820171_INSPECTIONS_20171231

F 50
QDivision of WateC Resod roes
I JlilrYll � �J �rr IlJJi,lal' �ill�,lu,ll Y' Ipl��s: �r�tlil i �€ t!tl h� r't,�, �'r.� , ','�; �€r- '!,. r' i ,•I. €, ,
.l,peih Number l.``:�j It"I ,la::F'! ;, �, C�, Division of'Soil and 'Wate'r, Conservation
It IaII II rA i,r I"yIyI`�lri4 r i�t�E ul+Rl,l, l Ij (t 3 , rR"� r . , !-II r. I QI Uthei• Agency.
•
`°L'.Ii1 II 11 J1 R f `I!� i r i�'� r1 Ira.. ..I�n�:,�
Type of Visit: 7Routine
Hance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: County: S Region:
Farm Name: Food Fae-tM Owner Email:
Owner Name: COY �l i`� �� i t' ✓`W Phone:
Mailing Address:
Physical Address:
Facility Contact: C,6"4'G ` -q Title: Phone:
Onsite Representative: f ( Integrator: P f et
Certified Operator: _ �"�..� ' �;�Certification Number: ��
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
J`I i:.: 3}!�'€'; J!! !I'II+I�; J',i I I� I' , "" " II ! + +
fI I 1 III��Ilui t"1i+J,I;:rr€:t.,k!i, .[[qqpp !�,.;I{,1 lIuj I!�gnllIl Ctirren,,�[�,rll�l ��i� tG , Design iCurrent ',Ir;l;aa i„ '��-1. Design t Current
� MNI I
011!111"Jilili II�:'I I 'EF lii iI� � '
I F Y f'" € Ii � ti �II �� �Il�li,l{I I, t,I. 111II��� I �' !14 � I
!��,Swine IFr '+ JJt', Capacity I ';Pap.
i
' � " ` 4l X I r ,e�� t �
��
"IWet Po>ulltry 4 Capacity -Pop.
Cattle Capacity Pop.
i
Wean to Finish
Layer �
1#I, Wean to Feeder
€'
Non -I a er
Feeder to Finish Z
!
Farrow to Wean
`
I I,r�
l� ufl 1i� rll,tll ;, Desina Cu rant
'Poult
Farrow to Feederr,�,
0 Cs aci Po
Farrow to Finish
Layers
� Gilts
Non -Lavers
Boars
Pullets
PH gllltli i ;l;l y IVi:! I `r ! , m I
t
Turkeys
Ifll!{OItH'er "ihlrrl;lilaldl�ll�f+,.I1+ 1t,''„"Ia 1 �.,Ill..lri
TurkeyPoults
,
Other
..'I
H._ Other
,
. rairu�
Dairy Cow
Dairy Calf
Dairy Heifer
Q Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharees and Stream Impacts
I. Is any discharge observed from any part of the operation? es NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field Other:
a. Was the conveyance man-made? ❑ Yes No g.� ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
[:]Yes
02,No
❑ NE
j `
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
tt�L'�" D NE
Z. is there evidence of a past discharge from any part of the operation?
❑ Yes
[: l o
❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
eNo
❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2015 Continued

Faclll N mber: Date of Inspection: a I FiZ
W4te Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [3-Ido M NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [5'1TX__❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 33 33
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
[!]'1 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?
es
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
L`J '`'o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
� No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[2-No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): r '(5 S(� D
13. Soil Type(s): 1i W_
❑ NE
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E�`&/o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
'f-' ' -
❑ 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
,EffNo
❑ NA
[] NE
Re aired Records & Documents
19.. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
13<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
-❑1<o­
❑ 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
o
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EEr<o
❑ NA ❑ NE
Page 2 of 3
2141201 S Continued

Facili Number: - Date of Inspection: aj =-
24pid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes L ]-Ko ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes E3No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? Yes 2<o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
es
❑ No
❑ NA
❑ NE
❑ Yes
ED-No
[DNA
❑ NE
El Yes!J No [3 NA
❑ Yes *1011" ❑ NA
❑ Yes Rio ❑ NA
❑ NE
❑ NE
❑ NE
Comments (refer to question #): Explain any YESaanswerg,and/or,,any additional;recommendatians or any other con.im,ents
Use drawin'g's'of facilit� to,better°exe laln sltuations'.(use` a' ditlonal`:' ages,"�necessar ).�: s - i
Reviewer/Inspector Name: Phoned
Reviewer/Inspector Signature: Ct Date:'
Page 3 of 3 121412015

7
9
Facility Number - 0
UT -Division of Water Resources
O Division of Soil and Water Conservation
Q Other Agency
Type of Visit: (3 Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Q'I+;outine Q Complaint Q Follow-up Q Referral Q Emergency Q Other O Denied Access
Date of Visit: VArrival Time: Departure Time: County: C` Region: h�J
Farm Name: ,ic{—' v Owner Email: _
Owner Name: 4LdV`C"LO r Phone:
Mailing Address:
Physical Address:
Facility Contact: Cdy,49 Title:
Onsite Representative:
Certified Operator: _,&= ICtL(,+/
Back-up Operator:
Phone:
Integrator:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle
Wean to Finish
Wean to Feeder
Feeder to Finish a I Ye
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Discharges and Stream lmnacts
La er
Non -Layer
Design Current
Dry Poultry Capacity Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Points
Other
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
,Non
-Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
1. Is any discharge observed from any part of the operation?
❑ Yes
[9-'Ko-
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[j 'IVA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
0'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
[;a<
❑ NE
2. Is there evidence ofa past discharge from any part ofthe operation?
❑ Yes_[i]'Icfo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
E!fNo
❑ NA
❑ NE
of the State other than from a discharge?
M.
Page 1 of 3 21412015 Continued

