090015_INSPECTIONS_20171231

Type of Visit: CTCompliance Inspection U Operation Review 0 Structure Evaluation Q Technical Assistance I
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: f f Arrival Time: Departure Time: 'p County: Region:/
Farm Name: Owner Email:
Owner Name: P17r, Phone:
Mailing Address:
Physical Address:
Facility Contact: Y!'�19•t ��/ rnl�-•-+_ Title: 4:��y1 Phone:
OnsiteRepresentative: K-YM17P7T'L er y} Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: 2 _24am_
Certification Number:
Longitude:
Design
Current
Design
Current
gn1LtW.Urrent
Swine `
Gapacty
Po'p
Wet Poultry
GapacttyPop
�" ,
Cattle. Capacity Pop.
Imup,
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
on -Layer
—'Dairy
Calf
Feeder to Finish
:-=•'
Dairy Heifer
Farrow to Wean
Design
Current !
Dry Cow
Farrow to Feeder
D , IPoul
Ca aci
1'0 .
Non-Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
iU
Turkeys
Otbe
Turkey Poults.
OuterI
10ther
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 ;a 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 [S No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [—]Yes F'No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: H - Date of Inspection: --
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E�_No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? D Yes D No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /g
Observed Freeboard (in): 27 / f l
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes B 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 Ej?LNo ❑ 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 RNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ,MNo ❑ 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 M No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes �o ❑ 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):�rl?r
13. Soil Type(s): 4 1-?"4�> G .lam
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 E3-1 to ❑ NA ❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes D3 o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
jj:LNo
❑ NA
❑ NE
18_ Is there a lack of properly operating waste application equipment?
❑ Yes
FNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�No
❑ NA
[] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�o
0 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
❑ 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
[ o
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

. Facility Number: - /, Date of Inspection: 2 --/ /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ,j No
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes P�r_.No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes P!�No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [] Yes _J?�_No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
1�3.No
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
[MNo
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
5LNo
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
,gNo
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWNP?
❑ Yes
23-No
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ENo
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
gC No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
�]NA ❑NE
❑ NA ❑ NE
[]NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Commensts (refer�ta,que scion #) Explain any YES ansviers,and/or any�addlteoual recornMendativns or any atlier,,rnnimeats.''giP'v
Use dra _win of faedi to,�better ex !a gs, ty p_ io sits Ons.(ose additi6"Upages s necessary)-
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone:
Date:
21412015

e ype of visit: %zruompuance inspection V Vperanon Keveew V structure r:vatuatton u iecnmcat 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: _' �` County: "- Region: i7
Farm Name: _ r".rannA � m� „� ��J r►-�-� Owner Email:
Owner Name: h Y .--7 017 = k L y1 ,..tom �_ Phone:
Mailing Address:
Physical Address:
Facility Contact: Y"/I �� ��I11G�—T itle: �Uf��z' Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:a2—
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current" fiDesign Current.
�•; - ; -
Capacity Pop. -- WetPoaltryCapaetty Pop. Cattle apacety Pop.
Wean to Finish jDairy Cow
Wean to Feeder Non La er "'` Dairy Calf
Feeder to Finish v Dairy Heifer 7.4
Farrow to Wean _ D`estgnCurrent Dry Core
Farrow to Feeder DP,oult Ca ace!Po Non -Dairy
Farrow to Finish La ers Beef Stocker
Gilts -Layers Beef Feeder
Boars Pullets Beef Brood Cow
Turkeys
Oti�er Turkey Poults -14,iy
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?
❑ Yes [Z No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
D NA
D NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation'?
❑ Yes
�No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[&No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: Cy - S jDate of Inspection-
—)
Waste Collection & Treatment
.4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeb rd?
❑ Yes
❑ No
❑ NA
[] NE
Structure 1 Structuf&-2— Structure/ Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z72/f
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�KNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[-]Yes
allo
❑ NA
❑ NE
waste management or closure plan?
1f 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
[g--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
4�1,No
❑ NA
❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes FA -No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphors ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): A!-z- / �Va , "'iK JW �rn Kv— f D Y��S 7 rJ
13. Soil Type(s): �`Q /¢� ) , V17 L(1 O
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [I No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [ 4 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Eallo ❑ 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 Eq_No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [qNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes. check ❑ Yes allo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [LNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes F2"o
23. If selected, did the facility tail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �&No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Facili Number: 77- / j Date of Inspection: 3
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
MNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
�64,No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
q No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
0 Yes �No ❑ NA ❑ NE
❑ Yes FNo ❑ NA ❑ NE
❑ Yes [allo [] NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes No
❑ Yes ® No
❑ Yes C?-No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #f): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
VD _3 d` �� r 7./v L-:r 1/z/
41,6--r- 1=fr -46
y
rY,Q
lov
rn Gv 'T�
7 a T/'�fa��
he, 9U_'V
f l ,I
IS ''l '�
PO f I `'� -�1-� t' �i 1va5 !a►��f�7'al y� u
7-n � 7e � P. Y �� II 3, -�-) ,,mod- !e/
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
7�
Phone: %%1) �03� ISr r
Date: 3--3/ —,;20 �7
21412015

