820599_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Date of Visit: Q Arrival Time: : j Departure Time: :3 D County: Region:
Farm Name: _! t rjjk -jdj�,r/` arn� _ Owner Email:
Owner Name: i T —;Tatl-eo— Phone:
Mailing Address:
Physical Address:
Faciliity Contact: t:5jY' 14-�_ Title: Phone:
Onsite Representative: 5e"—e— Integrator:
01
Certified Operator: �� Certification Number:
Sack -up Operator:
Location of Farm:
Latitude:
Certification Dumber:
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)?
❑ Yes / No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [] Yes [:]No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [—]Yes D" o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes fNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3
21417015 Continued
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
[Layer
IDairy
Cow
an
cto Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D , P,onl
Ca aci
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
'
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
fa
Other
Other
i
FWm.uiwwHwMYlll9+'
'. '. &.."d.
4N'wlVtryuw.Vww nbl,': . '
:gii
el$. 9Yj= -
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b_ Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes / No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [] Yes [:]No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [—]Yes D" o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes fNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3
21417015 Continued

Facili Number: - Date of inspection: D /
Waste Collection & Treatment
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ETNo ❑ 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): 19
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E3 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 13<0 ❑ 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 E 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 ISNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E N ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. El"Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ frozen Ground [i] 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): _ Q 4 Jr/'Sr>~ f %(J �• I .., Pays S �Gy art_
l"
13. Soil Type(s): ©,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[fj No
❑ 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
❑ Yes
[�No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[3 -Ko
❑ NA
[] NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[] No
❑ NA
❑ NE
Required Records & Documents �,�,�
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [3To ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes []'FTo ❑ 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 [r No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0-<o ❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

!{Facility Number: _5-g jDate of Inspection: ,30
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 E] -<'o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
5
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 10 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ONo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [3"No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Ej 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
ErNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
ErNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
[] Yes
[Erl�o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
I_ I fqo
❑ NA
❑ NE
Gonane©ts (refew�.to questiout Ea' lain aay;YES answers and/or any aadihoualrecom[nendafions or any other comments:a
facili to',better e ' Ia fsiivatiods (use additional es` " " ' s 'v
Use Ings of ,
h'' � f. / P� as�gecessary�.` , - ��� � .
1 �. T/ Z'�� d2 Z. ��d�� il a3 ��ap•�+i �� em �m5`� y�ct.�
v�/Y v7l S�
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone: top:30-0t 53
Date: j/__3 ID
l�
2/4/20!5

Type of Visit: Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance j
Reason for Visit: O'ifoo—utine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access I
Date of Visit: Arrival Time: Departure Time: County: Region: (�
Farm Name: its, �j �l/� Owner Email:
Owner Name:��- Phone:
Mailing Address:
Physical Address:
Facility Contact: f l� rr
Onsite Representative:
Certified Operator: ]�
Back-up Operator:
Location of Farm:
r Title: 0-60 y }- ✓ Phone:
Integrator: ZEC:i 1—�'
Certification Number:
Certification Number:
Latitude: Longitude:
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation? ❑ Yes JA_No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [] No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes ❑No ❑ NA ❑ NE
[:]Yes EA No [:INA E]NE
❑ Yes jEg No ❑ NA ❑ NE
Page I of 3 1/4/1015 Continued

Facility Number: - Date of Inspection: —/
Waste Collection &Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �Po ❑ 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 S Structure 6
RNo
Identifier:
❑ NE
18. Is there a lack of properly operating waste application equipment?
Spillway?:
_RNo
❑ NA
Designed Freeboard (in):
R uired Records & Documents
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
[a Yes JZ No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes [KNo ❑ NA
❑ NE
waste management or closure plan?
the appropriate box.
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 JZ[ No ❑ NA
❑ NE
S_ Do any of the structures lack adequate markers as required by the permit?
[] Yes [allo ❑ 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 P!�No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes F,4LNo ❑ 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 WindDrift ❑ Application Outside of Approved Area
12. Crop Type(s): Zy,,h, J,. /tx/l--Srrsf / J��r-�X � �t�hrr.��i
�< - -7-
i
13. Soil Type(s): A9 0 z±
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes RNo ❑ NA ❑ NE
15_ Does the receiving crop and/or land application site need improvement? ❑ Yes [RNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [a No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
_RNo
❑ NA
❑ NE
R uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
V No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E4,No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ DesiLm ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q N
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [:]Waste Transfers
F] Rainfall E] Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? Ej Yes � No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? E] Yes KNo
No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 214z2015 Continued

Facili [Number: - Date of Inspection:
—/
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
C,No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? Ifyes, check
❑ Yes
ENo
❑ 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:
25. Did the facility fail provide documentation of an actively certified operator in charge?
[:]Yes
allo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
EaNo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes JaNo DNA ❑ NE
❑ Yes Eg,'No ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes allo
❑ Yes Co No
❑ Yes O—No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer toquestion _) Explain aay YES answers=and/or any additional recommendatious.or any..other�comments,
.k., w 3 . 4
Use drawings of facrl�ty,tolbetter,eaplain s�taatwons (nse additional pages as ne
cessary). f�
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone:
Date:
21412015

Type of Visit: Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: �p Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: V Arrival Time: �,DD Departure Time: County: �� Region: ��j
KFarm Name: Art,
Owner Name: b,d
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: kis �f• r Title: r5r Phone:
Onsite Representative: r)f"Me
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
integrator: Rn�i4p
Certification Number: 17211
Certification Number:
Longitude:
. -
❑ No
❑ NE
r'
Design Current
Design Current
Design Current
5�s�ni v �Y
Capac ty Pop.
Wet Poultry_ Capacity Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cowy
Wean to Feeder
O
Non Laver
Dairy Calf
Feeder to Finish
= "=-:=--," = - `
Dk7wesign Current
Dry P,aultry C i _
Dai Heifer
D Cow
Non -Dai
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Nan -La ers
Beef Feeder
Boars
Pullets
$eef Brood Cow
- ;,,,, x
Turke s
tae
Qther
.:.:
TurkeyPoults
Other
"Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system'? (I f yes, notify DWR)
2. is there evidence of past discharge from any part of the operation'?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
rM No
❑ NA
❑ NE
❑Yes
No
❑NA
❑NE
Page I of 3 21412015 Continued