F�il.iili Number: Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Cg-NiT' ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ®EGA ❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
fn
Observed Freeboard (in): ..2
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
©.too
❑ 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
0a 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
o any of the structures need maintenance or improvement?
Erfes eo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[5 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 [3'NIo ❑ 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): GJ`wiwt t S- & "V
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?
Required Records & Documents
19, Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes
ro
o
❑ NA
❑ NE
[:]Yes [5 No ❑ NA ❑ NE
❑ Yes [, <o ❑ NA ❑ NE
[:]Yes ["No ❑ NA ❑ NE
❑ Yes [F No ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Kr No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ffNo
[�'❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

go N4
Fikili Number: -If Date of Inspection: t5 If I L�
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes i�o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0f 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 E115o ❑ NA ❑ NE
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [_jWo' ❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑W6' ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
`;
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
T
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
EfNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
ZNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[!rNo
❑ NA
❑ NE
33. Did the Reviewer/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
rfNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommend
ations�br'any other comments _R `,�
Use drawings of facility to better explain situations (use additional pages as=necessary).
's
rf ?,r+ .„
cell 44 %z" -- - z _Xo '/7
V-Epra Sul
.�
- 1
emu.
COvP.� @3'1 L oa -1 6 of
V
VO �sr
Reviewer/Inspector Name: 43 , `� U ti(, Phone:
Reviewer/Inspector Signature: Date: SAL Jt
Page 3 of 3 V 2/4/2015

QI05.r'k tb¢
Structure Evaluation Inspection
Facility Number: Date:910t16
Time in: Time out: .
Farm Name: Farm 911 address:
Owner Name: �o.^`` �o.�� Phone r
Facility Contact: Lt
Onsite Representative: it Integrator: r1les
.�
Certified Operator: �� Cert. Number
Is storage capacity less than adequate? Yes No c�,—
If yes is waste level into the structural freeboard? Yes No
Was non -compliant level reported to DWR POA received
Structure: 1 2 3 4 5 5
Identifier:
Spillway?
Designed Freeboard (in.):
Observed Freeboard (in.):_
Are there any immediate threats to the integrity of any of the structures
observed? Yes No =�
Do any structures lack adequate markers as required by the permit? Yes __. No
Does any part of the waste management system need repair Yes No
Condition of field's -
Condition of receiving crop ^A�-
Comments:

U Division of Water Resources
11 Facility Number - O Division of Sol) and Water Conservation
Q Other Agency
(Type of Visit: OKompliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance I
Reason for Visit: (! Routine Q Complaint 0 Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: � �;c tp� Owner Email:
Owner Name: Mt.4 9 /'t C-,-/ Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: I
Certified Operator: _L
Title:
Phone:
Integrator:�.1
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
tr f d5 G `/� j{Jl w� l tt7�
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
on -Layer
ury Youitry
Layers
Non -Layers
Pullets
TurkeXs _ —
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 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?
Longitude:
Region:
ez
Design Current
Cattle Capacity Pop.
Daia Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non-Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
[3 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 21412014 Continued

Facility Number: - Date oT Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes J! o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [?�KA ❑ NE
Structure'] 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
T-Wo
❑ 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
�' 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
NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E 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
No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [k o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 tbs. ❑ 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): Stv" 9 G )
13. Soil TYpe(s): I&J,, A
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes R2-4�0 ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0 o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [�o ❑ 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 [ (o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [f No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [Qb ❑ 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 [3-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 2r�o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes gg No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

li acili Number: Ick- Date of Inspection: Ua-_ft
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 23-No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [(>o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
pp-
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 ONo ❑ 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:
❑ Yes [KNo [DNA ❑ NE
❑ Yes Z fNo 0 NA 0 NE
❑ Yes [2'110 ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [XNo ❑ NA ❑ NE
33. Did the Reviewer/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 P-No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES,,answers and/or any:additional reconinendations ortany,other comments .
Use drawings of facility to better explain sittiations'(use additional ¢pages as necessary):
cvc'�e.+Dn —
sG`�P7��y
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
6,3(>
Phone: CM -
Date:
214 014

(Type of Visit: GLCompliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: (300utlne Q Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: s
Farm Name: TO 1-4 �--� s/_r� /J Owner Email:
Owner Name: H�l*,� 94,/t,�a---(Y Phone:
Mailing Address:
Physical Address:
Facility Contact:
Co,tAl s `t .��✓ Title:
Onsite Representative:
It
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: Fly -CC
Certification Number: 6
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Design Current Design Current
Wet Poultry Capacity Pap. Cattle Capacity Pop.
]Layer DairyCow
Wean to Feeder
Nan -La er
DairyCalf
Feeder to Finish
���
DairyHeifer
Farrow to Wean
Dealgn Current
D Cow
Farrow to Feeder
Farrow to Finish
D.r, nultr� 'l aci Pa
La ers
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
11"'All INS OR: Turkeys
Other TurkeyPoults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
EB<o
[DNA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
MINA
❑ 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
[3'1�o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[r]"No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facility Number: - Date of Inspection: r2�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 0<A ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ETNo
❑ 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 hrent, 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
040
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[d" ""'
❑ NA
❑ NE
maintenance or improvement?
Waste_ Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
CI'No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Er< ❑ 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):a
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0No ❑ 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 Q No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Rio
❑ NA
❑ NE
I& Is there a lack of properly operating waste application equipment?
❑ Yes
[/r No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[2r'�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ff No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[�'No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
[] Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and V Rainfall inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[7f No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[2rNo
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Facility Nldmber: r5, - 1 Date of Inspection: 2.7 y
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 ❑ YesF]<o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/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 Lj 4' ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
[:]Yes [ No ❑ NA ❑ NE
❑ Yes 'f' ' o ❑ NA ❑ NE
❑ Yes No
❑ Yes U N
❑ Yes 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 drawings of facility to better explain situations (use additional ages as necessary).
6
cu Allle� V 'r7,o
Reviewer/Inspector Name: J,t N r tj Phone: 43 V��]
c �
Reviewer/Inspector Signature: Date: tAV
Page 3 of 3 2141201

