090016_INSPECTIONS_20171231

G IM's It l iS
Type of Visit: Q'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: e4outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: _ T g�' Arrival Time: 1 r Departure Time: County: Region:�]�'
Farm Name: e t. Owner Email:
Owner Name: �yU1 !`crLy[�r`r'� 'L Phone:
Mailing Address:
Physical Address:
Facility Contact: C ty + S Title: Phone:
Onsite Representative: Integrator: &[r
Certified Operator: Ra'l " L f P01 14 15, Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current Design Current
Swine Capacity Pap. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish La er DairyCow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
u 4 DairyHeifer
Design Current D Cow
1] . P,oult . Ca aci IP.o Non -Da
Layers Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -La ers
Beef Feeder
Boars
Other
Other
Pullets
Beef Brood Cow
Turkeys
TurkeyPoults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes Q'No ❑ NA ❑ NE
a_ Was the conveyance man-made? ❑ Yes ❑ No El —A ❑ NE
b_ Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No QJNA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes FN
< ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4.1 storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
NE
�❑�NAD
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 r�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�o ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[R<o ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
['N0 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
EJ15❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes []'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of t�Wind
ddjDrift ❑ Application Outside of Approved Area
12. Crop Type(s): 1-3 _S(r10 1,AJ6
13. Soil Type(s): 6+� ' /Vp 60
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ ❑ NA ❑ NE
QDoes the receiving crop and/or land application site need improvement?W ryes 0'1qo_ ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
iD-<o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E2<o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
to
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
wo
[314
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
DNA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
iallo
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facili Number: 2 - 16 Lj jDate of Inspection: 40
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
the facility out of compliance with permit conditions related to sludge? If yes, check es E] NA ❑ NE
(!�tshe
propriate box(es) below.
lure 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 FRINo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application field ❑ Lagoon/storage Pond ❑ Other:
❑ Yes arNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
®wo, ❑ NA ❑ NE
No ❑ NA ❑ NE
3o NA ❑ NE
o ❑ NA ❑ NE
1� V Il9V� f'V'�V JIk.CK ,C �a1Ve_7 3r1�••[V
0.
ZS � Ned G(erreit+ s«y.e 5/u 4411D N �
CA llu- 3L)W- �M
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phonell p -q3 J `3 33 L
Date: g J
21412 15

a
Type of Visit: El -Compliance Inspection Q Operation Review U Structure Evaluation Q Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 7� Arrival Time: Departure Time: County: �r�r� Region:
Farm Name: ' jjL jjgk,_ �(� �,2f j' s; -� l of`o— Owner Email:
Owner Name: '41fy—fif , L L G Phone:
Mailing Address:
Physical Address:
Facility Contact: Q,/`�/� Title: Phone:
OnsiteRepresentative: �Integrator:
Certified Operator: 154 � Certification Number:
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
Swine '.
Design Current _ Design Current
Capacity Pop. Wet Poultr, . a ity Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
11
La er
Dairy Cow
Wean to Feeder
INga-Layer
I
airy Calf
Feeder to Finish
5 ! D
'°
Design Current
D , P■ouRE Ca acrt P,o
La ers
Uai Heifer
Farrow to Wean
Farrow to Feeder
Dry Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other __..... _
Turkeys
TurkeyPoults
-
Other
Other
Discharges and Stream ImDBCtS
1. Is any discharge observed from any part of the operation?
❑ Yes
Di -No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does the discharge bypass the waste management system'? (If yes, notify DWR)
❑ Yes
[:]No
❑ NA
❑ NE
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
�o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
fl-g No
❑ NA
❑ NE
of the State other than from a discharge?
Pape I of 3 21412015 Continued

