040035_INSPECTIONS_20171231

Fi
__ _ _ __ 0-(�_s��
'� �—�ivision f Water Resonrces
Facility Number - Division of Soil and Water Conservation
0 Other wq
Agency
Reason for Visit: ® Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other
,y 1I0 Denied Access
Date of Visit: Arrival Time: Di Departure Time: I . County: I`t7V Region: ��_
Farm Name:
Owner Email:
Owner Name: W �� RXJ� iG-t'11 W1S i t.W Phone:
Mailing Address:
Physical Address:
Facility Contact: (t v. k Title:
Onsite Representative: N j} OS � 12""'
Certified Operator: J -a4 ry�
Phone:
Integrator:
Certification Number: 9 70 6
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Caparity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Cnrreat
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Wean to Feeder
I jNon-Layer
I
Dairy Calf
Feeder to Finish
❑ No
� NA
❑ NE
Bairy Heifer
Farrow to Wean 2
® No
Design
Curreat
Dry Cow
Farrow to Feeder
D , P,oul
Ca aci
P,o
Non -Dairy
Farrow to Finish
ILayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Outer
Turkey Pouits
LJ (3ther
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: p Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes Vo No ❑ NA ❑ NE
❑ Yes 0 No [�g NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
® NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[:]Yes
❑ No
� NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
CH No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

F+tcili l lumber: - Date of Inspection f
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
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
Identifier:
® No
❑ NA
❑ NE
acres determination?
Spillway?:
17. Does the facility lack adequate acreage for land application?
Designed Freeboard (in):
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
Observed Freeboard (in):
0 No
❑ NA
❑ NE
Required Records & Documents
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
U5 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
Fol No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[)3 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
Qg 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)
77'
9. Does any part of the waste management system other than the waste structures require
❑ Yes
P No
[DNA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
� No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence ofQQWind Drift ❑ Application Outside of A proved Area
12. Crop Type(s): Q _.f CP"`s '�I k Tom✓ .
13. Soil Type(s): %,k 14 sN gCIA
/WdrrL.
r
14. Do the receiving crops differ om those designated in the CAWMP?
❑ Yes
EA No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
N No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ 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
0 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily avaiiable?
❑ Yes
Fol No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
CM No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [P No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 54 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
F-1 NA ONE
Page 2 of 3 2/412015 Continued

Facili ''Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
25. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes J�p 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?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [�PNo [] NA ❑ NE
❑ Yes [D No ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
❑ Yes
No
❑ Yes
© No
❑ Yes
[;jk No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Phone: / t ' O
Date:
214/1015

IS"
I ype of Visit: 49 Compliance Inspection V uperanon Kcvlew U btructure Evaluation U 'technical Assistance
Reason for Visit: • Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: U M , Arrival Time: =l 4--4 Departure Time: QK2Jd County:
Farm Name: (��, �o $ Owner Email:
Owner Name: W nr f vh S Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: f✓I,S Title: Phone:
Onsite Representative: tl D Au�SP-r Integrator: �4�CJ
Certified Operator: S i 4, Certification Number: AP0W' T?7443
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
❑ Yes
Design
Current
Design Current
Swine Capacity Pop.
Wet PoaItry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
❑ No
NA
Dai Cow
Wean to Feeder
Non -La er
❑ No
NA
Dai Calf
Feeder to Finish
Design
Current
Dai Heifer
Farrow to WeaLH
n 7_200
Cow
Farrow to Feeder
Dr P,oult .
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Beef Stacker
No
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
s
Other
1[Turke
TurkeyPoults
Other
Other
Discharges and Stream Impacts
1. 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 DWR)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
[2TNA
❑ NE
2_ Is there evidence of a past discharge from any part of the operation?
❑ Yes
r�_-t No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2014 Continued