• ' ivi"sion of Water Resanrces
Facility Number - 4_1i-�iQ6%SSoil andQ• ther Agency
hype of visit: (,Compliance inspection U operation Review U Structure Evaluation C J Technical Assistance
Reason for Visit: routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: -/ Arrival Time: .' 3 Departure Time: County:
Farm Name: •rn niez - Fez/_rl ' Owner Email:
Owner Name:,Qy, ,r ='7 INS - Phone:
l
Mailing Address:
Physical Address:
Facility Contact: �L jn /7 Y /ilk-•.- Title: 6k-C11Z+� /� Phone:
Onsite Representative:' e'- ��
Certified Operator:
Region:��
Integrator: , e
t —
Certification Number: / % Z4, 2--
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
SwiQe Capacity Pop. Wet Poultry
Design
Capacity
Current Design Current
Pop. Cattle Capacity Pap.
Wean to Finish
La er
Dai Cow '
Wean to Feeder
er
Current
Pa
Dai Calf
Feeder to Finish
D . P,oul
Design
Ca aci
Dai Heifer
Farrow to Wean
Farrow to Feeder
Dry Cow
Non -Dairy
Farrow to Finish
I Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Other
Other
'Pullets
Beef Brood Cow
Turkeys
- -.
Turkey Pouets
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?
[:]Yes allo ❑PNA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
[:]No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[-]Yes
[-]No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
,g No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
Pq-No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3
21412014 Continued

Facility Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [allo
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: p
Designed Freeboard (in): / / 7
Observed Freeboard (in): 2 7
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ NA ❑ NE
❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ,Z�No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �o ❑ 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 allo ❑ 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 :� No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Dq-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):li71LL�2
13. Soil Type(s): G Iwo�.
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 andlor operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[Z No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Rectuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[RNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 ° Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Q No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Callo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: jDate of Inspection: — >r —/ L
24_ Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes &No ❑ NA ❑ NE
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [, No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes M No ❑ NA ❑ NE
Otherlssues
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 CA WMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes LANo ❑ NA ❑ NE
❑ Yes [Z No ❑ NA ❑ NE
❑ Yes [a No ❑ NA ❑ NE
❑ Yes E� No ❑ NA ❑ NE
❑ Yes [2_No
❑ Yes CR No
❑ Yes allo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to 4 estiow###) Explain any YESyansw$rs and/or,4tiy:idditi&nal:iecommendationg6r4any,','oth-er.,coffihieiiUt
9
Use drawings of faciliWlda,better.explain situations.(use.;add�ttonal!pa esxas,necessary)
Reviewer/Inspector Name: z" l
4-71
pwas f�J�XY�`
-,- ))o -C_ A e C'e_,u3 �`L
Phone: 2yo--sK 33 zx;'
Reviewer/Inspector Signature:
Page 3 of 3
Date: ` _ �6—�z'�/6
21412014

Ise
(Type of Visit: (;�'Com 'ance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Routine Q Complaint () Follow-up Q Referral 0 Emergency Q Other O Denied Access
Date of Visit: Arrival Time: . t? o Departure Time: % Q ,+� ci County: LAY Region: 712�?d
Farm Name: f'(Y�.� Y L ,'&,"_ I—a'w-v Owner Email:
Owner Name: Zi_eorj r- _:y'h yyr --�- Phone:
Mailing Address:
Physical Address:
Facility Contact: -,, Title: e9G1-Pj r-�~ Phone:
Onsite Representative: �-- Integrator:
Certified Operator:<< Certification Number: f 7
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Desigu Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
G �l �D
--'�.�
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Desigu
Current
Dry Cow
Farrow to Feeder
D . al?onl
Ca ac'
P,o
Non -Dairy
Farrow to Finish
I Lavers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
-
-
Turkeys
Qther
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
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 allo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes ,j No
[:]Yes 2g_No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3
21412014 Continued

Facili Number: jDate of Ins ection: —
—/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
CS 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): f�
Observed Freeboard (in): f
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[Z No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® 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
CaNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
j&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
PNo
❑ NA
❑ NE
maintenance or improvement?
1 I . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Wo ❑ NA ❑ NE
0 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): al L6L k U ev- --,
13. Soil Type(s): a A- f j c
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 ja No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes MNo ❑ 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 [jNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes E - No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [74 No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes (� No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [R No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ;KNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Ins ection: S =1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [S No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [2No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26, Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes allo
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [ANo
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)
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [�,No ❑ NA ❑ NE
[] Yes La No ❑ NA ❑ NE
❑ Yes a No ❑ NA ❑ NE
❑ Yes FANo ❑ NA ❑ NE
❑ Yes 1No
❑ Yes EC No
❑ Yes EZ�_No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Phone: rf} 3'T .A'_,o
Date:
21412011

