470032_INSPECTIONS_20171231

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Type of Visit: ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: It Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: / Arrival Time: 'vAa„ Departure Time: .. County: Region: /—V
Farm Name: (nJAw( fa, Owner Email:
Owner Name: _ 2�A4 ZA2W T Phone:
Mailing Address:
Physical Address:
Facility Contact:�� I
Onsite Representative: 14
Certified Operator: N
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator: 6ct32ji/'_9t1'fA w1'.r
Certification Number: 9' CZ % i
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes rL;pallo ❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes ❑ No ® NA ❑ NE
[:]Yes ❑No
❑ YesNo
❑ Yes No
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page l of 3 214/1015 Continuer!
1
I . k II
i �°Pu .,
�f JQHIurrentl'
esign Current
#1 iwmu�n,, •E„ �lituli
i�l� mPk°auElwn� a�icit ! tPOpiii ``,
I III
i
Cn�int�e
III
Design Current�,1,�iutal;
ICapncityl It plmpll !!!!
�mu�sw„„iunroll'�wEeffCapc�uty4
dumm„uwuwm„ ��iu i4ll
Wean to Finish
Layer
Dai Cow
Wean to Feeder �`
Non -La er
; '�'' ' ��y�!, �
�Nllti�ll'1�
Design Current
n�6f..4 wuim
Dry, 1?oult Cn Bel Po,u
DairyCalf
Feeder to Finish Q
Dairy! -leiter
Farrow to Wean
�
D Cow i
Farrow to Feeder
Non -Dai
Farrow to Finish
Gilts
Layers
Non -Layers
Beef Stocker
Beef Feeder
Boars
Pullets
Beef Brood Cow
tUther s
Turkeys
1
-Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
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 rL;pallo ❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes ❑ No ® NA ❑ NE
[:]Yes ❑No
❑ YesNo
❑ Yes No
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page l of 3 214/1015 Continuer!

Eacili dumber: 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 Struct re 6
Identifier: 1
Spillway?:
Designed Freeboard (in):
sly
Observed Freeboard (in): rl
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.) T
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes [M No
[:]NA
❑ NE
waste management or closure plan?
❑ NE
15. Does the receiving crop and/or land application site need improvement?
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 1� 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)
acres determination?
9. Does any part of the waste management system other than the waste structures require ❑ Yes No
[3 NA
❑ NE
maintenance or improvement?
❑ Yes
❑ No
Waste Anolication
❑ NE
18. Is there a lack of properly operating waste application equipment?
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No
W NA
❑ NE
maintenance or improvement?
Ree tired Records & Documents
1 I . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No
071 NA
E]NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
Yes
❑ No
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ NE
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
❑ Yes
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
E0 NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
1� NA
❑ NE
Ree tired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Yes
❑ No
MNA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NoNA
-4
❑ 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 0 Soil Analysis
❑ Waste Transfers
Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[] No
5R NA
[] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
41%
NA
❑ NE
Page 2 of 3
2/4/2015 Continued

Facility -Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
V 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
0 No
�3 NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
99 NA
❑ NE
Other Issues
2$. 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?
as:
Reviewer/lnspector Name:
ReviewerAnspector Signature:
Page 3of3
❑ Yes [—]No 1�NA ❑ NE
❑ Yes ❑ No [P NA ❑ NE
❑ Yes [] No
❑ Yes 0 No
LpNA ❑ NE
INA ❑ NE
❑ Yes ❑ No [)� NA ❑ NE
❑ Yes ❑ NoNA ❑ NE
❑ Yes ❑ No NA ❑ NE
Phone: r0• _ 7;eo
Date: !' lT 1 %
Al,?;)15

. AF Division of Water Quality
Facility Number - L.� 0 Division of Soil and Water Conservation
0 Other Agency
type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ® Routine 0 Complaint 0 Fallow -up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: J Q Arrival Time: Departure Time: ' n County: Region: V�"y
Farm Name: Owner Email:
Owner Name: od Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish La er I I �:�]
Wean to Feeder Non -Layer
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Discharees and Stream Imnacts
Design Current
Dry Poultry Canaeity Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -1326r
Beef Stocker
Beef Feeder
Beef Brood Cow
1. Is any discharge observed from any part of the operation? ❑ Yes [ No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: TT
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)? TT
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 V NA ❑ NE
❑ YesNo F]NA E]NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 2/4/2011 Continued

Facili Number: - Date of Ins ection:
Waste Collectlon & 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 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: lJ L
V1 No ❑ NA ❑ NE
!❑ No 1P NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
_
Observed Freeboard {in}: �N
�j
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 N ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ YesNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) 1P
9. Does any part of the waste management system other than the waste structures require ❑ Yes Qff No ❑ NA ❑ NE
maintenance or improvement?
Waste AP12lication
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 D Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Totai Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Renuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropriate box.
[—]Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA NE
❑ NA NE
❑ NA E
❑ NA NE
❑ NA NE
❑ Yes ❑ No ❑ NA P NE
❑ Yes ❑ No []NA � NE
❑ WUP ❑Checklists [] Design D Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes ❑ No ❑ NA 5 CNE
El Waste Application ❑ Weekly Freeboard E] Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weatler ode
[❑ Rainfall ❑ Stocking M Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA NE
Page 2 of 3 21412015 Continued

Facifl Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes []No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative'?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes ❑ No
[:]Yes ❑ No
❑ Yes []No
❑ NA [ NE
❑ NA NE
❑ NA
NE
❑ NA
NE
❑ NA
NE
❑ NA
NE
❑ NA
NE
❑ Yes ❑ No ❑ NA f NE
[]Yes ❑ No ❑ NA NE
❑ Yes ❑ No ❑ NA NE
❑ Yes ❑ No ❑ NA NE
Phone: 910 r l 2-3 —33eo
Date: j6 q1 b
2/4/2015

Type of Visit; ti Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ID Routine 0 Complaint 0 Follow -u 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: � Arrival Time: Departure Time: /o:L17aw County: Q Region:
Farm Name: pQ Owner Email:
Owner Name: �y, p� L&d Phone:
Mailing Address:
Physical Address:
Facility Contact:+ri�, fppo� Title: Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Cr
Latitude:
Integrator: W
Certification Number: NI+
Certification Number:
Longitude:
Design Current
❑ Yes
Design
Current
Design Current
Swine Capacity Pop.
,a
Wet Poultry
��M i�
Capacity
«J16 A Itlhr
Pop.
Cattle Capacity Fop.
'Mal
Wean to Finish
La er
❑ No
�D NA
Dairy Cow
Wean to Feeder
I INon-Layer
I
E0 NA
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
❑ Yes
Dcsign
Current
DEX Cow
Farrow to Feeder
D. Point
C.a aeit
P,o
Non -Dairy
Farrow to Finish
La ers
No
❑ NA
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Inoher
Discharees and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
® No
T
❑ NA
❑ NE
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
�D NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
E0 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
C5 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 ] of 3 214/2011 Continued

12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
[�NA
Facility Number- 7- Date of Inspection: $
.i
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
NA
Waste Collection & Treatment
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
NA
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
J[] 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
❑ No
Identifier: N Z
❑ NE
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
Spillway?:
[]No
P NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Designed Freeboard (in):
[:]No
to NA
❑ NE
Page 2 of 3
Observed Freeboard (in): Z Z3 r�
2/412011 Continued
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.)
T
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
f�a No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yesi
No
`�
E]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
[j§ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ No
�gNA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
[�NA
❑ 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?
❑Other:
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
MNA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[] No
Q9NA
❑ 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
[]No
P NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
[:]No
to NA
❑ NE
Page 2 of 3
2/412011 Continued

Facility Number: - 3Z Date of Inspection: $ r
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, cheek ❑ Yes [:]No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
�NA ❑NE
NA ❑ NE
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ No MM NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ No�pj
NA ❑ NE
and report mortality rates that were higher than normal?
r
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
❑ NoNA
❑ NE
permit? (i.e„ discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No
M NA 0 NE
❑ Application Field F]Lagoon/Storage Pond ❑ Other:
TT
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
(A NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
❑ No
MNA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No
M NA ❑ NE
Comments (refer to question #): Explain Any YES answers.and/or any. additionalrecommendations or;any other comments.
Use drawings of.facilitV to better explain sifuatlobs (use additional pates as neces'sary}:
Reviewer/Inspector Name:
Reviewer/]nspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2011

I"
s
6I'71bi1z
0 Division of Water Quality
11 1 Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency
`Type of Visit: 0 Compliance Inspection Q Operation Review Q Structure Evaluation 0 Technical Assistance
(Reason far Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access jl
Date of Visit: Q, Arrival Time: Q Oa-- Departure Time: p: � County:
Farm Name: �0 Nn Owner Email:
Owner Name: woo Phone:
Mailing Address:
Physical Address:
Facility Contact:` �pD� Title:
Onsite Representative: N
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
N
Latitude:
Region: /?_Z0__
Phone:
Integrator:A4
Certification Number: g2'0b)7
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -Layer
Design Current
D& Poultry CaDaclty Pon.
Layers
Non -La ers
Pullets
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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)
1 Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page 1 of 3
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes r
No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
[:]Yes ❑ No
[:]Yes No
❑ Yes No
[3jNA ❑ NE
® NA ❑ NE
J4 NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
2/4/2011 Continued

V
Facili Number: - Date of Ins ection:
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 P NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): k
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes D 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 T No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an Immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No [] NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) T
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 ❑ NALCI
21 NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [:]No ❑ NA 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?
Reauired Records & Documents
❑ Yes ❑ No ❑ NA NE
❑ Yes ❑ No ❑ NA NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
E4 NA I__! 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.
TT
❑ WUP ❑Checklists ❑ Design [] Maps ❑ Lease Agreements
❑Other:
2 L 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 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
❑ No
NA ❑ NE
Page 2 of 3
2/4/2011 Continued

acili Number: - Z Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NoNA ❑ 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-compiiance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes ❑ No aNA ❑ NE
❑ Yes ❑ No [3NA ❑ NE
❑ Yes ❑ No 0 NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
t NA
❑ NE
NA
❑NE
NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use"drawingi of facility to better explain situations (use additional paces as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 7M
Date: 41-7
'Zz_
2/4/2011

Division of Water Quality
Facility Number O Division of Sol] and Water Conservation.
Q E-91
Other Agency
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: � County: Region: _FAD
Farm Name: M W
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: I'`+W04� Title:
W
Onsite Representative:
Owner Email:
Phone:
Integrator:
Phone No:
Certified Operator: I Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = =I = Longitude: =0=4 o=s
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Other
❑ Other----- _�
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pou Its
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Caif
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
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: E-11
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 IPNo ❑ NA [:1 NE
❑ Yes
❑ No
E ] NA
❑ NE
❑ Yes
❑ No
[n NA
❑ NE
0 NA
❑ NE
❑ Yes
❑ No
❑ Yes
EtNo
❑ NA
EINE
❑ Yes
t!�No
❑ NA
❑ NE
Page I of 3 12/28/04 Continued

,1.
Facility Number: — 3 Date of Inspection
❑ Yes
❑ No
Waste Collection & Treatment
f6 NE
15. Does the receiving crop and/or land application site need improvement?
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
M No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ( NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
17. Does the facility lack adequate acreage for land application?
❑ Yes
Spillway?:
❑ NA
[4NE
Designed Freeboard (in):
z
❑ Yes
❑ No
Observed Freeboard (in): Gd
JK NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes�No
El NA E] NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
�'No [INA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'?
❑ Yes
No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
(] Yes
No ❑ NA '❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No ❑ NA NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑ No ❑ NA VL NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or IO lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
f6 NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
® NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?
❑ Yes
❑ No
❑ NA
P NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
[4NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
JK NE
f&^ t� CAW
ta)VOPI A4$ A el�
r� 3
Reviewerhnspector Name ' E-, , , Phone:
Reviewer/Inspector Signature Q Date: D
Page 2 of 3 12128/04 Continued

.i • .L
Facility Number: -'1j� Date of Inspection
RequiredRecords& 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 ❑ 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
(P 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
"01 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.
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
PNE
Other Issues
i
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
J°] NE
29,
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
[P 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
[4NE
If yes, contact a regional Air Quality representative immediately
3 I.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
❑ No
❑ NA
® NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
%NE
/'^�C-!'a3 �. fi y 4 t'r 3 t J'. s 4
Addtttonal Comments and/or Drawings r . ,
w' i
� l r _AO
MM
4
a
i
Page 3 of 3 12128/04

• Division of Water Quality
Facility Number - ® 0 Division of Soil and Water Conservation
0 Other Agency
Type of visit: 0 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 0 Denied Access
Date of Visit:� Arrival Time:® Departure Time: County: N_
Farm Name: IJV IniDOd1„1 Owner Email:
Owner [Name: 9, W,xd- Phone:
Mailing Address:
Physical Address:
Facility Contact:
JZrckard LJppj Title:
1t
Onsite Representative:
Certified Operator: f)
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Integrator:
Phone:
Region:
Certification Number: I `f 0o j r,
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Dry Poultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
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)?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
(� NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes ❑ No [P NA [3NE
2. Is there evidence of a past discharge from any part of the operation? C3Yes 10 No T❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [q No ❑ NA ❑ NE
of the State other than from a discharge? TT
Page 1 of 3 2/4/2011 Continued

"
Facilii7y Number; - Date of Ins ection:(01 if I
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 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in);
Observed Freeboard (in);
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
No ❑ NA ❑ NE
No NA ❑ NE
Structure 6
❑ Yes r10 ❑ NA ❑ NE
❑ Yes rpNo ❑ 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 QD No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes r&No E:] NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) "F
9. Does any part of the waste management system other than the waste structures require [] Yes No ❑ NA ❑ NE
maintenance or improvement? TT
Waste ADnlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No IM NA [3NE
maintenance or improvement? LF
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes []No EP NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ 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?
T
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
NA
❑ NE
18. is there a lack of properly'operating waste application equipment?
❑ Yes
❑ No
NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
❑ No
[?] NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [] Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes❑
No
[3 NE
El Waste Application Weekly Freeboard Waste Analysis E] Soil Analysis
[] Waste Transfers
�NA
Weather Code
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections
[:]Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[] Yes
❑ NoNA
[:]NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
NA
❑ NE
Page 2 of 3
2/412011 Continued

Facili Number: - Date of Inspection: [0110 ll
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No MINA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [:]No ® NA ❑ NE
the appropriate box(es) below. t
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
NA ❑ NE
�{ NA ❑ NE
NA ❑ NE
® NA ❑ NE
[� NA ❑ NE
❑ Yes ❑ No ® NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [) No NA ❑ NE
33. Did the Reviewcr/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes ❑ No ® NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ No §M NA ❑ NE
Comments;(refer to question ft. Explain any YES answers and/or any additional recommendations.6e any othi r;comments
k
Useid'rawings of facility to better.explain situations (use additional pages as necessary).'
Z
La
,)oo n 5
Reviewer/Inspector Name:
54-�1r PiesGh,'
Reviewer/Inspector Signature:
Page 3 of 3
r
Phone: 21,9j%ffr3
Date: 6 (of( I
2/4/1011

?3(t15 31a3 0
®'Division of Water Quality
Faeilit Y Number O Division of Soil and Water Conservation
O Other Agency
IType of Visit OLCompliance Inspection O Operation Review Q Structure Evaluation 0 Technical Assistance I
Reason for Visit 1$t Routine 0 Complaint 0 Follow up Q Referral 0 Emergency 0 Other ❑ Denied Access
LkilinniNt
vim,
Date of Visit: Arrival Time:� Departure Time: + 1- County: Region: F�e! eo
Farm Name: 00V Wid, Owner Email:
Owner Name: Roy VVO OL Phone:
Mailing Address:
Physical Address:
Facility Contact: Rlrha VVOOA_. Title:
Onsite Representative: i U'1 t"�ndh , V, Q OL..
Certified Operator: jjac ib_Vp 1 j#I I j
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
L Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o ❑ ' = Longitude: = ° = a
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
kI ❑ Non -La ei
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑
Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Daia Calf
❑ Dairy I-leifei
❑ Dry Cow
❑ Non -Dai
❑ Beef Stocke►
❑ Beef Feeder
❑ Beef Brood Cowl I
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 5j No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
5No
❑ NA
❑ NE
12/28/04 Continued

Facility Number:q) 3g Date of Inspection 3 0
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application'? ❑ Yes
Waste Collection & Treatment
❑ NA
EINE
18. Is there a lack of properly operating waste application equipment'? ❑ Yes
VNo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
C'No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: U Lp)t L_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 22 aZ�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
C'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?
12 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 CYNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes (9'No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application'? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding tgHydraulic Overload ❑ Frozen Ground ❑ Meavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) WOJfQ &Vm da- N4K f6Le-,1 ' SG �! -
13. Soil type(s) CAB
14, Do the receiving crops differ from those designated in the CAWMP? [:]Yes EgNo [:INA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ®'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application'? ❑ Yes
MNo
❑ NA
EINE
18. Is there a lack of properly operating waste application equipment'? ❑ Yes
VNo
❑ 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):
Reviewerllnspector Name OAV 50 ✓EI E:�-k Phone: f gl(D) Lb -3-33O0 X3333
Reviewer/ lnspector Signature: Date: # Doi I
12/28/04 Continued

• Facility Number: q1 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No �R NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [:]No rRNA CINE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes IM No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
W No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'?
❑ Yes
❑ No
[3NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
[ENE
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
SNA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[RNA
❑ NE
Other Issues
2$.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
tgNo
❑ NA
❑ NE
29,
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
CR 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
�9 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
f9 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
D5No
❑ NA
❑ NE
33.
Docs facility require a follow-up visit by same agency?
❑ Yes
tErNo
❑ NA
❑ NE
Additional;Camments.and/or Drawings:
sgvm s, Mol of �f�e� ) s
Pl�tare rnow 1 orv� I�o� ,ns,d�. ba�k� 4 �o��a, �' � p
P fe3�+ m bQ� ks, Z uy oa, rm v +14e- m41'40.
Page 3 of 3 12/28/04

),Division of Water Quality
Facility Number 3 Z O;Division of Soil and Water Conservation
- 0 Other Agency
Type of Visit 'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit OLRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3 1 Arrival Time: f1T (357 Departure Time: County: TTE Regio
Farm Name: n -k �� _ _ Owner Email:
cc
Owner Name: a r Phone:
Mailing Address:
Phvsical Address* _R ^
Facility Contact: _1�-► C.IJ�X Title:
Onsite Representative: �f
Certified Operator: ' _%
Back-up Operator:
Location of Farm:
1. Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to 1=eedei
Farrow to Finish
Gilts
Other
❑ Other
Phone No:
Integrator:
Operator Cerleation Number
Back-up Certification Number:
❑o ❑` ��� g =o=i �
Latitude: Longitude:
Design Current Design Current
Capacity. Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑
Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity. Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (Iryes, 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 1$ No ❑ NA EINE
❑ Yes
❑ No NA
❑ NE
❑ Yes
❑ No ;a NA
❑ NE
❑ No Q NA
❑ NE
❑ Yes
❑ Yes
�9 No ❑ NA
❑ NE
❑Yes
—bNo ❑NA
El NE
12/28/04 Continued

s In
` Facility Number:'l Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: Z
Spillway?: +
Designed Freeboard (in): ! 1
Observed Freeboard (in):
❑ Yes f No [3NA ❑ NE
❑ Yes ONo [INA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes .51 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 _E�No ❑ NA [INE
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
E� No ❑ NA [:INE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
15. Does the receiving crop and/or land application site need improvement?
9. Does any part of the waste management system other than the waste structures require ❑ Yes
No ❑ NA ❑ NE
maintenance or improvement?
❑ NE
Waste Application
No
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
® No ❑ NA ❑ NE
maintenance/improvement?
❑ Yes
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
P No [INA ❑NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [:]Heavy Metals (Cu, Zn, etc.)
18. Is there a lack of properly operating waste application equipment`?
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop El Evidence of Wind Drifi [:]Application Outside of Area
❑ NA
fWiind�ow
)
12. Crop type(s) '.X/t-+Y�, 3 Q rQ 7,k S,-, C, �r () L
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
IS No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment`?
❑ YesA
No
❑ NA
❑ NE
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. 1
Use drawings of facility to better explain situations. (use additional pages as necessary): I
Reviewer/inspector Name U Iu j N 101 i Phone -110 3LVI.
Reviewer/inspector Signature: Date:
12/28/04 Conth

• Facility Number: 7 Z Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No $2 NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA EINE
the appropriate box. ❑ WUP ❑ Checklists
❑ Design 1:1 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 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes 93 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
N9 NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes M No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes Ej No
,KNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge'?
❑ Yes X No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No IMNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes —V3.No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes ,M No
ElNA
[__1 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 ,i No
❑ NA
EINE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes �DNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency'?
❑ Yes _1�; No
❑ NA
❑ N E
Additional Comments andloir Drawings:
nae-�►rc m
Page 3 of 3 12/28/04

of D WO inspection O F
Facility Number _�� Date of Inspection
Time of Inspection E� 24 hr. (hh:mm)
Registered ACertitied [3 Applied for Permit 0 Permitted 113 Not Operational I Date Last Operated:
FarmName:...../ ......jl..' cr.... ................ County:........ 1.k.k ..................... I ............. .......................
Owner Name:... !!'.. Phone No:.............. Z7Q....................................
t. J . ............. ....... 0�
Facility Contact:.....1.......�............................ Title• .......C1.�_ ........ Phone No: ,.............,....................................
Mailing Address: ......... 1..� �......�/..�!f..G ...../..�.Cif ..:.....................I...... ....1.. ...L,!!.... "",,..................... ...�.......7f
Onsite Representative:.... )!. t r {�.. ....... Integrator:.....' .( yw
Certified Operator, .....
k, `���, � t�:� ..............Cr�,/...... ............. Operator Certification Number,.........................................
Location of Farm:
Latitude • =` =LL Longitude =• 0' ="
De$Ign' Current,
d ,� 3' P 3 �,6 < �gn Current � -
t Destgm�,`•�-�: Current yiN
Capacity: Pgpulatton
; Poalt.ry Population, ' Cattle
'Capacity Population
4�Swtne
�] Wean to Feeder
s ,Capacity
10 Layer I I Dairy
Feeder to Finish
10 Non -Layer I I ❑ Non-Dairy
Farrow to Wean
❑ Yes
❑ No
❑ Farrow to Feeder
JE1 Other I I
❑ No
❑ Farrow to Finish
Total Design CapaCiit3�
`,
❑ Gilts
❑ Yes
❑ No
<
❑ Boars
' Total SSLW
No
Numb of Lagoons / Holding Panels;
10Subsurface Drains Present ❑Lagoon Area ❑ Spray Field Area
a
❑ No Liquid Waste Management System
❑ YesNo
maintenance/improvement?
General
1. Are there any buffers that need maintenancelimprovement?
❑ Yesko
2. Is any discharge observed from any part of the operation?
❑ Yeso
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. If discharge is obsen ed, dict it reach Surface Water? (If yes, notify DWQ)
❑ Yes
❑ No
c. If discharge is observed, what is the estimated flow in gaflmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ YesNo
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ YesjNo
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
7125147
Continued an back

I
Facility Number: Y7 — 3 Z
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,Iloldijig Pon(is, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
.............................................................................................................................................
Freeboard (ft):........... �j�.`r...............................................
......................................................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed'?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate.minimum or maximum liquid level markers?
❑ Yes ANO
❑ Yes No
Structure 5 Structure 6
........................................................
❑ Yes fl�No
❑ Yes 5 -No
❑ Yes IR
No
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering w ters of the State, notify DWQ)
rI:
15. Crap type .... ... .... .......
. .... �............ ........... .............. .............................................................
16. Do the receiving crops differ with thos designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency'?
21. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes f(No
❑ Yes 0,No
�Yesio
❑ Yes
ANo
❑ Yes
Z 0
❑ Yes
o
❑ Yes
No
❑ Yes
No
❑ Yes
ITIO
No.vio'lations•or deficiencit s. were-noted-durin ' this' isit' - You.will ' iCr ', ' -ito-further
:-:��corres�pndtznce:�tioutthis:visit.•:•:�:�:�:�:- •:•�•:•:-:��.:�:�:�:�: ::• •:•:•:•.�:�..:•:�.•:-
El Yes I
❑Yes 1
❑ Yes ❑ No
;Comments (refer ta.giuestiorr 0). �Exp.Iain iny',YES`answers and/or any RZommE �endaflons:opiiny �er comments, y �
r:
Use'dcawingsoftacility tocttcr explain situ�tlion(usdditionalfpages as necessary} Vit:
ky
o"•rxl..___
16� /i/Ee.;) �V QaVlye etpe rwd 4 It vsle
oi) Cane r a�- new /ea av—,
�old rCc6vds.
7125197
,vFoa. Kf.,,,,. �. �.,Yf r• xaz f1, 'C y{. _ t' w,l 3 xy +na m y -..`i
Reviewer/Inspector Nano `k
Reviewer/Inspector Signature: Date: —