f
Facility Number: Q - S Date of Inspection_
❑ Yes
P No
❑ NA
Waste Collection & Treatment
maintenance or improvement?
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
P No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
0 NA ❑ NE
StrucrI Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
maintenance or improvement?
Spillway?:
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
Designed Freeboard (in):
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
Observed Freeboard (in):
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 No
❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
dRQ a� QS
12. Crop Type):
(
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes P No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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
P No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence �f in Drift ❑ pplication Ou
117
'de of Approved Area
dRQ a� QS
12. Crop Type):
(
e(s) : Yr3"' KL4a
1
, L
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
IS. 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
❑ YesNo
LIN
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
M No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[] No
❑ NA
❑ NE
R_enuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes q No
❑ 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 W No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E)j No
E:] NA 0 N
❑ Weather Code
❑ Sludge Survey
❑NA ONE
❑ NA ❑ NE
Page 2 of 3 2/412014 Continued

i
facility'Number: - Date of Inspection:
❑ Yes
O No
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 permit conditions related to sludge? If yes, check
❑ Yes M No
❑ NA ❑ NE
the appropriate box(es) below.
32. Were any additional problems noted which cause non-compliance of the permit or CAW IP?
❑ Yes
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge
levels
❑ NE
❑ Non-compliant sludge levels in any lagoon
❑ Yes
P No
List structure(s) and date of first survey indicating non-compliance:
❑ NE
34. Does the facility require a follow-up visit by the same agency?
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes F No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes P No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes to No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes ONo
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes P No
❑ 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
O No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAW IP?
❑ Yes
Pq No
[DNA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
P 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 #f): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pales as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: -7r0::: � � 33V
Date: 3
2/412014

i ype of v isit: jW uompuance ,nspecnon v uperanon meveew V Ntrucrure Evaivatnon V i ecnmcai Assistance
Reason for Visit: • Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 2i Arrival Time: a7 ; Departure Time: D`j: . ' c: County: jiia[7s.! Region:
Farm Name: Li 11,4 pzocK f�' w+s Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Com? QL� �I.A,42,1 Title:
Onsite Representative: 3o Sti. PM.- V_el,
Certified Operator:
Phone:
Integrator: 1�
Certification Number: YcJ
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
0 Yes [A No ❑ NA ❑ NE
❑ Yes
Current
® NA
Dgn Current
Design Carrent
Swine !
Capacity ;Pop.
Wet Poultry
@apacit Pop.
Cattie Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I
INon-Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
7-2 CRI
ign Current
D Cow
Farrow to Feeder
.
D P,oul
Ca aci P,o P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Ocher
TurkeyPoults
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)?
0 Yes [A No ❑ NA ❑ NE
❑ Yes
❑ No
® NA
❑ NE
❑ Yes
[]No
P NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No Qg NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/412011 Continued

Facili Number: jDate of Inspection:412-1113
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes IM No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 0 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes [� No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 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? T�
Waste Aoolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes P No [DNA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA 0 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 ❑ Evide a of Wind Drift ❑ Application
l
fAproved Area
12. CropType(s): � SS W-�
---
13. Soil Type(s): rt"cl L"44 , C74dB,� L 'f�+('V" 1(T1a1.ja4- k f__1�b4I-
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
No
❑ NA
❑ NE
❑ Yes
$D No
❑ NA
❑ NE
❑ Yesyna No ❑ NA ❑ NE
❑ Yes F0 No [:]NA ❑ NE
❑ Yes T No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑WUP ❑Checklists ❑Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes ® No
❑ Waste Application p Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Trannsssfers
❑ 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 `C" No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E] No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

'lFacility. Number: L4 IDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes No
the appropriate box(es) below.
Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [ No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes ® No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
TT��
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes �5 No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes �a No
❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes rp No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes §j No
❑ 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 pages as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 410r ` 33 g5QO
Date: Y 2 Zi.3
2/412011