'acili `umber: 3X - Date of Inspection: t
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[Id No
❑ NA
❑ NE
a. if ves. is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: 1
Spillway?: Vta
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan'?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes �No ❑ NA F] NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [&No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes {&No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2LNo ❑ 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 p 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 D Application Outside of Approved Area
12. Crop Type(s): uct DS ?.� [.liLl pt
13. Soil Type(s): D�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [2�No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ZI No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [?g No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [g No ❑ NA ❑ NE
❑ Yes [&No ❑ NA ❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes n 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.
❑ Wj ;;P ❑ 4�esrgrt ❑ #aps ❑ se srrertts [:]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ 1�act"4paaa"n [❑ ❑ . ❑hers
❑$akt#a4 [:]Stocking W Crop Yield ❑ ns ❑
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
❑ Sfdit�eey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facility Number: Date of Ins tion:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Mi No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Q No ❑ NA ❑ NE
the appropriate box(es) below.
❑ ❑ els
❑Nun,oon
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 concem?
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 ReviewerMspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑Yes
R]No
❑NA
ONE
❑ Yes
W Ql c�
..20L,-
u3t
IwAov\ + "
recocc)5
❑Yes
R]No
❑NA
ONE
❑ Yes
❑ No
❑ NA
CR NE
❑ Yes
EI�No
[] NA
0 NE
❑ Yes No [] NA ❑ NE
❑ Yes Dq No [] NA ❑ NE
Yes
Kj No
[] NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑Yes
No
0 N
❑NE
❑ Yes
ZLNo
❑ NA
❑ NE
a5_� rlay !U, S sl,�j rlowl � �� tee�j
exf,<reiqce� Vi5� gee �� t -e �+, �►� �►� r,C,
�qGk ; ✓► CoWP1,'W0 c.e w fiL,: h 0. we*.
Reviewer/Inspector Name:
Reviewer/Inspector Signature: [jvN f_,
Page 3 of 3
Pk" .'PA- I Gtr
w4s
Phone: d))e4 36o
Date:
2/4/2015

Type of Visit:Comp ' nce Inspection Q Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ' p 0 Departure Time: County:- Region; (�
Farm Name:, 3 T Fa rel-, Owner Email:
Owner Name: Z= ; 'a A2U y- rl Phone:
Mailing Address:
Physical Address:
Facility Contact: .�; 7 +LI r Title: z -,r Phone:
Onsite Representative:_ Integrator:
Certified Operator: Certification Number: /Zn
Hack-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharees and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
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 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑No
[:]Yes No
[:]Yes ® No
[:INA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page l of 3 2/4/2014 Continued
Design
Current4.yr°
Desi n
g
Current
Des' Current
rgtt
Swine
CapacityPop.
"_
WetPoaltry
Capacity
I'o _
Cattle Capacity PaP_
Wean to Finish
Laver
Dairy Cow
Wean to Feeder
�J
00V
Non -La er
Da' Calf
Feeder to Finish
Daig Heifer
lcarrow to Weans
''
Design
Current
Dry Cow
Farrow to Feeder
I)t. P,oultry
Ca tachy
Fo
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Vol
Turke s
_.
Clther
_-
Turke Poults
Other
------
Other
Discharees and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
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 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑No
[:]Yes No
[:]Yes ® No
[:INA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page l of 3 2/4/2014 Continued

Facili Number: - 1 1 bate of Ins ecNon:
r Waste Collection & Treatment
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [-]Yes Jallo ❑ 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:
[:]Yes
_(RNo
[] NA
Spillway?:
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
2a No
Designed Freeboard (in): f.
❑ NE
the appropriate box.
Observed Freeboard (in):�
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
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.)
'0
kqf o
❑ NA
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes r'71 No
❑ NA
[:]NE
waste management or closure plan?
❑ Rainfall ❑ Stocking ❑ Crop Yield �Z 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
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
R. Do any of the structures lack adequate markers as required by the permit?
❑ Yes [S 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 [ANo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes r%71 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes C�J.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): eErr,�jt1� }—.T �S2 7i1i.•�w f /�e��rrt�.Aal
�Dvcrs -,re/
13. Soil Type(s): jJQ
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes RNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes EjNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes allo [DNA ❑ NE
acres determination? `
IT Does the facility lack adequate acreage for land application? ❑ Yes C!allo [DNA ❑ NE
18_ Is there a lack of properly operating waste application equipment? ❑ Yes ® No [] NA ❑ NE
Reauired 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
2a 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.
0 -Yes
kqf o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
® Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield �Z 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[&No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
®.No
❑ NA
❑ NE
Page 2 of 3 214/2014 Continued

Facili Number: - Date of Ins ection: — /,Y— Z�5--
( IN '
—
r' 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 ELNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of fust survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Stomge Pond M 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?
fuse d
is necessary)'::
❑ Yes [, No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes � No C] NA E] NE
❑ Yes ® No ❑ NA ❑ NE
[::]Yes ® No
❑ Yes No
❑ Yes Q!�No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2014

rype of Visit: pliauce Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: f D Departure Time: County: �P^ Region:
Farm Name: Owner Email:
Owner Name:zr ]�t T /` Phone:
Mailing Address:
Physical Address:
Facility Contact: ' _ -t-l' � a Phone:
Onsite Representative: �u.�.L integrator: _'?Zs
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
❑ Yes
Design
Current
Design Currettf
Swiae Capacity Pop.
Wet Pouitry
Capacity
Pop.
Cattle Capacity Pap,
a_ Was the conveyance man-made?
Wean to Finish
❑ No
Layer
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
[:]Yes
Da Cow
C] NA
ean to Feeder
c. What is the estimated volume that reached waters of the State (gallons)?
]Non -Layer
Da Calf
Feeder to Finish
[] No
[3 NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
Da Heifer
Farrow to Wean
❑ NA
❑ NE
Design
Current
D Cow
Farrow to Feeder
❑ NE
D Poul
Ca aci
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stacker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
10ther
Discharges and Stream ImOactS
1. Is any discharge observed from any part of the operation?
❑ Yes
21 No
[DNA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
[:]Yes
❑ No
C] NA
❑ NU
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[:]Yes
[] No
[3 NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Q No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
R No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facilt Number: - Date of Inspection:1,,X-10—lil
Waste Collection & Treatment
t 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes ZI No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):_
Observed Freeboard (in): Z)
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 arty 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 FM 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]C 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 ZI No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. 0 Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift [:]Appliication Outside of Approved Area
_ /
12, Crop Type(s):epAnemia /oyl<fi eo/hzL' } /f i. 14-1 �s�96x2�►�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CA W MP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 51 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes [a No ❑ NA ❑ NE
❑ Yes [&No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [K No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:)Yes El 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 [ o ❑ NA ❑ NE
El 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 K No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes LS No ❑ NA ❑ NE
Page 2 of 3 2/412014 Continued