`l
� ivision of Water Quality � ��,.._� r�
Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: omp lance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: %4 Arrival Time: % D D Departure Time: : a t7 County:S`'
Farm Name: Owner Email:
Owner Name: V51 6117 y Phone:
Mailing Address:
Region:
Physical Address: Q
Facility Contact: %�� 2 � �n Title: Bt,LJ� r� Phone: 9/0—
Onsite Representative: _� Integrator: zo2 ,O-aI'�w�
Certified Operator: 9�►-.� _ Certification Number:p�—
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
_
Design Current
Design
Current
_
Design Current
Swine
Capacity Pop.
W.et Poultry -
Capacity
Pop.
Cattle
Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
4 yvt:)
S 1
Non -Layer
-
I
Dairy Calf
Dairy Heifer
Feeder to Finish-
Design
Current
Dry Cow
Farrow to Wean
Farrow to Feeder
D yPoUlt
Ga aei
P.o
Non -Da'
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
Boars
Turkeys
_
Other
Turkey Poults
Other
P ..
- -
Other
Discharees and Stream Imoncts
1. Is any discharge observed from any part of the operation?
[:]Yes
jo�No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
0 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? (lf yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
C. 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 21412011 Continued

Faciti Number: q -I Date of Inspection:
Waste Collection & Treatment
is heavy less
Yes
y 4. storage capacity (structural plus storm storage plus rainfall) than adequate?
❑
t! .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: '�Jeck)
Spillway?:
Designed Freeboard (in):�
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
J�rNo
❑ 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
CNo
❑ 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
La No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
gNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes\JEJ_No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 25 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): G
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes W No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[Z No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[—]Yes
Lg No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
L&No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes � No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection: 7
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes RNo
' 25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes 0 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 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 2�No ❑ NA ❑ NE
0 Yes [.No ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
❑ Yes E&No ❑ NA ❑ NE
❑ Yes 2,No
❑ Yes 21 No
❑ Yes MNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question #} Explain any.YES answers and/or any additional:recommendations or any other comments w
Use drawings of facility to: better explain situations (use additional pages as necessary):
y
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: � v2lZO����
21412011

Type of Visit: G,Com nee Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: C5 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ..moo Departure Time: County:
Farm Name: 6%F_-kt K 4t `a✓w�- Owner Email:
Owner Name: f C- , ,,'7h =ZFAwo� _ Phone:
Mailing Address:
Physical Address:
Region: j� 0
Facility Contact: KTrr" "7%4 -yea. Title: Phone:
Onsite Representative: Integrator:
Ir
Certified Operator: Certification Number: /,.7
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
SwineMapacity Pop. Wet Poultry
inish Layer
Design Current
Capacity Pop.
Design Current
Cattle Capacity Pop.
DairyCow
DairyCalf
Dai Heifer
D Cow
Non-Dai
Beef Stocker
Beef Feeder
eeder
Non -La er
Finish
pFedertoFinish
Wean
Feeder
D , P,ouI
Design Current
Ca aci P,o .
Finish
La ers
Non -La ers
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkex Poults
Other
Discharves and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
allo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify 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
g No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
[S No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Faciii Number: - / Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: 'e"Lj C 1
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
N 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
R No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[a 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
Q No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Uj 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): G
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 2D No [] NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [—]Yes � No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check [—]Yes M No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes (4 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 'U No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes j!j No
DNA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 214,12011 Candnued

Facility Number: - / Date of Ins action:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 5jLNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes 10 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ®, No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Q 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 file drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field (aLagoon/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?
0 Yes K No ❑ NA ❑ NE
❑ Yes ED No ❑ NA ❑ NE
❑ Yes [K No ❑ NA ❑ NE
® Yes ❑ No ❑ NA ❑ NE
❑ Yes ® No
[:]Yes ® No
❑ Yes 5a No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments..,
Use drawines of facility to better exnlain situations (use additional naves as necessarv). $'
3 i dry Sys�r. fi /b"/ G oa- � ,-'-'R , M;p . / -�y --- Jp7 l
Tr ac dryYr �/t � k ftty� �tvr�S J e�Dul ii �`•
r a� v t r
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone:
Date:
21412011
Page 3 of 3

r-r-! OCIX3
I . of Water Qaality"
Facility Number - /s 0 Division of Soil and Water Conservation
- ®Other Agency
U-51
Type of Visit: ompliance Inspection O Operation Review Q Structure Evaluation p Technical Assistance
Reason for Visit: routine O Complaint Q Follow-up Q Referral 0 Emergency O Other O Denied Access
Date of Visit: 1 /— � Arrival Time: Departure Time: ; 3 p County: r. �-
Farm Name: &,W,7yt Owner Email:
Owner Name: Alf A! e� _Z7;t„f Phone:
Mailing Address:
Region: IA' o
Physical Address:
Facility Contact: Title: ZGC1H1"✓~ Phone: /
Onsite Representative: S�� Integrator: /kra_'fy
Certified Operator: 5��.. e _ Certification Number: /7 5w,
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wet 1?oultry
Design
Capacity
Current
Pop.
Cattle
Design Current
Capacity Pop.
Wean to Finish
Wean to Feeder
O lvd"
Layer
on -Layer
Dairy Cow
DairyCalf
Feeder to Finish
� m -
D ,. P,outt
Layers
Non -La ers
Pullets
Turkc s
Turkey Poults
Other
Design
Ca aci_
Current
PloP.
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
U.ther
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [&No [:]NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