Type of Visit: 0 Compliance Inspection O Operation Review 0 Structure Evaluation Q Technical Assistance I
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: County:
1J
Farm Name: Wyk M Owner Email:
Owner Name: RLa {�¢ f Phone:
Mailing Address:
Physical Address:
Facility Contact: r[nrlTitle: Phone:
Onsite Representative: +^ Integrator:
Certified Operator: �OCy r Certification Number- g� �
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure p 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)?
❑ Yes iP No ❑ NA ❑ NE
❑ Yes
Design Current
Ep NA
Design
Current
- Design Current
® NA
Swine
PREiain�itoTc�eder
Capacity Pop.
Wet Poultry,
Capacity
Pop.
Cattle Capacity Pop.
La er
Dair Cow
Layer
Daia Calf
Feeder to Finish
= "''
Dairy Heifer
Farrow to Wean2?.Ofi
Design
Current
Dry Cow
Farrow to Feeder
D . Point.A
Ca ae_i-
P,o P.
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
NJ Other
10ther
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure p 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)?
❑ Yes iP No ❑ NA ❑ NE
❑ Yes
[—]No
Ep NA
❑ NE
[] Yes
[—]No
® NA
❑ NE
d. Does the discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes No
❑ Yes No
NA ❑ NE
NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/2011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: I�
rNo [3 NA F] NE
❑ No [�j NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
3
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(�
No
❑ NA
E] NE
waste management or closure plan?
T
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
99 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
W No
E] NA
E] NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
acres determination?
9. Does any part of the waste management system other than the waste structures require
❑ Yes
P No
E] NA
❑ NE
maintenance or improvement?
18. Is there a lack of properly operating waste application equipment?
h
No
❑ NA
Waste Analication
10_ Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): LS+`y U--Vf L�Ir W x
13. Soil Type(s): K Sbsu Q,t„/a e
14. Do the receiving crop differ f om those designated in the CAWMP?
❑ Yes
P] No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
V] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�] No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
C] NE
Required Records & Documents
t9. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists []Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �j No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA LINE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? El Yes No ❑ NA F] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
EJ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes � No E] NA [:]NE
❑ Yes ffp No ❑ NA ❑ NE
❑ Yes 1� No ❑ NA ❑ NE
❑ Yes �j No ❑ NA [] NE
❑ Yes No
❑ Yes No
[]Yes M No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone:
Date:
2/4/2011

Type of Visit 0 Compliance Inspection 0 operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I Arrival Time: Departure Time: �}Q�y, County: )%l Region:
Farm Name: -fie ltwOwner Email:
Owner Name: O�� i;wjtPhone:
Mailing Address:
Physical Address:
Facility Contact: tlt+Q✓ __ Title: Phone No:
Onsite Representative. Integrator: I `'1 r�� _-124w,�' C
Certified Operator: Operator Certification Number: a
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = 0 =I 0 u Longitude: =,D=1 = u
1111 Design Current
❑ Yes
Design Ig
Current
Design Current
11101 � i
Swibie Capacity Popes lahon
Wet Poultry
Cap city Popufat�on
Cattle Capacity Popuiation
a. Was the conveyance man-made?
❑ Yes
❑ Wean to Finish
❑ Layer
❑ NE
❑ Dairy Cow
❑ Yes
❑ Wean to Feeder❑
Non -La er
❑ NE
❑Dai Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Yes
Farrow to Wean -2-zco
D_ry Poultry
�
❑ D Cow
❑ Yes
Farrow to Feeder
❑ La ers
❑ NE
❑ Non -Dairy
❑ Yes
6No
[:1NA
❑Farrow to Finish
other than from a discharge?
❑ Beef Stocker
❑ Gilts
❑Non -La ers
12/28/04
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
.-
❑ Turke s
Othei wx Rr
� .,.
❑Yorke Poults
❑ Other
❑ Other
Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
19 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
W NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
§1NA
❑ 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
to No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
6No
[:1NA
ElNE
other than from a discharge?
lr
Page I of 3
12/28/04
Continued
J