Facili Number: - Ds ection:
s
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check © Yes �g 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 structures) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [ No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30- Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ®,No ❑ NA ❑ NE
[—]Yes KNo ❑ NA ❑ N -
❑ Yes [a No ❑ NA ❑ NE
❑ Yes b?j'No ❑ NA ONE
❑ Yes
E&No
❑ NA
❑ NE
❑ Yes
CS No
❑ NA
❑ NE
[:]Yes
C'No
❑ NA
❑ NE
Comments (refer to question #): Esplah any YES answers and/or any additional recommendation_ s or any other�cominents aw
� �^
Use drawings of facility to better einlai&situations (use additional oa6k as necessarv).• -
�/? i, C�h �l��l ! °'.� 'a�O�y% 1►� �rB�--�- / J D Q fes+ i� TzJ
v
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: }1033 3300
Date:
214/1074

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: -� Arrival Time: _! Departure Time: ' h(S County _*_-
Farm Name: x1'jL&r Fes- Owner Email:
Owner Name:r79 , 9,A7k, /- Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: z (u.'wer^ Phone:
Onsite Representative: Integrator:110,
v
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Region:
Design Current7P.
Design
Current
Design Current
Swine _ Capacity Pop.
Wet Poultry
Capacity
Ppp.
Ca#tle Capacity Pap.
Wean to Finish
ILayer
Dairy Cow
Wean to Feeder ,p AE�>7 p
Non-La er
I
Dairy Calf
Feeder to Finish
~
`'''"
Dairy Heifer
Farrow to Wean
_'
Design
Curren#
Cow
Farrow to Feeder
Dr I;oult V.,
a aci
1'0 ..
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boats
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
::J
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 U§.No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
[—]Yes ❑No
[]Yes allo
❑ Yes 5g No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/412011 Confinued

Facility Number: - Date of Inspection: - 3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes (3 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): p -
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 [K 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 RNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes 2g -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 E!�-No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Q4No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ®,No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12_ Crop Type(s): �rrntja � `j�f-�I ealln
13. Soil Type(s): Q -k _
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 ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Ed No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes E No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 5INo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes [qNo 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
❑ Waste Application ❑ Weekly Freeboard 0 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? 0 Yes [Z No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes C.No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/412011 Continued

• Facility Number: __3W Date of inspection: —
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes UNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes L.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 LZ No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes J[7=)j No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
NA ❑ NE
❑NA 0 N
0 N 0 N
❑ NA ❑ NE
❑ Yes JZ] No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑Yes ®No 0 N 0 N
❑ Yes ® No ❑ NA ❑ NE
❑ Yes No
❑ Yes ® No
❑ Yes No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #): Explain an VES answers and/or any additional recommendations or any other comments
Use drawines of facility to better explain situations {use additional oases as necessarv).
Reviewer/Inspector Name:
Phone: '2J 4 �—,3302 .
Reviewer/Inspector Signature: J Date:
Page 3 of 3 2/4/2011

&�=vw}t'r`+if•"�iP�,'',:+Y�!''�y--.ni..��"" �d�.��Ja�w:..c"prr". r r:. J"•i..�.�'ydl�/�idw,�w;'�4w�Sa'Z'"iky'3t;;4"L'.•=sTk's.. • sc .. �.d.. r.y.ti+t.�,';iW."Q: '� r�• nr.: ,� .i2 ti:�5.} .,, :vvt: :,�w- -•.... w �. i., irr_. � ".
*_ La=ter _•.,r��
I
i ype of v isit: wo-eompuance fnspecuon k_j uperanon review k_j arructure r vaivagon v i ecamcm Assistance W
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: =� Arrival Time: Departure Time: / Z) ,' ar] County- Region:
Farm Name:,; �'� ,� �G �4/ Owner Email:
Owner Name: ("tom ; "t1L, a . z tztk— " Phone:
Mailing Address:
Physical Address:
Facility Contact: /-�y; .�L ,r.� _Title: ASC,.V Phone:
Onsite Representative:Integrator:
Certified Operator: ��� Certification Number:
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: 'Longitude:
D ign�Carrent
G�4�fDesign
@urrent
Design Current
Swine ,apaclty Pop.
Wet Poultry TCapacity.
Pop.
Cattle Capacity Pop.
a. Was the conveyance man-made?
(:]Yes
o Finish
La er
❑ NE
Dai Cow
o Feeder
❑ No
❑ NA
Non -Layer
c. What is the estimated volume that reached waters of the State (gallons)?
Dai Calf
to Finish
--
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
Dai Heifer
❑ No
to Wears
U
17e§ign
it , 1P,au1 . ; �Ca acitti
Current
Po
Cow
Non -Dairy
JZ No
to Feeder
❑ NE
to Finish
La =ers
® No
Beef Stocker
❑,NE, -
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
sTurkeys
` r
w a"
Other ""Y
Turkey1?oults
Other
10ther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
[] Yes
© No
NA
❑ NE
'Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
(:]Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[] Yes
JZ No
] NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑Yes
® No
[] NA
❑,NE, -
of the State other than from a discharge?
Page I of 3 21412011 Continued

11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes & No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑/Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): }V
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [Z No ❑ NA ❑ NE
t
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [g No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes No
❑ Yes ® No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No
20. Does the facility fail to have all components of the CAWMP readily available`? If yes, check ❑ Yes [2 -No
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement'? If yes, check the appropriate box below. ❑ Yes [& No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [K No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [RNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
Facility Number- jDate of Inspection:
❑ NA
❑ NE
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ YesX❑
No
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in).
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
' 6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
if any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
ED No
❑ NA
❑ NE
' 8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
allo
❑ 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
[j No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes & No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑/Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): }V
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [Z No ❑ NA ❑ NE
t
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [g No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes No
❑ Yes ® No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No
20. Does the facility fail to have all components of the CAWMP readily available`? If yes, check ❑ Yes [2 -No
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement'? If yes, check the appropriate box below. ❑ Yes [& No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [K No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [RNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

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 concem?
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 GAWMP?
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 Ea No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes ❑C No [DNA ❑ NE
❑ Yes ® No
❑ Yes CM No
[:]Yes No
❑ NA ❑ NE
❑NA ❑NE
[:INA 0 NE
b _ .:, r p .,a .. y f M ;i7� an other comments.
fir,. y
Use drawing of facthty tot better exp_laan a tuations (use edd..thonal paesast ecessary} men ahons or m�
Av' N D
Dov r.•� cxtr-� 5
�c dop oD't-
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: �'/9`1433 `330J
Date: Z=1
-
-- r
2/412011
Facility Number: -9 bate of Inspection: �7— Ito -
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�ONo
0 NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? if yes, check
❑ Yes
E_No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
r-_1 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 concem?
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 GAWMP?
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 Ea No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes ❑C No [DNA ❑ NE
❑ Yes ® No
❑ Yes CM No
[:]Yes No
❑ NA ❑ NE
❑NA ❑NE
[:INA 0 NE
b _ .:, r p .,a .. y f M ;i7� an other comments.
fir,. y
Use drawing of facthty tot better exp_laan a tuations (use edd..thonal paesast ecessary} men ahons or m�
Av' N D
Dov r.•� cxtr-� 5
�c dop oD't-
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: �'/9`1433 `330J
Date: Z=1
-
-- r
2/412011