fs tD
EP-Mv Facilits'on of Water Quality
y Number L_ul�J - 0 Division of Soil and Water Conservation
0 Other Agency
type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Season for Visit: routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: UZArrival Time: Departure Timer
Farm Name Ylh S*cam. Q Owner Email:
Owner Name: L Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
County:�a &&4 Region?=
Certification Number:
Back-up Operator: Certification Number:
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
Latitude:
CfDSCI
Design Current Design Current
Capacity Pop. Wet Poultry:Capacity Pop.
La er
Nan -La er
Pullets
Puuets
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)?
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?
Longitude:
Design Current
Cattle Capacity Pop,
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[]Yes ❑' Ih o ❑ NA ❑ NE
❑ Yes
❑ No
[&4 A
❑ NE
❑ Yes
❑ No
i__ -<A
❑ NE
❑ Yes
❑ No
<A
❑ NE
❑ Yes
[2440
❑ NA
❑ NE
Yes
"No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

[Facility Number; - Datc of inspection:
Waste Collection & Treatment
NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[! o ❑ NA
❑
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No CD NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed JJ
Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
'A
❑ 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
ZJ 1Ve
❑ 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[ 4o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes �10
❑ 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 2 wu
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes OXF
❑ NA
FINE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
X
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes dNo
❑ Yes No
❑ Yes LS 0
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes
P o
❑ NA
❑ NE
[:]Yes
[ Io
❑ NA
❑ NE
] Yes
E]O'No
❑ NA
❑ NE
❑ Yes
[ Io
❑ NA
❑ NE
❑WUP ❑Checklists ❑Design [3 Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes g o ❑ 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& ❑ 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 21412011 Continued

Fac11i Number: jDate of Inspection:
t
24. Did the facility fail to calibrate was 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 �!d'"o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [:]Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes L4d''` o ❑ 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:
❑ Yes fo ❑ NA ❑ NE
❑ Yes [Zp o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes L B4o_ ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
C j N
❑ NA
❑ NE
33. Did the ReviewerlInspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ENo
❑ NA
❑ NE
34, Does the facility require a follow-up visit by the same agency?
❑ Yes
if'No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments ,; 5 >y f.
Use drawings of facility to better explain situations (use additional pages as.necessary).,.
e4,Jye�y G-3o-1�( o— s.y
ReviewerlInspector Name: (2UPhonege 3,3 33
ReviewerlInspector Signature: 0 A Date: '
Page 3 of 3 2/4/20

VL, s c r
lvislon of Water Quality
Facility Number - ��-+--+--1 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: (EfCo 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 0 Denied Access
Date of Visit: JJ 61 ,l'[ Arrival Time: Departure Time: County: Region-
j—
Farm Name: ,ty' 9`r=/L1, T({ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: �(��� l 'j' t1 Title: o�Cc 10 Phone:
Onsite Representative: t� Integrator:
Certified Operator: a,., S'{Y+�.IZ.�--- Certification Number: 3
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
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Non -
Other
Poults
Design Current
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?
Longitude:
.Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non-Daity
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes Q o ❑ NA ❑ NE
❑ Yes ❑ No CTNA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[fNA
❑ 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
[TNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[!fNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 21412011 Continued

Facili Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2 f No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes Io ❑ NA ❑ NE
Structure 1 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 [JI o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[E,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
�fo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[nNo
❑ 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
C]"o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
UTNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 o [3 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): _S4e� n11 A1,. .0 L)t.J G,-fV -d f i W 9
13. Soil Type(s): 119%k p(,wT—L-9
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
U-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[L] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[Z No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for Iand application?
❑ Yes
[I�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EB-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
EYes
Q&lo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design [:]Maps 6Z�ase Agreements
❑Other:
r
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
EE�Tfo
❑ 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
[13'No
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[/
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

[Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�o
❑ NA ❑ NE
25. Is the facility out of compliance with pen -nit conditions related to sludge? If yes, check
❑ Yes
[301Io
❑ 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
[b-No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[j�No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[:!rNo
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[� o
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately. 9
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
C9'No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
62No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP7
❑ Yes
[2�hlo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[r]'No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ErNo
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
UwArawings of facility to better explain situations (use additional pages as necessary).
iww ini i uri i i u rr
i ui rir
w�rw�
CA6 v` `��
s(al r s-e�
(— (0 —a
-7- ((- �-�
C) a
L"—Qyr 0'%C' gook 3Y*..rs P-,J-r.
Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:/s �C �_3
Dat K3`333
21412011

�, rf
X.
("ivision of Water Quality
Facility Number ®- l'Z , 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: (DrCompliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
W Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emeraency 0 Other 0 Denied Access
Date of Visit:
Arrival Time: ti p
Departure Time: * y$ ]r+>,
County4
Farm Name:
\tT0.&i%
aLAtZstk \AnA !�q arj
Owner Email:
Owner Name:
\itLry\
t LA ilt OK\ ra
Phone:
Mailing Address:
Physical Address:
Facility Contact:
Fo(kC) Title:
Onsite Representative: q cn C
Certified Operator: 2 } lNe n 'SkA c K I 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
Latitude:
Integrator:
Region: R0
Phone: i'101- a 49 `331L)
N Cyr`[ 9—
Certification Number: 9 R Lay3 y
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
I.a er
Non -La er
lets
Poults
Design Current
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
DaiEX Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
]Beef Stocker
Beef Feeder
Beef Brood Cow
[:]Yes [Dlo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes No
❑ Yes [TNo
❑ Yes C!(No
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