Facility Number: - Ds ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
' a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1
Identifier: AjGW
Spillway?:
Structure 2 Structure 3 Structure 4 Structure 5
�L
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
Designed Freeboard (in): oZZ— v/
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
0 NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
® Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)i"
13. Soil Type(s): Z�2 Z-
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 [M No ❑ 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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [g No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes El No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [—]Yes ® No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. EQ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ® Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes Eg No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Faci lity ]Number: - Date of Inspection: /7� /
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 L&Yes eo,
❑ NA ❑ NE
the appropriate box(es) below.
® Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field to 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 10 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Yes 'moo ❑ NA ❑ NE
❑ Yes No
❑ Yes gj No
❑ Yes [0 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments Use drawings efer to of facilq�ty #oton �#)-,,EjtpMinan 'YES answers and/or any: better explam,s to tons (use additio al pagesas neces endations orYanyotercomments
�/ lus�9rJ� DrdYr :3 i
W, T �s%.S
y �
S07 ,rv_74—
Ar
75,7
r La D "L �PS; r r/� SG�•.,��or�"Y,,.'� �G��""�!� f � �-u1��/z
Reviewer/Inspector Name:,
Phone: %V_*33' 33 W
Reviewer/Inspector Signature: Date: / —/ 7--VLtW102`
Page 3 of 3 21412011

Type of Visit 4DICompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit G�<utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: A Departure Time: 2- % 30 1 County: �'�� Region: f_ zQ
Farm Name: K em n G71� _Z7n Owner Email:
Owner Name: R--na Phone:
Mailing Address:
Physical Address:
Facility Contact: r n / » ►taw Title: Wn Phone No:
Onsite Representative: �`�'�`� Integrator:br��
Certified Operator: moo—e Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 e ='
= Longitude: = ° = I = "
Design @urrent Design Current
Design Current
Swine Capacity Popp latiop Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish ❑ La er
❑ Dairy Cow
® Wean to Feeder P Lo. ❑Non -Layer
❑ Dairy Calf
❑ Dairy Heifer
❑ Feeder to Finish
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder _
❑ Layers
El Farrow to Finish
❑ Gilts Non -Layers
❑ Pullets
❑ Boars
-sawill 111151-5 ❑ Turkeys
Other r 0 Turkey Pouits
❑ Other El Other
❑ Dry Cow
❑Non -Dairy
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Co
Number of Structures:
Discharges & 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 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
CE�No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[&No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12178104
Continued

Facility Number: — % j Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
UNo
❑ 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: O U it-
Spillway?-. Gti4
Designed Freeboard (in): /t} '
Observed Freeboard (in): ye
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
® No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
J3 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
19 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
(Z No
❑ NA ❑ NE
maintenance/improvement?
I I . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes N 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) A/'A/t
T
13. Soil type(s) r-Q.* / t9C_
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes [SNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
9 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
E[No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
VNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
CA No
❑ NA
❑ NE
W'p,4 ; s 04
Reviewer/Inspector Name ��
Phone:
/d 3
.3 O a
Reviewer/Inspector Signature:
Date:
"L- `
D
rage Z q j 1 , cicoiv r ...1...r.wcs

- Facility Number: '5_1 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 10 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 CA 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
W No
❑ NA
❑ NE
❑ Yes
[9No
❑ NA
❑ NE
❑ Yes
D5 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes C&No ❑ NA ❑ NE
❑ Yes CA No ❑ NA ❑ NE
❑ Yes E3No ❑ NA ❑ NE
❑ Yes WNo ❑ NA ❑ NE
❑ Yes
JZ No
❑ NA
❑ NE
❑ Yes
LA No
❑ NA
❑ NE
Additional 'Cgnimeiits and/or Drawings_ = `` v
s-•. #
Page 3 of 3 12128104

S oio
WAL®
Type of Visit Com lance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for VisiE Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: -08- /D Arrival rime: //.�Z� Departure Time: County: 25'. e7eA✓ Region: ^' "
Farm Name: .6.,§.jVr,_1 7. , X4 91 AJ +rr+- Owner Email:
Owner Name: /<e.tJNG 4 &'Wlq'V Phone:
Mailing Address:
Physical Address: ,,r}
Facility Contact: �C G+✓N -�� ` Title: �r+JN [r!� Phone No:
Onsite Representative: integrator: �k h 4-2gov eaAl
Certified Operator: `'r�`' `''~ Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: . Latitude: = o = 6 = [L Longitude: ❑ ° 0 f = u
Design Current
Swine C►apacity Population Wet Poultry
Desigu Current
Capacity PEopuElation
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑Dai Cow
Wean to Feeder
82
❑Non-La er
❑Dai Calf
Feeder to Finish
Dry Poultry
❑ Layers
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Co
El Turkeys
Other ❑ Turkey Pouets
❑ Other ❑ Other
Number of Structures:
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes G<oo ❑ NA ❑ NE
❑ Yes
❑ No
ElNE
El Yes
El No
�[,3"IC��A
E3- A
[I NE
El-NX
❑ NE
❑ Yes
E] No
❑ Yes
�o
❑ NA
❑ NE
❑ Yes ETNo ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: 0
Date of Inspection —D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
❑NA El NE
❑NA ❑NI?
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: / .4r— Z, -z�
Spillway?:
Designed Freeboard (in): jr/yCo�rsc�a3
Observed Freeboard (in): !�1 Z fl �1 Ale r q3
❑ Yes MNo
❑ Yes No
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
R'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
2110
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental) threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[�o
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
9110
❑ 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
,.,
9HIo
❑ 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 ffNo ❑ 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 types)riwK��►.
13. Soil type(s)
//GLI
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
IJ No ❑ NA
❑ NE
No ❑ NA
❑ NE
'NNo❑ NA
El NE
2"N❑ NA
El NE
��O_❑ NA
❑ NE
Comments {refer to queshou'#) I✓zplain any YES. answers and/or a©y r`ecomuiendattons ©r an)other comments _
Use drawings of facr[ityto better explain situations. {riseadditional pages as°necessaiv)�
3=:
A.
Reviewer/Inspector Name
- �V t
Phone.
Reviewer/inspector Signature:
hate: 7-DS- -z0/0
12128104 Continued