' Facility Number: - Date of Inspection: 3—
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 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): % Z
Observed Freeboard (in): $� 7 /
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
r'vi No ❑ NA
❑ NE
(i.e_, large trees, severe erosion, seepage, etc_)
6. Are there structures on -site which are not property addressed and/or managed through a ❑ Yes E4.No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? [:]Yes KNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit'? ❑ Yes C9_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 allo
❑ 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 �o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): /(f ra � 4 �Lill
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 Jallo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �No ❑ NA ❑ NE
acres determination'?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes PLNo ❑ NA ❑ NE
❑ Yes jc No ❑ 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
'51
❑ Yes tA-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 f�j No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes §;LNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes JK�No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E2� No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes 5�_ 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[3-No
❑ NA
❑ NE
❑ Yes
E3 No
❑ NA
❑ NE
❑ Yes
fNo
❑ NA
❑ NE
❑ Yes ®.No ❑ NA ❑ NE
❑ Yes [. No ❑ NA ❑ NE
❑ Yes ®-No ❑ NA ❑ NE
❑ Yes allo
❑ Yes ®.No
❑ Yes [Z-No
❑ NA ❑ NE
❑NA ❑NE
❑NA ONE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone:%38�l
Date:3��7 7
21412015

Type of Visit: (�F_Compllance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: outine 0 Complaint " 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access 1+
Date of Visit:
-j (o Arrival Time:
Departure Time: J �
County:
Farm Name:
3 rld ys, J,y - �_ y
Owner Email:
Owner Name:
40 rf- fi- TA- ) 1• -v 1, L
L G Phone:
Mailing Address:
Physical Address:
Facility Contact: t Title: Y/ Phone:
Onsite Representative:
Certified Operator: _ 5r��
Back-up Operator:
Region: Az 0 -
Integrator: ,QM;-A41rd
Certification Number: �'-Z� --/1
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pap.
Cattle . Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
/
`-
DairyHeifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
itmP,o
,.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
D11
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes allo ❑ NA ❑ NE
[]Yes [:]No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
[] No
[] NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
0 No
[] NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[allo
[] NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facility Number: - 7Z Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes JZ 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): 9-/ g
Observed Freeboard (in): `3 1,T
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 Co No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes EgLNo
❑ 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 [allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes [2 No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop ❑ Evidence of Wind Drift Application Outside of Approved Area
/Window
/❑
12. Crop Type(s):
13. Soil Type(s): N O,a C
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes n No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes M 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
[a No
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[allo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[RNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes 5jNo ❑ 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 [KNo ❑ 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 21412014 Continued

acifi Number: g - (a Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ELNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes fELNo
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?
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?
❑NA ❑NE
❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes [, No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[ANo
❑ NA
❑ NE
Comments (refer to question ff): Explain.any.YES answers and/or any. additional.recommendations or any'other:comments.
Use drawings of facility to better explainsituations (use -additional pages as necessary).
Revicwer/Inspector Name:
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412014

ivision of Water Resources~
Facility Neitnber � - ® O Division of Soil and Water Conservation
DQ t]ther Agency
Type of Visit: &Cohmpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: - L- Arrival Time:�,7� Departure Time:�County: , .. — Region:
Farm Name: 3 %et ��1. ��►s�`J ��� �� �' Owner Email:
Owner Name: /yJ ; i a s Phone:
Mailing Address:
Physical Address:
Facility Contact: / ���;�'� Title: 40� n /`—
Integrator:
Certification Number:
Onsite Representative: 4'0-�_
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number:
Latitude: Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
I
ILayer
I
Dairy Cow
Wean to Feeder
J
iNon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D , P.oul
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Uurl:ex Poults
Other
Other
Dischar es and Stream Impact
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 WNo ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[-]Yes
[:]No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[:]Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
CB.No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
5g.No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Wacility plumber: q - I Date of Inspection: !/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Eg-No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):ti�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Dallo ❑ 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 0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes O—No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes Cg!No
❑ NA
0 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 6 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes C2CNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes E4No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 tbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside/of Approved Area
l2. Crop TYpc(s): 7_wo_Jrr vt� LPL S Y � CO /0_L W� •r� �cS ll1 rA-w.!
13. Soil Type(s): 10 12 1 f/AJa Z 6—-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Z No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes o No []NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes 5�_No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes [j�NNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [] Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes RNo
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes L�[No
[] NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

r Facility Namber: - le I Date of Inspection: a—
i
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ONo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes M No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance;
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes M No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes M No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes �Z No ❑ NA ❑ NE
❑ Yes L&No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes g No ❑ NA ❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
29 No
❑ NA
❑ NE
❑ Yes
Q@-No
❑ 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:D� D'O
Date:
21412014

