090006_INSPECTIONS_20171231

type of visit: (�y7Routine
fiance inspection V operation Review V Structure Evaluation U Technical Assistance
Reason for Visit: O Complaint O Follow-up 0 Referral O Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 0 Departure Time: County:_ Region:
Farm Name: S,
"Mill ill Zpg � y f vt- Owner Email:
or
Owner Name: ()Ivt��/�j�4G%�c� �GG Phone:
Mailing Address:
Physical Address:
Facility Contact: Cr -j t5 L G-V'Lu "C4'_ Title: Phone:
Onsite Representative: t( Integrator: _ Iq 9 _S
JI-
Certified Operator: (. JA a.'J Certification Number: C iii 81
Back-up Operator: 1L}11 V,,,,A n1 1�t"t Certification Number: lb0
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [D -N -o- ❑ NA ❑ NE
[—]Yes ❑ No �A. ❑ NE
[-]Yes ❑No ['1 NA ❑ NE
❑ Yes
[:]No
[j] NA
❑ NE
❑ Yes
Design Current
Swine Capacity Pop.
Wet Poultry
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
[Layer
Dai Cow
Wean to Feeder
JDesign
Non -La er
Dai Calf
Feeder to Finish
Farrow to Wean
D . Poul
Layers
Ca aCi
Current
P,o
Dai Heifer
D Cow
Farrow to Feeder
Farrow to Finish
No
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Other
Other
Pullets
Turkeys
TurkeyPoults
C+iher
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [D -N -o- ❑ NA ❑ NE
[—]Yes ❑ No �A. ❑ NE
[-]Yes ❑No ['1 NA ❑ NE
❑ Yes
[:]No
[j] NA
❑ NE
❑ Yes
❑To
❑ NA
❑ NE
[:]Yes
❑/ NNo
❑ NA
❑ NE
Page 1 of 3 2/4/2015 Continued

I7acil' Number: jDate of Inspection:
Waste Collection & Treatment
4. 1's storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [D.#a—❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 0jhLA-0 NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[D'lr
Spillway?:
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Designed Freeboard (in):
❑ NA
❑ NE
acres determination?
?
Observed Freeboard (in): p�J
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
G.N6---o NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
18. is there a lack of properly operating waste application equipment?
❑ Yes
D "o
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
l N`6 ❑ NA
❑ NE
waste management or closure plan?
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7 bo any of the structures need maintenance or improvement?
es
tf"❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[r}Ai6--❑ 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
Lt],No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[a -N-6 ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes [3'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 rrCC�rop Window [:]Evidence of Wind Drift ❑ Application Outside of Approved Area
TJ
12. Crop Type(s): C-— tfcy _ S(S- l)
13. Soil Type(s): La We- -cr l/b
14. Do the receiving'crops differ from those designated in the CAWMP?
❑ Yes
M -Ko—
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[D'lr
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[ZjXo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑,Iqo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
D "o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[]I -<o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
I21"O
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists p Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes L.D N'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 [aVo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E],No ❑ NA ❑ NE
Page 2 of 3 1/4/1015 Continued

Facility Number: It- Date of Inspection: c.
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes R],?iv ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes[]
NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[3,W_ ❑ NA
❑ NE
Other Issues
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
®-A}c!r—❑ NA
❑ NE
and report mortality rates that were higher than normal?
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
I
❑-o ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
❑ Yes
[3-9-o
❑ NA
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
l.4 "
❑ 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
❑�❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[2 -1q -o—
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[3-9-o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency'?
❑ Yes
[] No
❑ NA
❑ NE
a :rornmmwn
Use drawtngs of*fac ty,#o better ex lain sttuah9ns;l(qse add�honal, a essas necessa
c,-1, _ -�,� JY7
-7 CA�,vtl,(Lc ^ O to0A on ��AOV cul '9 -C W W lJ' L)e 6?
bbj(';� [" v0-1 61j�
-,,q W0-36�- 6E.51.
Reviewer/Inspector Name: l 1 hv1. Phone+ 0 3
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412015

type of visit: (9 Compliance inspection V operation Review V Structure Evaluation V t ectinical Assistance I
Reason for Visit: (3 Routine 0 Complaint O Follow-up Q Referral O Emergency 0 Other 0 Denied Access
Date of Visit: 7h i]1 Arrival Time:i'a�'r U Departure Time: County: Region:
Farm Name: a1�` #—G<1 Owner Email:
Owner Name: Phone:
Mailing Address: �� l J d �' v` u t�-s F AN L' &--o
Physical Address:
Facility Contact: rt4 T 15 .G 0- Title:
Onsite Representative:
l�
Certified Operator: 4e ti - ANs -0 "1
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: 14' — 's -
Certification Number:
Certification Number:
Longitude:
>�'- Design Current
Design
Current
DesiguProrpe.nt
Swtne Ca P act t3 Po P
Cct
Wet�P�,oultr3 ``¢
city
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
jDairy Calf
Feeder to Fin ishdv ILE
Dai Heifer
Farrow to Wean
Design
56
@urrent
D Cow
Farrow to Feeder
-
D al?oult'KC*.a aci.
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Otherw.,.,
Turkey Poults
Other
Other
H�
Discharizes and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes E] 'Vo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ED--N-A ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes. notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes []"No
❑ Yes [E]�No
[rNA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