Facility Number: — Date of Inspection
❑ Yes
A No
❑ NA
Waste Collection & Treatment
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Wo
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
F3 No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
R9NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
j9No
❑ NA
❑ NE
Spillway?:
Designed Freeboard (in):
Freeboard
Observed (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Ep 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
10 No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[9 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
EP No
❑ NA ❑ NE
maintenance or improvement?
Waste Avolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ NA ❑ NE
maintenance/improvement?
TNo
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
1P 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 Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
{C,;,,rop
C
12. Crop type(s) IU-l"'t 5"
13. Soil types) f Linti� u`` r AlaSoo Fbl7rlLla�-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
A No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Wo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
*o
❑ NA
Cl NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
eNo
❑ NA
❑ NE
I& Is there a lack of properly operating waste application equipment?
❑ Yes
j9No
❑ NA
❑ NE
Reviewer/inspector Name Phone:
Reviewer/Inspector Signature: Date: Llf
Page 2 of 3 12/28/04 Continued

Facility Number: Ll Date of Inspection 7L 1► I
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? []Yes (p No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes V No ❑ NA EINE
the appropirate box.
❑ WUP El Checklists ❑Design El Maps El Other
21. Does record keeping need improvement'? If yes, check the appropriate box below. ❑ Yes 9? No [INA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes §9 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No 59 NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[P No
[INA
❑NE
25. Did the facility fail to conduct a sludge survey as required by the permit'?
❑ Yes
�] No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
EINE
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
P 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
LvJ No
❑ NA
EINE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Additional Comments and/or Drawings:
sc 1 �r+ s � +1 5 k 171t�E_ ) - SrL17� /Z
Page 3 of 3 12128104

A -
Type of Visit 40 Compliance Inspection O Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit 0 Routine Q Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 3 l 10 Arrival Time: i Departure Time: I 0rj.'1CqMj County: �COd Region: E
Farm Name: N" S Owner Email:
Owner Name:� ��fS�;r Phone:
Mailing Address:
Physical Address:
Facility Contact: Pu tTS�� __ Title:
+r
Onsite Representative:
Certified Operator: ! j
Back-up Operator:
�, Phone No: L
Integrator: �' f P " P no 1
Operator Certification Number: -2&ZY2
Back-up Certification Number:
Location of Farm: Latitude: 0 0 01
0 Longitude: =
Design Current
Design Current :
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
C•attte Capacity Population
❑ Wean to Finish
❑ NE
❑ Layer
❑Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Da' Calf
❑ Feeder to Finish
❑ No
❑ Yes
❑ Dairy Heifer
Farrow to Wean
'.u` ' _ �Cj
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ NE
ElNon-Dairy
El Farrow to Finish
El Layers
El Beef Stocker
❑ Gilts
❑Non -Layers
El Beef Feeder
❑ Boars
El Pullets
JE1 Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Poults
Number of Structures:
❑ Other
❑ 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)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
Page I of 3
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
It NA
❑ NE
❑ Yes
❑ No
[P NA
❑ NE
[)INA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
1ANo
❑ NA
❑ NE
12/28/04 Continued

Facility Number: — Date of Inspection I SIIS IIy _I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes MNo ❑ 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): rr
Observed Freeboard (in): 3fO y
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ANo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes U No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes P No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes b No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 'n No ❑ NA ❑ NE
maintenance or improvement?
Waste Ani lication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
&No
❑ NA ❑ NE
maintenance/improvement?
Reviewer/inspector Name A Phone:
Reviewer/Inspector Signature: Date: 3T El D
L
Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
N No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [] Application Outside of
Area
12.
Crop type(s) R Garkwq SS Sr• va^" ov'e
/
13.
Soil type(s) Ca g d A I TnA
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
to No
❑ NA ❑ NE
15_
Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
�q No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
I�LNo
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
ijgNo
❑ NA ❑ NE
Comments {refer to question #): Explain any YES answers and/or any recommendations or any other comments.
s of facility to better explain situations. (use additional pages as necessary):
IWO=
%
a
Reviewer/inspector Name A Phone:
Reviewer/Inspector Signature: Date: 3T El D
Page 2 of 3 12/28/04 Continued