R
A
Type of Visit: G�-Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 11 Arrival Time: Departure Time: 3 County: Region: 7c:'-X 0
Farm Name: A&%"Se. / l tl +/�7 S ys �'� Owner Email:
Owner Name: L L c- Phone:
Mailing Address:
Physical Address: /.
Facility Contact: /YJct'1 ha__A6T f f �/i l�; s Title: fj� (, yr �� Phone:
Onsite Representative: Integrator: i y rL
Certified Operator: �Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design :Current
Design
Current
Design Current
Swine Capacity. Po
it
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
/
T>'`'
Dairy Heifer
Farrow to Wean
Design
,,
Current'
Dry Cow
Farrow to Feeder
D , P,oult .
Ca acs
Ro P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other;_
Turkey Poults
Other
FFOther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes allo - ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? []Yes g[No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes L& No ❑ NA ❑ NE
of the State other than from a discharge?
Page l of 3
21412011 Continued
/,

[Facility Number: jDate of Inspection: /
6
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
OLNo
❑ 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): / 2
Observed Freeboard (in): ,33
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
J& 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
MNo
❑ 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
[K 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
(MNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
ZLNo
❑ NA
❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence/of Wind Drift ❑ Application Outside of Approved Area
12. Crop TYpe(s)r/',,,
13. Soil Type(s): AIDt 14-A4 l ND - - - - -- -
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Q4-No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [KNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? Ifyes, check
the appropriate box.
❑ Yes Z�No
❑ Yes [- No
❑ Yes ® No
❑ Yes CB -No
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes [:]No
❑ Waste Application ❑ Weekly Freeboard ,@ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 5D No
❑NA ❑NE
[DNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
DNA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: C- Date of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [KNo ❑ NA ❑ NE
i 25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes allo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes KNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes � No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
g 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
rXI.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
O-No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
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
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
2jNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Ig No
❑ NA
❑ NE
Comments:(refer_4o gnestion #):`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:
(-!\1 0 � J
Phone: 9-fp,33
Reviewer/Inspector Signature:
Page 3 of 3
Date: 31
21412011

(Type of Visit: Q'Comp lance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: ffjVa/,­-- Region:
Farm Name: w , Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: ::L �1
Certified Operator: 151.1
Back-up Operator:
Phone:
1�',Cth_ _ll.�lLt`I�✓ Title:
Integrator:rvn.
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
.:..
Design Currenta
Design Current _ Design Current
Swine CMMI apacity Pop k Wet Poultry
Capacity Pop. Cattle Capacity Pop.
N
Wean to Finish
Layer
I INon-Layer
Dairy Cow
Dairy Calf
Wean to Feeder
I
Feeder to Finish''
.' III
..
Design Current
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to FeederDachy
I Lavers
l;o
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Pullets
Turkeys
Beef Feeder
Beef Cow
Boars
M
rA, _Brood
Othe
urkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes F No [:]NA [:]NE
❑ Yes [—]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes JZLNo
❑ Yes SNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412011 Continued

1Facility Nurgber: Z7- Date of Inspection:
i
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 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: J� l i 14
Spillway?:
Designed Freeboard (in): 12 19
Observed Freeboard (in): / 0
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
� No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
60 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[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 Approved
Area
12. Crop Type(s): �Wa04-levetl`�jre7z_el Z"9 ~►'`
13. Soil Type(s): JVaA 1 jVV
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[A No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[:]Yes
[,No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
RNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes �RNo ❑ NA ❑ NE
❑ Yes [Z No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[-]Yes
[K No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[—]Yes
DNo
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Desigm ❑ Maps ❑Lease Agreements
❑Other:
2I . Does record keeping need improvement? If yes, check the appropriate box below.
[—]Yes
[allo
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[ No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes CZ�No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