F'acili Number: jDate of Ins ectiow
❑ Yes O X56
❑ NA
Waste Collection & Treatment
Reguired Records & Documents
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes C9'N-5�­❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
❑ Yes No
Identifier:
❑ NE
the appropriate box.
Spillway?:
Designed Freeboard (in):
❑Other:
Observed Freeboard (in): r
2 1. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes Q No
¢,'Are there any immediate threats to the integrity of any of the structures observed?
es ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes Zj 1V U ❑ 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?
Ervcso NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ❑'N -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 Ejkas ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [:J� ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes to ❑ 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 Types}: 9 e" ftty dk 15 L
13. Soil Type(s): LSC 'NO _�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [i]`No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes LTJ 1"O ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E -N,00 NA ❑ NE
acres determination'?
17. Does the facility lack adequate acreage for land application? ❑ Yes Vo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes O X56
❑ NA
❑ NE
Reguired 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:
2 1. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes Q 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 ETNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes F�No ❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facility Number: jDate of Inspection:
24_ Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes [E' -No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑.Pdo ❑ 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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 E] No[:INA ❑ NE
E]Yes [.31Nom ❑ NA ❑ NE
❑ Yes E]4o ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
❑ Yes 0 --No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes [%"No
❑ Yes [J"No
❑ Yes EfNo
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question.# ): Explain any YES answers and/or any additional recommendatiiins or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
C"'( "b �d� - �� S�U47,
"b��(A\' coOr-� � 1__C_j 601A����'� '.4
o
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
-C,e
PhoneLlto \k—
Date:
2/4/201

I
1",\\ 5 W oe,_ib
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: tine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: d e4k Region: 7v--Z)—
Farm
--Z)Farm Name: _Sat"jt1 [' #0q Owner Email:
Owner Name: Jy / ty j ol eft, iA Phone:
Mailing Address:
Physical Address:
Facility Contact: Cu 1 s 60(A &A Title: Phone:
Onsite Representative: r Integrator: I=1 S
Certified Operator: �-e.,� G SI? c1 Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Current
p ty .�
Ca act Pop
VVet Poult rY
WelDestgn
Design Current r�Destgn42a
p.�..ty P- �. �.�
Ca ;aci Po Cattle = Capacity
Wean to Finish
I ILayer
F; NA
=
V YPop
Dairy Cow
Wean to Feeder
I JNon-Layer
❑ NE
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current,
Farrow to Feederci
P,o P. , j
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
.
T�
Turkeys
Turkey Pouhs
rt
,
Other
_>
Other
p�
- -
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 0,11U [] NA ❑ NE
❑ Yes
❑ No
A
❑ NE
❑ Yes
[:]No
F; NA
❑ NE
Page 1 of 3
❑ Yes
❑ No
[/f NA
❑ NE
❑ Yes
EErNo
❑ NA
❑ NE
❑ Yes
E;kNo
❑ NA
❑ NE
21412015 Continued

I'
Facili Number: - Date of Ins ection:
Waste Collection & Treatment
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [j3'1qo�❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No EEJ- A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NE
Identifier:
No
❑ NA
❑ NE
[:]Yes
Spillway?:
❑ NA
❑ NE
[::]Yes
UNo
Designed Freeboard (in):
❑ NE
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
esfffNo
❑ 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
El<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
�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
[D -111o_
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
R -N-6—
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ffN. ❑ 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 E] Application Outside of Approved Area
4.k
12. Crop Type(s): �J` Akc6 V _ _ _
13. Soil Type(s):
a t lel 4 M
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?
Re uired 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
No
❑ NA
❑ NE
[::]Yes
UNo
❑ NA
❑ NE
❑ Yes
E]"No
❑ NA
❑ NE
❑ Yes
El"No
❑ NA
❑ NE
❑ Yes
[f No
❑ NA
❑ NE
❑WUP ❑Checklists ❑Design [:]Maps ❑Lease Agreements E] 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 I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [ZfNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Q No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

F4Fility Number: JDate of Inspection:
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
C�14es ❑ No ❑ NA ❑ NE
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
to ""'
❑ NA ❑ NE
the appropriate box(es) below.
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes [-P Ko ❑ NA ❑ NE
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Non-compliant sludge levels in any lagoon
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes ❑ NA E] NE
34. Does the facility require a follow-up visit by the same agency?
List structure(s) and date of first survey indicating non-compliance:
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 necessary).
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
E3<o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
Ea�o
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
C�14es ❑ 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 [2'fqo ❑ 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 r— o ❑ 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 [-P Ko ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes 0No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes ❑ NA E] NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ NA ❑ NE
VNo
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 necessary).
c�l�t 10 --t
s 7 � IA cue
e s �Co^r- i.� ��
�-b �AkUL­e,
oil Po
Svc A4�
,
Reviewer/Inspector Name: is 111
Reviewer/Inspector Signature:
Page 3 of 3
C '0 AA r loq I � �'
c��� X110
9-6.6351
Phone:
Date: p��
21412015