Facility Number: 179 —/ Date of Inspection
_Required Records & Documents ��
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes 2 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes L7 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
C 21�o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑ Weather
Cade
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
E Nc
❑ 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
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes�3�No,❑
NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�N
El NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
No
❑ NA
❑ NE
Other lssues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
B No
❑ NA
❑ NE
29. Did the facility fail to property 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
��/
L�1 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
2<
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
99 o
❑ NA
❑ NE
Page 3 of 3 12128104

hqS /d-o9--zoo q
Type of Visit 12rCornpliance inspection 0 Operation review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: /�. �OQ County: AN—d a e- `� Region: -2�
Farm Name: A���eyx--�/✓ a Owner Email:
Owner Name: A�e_-Mdt� M41A% Phone:
Mailing Address:
Physical Address:
Facility Contact: I +Lz t• IA-�A.J Title: Phone No-
Onsite Representative:
Certified Operator: K,,-A/C,-I ` .�Itilyt4 ,✓
Integrator- p
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = e Longitude:
Dn Currenk
Design Currents, Design �f Current
w Cai Pa Mahon F. Wet )'Dolt .
Ili �P r3'
Ca aci Po uIa lY on Cattle Ca aci Po ulatio
P ,��J P F; rY P
❑ Wean to Finish
❑ Layer
F_' ❑ Dairy Cow
��Vean to Feeder
Non-Layei
❑ Dairy Calf
❑ Feeder to Finish'
°' ❑ Dairy Heifei
El Farrow to Wean
�'`
�,.
Dry Poultry
tN `❑D Cow
���-
❑ Farrow to Feeder
'El
❑ Farrow to Finish
P ❑ Beef Stocker
P,; El Gilts
❑ Beef Feeder
❑ Boars,
El Beef Brood Co
Other
-•
+1'
❑Other
Number of Structures:
��'T
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Points
❑ Other
Discharp_es & 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
�,/
NSA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
,E
D 1v[�
❑ 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
/'iA
❑'1VA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
j-<oo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
,[
I�vo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

i
Facility Number: — /` j Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes3<o"i NA El
a. If yes, is waste level into the structural freeboard? ❑ Yes o ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ! 0-2i AC 3
Spillway?: �r ,• `,, , n Le
Designed Freeboard (in): ! claSe1 O
i
Observed Freeboard (in): ,SJr if 7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 3<0 ❑ 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? ElYes 2/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 El Yes No ❑ NA El NE
maintenance or improvement?
Waste Application _J �.,/
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes ITNo ❑ 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 Ibs ❑ `fotal Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl,/❑ Application Outside of Area
12. Crop type(s) �Gvr.,t.-c/.— C �j ) SOU
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[frNo
❑ 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
B
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Tom❑
NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
.� �
J�"1Vo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name ; G{ ✓ �S Phone:
Reviewer/Inspector Signature: Date:
I Z1Z51U4 t onanuea

Facility Number: e7? — /Jr' Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes d No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists ❑Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ErNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Vo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No ❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No ❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
I o ❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit A Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit '0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: �IC,_:;'26 Departure Time:
Farm Name: �YV1
Owner Name k _ I h rv1-A�
Mailing Address:
County:
Owner Email:
Phone:
Region: s L,-'
Physical Address: f
Facility Contact: �C 11 f'1 Title: Phone No:
Onsite Representative: V'yQ),,Y1 Integrator: M ` _
Certified Operator: Operator Certification Number: / 7T
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o =' [� " Longitude: = o ❑ f = «
Design C•arrent
;Design Current
Design Currentillillill
Swine Capacity Population
Wet Poultry ,Capacity Population
Cattle Capacity PopulatiW. on
❑ Wean to Finish
Layer
FN'on-Layer
El Dairy Cow
Wean to Feeder
5S Z
❑ Dairy Calf
❑ Feeder to Finish
-'
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry,, _, "'
❑ Dry Cow
❑ Farrow to Feeder
�.
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
-
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[VNo
❑ 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
'WNA
❑ 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
11fiNo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
0 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
�I No
❑ NA
❑ NE
other than from a discharge?
Page l of 3
12128104
Continued