]Facility Number: - Date of Ins ection: % ZW D
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 S No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [g No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below
Q Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes JR1 No ❑ NA ❑ NE
® Yes ❑ No ❑ NA ❑ NE
[—]Yes KNo
[:]Yes allo
[:]Yes 54 No
DNA ❑NE
❑NA ❑NE
❑NA ❑NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or N. any other commentsw�n r +;
Use drawings of facility to:better explain situations (use additional pages. -as necessary). �"" ,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9�--,qJ_T-5'50C'
Date:
21412011

Type of Visit: 4EMompliance Inspection U Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Z rrival Time: ; p D Departure Time: County: '^- Region:
Farm Name: 1���/� Tw�.%�y s; �s Owner Email:
Owner Name: �/t� Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:_
Certified Operator:
j
Title:
Integrator:
Certification Number:��
Phone:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Courrent
Design •arren#
in TeiRM Pop.
VVet Poultry
Capacity
P.
Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
Layer
ion -Layer
DairyCow
DairyCalf
Feeder to Finish
Dairy Heifer
r1..,
Farrow to Wean
,I
Design
Current
D Cow
Non -Dairy
Farrow to Feeder D , P,oul Ca aci. P,o
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Pullets
Beef Feeder
Beef Brood Cow
Boars
Turkeys
-
Other
Turkc 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?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes. notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Lc�kNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
KA No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facilit Number: Date of Inspection:
Waste Collection & Treatment
• 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
allo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):_
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
allo
❑ 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
IM 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
0 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ®,No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop TYpe(s)
13. Soil Type(s) VDA 420 7
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes PZNo ❑ NA ❑ NE
WZ
15. Does the receiving crop and/or land application site need improvement? ❑ Yes a No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [a No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application`?
❑ Yes
allo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
RNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Z_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 LM-No DNA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [. No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Vg.No ❑ NA ❑ NE
Page 2 of 3 2142011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [S No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0 No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes W No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [B 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.
JZ 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
C] NA ❑ NE
❑ Yes [� No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
[:]Yes � No ❑ NA ❑ NE
® Yes ❑ No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
O No
❑ NA
❑ NE
❑ Yes
JZ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or,,any additional recommendations or any outer comments
Use drawings of facility to better explain situations(use .additionat= a es as.necessa
31, s�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �/4-X es-�3 z) a
Date: Z—/ 7— ,00Z,_
21412011

Type of Visit t!,'F-Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit &y outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: iCit> County: _ �IQ�K— Region:
Farm Name: V W,1,1rn'`T SP)42-5 d1 Owner Email:
Owner Name: /%� rf �: .oS L L G Phone:
Mailing Address:
Physical Address: /
;
Facility Contact: /77,ao, �d _1V ,�i' ieI Title: Phone No:
Onsite Representative: Integrator: _ - ,
Certified Operator: Operator Certification Number: , L7/y
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 e 0 L 0 Longitude: = ° = I = u
Dr�ig6bW�Gurrent- y Design Current
Swine' We't Poultry
Design Current
Cattle
CapacaityPopulaho Capacity Popnon
Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
EaFeeder to Finish I Q C`7
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
-
❑ La ers
❑ Non -Dairy
❑ Farrow to Finish
❑Non -La ers
❑ Beef Stocker
❑ Gilts
❑ Beef Feeder
Boars
❑ Pullets
El Beef Brood Co
❑ Turkeys
er1-51f
❑Parke Poults
❑ Other
_
❑Other
Number of Structures:
Discharges & Stream Imigacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ENo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
RNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
EgNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: — Date of Inspection Vs=
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _ I
Observed Freeboard (in): 3 2 ]
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
[SNo ❑ 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
EZ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
fi4 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
RINo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
O No ❑ NA ❑ NE
maintenance/improvement?
IL 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 I0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) / r z "�ro_4ral
-
13. Soil type(s)Z'&2-'9ff
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
L&No [DNA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
jKNo ❑ 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
Q3.No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[&No ❑ NA ❑ NE
Reviewerllnspector Name Phone:
Reviewer/inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection I�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [E;NO ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ®No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 10 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Jallo ❑ NA [--IN E
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes M No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RjNo
❑ 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
[XNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[a No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
J@ 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
M No
ElNA
❑ 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
Z No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
®.No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
19 No
❑ NA
❑ NE
Additional.Cntnments and/or Drawings: 4.s
Page 3 of 3 12128104