Itype of visit: V Lompnance inspeenon v vperauon iceview v atrucrure r,vaivanou lJ i ecunicai wssisrance 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: DDeparture Time: County: ALADEJ Region:
Farm Name: sa"J Y u �} w� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: { )p_n O � K e V Title: Phone:
Onsite Representative: u Integrator:
Certified Operator: _ Certification Number:
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes F
No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2014 Continued
Design Current
Design
Eurrent
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
IF
Non -Layer
Dairy Calf
Feeder to Finish
7;�
IDairy heifer
Farrow to WeanDesign
Current
Dry Cow
Farrow to FeederDr.
P,oultr.
Ca act
P,v .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
F
Other
Turke Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes F
No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2014 Continued

FaciliNumber: - Date of Inspection: & 3
M No
❑ Yes
P No
Waste Collection & Treatment
� No
❑ Yes
No
❑ Yes�(�
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
[P No
Identifier: f
❑ NE
[:]Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Spillway?:
n 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?
Designed Freeboard (in):
W No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Observed Freeboard (in): 3
1P No
❑ NA
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ER 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
EpNo
❑ 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
M No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
bg 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
[R 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 [P No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground p Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Ai
12. Crop Type(s):
13. Soil Type(s):
❑ NE
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?
Reouired Records & Documents
❑ Yes
M No
❑ Yes
P No
El Yes
� No
❑ Yes
No
❑ Yes�(�
No
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑NA
❑NE
❑ NA
❑ NE
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
[P No
❑ NA
❑ NE
[:]Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
n 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
W No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
1P No
❑ NA
❑ NE
Page 2 of 3 2/4/2014 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permi ? ❑ Yes Eg No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(es) below.
0 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 SA 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 ❑ LagoonlStorage 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 W No ❑ NA ❑ NE
❑ Yes 1� No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
[:]Yes
[ No
[:]Yes
® No
❑ Yes
[� No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility:to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 3
2/4/2014

Type of Visit: 4P Compliance Inspection U Operation Review 0 Structure Evaluation Q Technical Assistance I
Reason for Visit: 10 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 'r Z5 Arrival Time: :'l Departure Time: 1��� County: 6L�� Region:_
Farm Name: a trot �C Owner Email:
Owner Name: L ! Phone:
11
Mailing Address:
Physical Address:
Facility Contact: Q41LQ _4 Title:
Onsite Representative: u
Certified Operator: _ �✓
Back-up Operator:
Phone:
Integrator: /Iwrp �roL_r
Certification Number: -1
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
❑ No
Design
Current
Design
Current
Swrtte Ca act Po
'z PP•
Wet Poult ry
Capacity
Pop.
Cattle Capacity
Pop.
T
Wean to Finish
La er
Dayy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . P,oWtry
Ca achy
P,o
Non -Dairy
Farrow to Finish
ILayers
I
Beef Stocker
Gilts
Non -Layers
I
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turlce s
Other.
ey Poults
Qther
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 �j No ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
�] NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No [P NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes J�o No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [�bNo ❑ NA ❑ NE
of the State other than from a discharge? TT
Page 1 of 3 2/4/2011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
� NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
EP 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
f�j 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
�3 No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[�TNo
[:INA
❑ 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?
TT
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�!rNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �j 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 Ai
12. Crop Type(s)-
13. Soil Type(s):
❑ NE
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?
❑ Yes
❑ Yes
❑ Yes
�} No
No
No
❑ NA
❑ NA
❑ NA
❑ NE
❑ NE
❑ NE
❑ Yes E�T No ❑ NA ❑ NE
❑ Yes [E No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes MNo ❑ 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. T
❑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 V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 1P No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes T No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Ds ection: /
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? ❑ YesNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? E]Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32, Were any additional problems noted which cause [ton -compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ Yes
EpNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes Qg No
❑ Yes LP No
[:]Yes ON No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: �� 7 3�
Date: Z -Z//l
2/4/2011

hype of Visit: • W Uomplianee inspection V Vperanon lceview V btructure !!:valuation V recftnieal Assistance
Reason for Visit: 40 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ' 002.. Departure Time: 12`,00 County: PWAS;Al Region:
Farm Name: �f * �� L X Fd*FrLS! Owner Email.
Owner Name: fiwin3 Phone:
Mailing Address:
Physical Address:
//
Facility Contact: Chef fzw �,jeA Title: Phone:
Onsite Representative: 1�1
Certified Operator: W
Back-up Operator:
Integrator: .1,.,/fGFJeJ�-
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
F No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Design Current
Design
Current
Design Current
Swine
Ca act Po
P h P•
Wet:P,oalt Ca aci
ry " -. P h'
Po P•
Cattle Ca aci Po
P h' P•
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
can to Finish
La er
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
Dairy Cow
can to Feeder
® NA
❑ NE
Non -La er
❑ Yes']
No
Dairy Calf
Feeder to Finish-'
�
-
M No
Dairy Heifer
Farrow to Wean
of the State other than from a discharge?
Design
Current
Dry Cow
Farrow to Feeder
D . @Poultr Ca aci
Pio P.
Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
F No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[A NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[] No
® NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes']
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
M No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/412011 Continued