Facility Number: — i;l t Date of Inspection t�
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �KNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [,VNo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 7 —otd 3 - o Q_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes MNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes OR�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 KNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0,No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Wo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
1 1. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes EA 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
12. Crop type(s) Lum=6 H , n.m c11- V l S
13. Soil type(s) ro A CD G 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
Wo
❑ 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
[3�10
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
R 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):
AL
Reviewer/Inspector [dame Phone: Q
Reviewer/Inspector Signature: Date: L
12128104 ConlinueU

FAcility Number: Date of inspection O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes M No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes tS No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g El Maps ❑ ether
21. Does record keeping need improvement? If yes, check the appropriate box below. []Yes �RNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ANo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[:1 No
]RNA
❑ 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
D9 No
❑ NA
❑ NE
27_
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
EANA
❑ NE
Other Issues
2&
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
;RNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
NNo
❑ 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
RNo
❑ 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
Wo
❑ NA
❑ NE
Page 3 of 3 12128104

Fagility Nc.0 + �J i / Time In �c� Time Out ��YD1ate L 4
Farm Name h /h Integrator 1 °
Owner lZ e `f » 07%.A Site R ly)
Operator h No. i `y
Back-up No.
COC Circle: �eneralr �NNPDES
i' `f� C Z
Desi n
Currentj
Design
Current
We —
Uca
Farrow — Feed
— inish
Farrow -- Finish
Feed — Finish
Gilts I Boars
Farrow —Wean
Others
jcj
FREEBOARD: Design
Observed
Crop Yield
Rain Gauge
Soil Test Wettable Acres
��
Weekly Freeboard Daily Rainfall
Spray/Freeboard Drop
Weather Codes L�—
Waste Analysis:
120 min Inspections
Date Nitrogen (N)
3 2-o 0�, z .3
r't zl �z
Sludge Survey A. i �_ -(O d9
Calibration/GPM /
Waste Transfers
Rain Breake_r'�__
PLAT
1-in Inspections
v 0 A
Date Nitrogen (N
\f
S Z.Z 3. t ,off ,a3
Pull/Field Soil Crop Pan Window
r�
Qf
r �'�

1t
`Division of Water Quality 1
Facility Number O-Division of Soil and Water Conservation `
Q Other Agency n-a-1 L
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1) a I Arrival Time: ®` Departure Time: County: n Region: F—r—.J
Farm Name: K.Q ne7Q k l fhrriD,ri Gt;k'K yV Owner Email:
y
Owner Name: 1 15:.,Y 1Phone:
Mailing Address: �[ r CJL (/ , a89 rz
Physical Address:
Facility Contact: 2l'1i+l4 Ll h Title: (D W rCK Phone No:
Onsite Representative: 11 Integrator: i1Wt�
Certified Operator: hl'Y14� lr� Operator Certification Number: ` l �F Z
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0e ❑ g = Longitude: = ° ❑ 1 ❑ "
r.
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
00 ❑ Non -La et
❑ Wean to Finish
can to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Dischar>Yes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
i
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 'k No ❑ NA ❑ NE
❑ Yes ❑ No V NA ❑ NE
❑ Yes ❑ No ❑ NE
❑ Yes ❑ No —DNA ❑ NE
❑ Yes &o []NA ❑ NE
❑ Yes tINto ❑ NA ❑ NE
12128104 Continued

• 'Faeiiity 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 I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: Q
Designed Freeboard (in): l 1
Observed Freeboard (in): IV
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 ''No ❑ NA ❑ NE
❑ Yes ❑ No [�6A ❑ NE
Structure 5 Structure 6
❑ Yes RNo ❑ NA ❑ NE
[--]Yes )gNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 9,Vo ❑ 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 •-b�No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. [:]Yes 9No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside /� of Acceptable Crop Window ❑
s l❑ Evidence of Wind Drifi 'Application Outside of Area
12. Crop type(s) . i.3t-�(1 Y� C�. ` H s Ym o", C) ✓k
13. Soil type(s) �7 D C ,
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
bkNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
r�UmNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Wo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
NNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to explain situations. (use additional pages as necessary):
+better
` I` t' l -tl JWac [ ER, —Z
4-,- [ prrej Cegj( Cg4.,o,ti &4eS
`
CQ-h �`11 a4L back Sle�
C-�r' /i� bi, 4 3
V
Reviewer/Inspector Name04
c�
f jV ' &mO Phone: l o y
Reviewer/inspector Signature:
Date: u� d�
12128104 LJ Continued

'h
✓ Facility Number —O( Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yeslo ❑ NA ❑ NE
the appropriate box. ElWUP ❑ Checklists ❑ Design ❑ Maps El Other //
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes %No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
)§,No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
WA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes )allo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes No
❑ NA
❑ NE
26_
Did the facility fail to have an actively certified operator in charge?
❑ Ye
[&NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ;k`No L&N
❑ 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 Wo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes E�PNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 72128104

— ---- Division of Wa#er Quality
iFacility Number® 0 Division of Soit and Water Conservation
0 Other Agency �r
Type of Visit & Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency A Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Regiotf." Rz
Farm Name: I EO.YYYLS Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: 4MV124L ftjQ_V\ Title: CC) ` V Phone No:
Onsite Representative: J<n x Wdl V, Mgun _ Integrator: r`
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [= 0 = = Longitude: EJ o =' = u
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
1 ❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
--
El 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?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: E411
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 A No ❑ NA ❑ NE
❑ Yes ❑ No XNA ❑ NE
❑ Yes ❑ No�XA ❑ NE
❑ Yes ❑ No [)VNA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Condnued