Date of Visit: Arrival Time: Departure Time: County: Region: t===
Farm Name: w`.- Owner Email:
Owner Name: ]U;d;e5 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator: .,Va�A"
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = ' [_] " Longitude: = 4 = ' [—] u
Design urrent
Design CurrenrNtyINUO
pulation
Wet Poultry Capacity Population
Cattle C*apacity Population
an to Finish
❑ La er
❑Dai Cow
an to Feeder
❑Non -Laker
El Dairy Calf
❑ Feeder to Finish
_
Dry Poultry
❑ DairyHeifer
❑ D Cow
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Layers
❑ Non -Dairy
El Farrow to Finish
Non -Layers
El Beef Stocker
❑Gilts
❑ Pullets
❑ Beef Feeder
❑ Boars
❑ Turkeys
❑ Beef Brood Cowl
Other
❑ Other
❑Turke Poults
❑Other
Number of Structures:
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge`?
El Yes (9No El NA �-
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
Cff-No
❑ NA
RVS 12, -
❑ Yes
V�No
[j NA
99NE
12128104 Continued

Facility Number: Date of Inspection —/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Stricture I Stricture 2 Structure 3 Stricture 4
Identifier:
Spillway?: q q
Designed Freeboard (in): / J
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes KNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes IgNo ❑ NA ❑ NE
1.
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 X No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
R 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
5Z No
❑ NA ❑ NE
maintenance or improvement?
Waste application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
KNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
(RNNo
❑ 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 ❑ Application Outside of/Area
%Drifi
12. Crop tyPe(s)/
13. Soil types) /ypI Ica 121
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2iNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[2[No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`
❑ Yes
B.No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
23,No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
kNo
❑ 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. additional pages as necessary):
/(use
��''/ �-r S ��`�r►�` f��7�r� f7"��t
�rr'f" j�'� i ,,t �c�a�f � �� GCf�,S .��.y i p
�
Irc3i-t'' L�!%Q.S
-e�-/ .r
Reviewer/Inspector Name 4C 42A::4v-.�
Phone:
Reviewer/Inspector Signature:
Date: a
1,11Y&U4 conanueu

Facility Number. — 1p Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes L No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes 19 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[l No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
9INo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[9No
❑ 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
RNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
5No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
LANo
❑ 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
[R�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
LkNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
51&
❑ NA
❑ NE
12128104

3
Type of Vislt GLrompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Viait Or outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Dale of Visit: %D Arrivat'Urne: t D Departure Time: '' D County: --w Region:
harm Name: ZZago4el
S / C}� Owner Entail:
Owner tName: /M `� ��L i'iJs Phone:
'[ailing Address:
Physical Address:
Facility Contact: %%%4����� 7��i�S Title: Phone No:
Onsite Representative: S�� integrator: ✓
Certified Operator: Operator Certifies ton Number:���y
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: = o❑ 1❑ a Longitude: o u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Dry Poultry
Pullets
Other
Dischar_Zes & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ DEy Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 5�No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE ;
❑ Yes
CR No
❑ NA
❑ NE'
❑ Yes
MNo
❑ NA
❑ NE
12128104 Condnued '

Facility Number: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
9No ❑ NA ❑ NE
a. if ves, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure I Stnicture 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): l �� g
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
O No ❑ NA ❑ NE
(it/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
ONo ❑ 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
0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
0 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[3No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Callo ❑ NA 0 NE
maintenancelimp'rovement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s) t! �D�YI �G� r.T S4t��s. ZZ�f'o'/yl[�s�� / a,, e'Oy -& -
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
Yes
KNWoob NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
19 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
,SNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
NNb
❑ 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 ,� ]�----- Phone: 2%9*�_j-3�c?a
Reviewer/Inspector Signature: Date: lD
12/2RA4 randn"ed