F'acili Number: Date of Inspection: S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes tP No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No '�]�N✓A/❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): yu
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
)Z 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
Y] No
❑ NA
ONE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
EpNo
❑ 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
[t No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload p Frozen Ground p 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/f ❑ Evidence of Wind D ft ❑ Application Outside of Approved Area
12. Crop Type(s): �57�f +�.rn•(� 152
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?
_Reguired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes No
❑ Yes ® No
❑ Yes No
❑ Yes y No
[—]Yes E�j No
[-]Yes P No
❑ Yes ® No
❑WUP ❑Checklists []Design ❑Maps p 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 V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ILNo
❑ NA ❑ NE
❑NA 0 N
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
[DNA ❑ NE
Page 2 of 3 2/4/2011 Continued

acifi `Dumber: i - Date of Inspection: 6r jJ13
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[] Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ NA ❑ NE
permit? (i.e_, discharge, freeboard problems, over -application)
❑ Non-compliant sludge levels in any lagoon
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes [�3 No
List structure(s) and date of first survey indicating non-compliance:
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
T No
❑ NA E]NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
yy No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ® No
[] NA ❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑Yes Lo 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 D No
❑ NA ❑ NE
permit? (i.e_, discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes [�3 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 to No
T
E] NA El 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 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 necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 110-33—V ap
Date: 6 1-7
22011

IN w"--> 10/7-thl
Type of Visit: IS'Com i ce Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: erRoutine O Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: / County: Region:
IrApx—
Farm Name: / Owner Email:
Owner Name: rxll� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: 711_0� - 4�
Onsite Representative: Integrator:
Certified Operator: �f`G���'� Certification Number:
Phone:
M-6.
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
}Design- Current �'
Design ,Curren.t
Design Current
Capac�tsi Pop:
Wet Poultry
Cap c tv Pop.
Cattle Capacity Pop.
�.
Finish
ra
La er
Da Cow
Feeder
Non -La er
Da Calfo
Finish
a gym;:*
Dai Heifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
D Poul
Ca " cl?o ,
ty.
Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
IM
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes Ifo ❑ NA ❑ NE
[:]Yes ❑ No �NA ❑ NE
[:]Yes ❑ No Fq'N.A ❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) Lj Yes ❑ No [�j NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes e o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes E3 fVo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

Facility Number: JJXJ - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No []'NA ❑ NE
Stru_ _ 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 E 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
FIe E o
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
J3<o
❑ 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
3io
E] NA
E] NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
io
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
E] NA
E] NE
18. Is there a lack of properly operating waste application equipment`?
❑ Yes
9. Does any part of the waste management system other than the waste structures require
❑ Yes
g3-<0'
❑ NA
❑ NE
maintenance or improvement?
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Waste Application
❑ NA
❑ NE
the appropriate box.
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
eNo
❑ NA
❑ NE
mainte ance or im r vement9
n po
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �5 lNo ❑ 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 4vidence of Win Drift E]Application Outside of Approved Area
12. Crop Type(s): 1�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in theCAWMP?
❑ Yes
8<0
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
J3<o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
g3 -<o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E] Ngo
E] NA
E] NE
18. Is there a lack of properly operating waste application equipment`?
❑ Yes
CLJ o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[:Ko
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
n; 1lo
❑ 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 i Zo ❑ 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 [DNE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes❑ No FIA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facili Number: - Date otinspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [!rNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 024o [DNA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ❑No ❑ NA
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?
A e-
Reviewer/Inspector Name:
Reviewer/Inspector Si
Page 3 of 3
❑ Yes E5<o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes Eio ❑ NA ❑ NE
❑ Yes L No ❑ NA ❑ NE
❑ Yes
EWo'
❑ NA
❑ NE
❑ Yes
g] -Ko
❑ NA
❑ NE
❑ Yes
[I]—
❑ NA
❑ NE
Phone:
Date: 16ho/zo(
214/201

Type of Visit: Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: eRoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: bid !a Arrival Time: i p Departure Time: t I'. f1 County: AADF nJ Region:
Farm Name_ nZPkr!,,I\ "0q V49 -y") - Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: GF -mo i4eano`i Title: _ II S C-
Integrator: 14 U RR fi IJ�t 0 WN
Certification Number: SS g
Phone:
Onsite Representative: QAtr E
Certified Operator: FRRQ
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Curren#
Design Current
Swine Capacity PopLL
Wet PoWtry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish %1R op -10M
Da' Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D , Pou!
Ca aci
P,o
Non -Dairy
Farrow to Finish
r
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood G m
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes E] No ❑ NA ❑ NE
[:]Yes [:]No
[] Yes [:]No
NA ❑ NE
]NA ❑NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ® NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [!I No ❑ NA ❑ NE
of the State other than from a discharge?
Page l of 3 2/4/2011 Continued