FacilityNumb_gr: —QJS 1 Date of Inspection tl L_Y 1 ur I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
A No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc_)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ No
❑ NA OR 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? Ayes El No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes No ElNA ❑ 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? f
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA �'iE
maintenance/improvement? ?"
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑AE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) J
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
E
15_ Does the receiving crop and/or land application site need improvement'?
El Yes
El No
❑ NA
—
E
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA F NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
*E
.Comments (refer to question): Explain any YES answers and/or any recommendations or any, other, comments,s
Use drawings of facility to,better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name k_�VJajiMr; r_51AWotJ I Phone-.4 )()1{ n j,411� %
Reviewer/Inspector Signature: Date:�fl� S 7�
Page 2 of 3 12128104 Continued

Faciftty Number: Date of Inspection fL _ ►1 �a j
Reauired 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 appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NANE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ElYes ElNo ❑ �NA OUNE
E
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No ❑ NA NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ❑ No ❑ NA NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No ❑ NA NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CA WMP? ❑ Yes ❑ No ❑ NA NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes ❑ No ❑ NA NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ❑ No ❑ NA NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes ❑ No ❑ NA NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ No ❑ NA NE
33. Does facility require a follow-up visit by same agency? ❑ Yes ❑ No ❑ NA NE
Additional Comments and/or Drawings:
Si jeQ v ;�►`t' '�� e55 -1 eA5 � b: �i 1-6 Pr -,4,s
m
Ge s �n �- : or, g on a� 1 Inoar15 - Z n +,ram
`-
O'feOb��s,�
L dens
111 du T_ C.c, w 4k ��U T'r m.
`InC.(tA,cLp lr]��}}"' Se. Iyv�ratj V,['[t i,n ��-4c P art F even
J�__ Q ✓1-fMe d i alC, 1i Se..
LA.n - i ( y-h', ovti i'hq P W . 4� e_C C A 'S c1r4Valve canC,�jss.( rtno t g °`XA\ 4retx5 �ot Qc.c -�or►.�
O�Cee'h C OL L 1 07 r14- &S C lA C� `{� iC e S r4Yv- $gyp Yl e tM!>Gt I l LiiiD��
,/� � i U �
Page 3 of rd HS } P �5�,° C"'k l �y ,3 Ca I td Oc -) 12128104

_ A vision fob ater Quality
IFFMIJ. Number ® �� Division of Soil and Water Conservation i,/
Other Agency
Type of Visit ompliance Inspection Q Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit outine O Complaint O Fallow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: 3 [7 County: Region:
Farm Name: C�_pzi: &r_s Owner Email:
Owner Name: //�/r P G / , _-77nIna-'e - Phone:
Mailing Address: / O/� r �44 AIe ` g�
Physical Address:
FacilityContact: M Met rZ _ Title:
Onsite Representative: �-�--
Certified Operator: ✓C�""�
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = O E--] ' = u Longitude: = 0 = ' 0
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Pogltry Capacity Population
Cattle Capacity Population
❑ W!antoinish
❑ La er
❑ Da' Cow
Weeder +�
❑Non -La er
❑ DairyCalf
❑ Feeder to Finish
x
�� 'I
,x
❑ DairyHeifer
❑ D Cow
❑ Non -Dairy
❑ Farrow to Wean
Dry'P.oultry ._
"x ❑ Farrow to Feeder
❑to Finish
❑
LaersFarrow
❑Beef Stacker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cowl
❑ Turkeys
Other
❑ Other
D Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
KNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
[ZNo
❑ NA
❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
❑ Yes
B,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
PNo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
®,No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
&No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: Date of Inspection
,t
Waste Collection & Treatment
y
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑Yes
[A No
El NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
MNo
❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
L,No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
53 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
[K No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
ZINo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ yes
[gNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
PqNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑l Evidence of Wind Drift Application Outside of
Area
/❑
12. Crop type(s) 5-r' NNij4._ �fm iY[� fjr'v% �f/rr✓r-rd / r�2 / ![/ft /Se�1�C��
��
13. Soil type(s) ��' r f fQ FyA Z&-O 7'-
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?
RYes
❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
9 No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
&No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ZI No
❑ NA ❑ NE
�� rn�� l� a r{� t ��� ���yi'� ��� i � � u r �r/'rn u o�a•
7a 4 FD -*--[ Ord 775t
T
ReAewer/lnspector NamePhone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: — s Date of Inspection V4.
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes J9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [&No ❑ NA FINE
the appropriate box.
❑ WUP El Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes KNo ❑ 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
KNo
❑ 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
Z 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
KNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
CgNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E9 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[allo
❑ 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
F�LNo
❑ 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
(RNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo
❑ NA
❑ NE
Additional Comments and/or.. Drawings: L-1
Page 3 of 3 12128104