Facility Number: '" — / Date of Inspection 3 1�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 5ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Desig
n ❑ Maps
p ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ®.No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
allo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
IgNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
®No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[RNo
❑ 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
B 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
ES No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
®.No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
&No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
®,No
❑ NA
❑ NE
12128104

011,1 S 5 i 131o9 J-�j
Type of Visit (DrCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint 0 Fallow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: El County: Region:
r.l ,,
Farm Name: Madan IyA S1kj ! u), Owner Email:
Owner Name: M 4 Q 1- elf that LLC- Phone:
Mailing Address:
Physical Address:
I II
Facility Contact: M Ursh Ql1 I {{! Title:
Onsite Representative: 11
Certified Operator: %'1'Q11�1Q i A i l f AY
Back-up Operator:
Phone No:
Integrator: 0-2
Operator Certification Number: D971
Back-up Certification Number:
Location of Farm: Latitude: [= e = = Longitude: = ° 0 I = u
w
Swine
Design Current
Capacity Population
Design Currentiffilill -
Wet Poultry Capacity Population Cattl
Design Current
Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
Feeder to Finish
DairyHeifer
❑ Farrow to Wean
❑ Farrow to Feeder
Dry Poul#ry ❑ D Cow
❑ Non -Dairy
❑ Layers
❑ Beef Stocker
❑ Non -La ers
El Pullets ❑Beef Feeder
Beef Brood Co
❑Turke s ,.
❑ Turkey Po Its I
❑ Other Number,of Structures:
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
m_ ..�,� .
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
JONo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?�
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
10 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
CRNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued
l

0
IKacali Number: R�✓ Sj13COq
ty — �! Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28_
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
. Pleeae. 1 x of let l�' ee� 1a.9 opn a Ao fleyAt er� ion .bvr► k
I RR -as ct� �� � SPa.,at.
?c> cam 01)14'900a)9md cow o) IPJ.0"', t
A ra►om'fF r-etomM0161aL 4� " 4ime be a(f I;ed d -e-b byh calcl,
g ` soyber.,7 Pieldi hviII ber
o�ro�nd�a Ca-,jlk� hl' o�� ears J ,�
t i,Pk lr`ecads.
NGt�J A 0i en-Rrm toe
*V;}110i') YnolILw 5 13)Deli p Co"'Pp oin`t 7. edca'0,2
fLm-eiAd 1,1 6* of4^� 1 elea� �
4 40
n��Ol�,��O►ldf�11
Page 3 of 3 12128104

Facility Number: C( — Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): Q r Iq,
Observed Freeboard (in): 3 y 33
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes J�j No ❑ NA ❑ NE
(iel 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? 10 Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes fgNo ❑ 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 ERNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes CRNo ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. [:]Yes CgNo ❑ 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
❑ 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
y.._:.,..
G w P -. t '� 4-_:'MG• Nq�., Wh Faa ys. Y✓� F
Comments {refer,to ques[ion, )Explain any YES, answers and/prirany recommendations or'
Use draww of cilt `�tobeter eg+ Y y other connmenfs.
gs #Y� plane sitnatiaas.,,{use additional pages as necessary)
Reviewerlinspector Name Phone: D -3 3_U
Reviewer/Inspector Signature: Date: Rev: Hay Q. a00
Page 2 of 3 tf 12128104 Continued

FacUity No. - Farm Name Bld,!!j a O , _ Date 01110 f
Permit COC _'�-/ OIC"'-' NPDES (Rainbreaker PLAT Annual Cert )
Pop.Type Design i Current FB Drops
- 1 -lo &I�
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
33
Sludge Survey Date
1a I
Id
Sludge Depth ft & %
3-
Liquid Trt. Zone (ft)_
. 3
9F, Q
}33 , 3K
won- nmr-MeTTI
Design Flow
Soil Test Date
pH Fields
Lime Needed [p3
Lime Applied
Cu Zn
Needs P
Ci � A617�jQIJ'O�fi r��lry
Crop Yield 120 min Inspections
Wettable Acres Weather Codes
WUP Transfer Sheets
Weekly Freeboard- RAIN GAUGE
Rainfall >1" ✓ Dead box or incinerator
1 in Inspections
Waste An�lysis Date
ur . 0"
. , : ��.
mRr�h�QI�ICS�
000 .
■�
rI �s'�
link i�c try",
j
Pull/Field
Soil
-Crtfp
WYE
PAN
Window
Max Rate
Max Amt
Ca 4
137
1 Ov�-
a
5�
13
3o
SO
_
'305-
c
a
�e
ajr
Yn.1 $'o-�3dU,y-o, a"fs,3os- -*M Noll
Verify�HO NUMBER nd affiliations
Tto lastW UP FRO I�I�b� Date last WUP at farm
� __ fd
FRO or Farm Recor s
Lagoon #
Top Dike
Stop Pump
Start Pump
iill lt�'h �!} - say bras -A rr 0o►6t
N05
I0� App. Hardware pivo j -11-3
said- A Of* °Pxe-