Faci6 Number: p - p Date of Inspection:
ti
No
❑ NA
❑ NE
Waste Collection & Treatment
[:]Yes
® No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
R] No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
N No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier: 4-2
the appropriate box.
Spillway?:
Designed Freeboard (in): Irl
Observed Freeboard (in); QL ��
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2] 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
[0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
M4 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes R] 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): A G. G-
13. Soil Type(s): Le x4tky nn WC Al 1J a ktzl l%
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes W No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑Maps [] Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes [Z 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 ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA [] NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
5YNA ❑ NE
Page 2 of 3 2/4/2011 Continued

I+acility umber: dR - Cl[ 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 Qn No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e_, discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑Yes ®No F] NA C] NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes C� No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
[:]Yes No
[—]Yes No
[:]Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
C� UQS0-�P'J a PRo�.n \0, caro tar, AAV � sn5zDE, Comtkr e-
fa('AiuTN-� Pig soot` rkS yeSS:L
4 wsz) -fid PaQRE-ss sn �-ASocr.\ Xr\ �1,s` t'kP_NR I-u4uP_F_ ,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: C40'3�e-&851
Date: (0- l ]�P
T
2ianolr

C,I •-c � i3z�^ 5 �,. DAG 6JWS e -,Ar ed b7 V'— IV —Q 7
�r.Li
Type of Visit�Commpliance
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
(,rcoutine O Complaint
o Follow up Q Referral O Emergency
0 Other ❑ Denied Access
Date of Visit: S—D7- Q% Arrival Time: Q ; O Departure Time: County: 914,3 A.1 Region:
Farm Name: SQ n Q Fay Owner Email:
Owner Name: F1r�c� n.i Phone:
T�
Mailing Address:
Physical Address: v
Facility Contact: l� L DuQ d n% Title:
Onsite Representative:
Certified Operator: t3 e-yey Fre �1a4r tJ
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
026023
Location of Farm: Latitude: =0 =g
[ « Longitude: 0 ° = { = U
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Design Current tY ;Design Current
Design Current
Swine
Ga aci Po ulation Wet Poul Ca aci Pa ulation
P tT p tY p
Cattle `' C•a aci Po uiation
�.�� p tY p
�;. �p
Wean to Finish
F13 -w-
a. Was the conveyance man-made?
❑ Layer
❑ Dai Cow
❑ NA
❑ Wean to Feeder
113
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Non -La er
❑ Dai Calf
❑ NA
Feeder to Finish
Y . ..
❑ Dai Heifer
❑ Farrow to Wean
Dry Podlrry V ., '
❑ D Cow
❑ Farrow to Feeder
`''
� Non-Dairyrow
to Finish
La ers'
❑Beef Stocker
ts
❑ Non -La ers❑Pullets
❑ Beef Feeder
ars
lie
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Beef Brood Courke
O No
s
EINE
other than from a discharge?
s x ❑Turke Poults17ce
N
_Ker
Number of
❑ Other
; Structures:
12/28/04
Continued
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
0 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
[34 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
O No
❑ NA
EINE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

s
FacilityNumber: 0 If —6& Date of Inspection I -071 Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
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 property addressed and/or managed ❑ Yes [A 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 Wo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes lNo ❑ 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 1�9 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [A 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) e:5"Al4, d.-_ t Pr. 5A, j- CJ -Wall (skn
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[0 No
❑ NA
❑ NE
15_ Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application'?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #� Explain any YES answers and/or any recommends ons or any other comments
Use.idrawtngs of facility to better:`explain situations. (use additional pages_as necessary):.
Reviewer/Inspector Name j Phone: Sia. `x1-3-3, 33300
Reviewer/Inspector Signature: Date: %—,Q'7 - 2-007
Page 2 of 3 12/28/04 Continued

Facility Number: 0 -- �(r Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes IXNo [INA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 99 No ❑ NA ❑ NE
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 VFNo ❑ 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 VNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [;FNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes QVNo ❑ 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
[yNo
❑ 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
[d 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
1� No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
Y No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss reviewlinspection with an on-site representative?
❑ Yes
[4 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
VNo
❑ NA
❑ NE
Comments and/or Drawings:
12/28/04