Facility Number: jDate of Inspection:
a.
Waste Collection & Treatment
,�,�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
l��O
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
St ctuuree I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
��___ _�'F Y` 5MA LL—
' Identifier: ��—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): %
5. Arc there any immediate threats'to the integrity of any of the structures observed?
❑ Yes
1�Io
❑ 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
[jIQ'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 DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[3io
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�4o
[DNA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E�&
[DNA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes 03,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): )'E RPnyfJ4 f (+O, Cc7Rn, L)ki-4T I Soy 6-o-n S
13. Soil Type(s): '\1\A+AuC\
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes EgOlNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [�lo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes dNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a tack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists []Design ❑ Maps ❑ Lease Agreements
❑ Yes YNo ❑ NA ❑ NE
❑ Yes QNo ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ 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 V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes E(No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [2'**No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: %a -A-I Date of inspection: Q ny jta
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 [rlNo ❑ 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 Qef4o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes l 34o' ❑ NA ❑.NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes CETNo ❑ NA ❑ NE
❑ Yes [R' +i�lo ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes [�io ❑ NA ❑ NE
❑ Yes [214o
[:]Yes YNo
❑ Yes 2�No
❑NA ❑NE
❑ NA ❑ NE
❑NA ONE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any, other.comments
Use drawings of facility to better ex lain situations (use additional pages as necessary).
M.v�h,•� �t�,x� Qu��g-0 � �n A .�ad1 �Wxklar� Attu Re,�,RbzskT.,n �AR�1
�uT �oe� �t1 �C7uS>S
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
au 6 - 'S o_5
Phone: 910.3 OS- 6Rs)
4a�4 1
Date: '1
21412011

i ype of visit: 4v uompuance inspection v uperanon Keview V btructure r.vaivation V i ecnmcal Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
t Il
Arrival Time:
Departure Time: '` M County>g�AT
Farm Name:
Vx
R j1k !Z-cnue.Kimo
Fpiz^
Owner Email:
Owner Name: 1 nw_ a�RXCklAV 15 Phone: a4-601s a
Mailing Address:
Physical Address:
Region: no
Facility Contact: _U- -%p,.wo Title: Q W t\ t`(k, Phone: 38S S63i
Onsite Representative: 1 f�- fyG� }AI&I I,qn 0 Integrator: UIiD�Iy 2Rnt,]A�
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design C►urrent
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop,
Cattle Capacity Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
]Non -Layer
DairyCalf
Feeder to Finish
�Yw u
DairyHeifer
Farrow to Wean
Design
Current
D Caw
Farrow to Feeder
Dr> Poultrp
Ca acl
P,a
Non-Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 JK] No ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
E4 NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facility Number: 3 a. J-11 jDate of Inspection: t algi 1,9611
Waste Collection & Treatment
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 kM No ❑ NA [3 NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 15 A11 t,mg V
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 30 2k La_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 1] 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
M 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
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 Apalication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[Z No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus [] Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [3 Application Outside of Approved Area
12. CropType(s): 16')t<Rffr\v0A �nt RSt? e4 i ✓ Cogn LAF411,5( 6-tiyf
13. Soil Type(s): \q rCrarJ
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes (0 No [3 NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes g] No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [Z] No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E] 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
[DNA
❑ 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 N 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 [!D No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 7] No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

L
Facility Number: jDate of Ins ection: i L lat I
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 Aj
No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes M 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 M No ❑ NA ❑ NE
❑ Yes [A No ❑ NA ❑ NE
❑ Yes [� No [3 NA ❑ NE
❑ Yes K] No ❑ NA ❑ NE
❑ Yes 1 ] No
❑ Yes No
❑ Yes No
0 NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations Or any other commentsse*�
Use drawings of facility to better explain situations (use additional pages as necessary).
Q`jN Mot4 a.G,aoko Nc o,2q Njo-v3%.ta Ar,,*_a 4hom wane No Sludq���RV�y
wsr? Nn S��c] Suva:. R naT For, awo C�2 apt1
NC pwc2 n3o�Tte.sD -�1►.�te.�• � Y � a�ytiA �luolgF.
RnD t-10 tq.�YQ rv.a.,�r e.a�.b�'N�=aN �ocZ as � o , Pl:r�►sz ��ra Co(JS�b
��au�.•� ti O `j Q
ON la la 0"tCIt- orr Uzo1AA=X-N VVVK, Salk
y
al
No a, X,5Su La h C o wl
RE.CD P-o
._� NtiEz sa\ S p moe- by va j�A any 1
Reviewer/Inspector Name: p�e ( S. J id s l am
Reviewer/Inspector Signature:
Page 3 of 3
( [a - U"n -
Phone:
Date: ape\
21412011

Type of Visit 0,C-ompliance 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: 2/— Arrival Time: Departure Time: %���� County :,,,S'�_15 - Region:
Farm Name: /A &;` f 1 �: G }[ /�� _ ___ _ __ Owner Email:
47
Owner Name: 44 �7'/'% G 1 ,,/ Phone:
Mailing Address:
Physical Address: /
Facility Contact: Title: ® OZVe V ►' _ __ __ __ Phone No:
Onsite Representative: /�tilh S%/": fC f'�-��/ Integrator:
Certified Operator: r- dig Operator Certification Number: 9�
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = a =' = ` Longitude: 0 ° 0 ` = "
Design nrllip
DesignIff
Current
Design Current
Swine Capac€ty Population
Wet Poultry Capac€ty
Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dai Calf
Feeder to Finish i
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑.La era
❑ Beef Stocker
Gilts
era
ElBeef Feeder
PC Boars
El❑Non-La
Pullets
El Beef Brood Cow
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑Other
Number of Structures:
Discharges & Stream ImRacts
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 E.No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[ZNo
❑ NA
❑ NE
❑ Yes
[5. No
❑ NA
❑ NE
Page I of 3 12128104 Continued

y Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure l Structure 2 Structure 3 Structure 4
Identifier: r Si+7
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �2 L
❑ Yes RNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(ie) large trees, severe erosion, seepage, etc.)
6. 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? ESYes ❑ 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
54No
❑ NA ❑ NE
maintenance or improvement?
Waste AVPliCatiDn
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
Z 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 ofAcceptableCrop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12. Crop type(s) 1 f�f �X9V,--/ e cI.er%-��-
13. Soil type(s) sL";6'
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
RNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
UNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
a 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
9No
❑ NA ❑ NE
s 31 A rw€�k dFr;''4.A'E°a:'
Comments refer to ucstion # : ;Explain an YES answers andor an recommendations or any-6ther comments }+
( a ) y y
=Use drawings of facilit ro better ex lain situations: use additionihpa es as necessar r
l•10*e « yVU �1,-c� C�ceXm��a.T%n-� Fo✓ n
yp 4 AltPd SL,, d� m 5#,v y to--P ✓ 1 Q
ector Name
p �, Phone:
Reviewer/Ins /O �-33oa
Reviewer/Inspector Signature: — Date: A)
Page 2 of 3 12128,104 Continued

Facility Number: Date of Inspection
5
Renuired 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 g ❑ 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 ❑ Stacking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
EINo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
'allo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
IM No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
q No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
JSZNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
qNo
❑ NA
❑ NE
Otherlssues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ZLNo
❑ 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
RNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 L
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
®,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
EK�No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
rZves
❑ No
❑ NA
❑ NE
r.I rpr' �u �ryrr y�d. N�r�j , .� %" Fhc r 8-1 i �
r o
Page 3 of 3 12128104

3
Division of Water Quality OiJi�+�7►�-�i l,r
Facility Number 7 0 Division of Soil and Water Conservation �p-a/ / d StF6'�
Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review tructure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint ollow up 0 Referral 0 Emergency l�ther ❑ Denied Access
Date of Visit: D/ / 0 Arrival Time: ; D D Departure Time: f� County'
Farm Name: I/ 1 S ✓ �"�`G f'� 1 a l�adl"t' Owner Email:
Owner Name: Tf , C-k i a. Phone:
Mailing Address:
Region: .=—
Physical Address:
Facility Contact: f Title: Phone
Onsite Representative:
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
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =0= & 0 Longitude: =0=6 = 6f
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Other
❑Other-- --- _ _�
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 Cowl
I
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: �-
J
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 0,No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes 12�No ❑ NA ❑ NE
❑ Yes C&No ❑ NA ❑ NE
Page I of 3 12128104 Continued

Facility Number: — J?
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?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: t ► FG
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in): /3 / 6-
5. Are there any immediate threats to the integrity of any of the structures observed?
(iel 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?
ayes JR.No ❑ NA ❑ NE
❑ Yes �R No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 5-No ❑ 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 [Z No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ayes ❑ 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 [RNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ff'fgo ❑ NA 5,NE
maintenance/improvement? (B
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes W No ❑ NA MN
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 7J
13. Soil type(s) ►__
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
RNE
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
1 \ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
j�'NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
I$_JNE
Comem_. t.,,,-_: . ''s „„`�•. "�r tP�;�?? '�'�"'Stir ��t .%•
nts refer;to uestion # Ez la..ht. an YES ,.answers and/o an ,recommendatin.iF.nstor an other�eomments
UseYdrawing§'df €acility to beitter:explain `situahpns (usetadditional pages as nccessary,)�. � r u Aa
.':
s
t,
6v,r 74 30�� Sir
7-r� , a �p►A- f�- 'Y� s V. Ile ; /yds'� roc, ►�
; 5 v
�O J ' Jow �� I [
/CGr'✓zr f7� �GZ/�
Reviewerllnspector Name' Phone:
v a
�33 04
Reviewer/inspector Signature:
Date:
1 0
Page 2 of 3 01 AV12128104 Continued

Facility Number: Date of Inspection
v
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA [34Z4E
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA RNE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps [3 Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA RNE
❑ 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
[R'NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
KNE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
[a NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
[!�NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
1;9.NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
,&�]E
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
9NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
1 No
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
P5
❑ No
❑ NA
❑ NE
nd rr in s� h � °•. �.�_ n w�..� ��-- :�"�,, � e.
w
Page 3 of 3 12128104

L'
1A'2;L/^1•0
ivision of Water Quality f
Facility Number j O Division of Soil and Water Conservation
O Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review tructure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint. 0 Follow up 0 Referral 0 Emergency (4%fier ❑ Denied Access
Date or Visit: �� Arrival Time: 1j9,'O Departure Time: �,�39 County: 6__&WCM9=7777Region:.ZM U
Farm Name: C- k Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: . _�lt ra 1 57- e-k i 0--,W Title: S)evnr'/- Phone No:
Onsite Representative: �}r�r�r ��r,1 Integrator: %�l/✓ r'9
Certified Operator: ` �1al�C Operator Certification Number: ,% 7921-f
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
13 ! I
o D
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other v
❑ Other
Back-up Certification Number:
Latitude: ❑ c = i = {I Longitude: = o = 1 ❑ 1{
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
--- - --
❑ Non -Layer J
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 Cow
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 2No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes [.No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
Page 1 of 3
12128104 Continued

L
Facility Number: — / Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes -allo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 511WZL&
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ,4No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes gNo ❑ 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
RNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
®-No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
J�jNo
❑ NA ❑ NE
maintenance/improvement?
l l . Is there evidence of incorrect application`? If yes, check the appropriate box below.
❑ Yes
2-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 DDrift�❑ Application of Area
Outside
12. Crop type(s) 3Tzr1H ^e1/&+Wwt�_/ G
13. Soil type(s)1��
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
KNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
R No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ENo
❑ NA ❑ NE
19. Is there a lack of properly operating waste application equipment?
❑ Yes
S�No
❑ NA ❑ NE
Comments,(refer'.to question #): Explain any YES answers and/or any recommendatioM or any other comments ,
Use drawings of facility fo better explain situations. (use additional pages as necessary):
eo1;'6 ram'-r- pz�cG`p�r.� !"r,��
swo
AU) /L� � d�rR+�G��'CJ r /! 74�eiXe /�l�192
Reviewer/Inspector Name A ;� r 4 qt Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: — f Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes C.No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [3�No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. &Yes ❑ No ❑ NA ❑ NE
93maste 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
E,No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
9No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
®,No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
UkNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[&No
❑ NA
❑ NE
Other Issues
2$.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
QNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
KLNo
❑ 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
19-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
Addltiopal Comments andliir Druiwings. °
I! �4 � �� �� �- V VL+v'V.r/ [� 4/ / •! � � I W®� V• � J �/1 Y(N
,�a�� 'lhY ��,t��ii//i \JJ ��c,J `i��� ��� �c� LDw�-✓`.
Tv�
Lj !1 4 v
Page 3 of 3 12128104

Type of Visit 0<6mpliance 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: 7 jArrival Time: n Departure Time: o,:,j E) County:
Farm Name: �� ,~� I�� T rick lal Owner Email:
nwnrr Narnp- I/ 1 &-A,- K I a —.,,I Phnnr!
Mailing Address:
Physical Address:
Region:
Facillty'Contact: j(1 ✓` - 1 r) G/\'�Title: —&WZ23C f_ _ _ Phone No:
Onsite Representative: S'� Integrator: 'Ot /+
Certified Operator: a`'L� Operator Certificatio Number: ! ��
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: ❑ 6 = 1 =, Longitude: = ° ❑ 1 = 1{
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Daiiy Calf
.Feeder to Finish (BOO
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
ElNon-Dairy
❑ Farrow to Feeder
El Farrow to Finish
❑ Layers
❑Non -La ers
❑ Pullets
❑ Turkeys
El Beef Stocker
❑ Beef Feeder
ElBeef Brood Cow
❑ Gilts
❑ Boars
Other
❑ Turkev Poults
❑ Other
❑ Other T
er of Structures:
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
Wo
❑ 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
[3 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
allo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — % Date of Inspection 7—
t
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes RLNo ❑ 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: +i=z
Spillway?:
Designed Freeboard (in): / 9- /9
Observed Freeboard (in):�,�, 3
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 ffNo ❑ 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 eo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes JRLNo ❑ 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 r NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes IN No ❑ NA ❑ NE
maintenance/improvement`?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes I -No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift ❑ Application Outside of Area
12. Crop types) %
rl/Iyll�,el- ! ihvY/S,er/ Gfl
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
L-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
JK 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
allo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment'?
❑ Yes
C&No
❑ NA
❑ NE
� ' �C A %ry.� {Sy �
Comments (refer to question #) Explain any Y5ES answers and/or any recommendations or�any other comments r � j
Use -drawings of facility to better explain situations.,(use additional paLles as necessary) `t�= ` � �° ����. �'
, :» ::ki
AL
T LC K✓v' T U2Y %Ir1C {rt� m� �G�'✓'
�
Reviewer/Inspector Name 1 2d _G — �410i, ' Phone:
Reviewer/Inspector Signature: Date:
- 1 12128104 Continued

r -
Facility Number: — Date of Inspection DF)"
' 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 14 No ❑ NA ❑ NE
the appropriate box. ❑ V,[Up ❑ Checklists ❑ Design ❑ Maps ❑ Other
3'
21. Does record keeping need improvement? If yes, check the appropriate box below. ,M Yes ItVo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard jZLWaste 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?
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
allo
❑ NA
❑ NE
❑ Yes
[a No
❑ NA
❑ NE
❑ Yes
ER No
❑ NA
❑ NE
❑ Yes
•LNo
❑ NA
❑ NE
❑ Yes
El No
❑ NA
❑ NE
❑ Yes
[-No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
BNo
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
C&.No
❑ NA
❑ NE
12128104

EMIvision of Water Quality
Facility Number Q Division of Soil and Water Conservation
O Other Agency
Type of Visit ompllance 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: .' [7 Departure Time; I//,/= County- Region: !
Farm Name: ��i f 3 Il iri r �� a r.�Gz �i�-/�--- Owner Email:
Owner Name: 7% i Phone:
Mailing Address:
Physical Address: 1 Facility Contact: J/J_✓`__`i _�_ 1 i_. t ir_ k 14%dTitle:
Onsite Representative: S11►C,_ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
U Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 c = 6 Longitude: = ° = 6
Design Current' Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layer
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Puults
❑ 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: a]
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [XNo ❑ NA ❑ NE
❑ Yes []No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[�-No
❑ NA
❑ NE
❑ Yes
�allo
❑ NA
❑ NE
Page 1 of 3
12128104 Continued

0
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
i)"' Structure I Structure 2 Structure 3 Structure 4
Identifier: —
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in): / 7
5. Are there any, immediate threats to the integrity of any of the structures observed?
Oe/ 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 [3No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? 0-Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
O-No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
®..No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
E&No
❑ NA ❑ NE
maintenancehmprovement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
51+Io
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s). / t A�c%Se•r� Le7I✓r-. Ad/ ,.�` L �.,--
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
O No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
R 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
M-NO
❑ NA ❑ NE
365*1 P2�- we-rt L-ss 7 .-
4%S Tv me, Tr� %� Thy ii� of Row- Wu. r-To
Ott
/ sT
A -3 I a� by f 4 7-0
Reviewerlins ector Name ""``
p Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: — Date of lnspectlon �CJ�
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 2!-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. RYes ❑ No ❑ NA ❑ NE
M-Waste Application ER Weekly Freeboard ❑�y�Waste Analysis Soil Analysis ❑ Waste Transfers ❑ Annual Certification
49 Rainfall ❑ Stocking ❑ Crop Yield Wi'Z[) Minute Inspections 51monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
C&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
JZ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
C�[No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ZNo
❑ 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
JNo
❑ 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
9No
❑ 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?
0-Yes
❑ No
❑ NA
❑ NE
AdW6nal Comments and/or Drawings. �li 2 .Ycts,a Z 4 , �;3'# i ✓
f9 ✓'mS' �'Dr►�t�
u e-f 7
Alev woS+�
o S-L -a Z v 7
l.�oar d- pY'D Jar
Y
r �
,e' Can rn7- i F -0P*W 49
0_61` re- ZA- 61 J, a
Page 3 of 3 V

Facility Number
O'Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit erComp ante Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit erRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: %77 Arrival Time: .�(�d Departure'1imc: Z1Q County: a'^` Region:
IV
Farm Name: K La K Owner Email:
Owner Name �i r�-i L _ . f!'r-G he Q +'td{ Phone:
Mailing Address:
Physical Address:
Facility Contact: // r`-2+ / : G/�� Title: Phone No:
Onsite Representative: ���uy Integrator: ul�+111.1
Certified Operator:_ Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [=] o =' 0 Longitude: [----] o =, = "
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑
Wean to Finish
❑
Wean to Feeder
Feeder to Finish
1,31,229
3voO
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
El
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ TurkeyPoulis
❑ 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?
Cattle
Design Current
Capacity Population .
❑ Daia Cow
❑ Dairy Calf
EI_Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures::
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. 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?
e
❑ Yes [&No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
El No
❑NA
[I NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
Callo
❑ NA
❑ NE
❑ Yes
�9 No
❑ NA
❑ NE
12128104 Continued

' Facility Number: Date of Inspection % �D
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): Lg /
Observed Freeboard (in): ;53
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes � No El NA El 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?
X1 Yes ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
(4 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
S 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
CN 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 Dri/fl Application Outside of Area
f❑
12. Crop type(s)
13. Soil type(s) _B-y✓
.
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
JR No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes RNo
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes KNo
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes �No
❑ Yes R No
❑ NA ❑ NE
❑ NA ❑ NE
El NA El NE
❑ 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):
�rLJ r�l L` Work
Reviewer/inspector Name Phone:
Reviewer/inspector Signature: Date: r
�/ 12128104 Continued

Facility Number: — 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 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 2!kNo ❑ 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 [9No ❑ 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
19No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
R No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
tZ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
C,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
2.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
Wo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
;&No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Inspection
Facility Number: Date of Inspection 1+2 uri
y 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 (SNo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): �] 4-% !
Observed Freeboard (in): / q r-2 /
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [ZNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [9No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate puhlic health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? (0 Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes IM 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 0 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/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [4 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifi ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
/•l
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
CK No
❑ NA
❑ NE
t6. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[]
Yes
[4 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
®.No
❑ NA
❑ NE
Reviewer/]nsp ector Name
— — J' p ►^� + '� "� "�
Phone:
Reviewer/inspector Signature:
Date:
O�dflSc�
116i16oivv a,unttnaea

Facility Number: —) Date of Inspection t7(p
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ Wup ❑ Checklists ❑ Design ❑Maps ❑Other
.111
21. Does record keeping need improvement? If yes, check the appropriate box below. L25kYes c o ❑ NA ❑ NE
,Waste Application ❑ Weekly Freeboard RWaste 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?
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 r7 No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes
JZ No
❑ NA
❑ NE
❑ Yes
g No
❑ NA
❑ NE
❑ Yes
[� No
❑ NA
❑ NE
❑ Yes
54No
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes CQ No ❑ NA ❑ NE
❑ Yes 10 No ❑ NA ❑ NE
❑ Yes JQNo ❑ NA ❑ NE
❑ Yes
QQNo
❑ NA
❑ NE
❑ Yes
,qNo
❑ NA
❑ NE
Additional'Cominents:and/or Drawings �,'r>'`•'k="�",�
b..��...u.� ...
� t ✓Yl, ►. V
r1r Ne-Lv W064c rJaX-
12129104