--
Type of Visit WCompliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit J@ Routine o Complaint O Follow up 0 Referral O Emergency O Other ❑ Denied Access
Date of Visit: ® Arrival Time: � Departure Time: ;,5 ounty: �,p 9& Region: F ft
Farm Name: �p TOlail 4 Owner Email:
Owner Name: M A` K1 I I L L G Phone:
Mailing Address: 203 i 04r lX[dR.U, Wow k/G Q8329
Physical Address:
Facility Contact: ��Isbalf �}1� � a S' Title: ©ww- Phone No:
Onsite Representative:: t
Certified Operator: I 1 Qi'rS CLI I �
Back-up Operator:
Integrator:
Operator Certification Number: �� a?71 `f __
Back-up Certification Number:
Location of Farm: Latitude: = o = { = u Longitude: = ° 0 4 = ff
Design C*urrent
Swine Ca aci Po elation
P ty P
Wet Poult ,1111-11!
r]
Design Current
Ca aci�o elation
= p�'P
Design Current
Cattle Ca aci Po elation
P t3' P
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
IQ Non -Layer I
I
Dairy Calf
Feeder to Finish
`„
Da' Heifer
El Farrow to Wean
Dry Poultry
ew`_�r{
-
El Dry Cow
❑ Farrow to Feeder
'"
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cowl
- _
❑ Turkeys
Other
❑ Turkey Poults
_
❑ Other
❑ Other
Number'of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
f,;kNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made`?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
15 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
DRNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

. Facility Number: 0— Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Cirjqo ❑ 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?:r
Designed Freeboard (in): Qr s f qi S
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
JRNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
CKNo ❑ 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
IR No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
JXNo ❑ 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
CdNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
0'No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
JR No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) n�''` Y � Boma g _ MwEig
'small Grol'n 12S
13. Soil type(s)
I4. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
IRNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
JR No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
IRNo
❑ NA
❑ NE
IT Does the facility lack adequate acreage for land application?
❑ Yes
ZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
C No
❑ NA
❑ NE
Reviewer/Inspector Name . +. Phone: q(Q 433 33Q0 X3_R3
Reviewer/Inspector Signature: Date: QS_)a,! 0 T
Pape 2 of 3 12128104 Continued

Facility Number: O --Q0 Date of Inspection S
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? 1f yes, check ❑ Yes '�j No ❑ NA ❑ NE
the appropiate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. KYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections &Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
(N No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
ERNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
CR No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[RNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
C'No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[RNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ERNo
❑ 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
CRNo
❑ 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
C 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
"0 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
BNo
❑ NA
❑ NE
Additional CoinMents and/nr;Drawings: .: _t
F
1. P1eajv ogm i-)e r` ad r beff ferp ndnoi?_ )veafA-ei- Coder,
-7. If -etc works on ba-eq& on 1�1�
a4, Plme, Ca ibraf,e, ,reels 'eor YVejj-ek dla"ef,&-,
well
Page 3 of 3 12128104

Facility No. Time In Time Out
Farm Name BI Integrator
Owner Site Rep
Operator No.
Back-up
COC
34`f
No.
Circle: General or NPDES
Date �c�,�
Design
Current
Design
Current
Wean -- Feed
Farrow — Feed
Wean — