Did the facility fait to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
R2 NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Cl Yes
❑ No
❑ NA
NE
29,
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
®EVE
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
P9 NE
Page 3 of 3 12/28/04

7
Facility Number S')
❑ Yes [9
hype of visit
IV isibn of Water Qualityo
O Devtsion of Sol and Wafer Conservat�onA`F
Q Operation Review O Structure Evaluation
/
z�
Reason for Visit
s O Other. Agency
O Follow up Q Referral O Emergency
Facility Number S')
❑ Yes [9
hype of visit
Inspection
Q Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
,,,�compliance
06- outine O Complaint
O Follow up Q Referral O Emergency
O Other ❑ Denied Access
Date of Visit: Arrival Time: Q -� O Departure Time: `. �a County: �`� Region:
Farm Name: u- U Owner Email:
Owner Name: ? Yer iV rG 7T • eKPhone:
Mailing Address:
Physical Address:
Facility Contact: � ��/� rLtr AZ7&*j yy ! ' Title: Phone No:
Onsite Representative: Integrator: _� r Jz/W
Certified Operator: _. ,5.� Operator Certification Number: 9-D7i�
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: ❑ o ❑ 4 � �, Longitude: ❑ o = f u
Design Current Design Current Design Carr
Swine
Capacity Population Wet Poul
p ty p try Capacity Population Cattle Capacity Population
❑ Wean to Finish
Wean to Feeder DO
❑ Feeder to Finish
i
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars _..
Other.
❑ La er
❑ Non -Laver
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ TurkeyPoults
❑ Other
❑ Dai Cow
❑ Dai Calf
❑ Dai Heifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structu
Discharges & 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 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?
Page 1 of 3
No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes CKNo [INA ❑NE
[:]Yes a
12/28/04 Continued
llo
❑ NA
❑ NE
12/28/04 Continued

' Facility Number: — Date of Inspection ��
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes [No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes JA No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): L� j
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes [A No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes ® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
® Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes N No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[--]Yes ®No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ®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 El Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) `pis—c n4 u d e �AU�d`�✓v�
13. Soil type(s) "? �a,>n"ti-,.--
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 acre determination ? ❑ Yes K No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes E4 No
❑ Yes Usk
El NA El NE
❑ NA ❑ NE
7Ile koLG , aC2 j V�rd �t O � J Ya ,n , `� Y� 1l a B1J �P rS %�a� /1 �r�9c �o b � y
7a pw vcd- or PG it r"' eo , AV KC -6 /-,7- r MAP -41.
47MIk- ltlfdj Lr. llolafker _ L 4� v{ ^1Y �L-A I17 iUccc� }U�r [.C1c�
a
Reviewer/Inspector Name`4�._�-
_ Phone: /�-- 33- o0
Reviewer/inspector Signature Date:
n ---
Is- 1
l/,./GWV7 v�isss��K�.r

Facility Number: Date of Inspection�`�
1• Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes X No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes BNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps p ❑Other \
21. Does record keeping need improvement? If yes, check the appropriate box below. .9 Yes tfNo ❑ NA ❑ NE
21 Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
3 1. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
[UNo
❑ NA
❑ NE
❑ Yes
10 No
❑ NA
❑ NE
❑ Yes
Q No
❑ NA
❑ NE
❑ Yes
Q No
❑ NA
❑ NE
❑ Yes
91 No
❑ NA
❑ NE
❑ Yes
[R No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
[.No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
®No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NG
Additional Comments and/or Drawings:
a
C. ew._ rico res
Page 3 of 3 12/28/04

0
Fac>!1�fyNumper^ 8a��� , SI
0 Division of Water Quality
0 `Division.of Sail and Water Cooserrattoa
Q Other Agency _
Type of Visit i Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: j0; S Departure Time: County: C --I _ Region: f�0
� Faiyy
Farm Name: U�,v_c1.s:. r� —.Ea i Owner Email:
Owner Name:... _.� f/e�r,;e fi✓�e�rG Phone: IA2-S9-7- Sa6857,&--75 1U
Mailing Address: FS -6
Physical Address:
Facility Contact:
Title:
Onsite Representative: _Ye,_,.�- Ha.�P�c-7`4 _
Certified Operator:fl-Crr��
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
can to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
eaxl ox
Phone No: 4i97 -19,9-R6&
Integrator: At"o &W..�
Operator Certification Number:
Back-up Certification Number:
Latitude: Longitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ La er
�,�� ' ❑ Non -Laver
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkevs
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifet
❑ Dry co",
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: a]
b. Did the discharge reach waters of the State? (If yes. notity DWQ)
c. What is the estimated volume that reached waters of the State (gallons)'?
d. Does discharge bypass the waste mana�aement 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 04 ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
EINE
❑ Yes
0, No
[-IE Yes
No
❑ NA
EINE
❑ Yes ff No ❑ NA ❑ NE
12/28/04 Continued

L .
Facility Number: — Jr
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: 1 2
Spillway?: .� o
Designed Freeboard (in):
Observed Freeboard (in): '7 '
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes FSNo [:INA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes [3 o ❑ NA ❑ NE
❑ Yes [�FNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑Ko ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑Ko ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Z*No ❑ NA EINE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [1!o ❑ NA ❑ NE
mai ntenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes Q -<o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
5 O 1'10
12. Crop type(s) 6-,e a
13. Soil type(s)
14_ Do the receiving crops differ from those designated in the CAWMP? ❑ Yes BIN' o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
ErNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
[XNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
21'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
IQNo
❑ NA
❑ NE
Reviewer/inspector Name �5 _ Phone: `j/0- �W, -/VV/ exA17
Reviewer/Inspector Signature: Date: `] -/ 3-01—
12/28/04 Continued

Facility Number: 82 —j-/dy Date of Inspection
i&eguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? 'es ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ©moo ❑ NA ❑ NE
the appropirate box. ❑ �,r� Che sis ❑ D,pio ❑ I)Ars ❑ 9iw
21. Does record keeping need improvement? If yes, check thea priate box Belo . 9 -'?'es ❑ No El NA [:1 NE
1/-,? /. _7 - / 0 -a /.
❑ 2<eekly Freeboard ❑ ❑
Dlainfall ❑ Stee� [Crop Yield 52<20 Minute Inspections ED4v nthly and V Rain Inspections �eather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Otber Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
Q'glo
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
E3 AXE
❑ Yes
❑ No
❑ NA
0-9E
Yes
El,
L4� o
❑ NA
❑ NE
El Yes
2<
[:1 NA
[__1 Yes
[__1 No
❑ NA
,,❑__,,NNE/E
11 ' E
❑ Yes
D o
❑ NA
❑ NE
❑ Yes
CJ<o
❑ NA
❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes B No ❑ NA ❑ NE
❑ Yes 9'1 o ❑ NA ❑ NE
❑ Yes 9' io ❑ NA ❑ NE
Additional+Comiittents-and/or Drawings:Y
Glnfi[ 6e4--f,-cJj✓ of Covera9C uds n04 an S•tC �/1S�oec)�r lr►rjJ
rnOL 1 CA �pr,
Please,/
�eeP weele/y �rtt�o-6/ eec&r l
/_20
/
�n✓�� � hsPeL���dnf � �ert�j� G�ell
r r.
AJO �a9oe� �Lvar'S rCC r���/
S� n Ce J A►t If
V ; J Ip J:
o„ r� any 6e SGn
12/28/04

t
IType of Visit 0 Compliance Inspection Q Operation Review Q Lagoon Evaluation I
Reason for Visit a Routine (_D Complaint Q Follow up O Emergency (Notification 0 Other ❑ Denied Access
Faciliry Number
Mtr of Vkit: J1'O Time: q'
p hot erationa! 0 Below Threshold
. ermined,.,�e~rtified ❑ Conditionally Certified Q Registered Date Last Operated or Above Threshold:
Farm Name: 1�,'y / For^ � _ Count': _,.�in,dsen 1�LL
Owner Name: 62ez //d L10, 'e L10 eg c_v_l- Phone No: 910 - S`>> - SOG $
Mailing Address: _ to v , Ro,r g� �5 - - - �%, n ort NL -;2 9 3 2
Facility Contact: Her,..' fro»r�itle: Phone No:
a 6/iL
Onsite Representative: HPrv,'e , /yy. rr.Integrator: - rroll .. _
Certified Operator: _ He/ ✓- r HD w. Operator Certification Number:
Location of Farm:
W?gwine ❑ Poultry ❑ Cattle ❑ horse Latitude ' 4 :. Longitude '0.4
Design Current
Swine (inn.2ritr Pnnnia"on
EKean to Feeder G -goo '!G u U
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultn Capacity Population Cattle CarlaciN Po ulation
Laver JL� Dain,
❑Nan -Laver �1[3
Non-Dain°
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons l .Z I JLJ Subsurface Drains Present HU Laigbou Area JU Spriv Field Area
Holding Ponds / SoUd Traps_ No Liquid Waste Management System
Discharges & Stream Impacts
3. Is any discharge observed from any pan of the operation? Eld r ❑ No
Dischame originated at: ❑ Laaoon ❑ Spray Field ❑ Other
a. If discharge is obsen.ed, was the conveyance man-made? ❑ Yes ED16)
b. If discharee is observed, did it reach Rater of the State? (If yes. notif}, DWQ)
ED Yes Uxo
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If ves. notify DWQ) ❑ Yes [;-,141��'o
2. Is there evidence of past discharge from any part of the operation?
El Yes L�'!vo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [3'1vo
Waste Collection S "treatment
4. Is storage capacity (freeboard plus storm storage) Iess than adequate? ❑ Spillway ❑ Yes Qa o
f w --Structure 1 Structure ? Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Frceboard (inches):
05103101 Continued

Facility Number: 6,7 — S/ 11 Date of Inspection 7/'U
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ yes 01Va
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes R<O—
(If any of questions 4-6 was answered yes, and the situation paws an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes El No
S. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes [}N�
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes L1q-0—
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [ 2N67—
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN []Hydraulic Overload
❑ Yes
elgo
12.
Crop type llr2.yI'l (~C,// xe" , n .
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
E�X-o
14,
a) Does the facility lack adequate acreage for land application?
❑ Yes
[ o
b) Does the facility need a wettable acre determination?
❑ Yes
[ G
c) This facility is pended for a wettable acre determination?
❑ Yes
oto
15.
Does the receiving crop need improvement?
❑ Yes
0-50
16.
Is there a lack of adequate waste application equipment?
❑ YesEJ-Ko
fired Records & Dpcuments
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? Ods ❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(tel l�vie#is'1�,srgtl usaps✓ctc.) ❑ Yes [�ivltf
19_ Does record kee ing need improvement? (ie/ ' ' ton, �r usw sis & Yes [> 0
20. Is facility not in cdmpliance with any applicable setback criteria in effect at the time of design? ❑ Yes ©-tds
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ❑-t�Ft�
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/_diseh-atgfreebo
e, s, o_yv applicrfion) ElYes _
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑ Yes MNa-
24. Does facility requite a follow-up visit by same agency? ❑ Yes 0'N-0—
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes [9-N6
1© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
C taents (refer, 'qu�tton #) Explain any YES;answers and/or any recommetaiiations or any other'cnmmen!E]
Use drawings ofafacihty to better explam situations. (use addtlional page�as necessary): G29k1d Copy Final Notes
} e�
i7. IP:v;tc+rrr tom. f/ s� nJ a fat%
r/ortr A -40 /A,r k., %etorc/ keeloer J.-.) A&& ks ,oL».��n� ►^tturc�
b'nte Aptc� .7v[i y, 1PCturc/savu�lo6/r of a /uf/rr Gl4�e
M�/ /
%. lloney 6J �S 90 n� _��/GJ, i'j.�s 3�t��S Aa,, ween /a wrevenf lvef'�tozs4l .+,
WI! ,1
'Ole5t=:
�� .5 M011 /Pa!! ar-Acve on ���, they hove 4ev" rvae/.;'5 on r�c
Reviewer/Inspector Named1+r( k 4 ; ,' t ,
Reviewer/Inspector Signature:Date: t✓i
05/03/01"1/ Continued
ulcr}rc a.aler i�la:a t1,
T!1eLedle �5 not e?ovf"np 4Ayw4we, s¢ �I�J a�oG� (/Mrd' ✓P,