IF I - i�[.'. }fir€ !f• f'1 ;€ i �� ':rE iaiV1S�0O'flf $ TT {��
.tetPualt
{i.°.f
3 r'Sa$i...3'
r SI u�.,.{{{f�it k - $ 11 !•}� Si+l j}pt ` Ij -I r.�(@� �F6�esi�t'C�Si'N, i����5�011'l0� �VF1W+� W�tei'f �.i�f4lea 1 [��Vn � Pd€ 3s fEr li: tiF-ii �� � E _�.e� [{ 66� (81 P 3Y`� i 1� €Y � ! �9p� i_-. E.�f €E€
Type of Visiv, ! Compliance Inspection p Operation Review O Lagoon Evaluation
Reason for Visit m Routine O Complaint Q Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit: i Time: ,' 40
Not O erational O Below Threshold
W'ermitted [9<ertifted 0 ConditionalllyrCertified © Registered Date Last Operated or Above Threshold; .........................
Farm Name: ...✓.. '.I...... .R.�k4....rG�M.................................................. County:..... a!o,Q..O.'A.................................. .. F!�Q......
Owner Name: .........V'. r ............................. .(.f.. f..,l %ate.ki...............J................... Phone No:.......1.10 . Slo zi .? i'lo............................
MailingAddress:..... �f ....... .l�. mer...... t?l................... C.A.e.7.14.0.............N.(...........2.432.8................................... ..........................
Facility Contact: .........✓... : J d.................. ar &:.��/i✓,t;x.f�... Title: ............................................. I .................. Phone No:...................................................
Onsite Representative:.........V r�:�................ ........�fl::rhl1,Z,..d........................... Integrator: .... l! -rah ... . ... /,Tro..Vd ................................
Certified Operator: .............. �.1..1........................ -? ! ::� L�� n.f ...................... Operator Certification Number:......... 7. . %Y.............
Location of Farm:
[gogwine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ' " Longitude • ' "
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 9-96
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes 9-Noo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) 0 yes QW6�
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 94-N6l
2. Is there evidence of past discharge from any part of the operation?
❑ Yes ®•NV
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes MN6'
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 13vo--
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............... I.................. ................. ....... »..... .................................... ................................... .....................................r....................I...........
Freeboard (inches):
12112103 Continued

i
Facility Number: 8,2 — 7
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed.? (ie/ trees, severe erosion, ❑ Yes GWo'
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes
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 3-Flo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes GNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes Of4o
elevation markings?
Waste Anulication
10. Are there any buffers that need maintenance/improvement? ❑ Yes MNo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes 21146
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type t3erm gda, 60. ckvc Lord S -", 4
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [-o
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 24o
b) Does the facility need a wettable acre determination? ❑ Yes Q No
c) This facility is pended for a wettable acre determination? ❑ Yes Q No
15. Does the receiving crop need improvement? ❑ Yes MN6
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Odor IRSueS
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 0-Idn
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 9-o
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 0 Yes p r o
Air Quality representative immediately.
nments EtE'aMr
❑ Final Notes
f !�q✓Z moL✓ �GG�jl��e py-' /GpOt7%S �0 �arJ/�o! weer 1 4y� J�1� /C.nOU� 4Jpdd
5a� /,'�55 �e`{are �Py bPfOrH� a
ReviewerAnspector Name 1"ill
ReviewerAnspector Signature:
Date: -IF- 17- O 1
1 Zil-1iv. [.onnnuea

Facility Number: d 2 Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/WOV, OeekltM, deeigit,.maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste ApplicatiSn ❑ Freeboard i❑ ;;_6 mg
1 z
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ Yes [pqo-
❑ Yes O-X6
[:]Yes M-Ko
❑ Yes 0-go
❑ Yes O No
❑ Yes
❑ Yes ❑"I o�
❑ Yes ONO
es ❑ No
❑ Yes EPK-
❑ Yes Q.l,
❑ Yes [-N'o
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑-Alm
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ ing-Ferfn - ❑ Crop Yield Form ❑ Iiainfa* ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑
12112103

Site Requires Immediate Attention: Au
Facility No. 2- i� ►
DIVISION OF E MONMENTAL MANAGEMENT
ANIMAL FMLOT OPERATIONS SITE VISITATION RECORD
DATE. 10 Akrwst , 1995
Time: 17--Vt
Far>x►NameJOwryer: •'tft, +�. S�¢..'► c�l+A�a.S
Mailing Address: �
County: S P- M'p S 0 N
Integrator: —"QiL P A 15 r '04-+MS NG Phone: I— S M -- Z%'9 — Zl19
On Site Representative: 1 Gll,. 5-Te_%r i4.LAN D phone:
Physical AddreasUcation: . _ i�' - •'7 ,` -S vo 1ZAb 1�; Z7
Type of Operation: Swine x Poultry Cattle
Design Capacity: 3 0-1 o Number of Animals on Site: 0
DEM Certification Number: ACE DEM Certification Number. ACNEW____ ��
Latitude: Longitude: �• . �„�,"
Circle Yes or No
Does the Animal Waste Lagoon have sufficient huboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches Yes)or No Actual Freeboard:. _fit. Inche
Was any soepage observed from the I
on(s)? Yes o No Was any erosion observed? Yea or o
Is adequate land Available for spray? r No Is the cove crop adequate?�P�r',No
Crop(ss) being utilized: i SA �.e.b �5� t,1,... � +Actits A oOL AV �'L4kt
Does the facility n=set SCS minimum setback criteria? 200 Feet from Dwellings��r No
100 Feet from Wells? es r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes 01(9)
Is animal waste lard applied or spray irrigated within 25 Feu of a USOS Map BIue Line? Yes we
U animal waste discharged into waters o the state by man-made ditch, flushing system, or other
similar man-made devices? Yes No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes OQ
Additional Comments:
Lupector Name Si ure
cc: Facility Assessment Unit Use Artachmentb if Needed.