Facility Number, —36 Date of Inspection 1 O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes TNo ❑ 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 El maps [:1 Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes )0 No ❑ NA ❑ NE
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No RVA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
15 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
19 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
S No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
PNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
W No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
tKNo
❑ 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
E�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
PONo
❑ 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
P No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
`P' No
❑ NA
❑ NE
Ad��honal Comments andlo'r�Draw ,, . '� ,
Page 3 of 3 12/28/04
Page 3 of 3 12/28/04

Division of Water Quali
ty
F==FUT'iumber = 3 Q Division of soil and Water Conservation
Other Agency
IType of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit a Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: � County:
�� � �u[�t'� TZKi►'L.7
ISFarm Name: VI �� Owner Email:
Owner Name: Ro-_�f::4,—Lame Phone:
Mailing Address:
Physical Address:
Facility Contact: p _ �t f UIPSIz— Title: Phone No:
Onsite Representative:
Certified Operator:
Back-up Operator:
i
Region: PAO
Operator Certification Number: 586 7
Back-up Certification Number:
Location of Farm: Latitude: ❑ o = ❑ u Longitude: = e ❑ ' ❑ N
ign Curret
Po ultion
V.7;ty p
*Design Current
Wet Poult ry ;Capacity Population
Design Currenaci
Cattle @apdcity Population
❑ Wean to Finish
❑ La er
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
❑ Feeder to Finish
❑ No
'}
❑ Dairy Heifer
Farrow to Wean UM
Dry Poultry
Fojj
❑ Dry Cow
❑ Farrow to Feeder
e. What is the estimated volume that reached waters of the State (gallons)?
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Beef Stocker
❑ Gilts
❑Non -La ers
❑ NE
El Beef Feeder
❑ Boars
El Puliets
❑ NA
❑ Beef Brood Co
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Turkeys
?vNo
-
a:s...
Othe
❑ Turkey Poults
❑ Other
❑ Other
Number of`Structures:
12/28104
Continued
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ONo
❑ NA
EINE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
N2qA
❑ NE
b_ Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[ NA
❑ NE
e. 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
LTA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
?vNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28104
Continued

Facility Number: — 3 Date of Inspection 3736
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P§No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [UNA ❑ NE
-70
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ru
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
KNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ NE
15. Does the receiving crop and/or land application site need improvement?
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
4 No
❑ NA ❑ NE
through a waste management or closure plan?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
QjNo
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
No
❑ NA ❑ NE
` 8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ Yes
P No
9. Does any part of the waste management system other than the waste structures require ❑ Yes
43 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
1p No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
5No
❑ 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 o//f��Acceptable Window ❑ E'Evfidence o�fj Wind Drift ❑ Application Outside of Area
QCrop
l
12. Crop type(s) I.LK� x( & ma& �A551 L .Rx�T re,) , GmWllma SS SMS % �1�15
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
EpNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
1pNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
QjNo
❑ NA
EINE
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
P No
❑ NA
❑ NE
USA l iulL,.� n2c,( �t n1 ,
4r k V,4 {-etd,d 16wf�.,5 ,
Reviewer/Inspector Name 94t, 4 t-
' , Phone: QI0-1 -3340
Reviewer/Inspector Signature: Date: 3a'a�
Page 2 of 3 12128/04 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JpNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes P9 No ❑ NA ❑ NE
the appropiate box. ❑ WUp ❑ Checklists ❑ Design g ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 154�No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EA No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
1p No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Wo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[ANo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�gNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[P 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
PNo
❑ 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
WNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency'?
❑ Yes
MNo
[__1 NA
El NE
Additional Gotiiments andlor Drawings:,
w
Page 3 of 3 12/28/04

Division of Water Quality
Facility Number , j 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine O Complaint Q Follow up O Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: hrl-ewy Region:
Farm Name: W h -k Wck_�7�s Owner Email:
Owner Name: �d jle ., L' PUr�S e� Phone:
Mailing Address:
Physical Address:
Facility Contact: TOAL3 R -SR ', Title:
Cl
Onsite Representative:
Certified Operator: H
Back-up Operator:Lew-
Phone
[ts f
No:
Integrator• r,
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [—]'
[::] ' 0 Longitude: = o =' =
Swine
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey i'oults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Daia Calf
❑ Daia Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures-
.
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 1] No ❑ NA ❑ NE
❑ Yes
❑ No
W NA
❑ NE
❑ Yes
❑ No
EPNA
❑ NE
❑ Yes
❑ No
tp NA
❑ NE
❑ Yes
[P No
❑ NA
❑ NE
❑ Yes
I -No
❑ NA
❑ NE
12/28/04 Continued

12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
Date of Inspection
ElNA
Facility Number: —
15. Does the receiving crop and/or land application site need improvement?
Waste Collection & Treatment
rNo
❑ NA
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
KI No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No 4NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Spillway?:
❑ NA
❑ NE
Designed Freeboard (in):
Observed Freeboard (in): So
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
❑ YesNo
ElNA ClNE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
T
9. Does any part of the waste management system other than the waste structures require
❑ Yes
EANo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ YesNo
ElNA
ElNE
15. Does the receiving crop and/or land application site need improvement?
ElYes
rNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] yes
E�No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
'1 o4- Gtr 2009, +?-Ae- 5 ib , J rcLc�7Fec� �� .0t,,0-60. &
1W
ReviewerAnspector Name e. Phone: [phone]
Reviewer/inspector Signature: Date:i6
12/28/04 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Ep 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.
❑ W1JP El Checklists ❑Design El Maps [:1 Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9 No [:INA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and i " Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
P No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
PNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�] No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
5 No
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�'No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
O No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
P No
❑ NA
❑ NE
12/28/04

IType of Visit 0 Compliance Inspection 0 operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit O Routine O Complaint O Follow up O Referral 0 Emergency 0 other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region: F40
Farm Name: , w�l if go %QrmS Owner Email:
Owner Name: _ UotA4 PWfw Phone:
Mailing Address:
Physical Address: Q
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
I
Phone No:
Integrator: P��1r+►� iu m 44
Operator Certification Number: 8b 7
Back-up Certification Number:
Latitude: =]' [--] ' ❑ « Longitude: ❑ o E:D ' ❑
"Design Current
❑ Yes
P No
❑ NA
❑ NE
Design Current
Design Current
Swine, Capacity Population
❑ Yes
Wet Poultry
[RNA
Cap�ac�ity Papulation
Cattle Capacity Population
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Wean to Finish
❑ Layer
❑ Yes
❑ Dai Cow
NA
❑ NE
❑ Wean to Feeder
❑Non -La er
[� No
Dairy Calf
❑ Feeder to Finish
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
yP' u. v„
❑ Dairy Heifer
Farrow to Wean ajovs
Dry Poultry
r
4'
❑ D Cow
❑ Farrow to Feeder
Layers
❑Non -Dairy
❑ Farrow to Finish
Continued
❑ Beef Stocker
❑ Gilts
❑Beef Feeder
❑ Boars
REINon-Layers
❑Beef Brood Coter
-
❑Other
Numttet of�Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
P No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
[RNA
❑ 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
[� No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[B No
❑ NA
❑ NE
other than from a discharge?
Page l of 3
12/28/04
Continued

` Facility Number: — Date of Inspection 1 a
❑ Yes
V3 No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
59 No
❑ NA
❑ NE
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
P NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway'?--
pillway?:Designed
DesignedFreeboard (in):
Observed Freeboard (in): 3 �!t
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E�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
PSNo
❑ 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 [P 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 43 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes t9 No ❑ NA EINE
maintenance/improvement'?
11. 1s there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
V3 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
59 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
t@ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application'?
❑ Yes
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E�U No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendation-'s"o--any, other commen s
Use drawings of facility to better explain situations: (usc.additional pages as necessary):
ReviewerAnspector Name .1 Phone:
Reviewer/inspector Signature. Date: Dobe
Page 2 of 3 12/28/04 Continued

Facility Number: Date of Inspection a4'7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes CS No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes ;RNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes IN No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes fU No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes X] No ❑ NA ❑ NE
24_ Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
N No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
F&I No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
(S No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ No
[1 NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
51 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
V] 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
14 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
7
Page 3 of 3 12/28/04

Type of Visit O'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: I P ' f_f' County: a- Region: L:z-o
Farm Name: ��L _Ll t� r° 1 , Owner Email:
Owner Name: & Phone:
Mailing Address:
Physical Address:
Facility Contact: 5x1x% e Title:
Onsite Representative: E=
Certified Operator: _$_::,
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Integrator: �lY,i,clse
Operator Certification Number:
Back-up Certification Number:
Latitude: = [=A 0Sd Longitude: =o ❑,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
��— ❑
Layer
�! ❑ Non -La et
Dry Poultry
❑
Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turke - Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: �0
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 [K No ❑ NA ❑ NE
❑ Yes
Q4 No
❑ NA
❑ NE
❑ Yes
rv-1 No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
No
❑ Yes
2 No
❑ NA
❑ NE
❑ Yes
Z[No
❑ NA
❑ NE
12/28/04 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 [M No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
[I Yes W No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):y
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [KNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes 9LNo ❑ 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 M No El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [Z 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 MI No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes g] No ❑ NA ❑ NE
maintenance/improvement?
]L 1s there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 5No ❑ 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 Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) s ,70,4 2_304' /,3jc Z VA/ ,: fWf cY6 G
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
fKNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
I No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determinations❑
Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
J4 No
❑ NA
❑ NE
/,5- eptrr4ar int �Px 13r; m�a�� �% d~ ' r����►�a
Reviewer/Inspector Name�� y Phone: y. r /54 1
Reviewer/Inspector Signature: Date: =011
12/28/04 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 El Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes X No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
CW 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
g -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
rF"I No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
R[NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
R No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[K 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
MNo
❑ 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
[XNo
❑ 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
El No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[KNo
❑ NA
❑ NE
A` iiitionakComri e-nts:an, d/or Dra*Wgs
12/28/04

Type of Visit 40 Compliance Inspection 0 Operation Review Q Lagoon Evaluation
Reason for Visit 4i Routine O Complaint 0 f=ollow up ()Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: L3 Time: �b
ro-7--o-T—Oner2tional 0 Below Threshold
® Permitted ® Certified 0 Conditionally Certified (3 Registered Date Last Operated or Above Threshold -
Farm Name: Qki 4-e. .I?od, 1;-( v C Count).: [ r� I—✓�
Owner Name: odn P_ t'<c_ Phone No: $ G — !c o
Mailing address: f - 1) + ,. QX 4 4- �- Ir S� _ C L'C.1`M 1 0 yc tt1 C. a P 21 S
Facility Contact: IZAn d n r 6.. pear - _ _ Title: Phone No:
Onsite Representative: er Integrator: Cmoi if _
Certified Operator: Operator Certification Number:
Location of Farm:
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' i " Longitude 0
Design Current
Swine ('anncity Pannintinn
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to '%Vear 2,,Z DC
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Csilts
❑ Boars
Design Current Design Current
Poultn Capacity Population Cattle Ca acitr Po ulation
❑ Laver I I I0 Da
❑ Non -Laver I Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present__JID La oon Area 10 S rav Field Area
Holding Ponds I Solid Traps ❑ No Liquid Waste Management System
Discharges g_ Stream Impacts
1. Is g
anv discharge observed from any part of the operation?
_ � _ El Yes 9 No
Discharge ori`*inated ar_ ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b_ If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ yes ❑ No
c, If discharge is observed, what is the estimated flow in Qal/min?
d. Does discharge bypass a lagoon system') (If yes, notify DWQ) ❑ Yes ❑ No
?. Is there evidence of past discharge from any pan of the operation? ❑yes EgNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection 8 Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillwav ❑ Yes No
Structure I Structure_' Structure 3 Structure 4 Structure S Structure 6
Identifier:
Freeboard (inches): .S1
05/03/01 Continued

Facility Number: 4 — Date of Inspection
I
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes f No
(If any of questions 4-6 was answered yes, and the situation poses as C
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes KNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes P,No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes allo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ONo
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ hydraulic Overload ❑ Yes [3LNo
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ YesNo
14. a) Does the facility lack adequate acreage for land application? ElYes gNo
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes [51No
16. is there a lack of adequate waste application equipment? ❑ Yes P No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes W No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ERNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes allo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 5 jNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ['No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes fip No
23. Did Reviewer/inspector fail to discuss review/inspection with on-site representative? ❑ Yes Wo
24. Does facility require a follow-up visit by same agency? ❑ Yes ,N No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes RNO
Q No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
AUQJ� ow
Cominents�{refer to -question:# Eiplsut anyYESanswers andlor Tiny recommendations or any_other Mal
sedrawutgsoffac�ttyrto better°explarp srtuahons'��Field Copy❑ Notes
w. wL y a6 +b �C a 5te_�1` i`Le-KA-� f e e c�l►,,r S�►oe� d ba Ch ed,
U �
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: p
05/03/01 Continued

Facility Number: — 3y Date of Inspection 13 0
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads. building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e, broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes 0 No
❑ Yes [�J No
❑ Yes © No
❑ Yes [R No
❑ Yes R] No
❑ Yes ❑ No
Additional Comments -and/or-Drawin
05/03/07

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
10 Routine O Complaint O Follow-up of DWO inspection O Follow-up of DSWC review O Other
Facility Number
© Registered © Certified © Applied for Permit #Permitted
• � !t t r -
Farm Name:
Date of Inspection�X-7X j
Time of Inspection G77 24 hr. (hh:mm)
10 Not O erational Date Last Operated:
....... County:.......�....................................................
COwner Name:...... ......................... Pi�[ � ......... ... - -..... ... Phone No:... ....5.3.'.....2.. ..........
...�.......................©[a� "-.....
Phone No:.Facilit Contact: ....I....N.....L............ Title: .................................................
bailiig Address:....
.. ------------ ---
r......Al�.._...:%S... .1�4­'.'
1:�
Integrator: ---.... Onsite Representative:l................
Certified Operator:........................................................................... ..... Operator Certification Number:..................
Location of Farm:
Latitude Longitude �• 0�f
` ; A Design s' .`'Current ;. 4 Design CurrenC
Swuie� ,Y° CapacrtyPopulation _,Poultry„,;.Ca_Pacity>Popiilation aCattle;
❑ Wean to Feeder
❑ Feeder to Finish
arrow to Wean Z 40
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
F] Layer ❑Dairy
❑ Nan -Layer [] Non -Dairy
❑ Other I_*
g �' Total Design Capacity � 2
.'FTota sswt �.
Current`'
�.,Poptilattoii .
1
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon [ISpray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes. notify DWQ)
c. If discharge is observed, what is the estimated flow in aal/min?
d. Does discharge bypass a lagoon system? Of yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7125197
❑ Yes No
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes *0
❑ Yes NNo
❑ Yes b'No
❑ Yes R(No
❑ Yes 5%�Lo
Continued on back

t. ti
Facility Number: --3
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lavoons,lloldinn Ponds. Flush fits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure t Structure 2 Structure 3 Structure 4
Identifier: ...........................•----
Freeboard (ft): &..... L ... ..............................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste :application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
Structure 5
15. Crop type....................................................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit'?
No.vilations or deciertcies were noted during' this. visit. You.willreceive no further
correspondence about this. visit'.,.'-'..'
❑ Yes 0�10
❑ Yes 1To
Structure 6
❑ Yes
No
❑ Yes• N0
❑ Yes•
No
❑ Yes
\'o
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Comments {refer to question #). Explain any 7rES ans-*crg andMir"any, recommendairons-or any gther comments �" :
Use drawings flf facilitytti better texplain situations (ii§e additttinal'pages as ",
-necessary) ,. ,µ
.
` y�tQt.J� t t.clri.a p L' L
I cti s � s
tv r7 s -fie a+- is VM e-
7/25/97
Reviewer/Inspector Name ` 14 S
Reviewer/Inspector Signature: Date:
l� v