a
Type of Visit JO'Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance f
Reason for Visit 41 routine 0 Complaint 0 Follow up 0 Referral 0 Emergency O Other ❑ Denied Access I
Date of Visit:Arrival Time: : �! G Departure Time: .00 County:
Farm Name: --�a.- Jk l mi ,, T i'r' Owner Email:
OF
Owner Name: Itli tS l v � Phone: _
Mailing Address:
Region: L�
Physical Address:
Facility Contact: n4b Title: Phone No:
Onsite Representative: Integrator:% y
Certified Operator: �P_ t U6��ii S�� r Operator Certification Number: �r —
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: E� o E--]' E__1 Longitude: [= o [� i =16
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish E=
❑ La—ver
❑ Yes
❑ Dairy Cow
❑ Wean to Feeder
10 Non -La er
❑ Dairy Calf
Feeder to Finish
0 Dairy Heifer
❑ Farrow to Wean
D . Poul ❑ Dry Cow
ElNon-Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑Non -La Non -Layers
El Pullets El Beef Feeder
❑ Beef Brood Cowl
❑ Turkeys
❑ Boars
Other ❑ Turkey Poults
lumber 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?
❑ Yes J3 No ❑ NA ❑ NE
❑ Yes
❑ No
[INA
❑ NE
❑ Yes
❑ No
[]NA
❑NE
❑ NA
EINE
❑ Yes
❑ No
❑ Yes X No
❑ Yes $4 No
Page I of 3 12/28/04
❑ NA ❑ NE
❑ NA ❑ NE
Continued

13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ,mac' No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Jallo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes J. No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[]Yes JONo [INA ❑NE
[]Yes JZNo ❑ NA EINE
Comments (refer to question #�: Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situatiaas. (use additional pages as necessary}:
a
acility-Number: - Date of -Inspection
Reviewer/Inspector Name7/ r a - ; jam.` Phone: Qjp -9'�j 33 t�D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
9No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
9 -No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
nNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
,® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® 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
0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
10 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 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 ,mac' No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Jallo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes J. No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[]Yes JONo [INA ❑NE
[]Yes JZNo ❑ NA EINE
Comments (refer to question #�: Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situatiaas. (use additional pages as necessary}:
a
Reviewer/Inspector Name7/ r a - ; jam.` Phone: Qjp -9'�j 33 t�D
ReviewerAnspector Signature: Date: D�a
Page 2 of -.3 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 [9No ❑ 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 ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application AWeekly 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
JO 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
10 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0 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
10 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
M No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EZ 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
10 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
J@ 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
1�0 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
;I No
❑ NA
❑ NE
Additional Comments and/or Drawings:
_f 1. j) frr ew J3 Pn A c�
Page 3 of 3 12/28/04

F
G@W /2/17-4/0
Type of Visit Ej'.otnpliance 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: ip -03-10 Arrival Time: Z VU h. Departure Time: Z.��r County: z bl-)14 ve^�
Farm Name: S4 -_'C /]r~ /G Y Owner Email:
Owner Name: rYTi tr� 4A/ phone -
Mailing Address:
Region:
Physical Address:
Facility Contact: (or_ 22 C -e Y�e�ti Titfe: A _ P i Phone No:
Onsite Representative: 10 A, -e_!5 Integrator: Of V,04V /?PV7,rA,10'
Certified Operator: I/� �u��-^ Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: ❑ o =' ED « Longitude: =0=&
e=& =
Design Current
Design C*urrent
Design Current
[__1 NE
Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ NE
inish
rWeederto
❑ La er
NA
❑ Dai Coweeder
❑ Yes
❑ No
❑Non -La er
No❑
❑ Dai CalfFinish
❑ NE
E]Yes
31 —o
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars I I
❑ Pullets
❑ Turkeys
El Beef Brood Co
Other
❑ Turkey Pouits
❑ Other
Number of Structures: l
❑ 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 1 of 3
❑ Yes K o ❑ NA ❑ NE
❑ Yes
❑ No
lA
B<
[__1 NE
❑ Yes
❑ No
�
Lr15A'
❑ NE
NA
❑ NE
❑ Yes
❑ No
❑ Yes
No❑
NA
❑ NE
E]Yes
31 —o
❑ NA
❑ NE
12/28/04
Continued

Facility Number: — 06,
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �,�o El NA ❑ NE
a. If yes, is waste level into the structural freeboard? El Yes L o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3711 711
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes to ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ElYes EN"o ❑ 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 threa , notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ YesNo NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes 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 [:1 Yes LT'No EJ NA ❑ NE
maintenance or improvement?
_Waste Application ,�,_T�
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes ENo ❑ 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 El Evidence of Wind Drift1 ❑ Application
Outside of Area l
12. Crop type(s) ,�t.✓!�-tom dc" f t �01't _2 �_/ _L Gl C9 t�/'J �� • S • J
13. Soil type(s)
10L,
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ff'N'o ❑ NA ❑ NE
Q No ❑ NA ❑ NE
EYNo ❑ NA ❑ NE
2 ��No[:]
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):
Reviewer/Inspector Name ! ,�1/ Phone: '7/0' y:3.3 3 4 v
Reviewer/Inspector Signature: tc� _ Date: ell Q3 20/0
Page 2 of 3 12/2$/04 Continued

Facility Number: DQ -D Date of Inspection Io -O 1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
No
[:INA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
R<
❑ NA
❑ NE
the appropirate box. ❑ WVp ❑ Checklists ❑ Desi -
gn ❑Maps El
21. Does record keeping need improvement? If yes, check the appropriate box below.
El Yes
,,,_ �
E
❑ 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
ffNo
❑ 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 E, N"o El NA [:1 NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ,L�,�N<o ❑ NA El NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes Ea<o ❑ 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? ❑ YesZo
NA El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document El Yes Ll 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 ❑ 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 nNo ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative? El Yes
No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes R<_'13 NA ❑ NE
Comments and/or
12/28/04

Facility Number
ivision of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0-610'Utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: S -.7l- O `� Arrival Time: 2 :1 y rti.. Departure Time: 3 3c County: 13�oar/c•v Region: 1'2-0
Farm Name: �� "��dr� fir_ MnFj !-[irwt Owner Email:
T..
Owner Name: B ey"!% f -YC cd ."" Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: L ol'uSo, i
Sack -up Operator:
Location of Farm:
Title:
Phone No:
'
Integrator: {G(rh f ��' '��'✓
Operator Certification Number:
Back-up Certification Number:
Latitude: =0 =
0= 6 Longitude: =0=6
°06
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population ^ ,
❑ Wean to Finish
❑ Wean to Feeder
Eaf5e_eder to Finish $ 8 0 o I
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La er
Dry Poultry
❑ Lavers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated av ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl I
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
0
❑ Yes E4 ❑ NA EINE
❑ Yes
❑ No
Lg 1vA
❑ NE
❑ Yes
❑ No
NA
❑ NE
D<
❑ NE
El Yes
❑_Ng�o
L1CT Yes
o
❑ NA
❑ NE
❑ Yes
afi o
[:INA
❑ NE
12/28/04 Continued

v9 -a4
Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes B<o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑'No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes LS - o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes ET.N. ❑ 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? [I Yes R o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [T10 ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) EJ'
9. Does any part of the waste management system other than the waste structures require [I Yes LI No ❑ NA ❑ NE
maintenance or improvement?
Waste Application ��/
10. Are there any required buffers, setbacks, or compliance alternatives that need
11 Yes L' No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 -Ko ❑ 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) 13tr.trucl .�_ q.
13. Soil type(s) �w141�•. d �L trfb i IL t,.J a K t �a.
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Er5oo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ,0 No ❑ NA El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes Ekil'o ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
D o
❑ NA
❑ NE
❑ Yes
0,9-o
❑ 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):
I It, dore- Q 5 ,ve e zoo t 53 i
e
ReviewertInspector Name %:Sx eve/_s Phone: 00, 953 -333
Reviewer/Inspector Signature: lq. AZ -4-41 Date: -5-- 21- Zoo 7
72/28/04 Continued

— v&
Facility Number: Date of Inspection
Required Records & Documents ,��
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes L'i"No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes 2 o ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design El Maps E] Other
21.
Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
M16 ❑ NA
❑ NE
29.
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
P'Ko-' ❑ NA
❑ 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?
El Yes
�❑
EB<o ❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
L9'IYo ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0 -Ko' ❑ NA
EINE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Elt o ❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
0 -Ko"
Ko"�❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Leo ❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Ej< ❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
P'Ko-' ❑ 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
[a<o ❑ 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
,�,
Lao ❑ 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
,__,, ��
Dlq_o ❑ NA
[INE
33.
Does facility require a follow-up visit by same agency?
ElYes
0-5. ❑ NA
❑ NE
Comments and/or Drawings:
12/28/04

/L1s e r -cct 7-0/-08
-Division.5 Water Quality
Facili#v Number D�Dn•Lsof Soil and Water Conservation
— - DOther Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit0<01U-tine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: -/7'O$ Arrival Time: //: SOR+�• Departure "Time: /Z : % County:-,�1f1� Region: 0/-o
Farm Name: s (x "i 1 [40% Owner Email:
Owner Name: _ L2>Qv-r`"1 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: /^u.� . 5ndc.'ydi r�— Phone No:
Onsite Representative: Ka+k.... JbUA4 4 11-Gc- IAJVSOn/ Integrator:
CertiCed Operator: _6M111_!4 Operator Certification Number: 2002.3
Back-up Operator: LSC 3'61wjsej%l Back-up Certification Number: Z5587
Location of Farm: Latitude: = o = 6 = Longitude: =()=i
°❑i = Ai
Design Current
❑ No
Design Current Design Current
❑ NE
Swine Capacity Populatio
oultry
Capacity Population Cattle Capacity Population
❑ NE
[E]
Wean to Finish
❑Laver
❑Dai Cow
1EKA
El NE
❑ Wean to Feeder
❑Non -La er
❑Dai Calf
B o
aFeeder to Finish I 8800
❑ NE
_ ❑Dai Heifer
❑ No
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑Lavers
❑ Non -Dairy
❑ Farrow to Finish
❑ Non -La ers'
❑Beef Stocker
❑ Gilts
❑ Beef Feeder
❑ Boars
❑Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
ructures:
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 FNo ❑ NA ❑ NE
❑ Yes
❑ No
BI A
❑ NE
❑ Yes
❑ No
LINA
❑ NE
1EKA
El NE
El Yes
El No
El Yes
B o
❑ NA
❑ NE
❑ Yes
❑ No
2<A
❑ NE
12/28/04 Continued

Facility Number: 09 —0600 Date of Inspection7—
Waste Collection & Treatment ��
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes LTJ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No LJ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
❑ Yes
Spillway?:
❑ NA
Designed Freeboard (in):
15. Does the receiving crop and/or land application site need improvement?
Observed Freeboard (in): 3Z.
Ngo
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.)
El Yes
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?
17. Does the facility lack adequate acreage for land application?
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? El Yes
2<o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'? ❑ Yes
2 o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
2 o
9. Does any part of the waste management system other than the waste structures require 1:1 Yes
[ Io ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
00 o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
L_ o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground Cl 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 types} Be ,,_ ..d, _ Pa s4% -.,v- L� 5-.1.[.
13. Soil type(s) /QbA . We K ja,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E7No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Ngo
❑ NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El Yes
,�,
❑ NA
ElNE
17. Does the facility lack adequate acreage for land application?
❑ YesE�No
,�E��,, �NNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2 o
❑ NA
❑ NE
Comments refer to uestion # Ex lamrat YES answers and/or apy recommendations or an ,other'coinments
Use drawings of facility to better explain m s'tuitionsuse additionapneages ascessary).
ReviewerlInspector Name Phone: '110. 't-33.3300
ReviewerlInspector Signature: R,Re's Date: `/— / 7- ZdO S
Page 2 of 3 12/28/04 Continued

Facility Number: p 2— Date of Inspection
Required Records & Documents Er
No Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes Lr No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E3<o ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design El Maps F1 Other
21.
Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
2<o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
L1 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ffNo ❑ NA
[__1 NA
El NE'
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
�ZIN �o
L�JNNo
❑ NA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
BIN o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
DIN o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E� o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
B No ❑ NA
❑ NE
29.
Did the facility fail to 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
ffNo ❑ 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
El Yes
B 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
To ❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No ❑ NA
❑ NE
Additional Comments and/or- Drawings::
Page 3 of 3 12/28/04

Type of Visit 40 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 4 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: W�2& Arrival Time: Z = /S Departure Time: I County: Q411 Q� Region:
Farm Name: 50,41Jr�i_ f%n Owner Email:
Owner Name: ^ (�S I: l( &Z14rQry _�n �� s�,-w. Phone:
Flailing Address: 'ly lei
Physical Address:
Facility Contact:
Title:
Onsite Representative: K441 w a a.+ti
Certified Operator: W-AaAfair-ears-�. �.,��Scs►.�
Back-up Operator- L*_
Location of Farm:
Swine
Phone No:
Integrator: _ /� 1�r—a��
Operator Certification Number:.�BS
Back-up Certification Number:
Latitude: [=O
=i
= Longitude: =0=1 °=1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish I I ❑ La er
ElWean to Feeder ❑Non -La et
Feeder to Finish $ AQ -:3-�
- b !
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑
Turkeys
❑ Turkex Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure 59 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 Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl I
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: M
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
® Yes ❑ No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
[--]Yes
B No
❑ NA
EINE
❑ NA
❑ NE
❑ Yes
(d No
❑ Yes
JgNo
[JNA
❑NE
❑ Yes ®.No ❑ NA ❑ NE
12/28/04 Con inued

Facility 'Number: Date of inspection ' I
Waste Collection & Treatment i
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: E
Spillway?: +1�
Designed Freeboard (in): j
Observed Freeboard (in):
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 4fi were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
❑ No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
❑ No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
❑ No
❑ NA ❑ NE
mai ntenance/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 ❑vidence of Wind Drift El Application Outside of Area
�[l5�,
z�z)
12. Crop type(s) J?>Bt-vK — tata !
f S+fV-IQ(� ��ct, K (5y�3e
13. Soil type(s) [�.� Ne-r�a , Wa Lu ltoL
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
P9 No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
(HNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination!❑ Yes
ONo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
9No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
U&No
❑ NA ❑ NE
G(. (Z e fx ' c —C" f IL( S ea. P""'p q,� „`s i s Y s c.w� -.
d ol c_e c_+ r f- bar -L 4 I&L
Reviewer/Inspector Name — '.' Phone: 2111
Reviewer/lnspector Signature: Date: 1�
12/28/04 Continued

Facuity'Number: q — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ENNo ❑ 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. ❑ WUV ❑ Checklists' ❑ Design ❑ Map@- ❑ Other
21 . Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9 No ❑ NA ❑ NE
❑ Waste Applications ❑ Weekly Freeboard ❑ Waste Anatysi r ❑ Soil Analysis' ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall' ❑ Stocking/ ❑ Crop Yield' ❑ 120 Minute Inspections❑ Monthly and I" Rain Inspection? ❑ Weather Code. -
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ZNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
BNo
❑ 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
RS No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[Z No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
19 No
❑ NA
EINE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[j9 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
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
® 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
[9No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo
❑ NA
❑ NE
Additional'Commentsiandlor•, ary ngs
V. NO ZOOS- 5-6-1
.31 +A -e e,.j
0-4(-- -V'
. T-Le,� s
C, sl�v,-t-f-; lmak . -
1tom-;baa_1
-Me_ la -a &0-- as
s CLS- doss;
11/28/04