Type of Visit: (2FC.,ommpiiance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 4e Keutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ; oo= Departure Time: County: SBS Region:
Farm Name: j -}� �j t' -f ,v r jE5k? rry, - Owner Email:
Owner Name: '} i Phone:
Mailing Address:
Physical Address: II �f
Facility Contact: r'� r'*-- J-Pj 1,,7f—&71— Title: 1 CU r Phone:
Onsite Representative: integrator:
Certified Operator: s.,,�r Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Design Current
® No
Design
Current
Design Current
Swine
Capacity Pop.
WetAoultry
Capacity
Pop.
C►attle Capacity Pop.
❑ NE
Wean to Finish
❑ Yes
❑ No
❑ NA
❑ NE
airy Cow
Wean to Feeder p Non-l_a yer
iry Calf
Feeder to Finish
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
aja Heifer
No
Farrow to Wean
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Dry Poul
Design-
Ca aci _
Current
P-oP
Dry Cow
Non -Dairy
of the State other than from a discharge?
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turk i'oults
Otlter
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field 0 Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
J&No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2141101.1 Continued

Facilii Number: jDate of Inspection-
ns ection-Waste
WasteCollection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[:]Yes
0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): �9
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
125k ­4
❑ NA
[] NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ballo
❑ 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?
l l . Is there evidence of incorrect land application? 1f yes, check the appropriate box below. ❑ Yes 64 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 CropWindow❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12_ Crop Type(s): r.i?r�l-1Y1ud�cr5_ . _
13. Soil Type(s): _ JU ZI d
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes] No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes MANo [:]NA E]NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box.
[:J 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 ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
[] NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

>Facili Number: - I Date of Inspection: —(
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M No ❑ NA ❑ NE
4 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [0 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[a No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
JZ No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewerfinspector fail to discuss review/inspection with an on-site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes &I No ❑ NA ❑ NE
( q_ ft p Y y- al recommendations orranyothetco�%eits:" 9
- M
Comments refer to. uesteon Explain an YES answers and/or addition
Use drawings =of facility to'bettei explain situations (use additional pates as necessary). ,
Reviewer/inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: -.33
Date:
21412011

Type of Visit JPoCo-mpliance inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit oilo- utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 3 fl Departure Time: ; 3 O County:. s Region: Fko
Farm Name: �r _ �t,,��Q �r+~�- Owner Email:
Owner Name' Phone:
Mailing Address:
Physical Address:
Facility Contact: A&; Title: 0u>1trr Phone No:
Onsite Representative: Integrator.�r�-�-�
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ e =I=,, Longitude: =0[=t
o[=t ❑ i{
Design Current
Swine Capacity Population
Design Current
et Poultry Ca_nneii Population
Design Current
CattlelUipacity Population
❑ Wean to Finish I 1
10 Layer
❑ No
❑ Dairy Caw
Wean to Feeder IL okV
ILI Non -Layer I
Dairy Calf
❑ feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry.
❑ Dry Cow
❑ Farrow to Feeder
El Layers
❑ Non -Dairy
❑ Farrow to Finish
❑ Yes
❑ Beef Stocker
Gilts
❑Non -La Non -Layers
❑ Beef Feeder
PEI]Boars
❑ Puilets
❑ Beef Brood Co
❑ Turke s
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures: E
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: 0 Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
h. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
14 No
❑ NA
❑ NE
❑ Yes
tZ No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: :129- Date of Inspection9
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
fig No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ffiio
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Arc there structures on-site which are not properly addressed and/or managed
❑ Yes
RZNo
❑ 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
[T No
❑ NA
❑ NE
9. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
W No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Q No
❑ NA
❑ NE
maintenance/improvement?
I 1. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ERNo ❑ 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 hrpe(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes J,No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes [KNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ®. No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of property operating waste application equipment?
4CT r.; V r L,: �7'-�1` C !`ray
H"V
Reviewer/Inspector Name �� _ Phone:;37--o
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128/04 Continued
❑ Yes WNo ❑ NA ❑ NE
❑ Yes J�LNo ❑ NA ❑ NE

Facility Number: — Date of Inspection
M
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes fR No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP 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 Ej 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
[allo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[5j 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
O -No
❑ NA
❑ NE
26_ Did the facility fail to have an actively certified operator in charge?
❑ Yes
E.No
❑ NA
❑ NEE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
5?1No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E=No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
B -Vo
❑ 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
R 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
O 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
1KNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
O -No
❑ NA
❑ NE
Aifditioiial&G•o,,.rnments an ar Drawings:
.r
12128/04

Type of Visit U<o_mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine O Complaint O Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time::r(O Departure Time: ` >J l'� County: Region: i n
Farm Name, � t'_ I T• 1]t�"tl. -tom`. Fn -k' Owner Email:
Owner Name' t'< '- i A— BL:[ I e r .... Phone:
Mailing Address:
Physical Address:
Facility Contact: ilk Title:
Onsite Representative:
Certified Operator: `s—
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o =I ❑ u Longitude: = ° = I =
Design Current
Swine Capacity Population
Design Current
Wet Poultry C«apacity Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
ID Laver
I
❑ Dairy Cow
Wean to Feeder O D
I0 Non -Layer I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder-
[K No
ElNon-Dairy
❑ Farrow to Finish
❑ La ers
El Stocker
❑ Gilts
❑ N ers
ElBeef Feeder
El
❑ Boars
Mets
El Pullets
❑ Beef Brood Co
❑ Turke s
Outer
❑ Turkey Poults
❑ Other
❑ Other
Number of 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? (Ifyes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ❑.No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[K No
❑ NA
❑ NE
❑ Yes
(4 No
❑ NA
❑ NE
12/28/04 Continued

s
Facility Number: — Date of Inspection O
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 Stnicture 2 1Structure 3 Stnicture 4
Identifier:
❑ Yes[ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure Structure 6
Spillway?:
N No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ Yes
Designed Freeboard (in):
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
P -No
Observed Freeboard (in):
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
2 No
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
G. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
[9 No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[R No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
LOo
❑ 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 improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes (-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10%or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s) &:C .� /D� r✓ _ _.,_.
13_ Soil type(s) j 4,_
14, Do the receiving crops differ from those designated in the CAWMP? ❑ Yes D�No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
N No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ Yes
X No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
P -No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
2 No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Q _ LA� n?a'e d /= 'K3 C- W -'r— `t a
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: O `
///28/04 Continued

I
Facility Number:Date of inspection
Reunired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Flo ❑ NA ❑ NE
24. Does the facility fail to have all components of the CAWMP readily available? If yes, check YesNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design 51maps ❑ 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 ❑ Annual Certification
❑ Rainfall E] Stacking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and V 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 rambreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
al Comments and/or Drawings:
❑ Yes
(R No
❑ NA -
❑ NE
❑ Yes
[5�No
❑ NA
❑ NE
❑ Yes
(gNo
❑ NA
❑ NE
❑ Yes
[$-No
❑ NA
❑ NE
❑ Yes
H No
❑ NA
❑ NE
❑ Yes
[,.No
❑ NA
❑ NE
❑ Yes
Z No
❑ NA
❑ NE
❑ Yes
I No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
9No
❑ NA
❑ NE
❑ Yes
&No
❑ NA
❑ NE
❑ Yes 50 No ❑ NA ❑ NE
1212$104

2
Type of Visit,C,,,ornpliance
Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
(D koutine O Complaint
O Follow up O Referral Q Emergency
O Other ❑ Denied Access
Date of Visit: Arrival Time: p Departure Time: b ; t) County: Region: fK0
Farm Name: — to" e'i-rL 21 b,zf f er Owner Email:
Owner Name: +� Phone:
Mailing Address:
Physical Address:
Facility Contact: K+�%� Title: Phone No:
Onsite Representative: S'�r�-t� Integrator: xlr
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: latitude: = u =I a 1
1 Longitude: =0=1 = u
Design Current
❑ Yes
10 No
Design Current
Design Current
opulation
Wet Poultry
.Cap ity Population
Cattle Capacity Popuiati
inish
n
❑ La er
❑ No
❑Dai Cow
eeder 3 i7
❑ Non -Layer
❑ Yes
❑Dai Calf
r to Finish
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Dai Heifer
to Wean
❑ D Cow
to Feeder
❑ No
�Non-Dairyw
❑ NE
to Finish
La ers
14 No
❑ Beef Stocker
❑ NE
❑ Non -La ers❑
❑ Yes
Feeder
❑ NA
Pullets❑Beef
other than from a discharge?
roo Cow
Turke sBee
Page I of 3
12/28/04
❑TkPoults 10 Other
Nunibe... f Structures:
'Ar..;.
. •�h��#moi.....
_. h
Discharges & Stream Imoaac_ts
1. Is any discharge observed from any part of the operation?
❑ Yes
10 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
14 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
M No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

Facility Number: — Date of Inspection _p
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
❑ Yes
Spillway?:
❑ NA
Designed Freeboard (in): /17
15. Does the receiving crop and/or land application site need improvement?
Observed Freeboard (in):
® No
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
(4 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
® No
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
19 No ❑ NA ❑ NE
through a waste management or closure plan?
❑ Yes
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
14 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
R No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ NA
9. Does any part of the waste management system other than the waste structures require [9 Yes
❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
® No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes
® 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) :Zer-'YI.1,t jt_ l o V er- �-rj
13. Soil type(s) QA
14. Do the receiving crops differ from those designated in the CA W MP?
❑ Yes
0 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
[R No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
&No
❑ NA
❑ NE
i.�?b
fi\G Q '-L A- i R tD i� v �• .. i4 tr'r �u `�' i ' ; s S tacu61.. L cce k.,
6(, � C �Yt c� i e 4J'►_''J
Reviewer/inspector Name 8 :. Phone: Y— -y27 -330 o
Reviewer/Inspector Signature: Date:j -,� c�-C'�a�
Page 2 of 3 12/28/04 Continued

Facility Number: — Date of Inspection
i
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes (@ No ❑ NA EINE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes &No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21- Does record keeping need improvement? If yes, check the appropriate box below. Cl Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ AnnuaI 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
14 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
91No
❑ 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
E4 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
JR) No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification'?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
2$_ Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
1Z 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
Ifyes, contact a regional Air Quality representative immediately
3 L Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
21 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
;K No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
191 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
/2/28/04

Division of Water Quality
[Facility NumberLai Q Division of Soil and Water Conservation
0 Other Agency
Type of Visit (9-CIOm Hance Inspection Q Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: LcI.� Departure Time: O ' D� County: Region:
Farm Name: c Owner Email:
Owner Name: _�,y� i ilt Phone:
Mailing Address:
Physical Address:
Facility Contact: 4 e' 0T, #-- I _),,-,T`L_,-,r- J Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o =I ❑" Longitude: = o ❑ I ❑ "
Design Current Design Current
Swine Capacity. Population,:- : Vet Poultry Capacity Population Cattle
❑ Wean to Finish
Wean to Feeder j}
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non-Layet 17771
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey 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''"
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
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 XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
D4 No
❑ NA
❑ NE
❑ Yes
5& No
❑ 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?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes WNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
7 - i ki ur e- UJb o �= ; W rL Lai-f� _ /)3�W ; �0 tart ' J`v D �' a 5 �I'% au1�j
0?'16e
Spillway?:
Reviewer/Inspector Name Phone: !jI D #V1_�3--,3,3D0
Designed Freeboard (in): l
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[K 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?
g[ 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 ApWication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
M No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
allo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s) �r-mLLJA.
13. Soil type(s) IJ p 14
14. Do the receiving crops differ from those designated in the CA WM P?
❑ Yes
E 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
[RNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[&No
❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ 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):
7 - i ki ur e- UJb o �= ; W rL Lai-f� _ /)3�W ; �0 tart ' J`v D �' a 5 �I'% au1�j
0?'16e
Reviewer/Inspector Name Phone: !jI D #V1_�3--,3,3D0
Reviewer/Inspector Signature: Date:
12/28/04 Continued