6—
Type of Visit ("-Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: 0 ! Q Z] County: Region:
Farm Name: �GL�)?'r� _ Owner Email:
Owner Name. ��/4,QH- Phone:��
Mailing Address: !D> 3—�i �-L,z 2E/ /y6 r1Z�3
Physical Address:
Facility Contact: _ _Sgo Title:
Onsite Representative: _<I*17 =c
Certified Operator: �S9.114e-
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c 0 I = Longitude: E:1 o = ' ="
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
Finish E ❑ La er
Feeder i� a e2 ❑ Non -La ei
❑ Wean to
Wean to
El Feeder to Finish
❑ Farrow to Wean
El Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
ElNon-Layers
El Pullets
ElTurkeys
El Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
El Dairy Cow
El Dairy Calf
❑ DairyHeifer
❑ D Cow
El Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
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)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2- Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes KNo ❑ NA ❑ NE
❑ Yes
�gNo
❑ NA
❑ NE
❑ Yes
LKNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
5QNo
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
RLNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes (Q 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): y3
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 04 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ® Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'? ❑ Yes ® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 1�1 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes C4No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement? I� Yes
I& No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination';[:] Yes
14 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
64 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'? ❑ Yes
�No
❑ NA
❑ NE
�GDrr7inelY G'r�+��r'/03� do �e��pn� ,�'l�i7rlEi-� OYt TAFIr✓ Gry�r,� (9st Na•a-
wo,-k Cn, C_ /--4 tC-Sf r n brr�rru�rr.
Reviewer/inspector Name K;''Y'
t _ Phone: %�
Reviewer/Inspector Signature: Date: &=ZE C
12AM104 t.onnnuea

Facility Number: Date of Inspection D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes O.No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes JZNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes N 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 UNo ❑ NA ❑ NE
23, if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes C0 No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
19Yes
E11251-
TD No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
Yes
6
_gNo
❑ 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
[A 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
JZ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
®No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Frio
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[0 No
❑ NA
❑ NE
nal Com uent_,c ai d/or DraWingi:'
'7Z'7 j02 'e— 1.u-11 6-'Cko,
12128104

Type of Visit • Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit • Routine O Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date or visit: i Z O Tine: c O!�
Not erationa! 0 Below Threshold
$LPernautted Pt Certified 0 Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
Farm Name: y�� _-_a�+^�S County: RL -
Owner Name:...,,,,.,,, A _ S v� v►16t.4A- 'Phone No: Oi 10 - U0 Z -
Mailing Address:..- o [ 5....._ ;U .._ _ ....... _ . S.lr.r)., P l N c- 2 Z
Facility Contact: T-zN&M w-. Title: Phone No: _
Onsite Representative: Integrator: Z=6M `.5 Is ces,-a
Certified Operator: _ . , �L v` wut,.� Operator Certifcation Number.
I f02Sd
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • � Du Longitude • 6 Du
Swine
Wean to Feeder MSOO
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boas
neat Desna ;Current
�ilatenn ..�pQtiltry,: . ;' ('city -'-Pnnalgi
.TOUT,-j
I Mrs=sz+�
Diechames & Stream hups
1. Is any discharge observed from any part of the operation? ❑ Yes P.No
Discharge originated at ❑ Lagoon ❑ Spray Field ❑ Other
a, If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 9No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes +gNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 5LNo
Structure l Structure 2 Structure 3 Stru 4 Structure 5 Structure 6
Identifier_ ..__ ___ ._�_ . . _. . _ _
Freeboard (inches):
12112/03 Continued

Facility Number: — !S Date of Inspection ,[ D
5 Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes allo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes Z[No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes EgNo
8. Does any part of the waste management system other than waste structues require maintenancerimprovement? ❑ Yes 12 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes allo
elevation markings?
Waste Applicatioa
10. Are there any buffers that need maintenancelanprovement? ❑ Yes ff No
I I . Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes SNo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type &r.4.t,,�.nv Swam o rc�� r. n v�.r-i Qo CQr n
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes E No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes JEq No
b) Does the facility need a wettable acre determination? ❑ Yes 2Wo
c) This facility is pended for a wettable acre determination? ❑ Yes RNO
15. Does the receiving crop need improvement? ❑ Yes CKNo
16. Is there a lack of adequate waste application equipment? ❑ Yes allo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes EffNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes JRNo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes KLNo
Air Quality representative immediately.

Fac7ity Number: — / S Date of Inspection / yq
Repaired Records & Documene;
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
MNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
5JCNo
23. Does record keep' cedd'' provement? If yes, check the' appropriate box below.
❑ Yes
IgNNo
❑ Waste Applicatiol� [] Freeboard❑ Waste Analysis ❑Soil Sampli�
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[&No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
19:No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
JZ No
27. Did ReviewedInspector fail to discuss review/mspection with on -site representative?
❑ Yes
Wo
28. Does facility require a follow-up visit by same agency?
❑ Yes
9,No
24. Were any addi, onal problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
1.No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
;4 Yes
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
RNo
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
RNo
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
J,No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
RNo
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below_
❑ Yes
ENO
❑ Stocking Fm* ❑ Crop Yield Form ❑ RainfhVt inspection After I - Rain
❑ 120 Minute inspection❑ Annual Certification Form
] 3 No violations or deficiendes were noted during this visit. You wfil rive no further correspondence about this visit_
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