Ii ype vi visci: k-o-t-ompnanee inspection V uperatton xeview v Ntrueture r;vaivatnon V l eennical Assistance
Reason for Visit: 01<utine 0 Complaint 0 Follow-up 0 Referral O Emergency 0 Other 0 Denied Access
Date of Visit: l�—�l7 Arrival Time: Departure Time: County: _7 cr-- Region:
Farm Name: Z{sti
y3na! { y
Fc? r-�
Owner Email.
Current
Design Current
Owner Name:
Swine ;'Capacity k Popp:' -
,i�rr
Phone:
Pop:`
'e
Fettle``' Capacity Pop:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Baelz-up Operator:
Phone:
Integrator: �Srn4
Certification Number: �/ �1'0 2�K
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 V No ❑ NA ❑ NE
❑ Yes
Design Curre©t.
❑ NA
Design
Current
Design Current
❑NA
Swine ;'Capacity k Popp:' -
Wet Pogltry -Capacity''
Pop:`
'e
Fettle``' Capacity Pop:
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf E: .
Feeder to Finish
Dairy Heifer
Farrowto Wean
Design
Current
D Cow
Farrow to Feeder
D iP,oult �'
Ca aci
Po
Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Lavers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Ot fi-C CA FM P
Turkey Poults
Other
Other
E
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
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 V No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
❑NA
❑NE
Page 1 of 3
❑ Yes ❑ No
❑ Yes ENo
❑ Yes [ANo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
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 KNo
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Identifier:
❑ NA ❑ NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Spillway?:
❑ Yes
[No
[:]NA
[:]NE
Designed Freeboard (in): _� j l -
❑ Yes
® No
❑ NA
❑ NE
Observed Freeboard (in): 3 H2 3 9-
❑ Yes
JZJ No
Q NA
ONE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ZI No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes
allo
❑ NA
❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
❑ No
❑ NA
❑ NE
waste management or closure plan?
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[ZL No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
D NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E -No [:INA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload [] Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 101bs. ❑Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑1 -Application Outside of Approved Area
12. Crop Type(s): 3r'W144
13. Soil Type(s): AJ d ,-I-
❑ Yes
[No
[:]NA
[:]NE
14, Do the receiving crops differ from those designate in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop andior land application site need improvement?
❑ Yes
JZJ No
Q NA
ONE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
Q NA
❑ NE
acres determination?
❑ Yes
allo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[allo
D NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes CNo ❑ 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
1101 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
allo
❑ 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
[qNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
0 Yes
[gNo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

lFacility Number: - Date of Inspection:
4 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C3,No
25. Is the facility out of compliance with permit conditions related to sludge? I f yes, check ❑ Yes RC No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss reviewlinspection 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
F] Yes MNo E] NA ❑NE
❑ Yes PS No ❑ NA ❑ NE
❑ Yes qNo ❑ NA ❑ NE;
❑ Yes .I No ❑ NA ❑ NE
❑ Yes pNo
❑ Yes E� No
❑ Yes 2g_No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (reser toquestYon-. 'Explain any YES answers and/or any additirinal reci mmendatians ar aoy other comments:a
rill I4 b„
Use drawmkys of+facility to betWE'Wolain"situations (use-additionakiages as necessary).
�ar's2 /'iu.� �Pt� � ,2 d. r� � ��UD�C f�!-�,P✓`� %p •jl�. ��Yr/d. 76
U
�Gt-' s� �'l�ac✓7�rrl La-�1vL !
xr-5 pt- y a_,
Reviewer/Inspector Name: �'' �G.te^ a--- Phone:fi'
Reviewer/Inspector Signature:
Page 3 of'3
Date:
2/4/2015

i�ision of Water Resources
Facelity Number ®- ® 0 Division oPSoil and Water Gonsen•atiou
QOther Agency
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint oliow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ,' J Departure Time: ; D County: Region: F7_0
Farm Name: i�Gt /�►'� Owner Email:
OwnerName: Gi g =-L. Phone:
Mailing Address:
Physical Address:
Facility Contact: (� tY�l f y% ye-r~r; Title:
Onsite Representative: y..! f
Certified Operator:
Back-up Operator:
Location of farm:
Latitude:
Phone:
Integrator: _�=
Certification [Number: D
Certification Number:
Longitude:
Design Current
Design
E Current-
,; is `iDesign Current
Swine C tpactty Pog.
Wet l?oultrNCapacity
Pop.
�
t.. Capacity Pop.
a. Was the convevance man-made?
❑ Yes
Wean to Finish $ _
Layer
❑ NE
Dairy Cow
Wean to Feeder -
Non -Layer �_
�
Dai Calf
Feeder to Finish -
- r
Dai Heifer
Farrow to Wean
P.� Desigq
Current
Dry CowFarrow
to Feeder
❑ NA
❑ NE
Non -Dai ry
Farrow to Finish
❑ No
❑ NA
Beef Stocker
Gilts
_Layers
Non -Layers
[] No
Beef Feeder
Boars
Pullets
Beef Brood Cow
*� T"
'i -
Turkeys
= -
Other '
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ No
[j NA
F%3 NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the convevance 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 v=olume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system'? (]lyes, notify DWR)
❑ Yes
[] No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation'?
❑ Yes
❑ No
❑ NA
[gNE
3_ Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[] No
❑ NA
[SNE
of the State other than from a discharge?
Page 1 of 3 2/4/2015 Continued

4'
FaciliNumber:- Date of Inspection: j
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes JE 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
❑ NA
Identifier:
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
DNA
Spillway?:
_Required Records & Documents
Designed Freeboard (in):
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
Observed Freeboard (in):
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
❑ No
❑ NA
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
❑No
❑ NA
Q NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7_ Do any of the structures need maintenance or improvement?
❑ Yes
®No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
Yes
I 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
❑ No
❑ NA
E3_NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA
;&NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA 2!�NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA ONE
15_ Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
}aNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
DNA
Q NE
_Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
M_NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
❑ No
❑ NA
Eig-NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis D Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" 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 E&NE
❑ Weather Code
❑ Sludge Survey
❑ NA [S -NE
❑ NA Ca NE
Page 2 of 3 2/4/2015 Continued

Facitity Number: - z Date of Inspection.
24. Did the facility fail to Calibrate waste application equipment as required by the permit? (—]Yes ❑ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28_ Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA CME
❑ NA faNE
❑ Yes
❑ No
❑ NA
0,NE
❑ Yes
❑ No
❑ NA
aNE
D Yes
❑ No
❑ NA
aNE
❑ Yes ❑ No ❑ NA DEI.NE
❑ Yes ❑ No ❑ NA MNE
❑ 'Yes ❑ No ❑ NA JZNE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
0 NA
jKNE
❑ NA
ONE
❑ NA
aNE
Comments (refer to question #i`): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawinim of facility to better exulain situations fuse additional napes as necessary).
t5oS
t�
Reviewer/inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: — 3t7 _v
Date: z � —56 � /b
1/4/2015

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 04 urine 0 Complaint 0 Follow-up 0 Referral 0 Emergence 0 Other 0 Denied Access
Date of Visit: 2, 1 -1 Arrival Time: pa Departure Time: p; County: ��.�gPr— Region: F O
z
Farm Name: _—U yL; ✓--- r_:r , �at /t'� Owner Email:
Owner Name: ey— (,1 Phone:
Mailing Address:
Physical Address:
Facility Contact: _4'g-er'- /fZaUtSr Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: jm
Certification Number:
Certification Number:
Longitude:
Discharges and Stream _Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge.reach waters of the State? (If yes, notify 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 o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑
Yes [�S_No
❑ Yes � No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: JDateof Inspection: 11-177;,:?9j
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes O 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): �/ J V Y_
Observed Freeboard (in): t 21f 3�
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 DWR
7. Do any of the structures need maintenance or improvement?
[R Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
Yes
[�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
Z No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[ZI No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): d-�-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
®k 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
O 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
[A No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[RNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[allo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [j Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [RNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ 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`?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes [S -No
❑ Yes ®...No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facili Number: - Date of Inspection: l— / 7 —.Ao r
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes [KNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes V[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 ENO DNA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes [, No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ YesNo ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
[] Yes C& No ❑ NA ❑ NE
❑ Yes
47 No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
J ,No
❑ NA
❑ NE
Comments (refe_r to-ques#aon_# Explain any _YES answers and/or.; any additional recommendations or any other cbmm_ments
ti
Use dr_awtngs of_ -facility to better:eaplain..situations (use_ additional pages as necessary
' ��/7G-� � ®�ri► 6^� A''`1 I � � -- �� C.Y 8-u>J � �/ JC �%`?7 5 B''�� �
I
Reviewer/Inspector Name:
Reviewer/Inspector Signature: /
Page 3 of 3
r--�r
Phone: ����3�1J✓`
Date:
21412015

-/oris
Type of Visit: 10 -Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: outine 0 Complaint 0 Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ,'3 a Departure Time: County: Region:
Farm Name- -s Owner Email:
Owner Name: r�r �j �p Lis. ,,� Phone:
Mailing Address:
Physical Address:
Facility Contact: '- -r— Title:
Onsite Representative: 1 r- -�
Certified Operator:
Back-up Operator: Tf) n '� y�-� P:,k j sy
Location of Farm:
Latitude:
Phone:
Integrator: In.13
Certification Number:
Certification Number: /Co 47?
Longitude:
Design CurrePEW
nt
.,
Design
Current
Design Earrent
Swine Cap$city Pop.
Wet Poultry Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder p f` Non -La er
Dairy Calf
Feeder to Finish
-
Dairy Heifer
Farrow to Wean-f3esign Current
D Cow
Farrow to Feeder
D 1Poult ._Ca aci
P,o ,
Non -Dairy P
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
v ,�
11 1.0 Turkeys
Other
Turkey Poults
,
Other Other
Discharges and Stream Impactsand Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �Vo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes Bj No
❑ Yes JE] No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/2014 Continued

.1
r Facility Number: - Date of Inspection:
1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ 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): _ L Z91 -
Observed
-Observed Freeboard (in):— � I G o t
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes [allo ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[a No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
�No
❑ NA
[:]NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[3 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 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 ofWind Drift ❑ Application Outside of Approved
Area
12. Crop Type(s): .9z'J MYAtL /
13. Soil Type(s): 3t ,_6 .._ Z AGj e"Z-ov
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Z No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[] Yes
0 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
jo No
[] NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
r-__1 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q No
❑ NA
❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
J�a 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 '0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stacking ❑ Crop Yield 0120 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 3 214/2014 Continued

I
Facili Number: - Date of inspection:
? 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Y],No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes allo ❑ 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 C! . No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes M No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
0 No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes
H No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
E. No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below_
❑ Yes
[�D 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
JaNo
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
allo
❑ 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: Phone: you 33 �
Reviewer/Inspector Signature: �''L�l _ Date:
Page 3 of 214/2014