'•�I Facility Number: 9;;Date of Inspection %
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes gNo ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes V 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 14 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
&No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
,l No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
IN No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
UNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
CSNo
❑ NA
❑ NE
27,
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
CZNo
❑ 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
M No
ElNA
ElNE
and report the mortality rates that were higher than normal?
low
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
EZ 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
O 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
CaNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by sante agency?
❑ Yes
P& No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12/28/04

r
Type of Visit s -Compliance Inspection Q Operation Review O Structure Evaluation a Technical Assistance
Reason for Visit 01Routine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: t7 O Departure Time: /' 7>D County: _ 4 Region: �� D
FarmName; 2 + f " 4 ���' ��''�''"f Owner Email:
Owner Name:Phone:
Mailing Address:
Physical Address:
Facility Contact: ,_,1:� r' i T t Title: Phone No:
Onsite Representative: Integrator: EL2_n�
Certified Operator: Ste'- Operator Certification Number: 121"16
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [=O
= ❑ Longitude: = ° =I ❑ "
IS
LDegn Current Design Current
Design Current
Swine
cityPopulation Wet Poultry Capacit3 Population
C►attle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dai Cow
Wean to Feeder
O p fl _ ❑ Non -Layer
❑ Dai Calf
❑ Feeder to Finish,_,
❑ NA
❑ Dai Heifer
❑ Farrow to Wean
Dry Paaltry ;~ :'~
H:,tf
❑ D Cow
❑ Farrow to Feeder
❑ NE
❑ Non -Dai
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
Other
❑ Turkeys
'r, ❑Turke Poults
RNo
❑ Other
� ❑ Other
Number of Structures:IT-]
_99RINEMMOW-5-
___ - -
❑ NA
Discharges'& Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
A No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
KNo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
KNo
❑ 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
RNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
® No
❑ NA
❑ NE
other than from a discharge?
Page 1 of
11128104
Continued

r
Facility Number: —
Date of Inspection x.31 O cl
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
[dent! tier:
Spillway?:
Designed Freeboard (in): / 9
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
[:]Yes E[No ❑ NA ❑ NE
❑ Yes [allo ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes C9 No ❑ NA ❑ NE
❑ Yes [Z No ❑ NA ❑ NE
If any or questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes KNo ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes IN No ❑ NA ❑ NE
(Not applicable to roofed pets, dry stacks and/or wet stacks)
9. Docs any part of the waste management system other than the waste structures require ❑ yes RNo [INA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes RNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes H 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 ❑I Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) C,�r`►�tu�# a► %f`r� i� �6[/<�z7��� C"� �/ {rsr'r'�
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Callo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? 5? Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[] Yes
1KNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
RNo
❑ NA
❑ NE
� Gtn-�`� rn v r w��� k. ••t� vi -t. Ncu�r S�-r��� �--rm Fr�Ec ([. oo �.g �d�
Reviewer/Inspector Name ��r r y 3; Phone: y/
Reviewer/Inspector Signature: Date: 4L�"3 r 1JCa(o
12/224/04 Continued

r
Facility Number: Date of Inspection 0 6
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Of No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 10 No ❑ NA ❑ NTE
the appropirate box. ❑ WUP ❑ Checklists ❑ ❑ Maps Design g p ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. CKYes []No ❑ NA ❑ NE
❑ Waste Application [:]Weekly Freeboard [4 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
[4 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
XNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[9No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
N 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
CRZNA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P& No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
54 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, lieeboard problems, over application)
y�
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
RjNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
jo No
❑ NA
❑ NE
t
AddiN©>i$I Gat�Itnettts and/or Drawings ?�r"s `ti t i, i"4 zw
uS,e year fJeu,t WaSf
1
YOU�1- p w � `ro rh �� �`©�c r- ���� -�r'r' i��' a�"'.' � bre � �'t o ►�-.
f
12129104

Type of Visit 4P Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit S Routine Q Complaint Q Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: SS Departure Time: County: Sa_-.s_ r sn!u Region: FIZO
Farm Name: — w14 e,;+1` [� k�-� cr_ - �..,, Owner Email:
Owner Name: ill e_ *14j, _ t,�+��n. Phone: Gell 't90— aSff G
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: KC 4k 13 A,-
Certified Operator: Ileik-! A"'t\e
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator- _ _ -Prat+aaye„
Operator Certification Number: l 7.2 /Jr
Back-up Certification Number:
Latitude: 0 0 ❑ ' F-1 Longitude: =0 = I = v
Design Current Design Current
Capacity Population Vet Poultry Capacity Population
❑ Wean to Finish I I ❑ Layer
® Wean to Feeder O 4-1 oa0 ❑ Nun -La es
❑ Feeder to Finish
❑ Farrow to Wean
❑ Narrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑
Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a- Was the conveyance man-made'?
Design.. Cirri
Cattle Capacity Popula
❑ Dairy Cow—
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
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 I No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
Cl NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[X No
❑ NA
❑ NE
❑ Yes
[4 No
❑ NA
❑ NE
12128/04 Continued

Facility Number: $7.1 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 10'd No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard'? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): '/ 9'�
Observed Freeboard (in): 3110
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
[)] No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
$0 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
% No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
V 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 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
R4 12. Croptype(s) 13Ct-V-%LAQQa c�rn�>~f�
13. Soil type(s) A e A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[S(No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® 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
�J No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
F�3 No
❑ NA ❑ NE
Reviewer/Inspector Name CJ(� P °i '; Phone:
Reviewer/Inspector Signature: Date: oi-
12128104 Continued

I
Facility Number: 8 — Date of Inspection LVAW/415"
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 © No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 2Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
[Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
[j Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
® 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
5d No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
® NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
GC No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
(A No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
E� No
❑ NA
❑ NE
33-
Does facility require a follow-up visit by same agency?
❑ Yes
[N No
❑ NA
❑ NE
Addtaona]X"'-fi iments,aizd/orDrawings.
PI Ca.a G G� �►,►, -i- o i ,n : \ wt S P c c�; o N C'X+c Ir..-
p� �„�
C�rC.a��r �+tc. �'�4^�'�aN �vcr.-�a �a �oca...w.�c,.--� �t' ash.
iraa�cd-��o+as,
� Ga1���rak�er-. c•�c� S 1�.Yc r ��. l 0 G.+a b z r o f A
12128104
r-

I
\1
L Facilin. lumber date of\"isit: '8 Q Time: O
•- -10 Not Operational 0 Below Threshold
Permitted EjYCerti/fled 0 Co/n�ditionally Certified ❑ Registered Date Last Operated or Above Threshold:
[S
Farm Name:—l[Q�+? � VI&C J5,01110 _ County:
177 A
Owner Name. _ ke,fb A aV RP/'t I _ /j_ / /_ Phone no:
Mailing address: nZ tiI ML (ee ChetrCiL Ron L LriJam IV L _ qJ ,;! Q
G cell
Faciliry Contact-. — kP i fb 6„ 41,0C Title: Phone No: I10 -
Onsite Representative: l e ; a 6 1, fief _ _ Integrator:�f ellaae _ F4, -m _
Certified Operator: �;A _ 8 ✓ H�Pr Operator Certification Number:
Location of Farm:
911; ne ❑ poultry ❑ Cattle ❑ Horse Latitude ` 0" Longitude ' �• �-
Design Current
Swine f'anarih• Pnnnlatinn
Wean to Feeder D o
❑ Feeder to Finish
❑ Farrow to Wean
❑ Fatraw, to Feeder
❑
Farrow to Finish
❑ Gilt.,
Boars
Design Current Design Current
Poultry Capacity Population Cattle Cs achy Population
❑ Laver 1 ❑ Dairy
Non -Laver ❑ Non -Dairy
10 Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ S rav Field .area
"Holding Ponds/ SoUd Traps [] No Liquid Waste Management System
Discharges S Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Laizoon ❑ Sprav Field ❑ Other
a. If dischamt is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Vater of the State? (if yes, notify DWQ)
c. if discharse is observed. what is the estimated flow in Qallmin?
d" Does discharge bypass a lagoon system? (If yes, notify DWQ)
2_ is there evidence of past discharge from any pan of the operation?
3" Were there any adverse impacts or potential adverse impacts to tate Waters of tate State other than from a discharge?
WaM CollgEtion g Treatment
4_ Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure ? Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05/03101
❑ Yes p,�1vo
Structure 6
Continued
❑ Yes+❑'9to
❑ Yes
7
a&.
❑ Yes
i
E:JNa
❑ Yes
�.o
❑ Yes
EK0
❑ Yes
M.?Qa
❑ Yes p,�1vo
Structure 6
Continued

i
N
Facility Number: —SRJ
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes 9110
❑ Yes LW4
❑ Yes 07Vo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
9INo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
elevation markings?
❑ Yes
C o
Waste -Application
f/GIO� ! J CQ(t fs �/b S UI/USTt' ►�TaYnaL�/+t fnf p1u„ . /+1 r+ Qv/1lrI' alp S4,>% he I S 04,,, ,nA
10. Are there any buffers that need maintenance/improvement?
❑ Yes
C -3g0
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
®No
12. Crop type CDec�t R_.td . --r- tss-- --.
E'Fo
20,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA WMP)?
❑ Yes
9 -No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
QA10
b) Does the facility need a wettable acre determination?
❑ Yes
Q -No
c) This facility is pended for a wettable acre determination?
❑ Yes
[ 0
15- Does the receiving crop need improvement?
❑ Yes
t[ o
16. 1s there a lack of adequate waste application equipment?
❑ Yes
El -No
Rouired
Records & Documents
of e:. n addrttonial pages as necessary} Q>rr�la cape ❑Fina! Notes
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑~1Qo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
f/GIO� ! J CQ(t fs �/b S UI/USTt' ►�TaYnaL�/+t fnf p1u„ . /+1 r+ Qv/1lrI' alp S4,>% he I S 04,,, ,nA
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
�0
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
E'Fo
20,
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[x-3+10
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
[ o
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
LINO
23-
Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
-No-
24.
Does facility require a follow-up visit by same agency?
❑ Yes
E leo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
Uwo
-146 violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
N{Y�:.�J�6YT hF-a edh 3 Y wiib� '.lam' _ 1- � - ' ` ...t. r[- Sem �s-'�'�k'� - .W �i wA °YI4'u..���J �R
Comments J(r ,fer to ues�oa F. iatn anv YFSaanswers and/oi an recommenclahons:or an other„ citmments
use drawings factL�ty to better situatrons�(use ^;`#
of e:. n addrttonial pages as necessary} Q>rr�la cape ❑Fina! Notes
s` ltl pie /S P'Gnn,'�� Ue G sQd iesr .Soon �P 1+S �Grt.n� f/r 1Ve-
li'/Ih/e /!- Ptavi' dv kd 6/1 h ioke-PArecP, Mr 6dlmr aho 6161d 4t e �5 �Atin •n�
f/GIO� ! J CQ(t fs �/b S UI/USTt' ►�TaYnaL�/+t fnf p1u„ . /+1 r+ Qv/1lrI' alp S4,>% he I S 04,,, ,nA
40 duly AP9 fhe Z -% -the 164,,1! Carnet 0/' 4& /ep,goan.
Fr /"I's o -
Re-ewer/Inspector Name
^�
Reviewer/inspector Signature: Date:
05103101
OF
Continued

DIVISION OF ENVIRONMENTAL MANAGEMENT
41 "Vf P r, �3 -z-
SUBJECT:
'SUBJECT:
Compliance Inspection
County S/9 pIo,/
1
Dear 1012 , /1 of
7_ I k-rrs—
On , an inspection of your animal operation was performed by the
Fayetteville Regional Office (FRO). Please find enclosed a copy of our
Compliance inspection Report for your information. It is the opinion of this
office that this facility is in compliance with 15A NCAC 2H, Part .DP17, and
that Animal Waste Management is being properly performed.
a
Should you have -any questions regarding this matter, feel free to contact
me at [phone].
GD/
Enclosure
Sincerely,
cc: Facility Compliance Group
ng+neer

.
R
a
rt

Farm Name/Own
Mailing Address:
Integrator: L�y� _r,4�••t Phone: ~
On Site Representative: Phone:
Physical Address/Location: f z.5j/1
Site Requires Immediate Attention:
Facility No. T
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS
SITE VISITATION RECORD
DATE: -' / i7 , 1995
Time: 0 2,14
Type of Operation:
Design Capacity: _
DEM Certification
Latitude: °
Swine _jZ
Number:
Poultry Cattle
Number of Animals on Site: 6 $�j(� R-
ACE DEM Certification Number: ACNEW
Longitude• "
Circle Yes or No
Does the Animal Waste Lagoon hFagoon(s)?
sufficient freeboard of 1 Foot + f25 year 24 hour storm event
(approximately 1 Foot + 7 inches)or No A Freeboard: �� Ft.� Inches
Was any seepage observed from the Yes or Was any erosion observed? Yes or iQo
Is adequate land available for spray? es r No Is the cover crop adeq te? o Flo
Crop(s) being utilized: _ r',r I�1' b6 ��? 4-�
Does the facility meet SCS minimum setback criteria? 204 Feet from Dwellings? Vc)or
100 Feet from Wells? '
feFs br No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or 0
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line:
No
Yes or @)
Is animal waste discharged into water of a state by man-made ditch, flushing system, or other
similar man-made devices? Yes KNY If Yes, Please Explain.
Does the facility maintain adequate was management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
P I- �'
JO -41r5
Inspector Name
jo
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

RMTH CAROL3M DRPARTM7T OF EiivrRQr T, MEAr.TH A NATURAL PJCSC ORCES
DIVISION OF I+RMOHI4MUL MANAGEMNT
Fayetteville Regional Office
Animal Operation Compliance Inspection Fora
'^"yr`i"aw'7.'c". o;y,S^ wi.irry.r .a:e'-";x7�:...'T,yr'` V ..++w.�h'.. ..r•'HYA!^,ii.'i: w„4 i1.':rs:.„�.
-��^.:. • ���;< A �AR'!� +i�i�/C!WNE� ���° �xz
<� M^""'.s„si'.`"."xwF `•.'c
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,"wig' -��INSPEf.Pi�N ;�kA'2'$
Rt M 6by,3o ► C linen ZP,32-8 (GI) v 4 - 4(908
All questions answered negatively Will be discussed in sufficient detail in
the -Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
SWTJON I
Animal Oiaeratign T e: 5n I SV-)
Horses, cattle, wine, ultry, or sheep
x0N Ii
Y 1 N ! COMMENTS
1, Does the number and type of animal meet or exceed
the (.0217) criteria? (Cattle (100 head),
horses (75), swine (250), sheep (1,000), .and
poultry (30,000 birds with liquid waste
systamjj
2. Does this facility meet criteria for
Animal Operation R—=ISTRATID T?
3. Are animals confined fed or maintained
in this facility for a 12 -month period? -
4- Does this facility have a CERTTFIM
WAS= MANAGENPRT PLAN?
5. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
6. Does this facility meet the SCS minimum
setback Criteria for neighboring houses,
wells, etc?

` SECTION III
FREM is
Field Site Management
1. is animal waste stockpiled or lagoon
construction within 100 It. of a USG5
Map Slue Line Stream?
2. IS animal, waste land applied or spray
irrigated within 25 ft. of a USGS Map
Slue Lime Stream?
3. Does this facility have adequate acreage
an which to apply the waste:'
4. Does the land application'site have a
cover crop in accordance'with the
CERTIFICATION PLAN?
5. is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
6. Does the animal waste management at this
farm adhere to Rest Management P:acticas
(BM.P) of the approved MTIFICA'TION?
7_ Does animal waste lagoon have sufficient
freeboard? How much? (Approximately ?
8. Is the general condition of this CAFO facility,
including management and operation,
satisfactory?
SLP=1 ON TV
Comments

ANZAMA 3Pli S='3 MAND, PLAN CXAT=?=CAT=oN POR U104 Olt 3=12 X02=1 PE.Z=Z,OTS
?lease rstux= tho cc=vlatsd fax=, to the Div ahwl of ':Sva�or-, =,Cal Manxasummt at
r :v zdCLsan as :mss =:verse gida of tis foss.
k1ame of fa--= (Pie se print) : f � I2rK
Add -es s : _ Kit ( - /fie Y '?o
C ? 7_'? Phone No.: G- v
Czuntl :--_qtk- e t
?arm location: latitude and Longitude:` U' -W'/T8' 25' 7 (=agzuir 1d) . Also,
please actacn a copy of a county road slap with location identified.
Type o: operacinn (swine, layer, da::r-
.,r, ecc.) c SWir)E
les i capacity (number of animals) Co G 90 W EA M - FcZQWr4
Average si=a of operation- CIZ. mcnzh pcpulacion avg.) 6oSa WEAn-f f wle
Average acreage needed for land application of :taste (ac= -%s).
ass aaaaasarlliasiaaa ssas��aass�sa��a7ssa7�a�as iaaip �3aaa?R ati aasaaia:��a3aa as aiaaa sada
As a tachnicai specialist desig_:ated by the North Carolina Sail hied water
Canser:-ation Commission pursuant to IgA NICAC Q .0005, _ Certify that the new or
eta.^.de= ani al waste management systam as installed f:) =e fa= lamed a.: -,Ove
^as an an:.ral waste management plat_ that meets the design, carstruc_ion,
o_e,acicn and =ai^.ceramcs st.a`_da.!s a. -_d specifications o: t. -le Ci:;sZor_ of
Zavi c=ental MW.ageme_rt and the USDA -Soil Conservation Service a,.^/o_ the :Dona
Carol -_s. Sail and riacer Car_serracicn C_=miss on pu_suart to WA NC,C 2E.0217 and
_ A NCAC 5= .0001-.0005. The following elements and their ....__3s,c.cn di_ g
c__tar.a-wee_^. ve_i_�ec by me ar ocher design acad technical specialists and
are included in the plan as applicable: mimOli'm separations (buffa=s) ; liners or
equivalent for lagoons or waste storage pods; waste storage capacity; adec-.:ate
quantity and amount of laved for waste um_lizacian (or use of third carry) ac=oss
or awnership of proper waste application egtApment; schedule for timing of
applications; application rates; loadj.g rates; and the concral of the dischw e
of pollutants f=am star -eater runoff events less severe whan the 25 -_yea -T, 24-hour
scow.
!J&M! of Teeti-i Gal aSpOC4AII.at (P
Affiliacion WsWe FAQMs
Add ess (agency) •0.
e ?riZt) [Fr1r� CLrrYprl
Phone No
Signature: 'g. C+-4�;.r Eace:_ SAZOA915_
a.�ama=aa�aasa as:asaaaass asaasaassaasaaaaa�taaaaa aayasaaa=�3a�»aasaaaa�a
C-.=er/Ma_-agsr a�"as=w=z
(we) understand he operation and =aJ-canance precadv es ascablis ed in the
approveC aril=ate waste mamagement plan ;O= the fa--= named a.;ove and will _ lemert
hese -rocecu_es. I (we) ?clow that any additional ex--ansion to the existing
design Capacity of the :paste treaz=ent and storage system or construction of neer
facilities will rsquire a new certification to be sut-mimtea to the Division of
:.:vicory.encai MA agement before the new arima.ls are stzakec. _ ;we) also
�.cerstarc
that there must be no discha. ge of ani -ma? waste __-... this system to
surface waters of tin state ei=ham— through a mar; -.made C_nveya:ce o= hz` ; L.,gh
_..:.off =,aro a storm event less severe -.2- n the 25-,/ea.r. 24-hour s:or--. '."he
3_7roved plan :rill _e ;_led at the =a_-= and at the office of the local Scil and
na_ar C=nser•vac_er. Dist=icm.
*Tara C! :.and Cw_-ar 01 ease Mint)
Signature- Data:�2�
Na=t of 3a:aca , if different from owner (?lease print
Sig,ac_re: Date:
A change in land ownership =eg-sires notification or a new certification
the apqrcved plaza is changed) to he suhmiwted to the Ci7isior_ of
w_.•vircrmen=a: Management within ori days of a title transfer.
DMI US : 0WL.Y.ACry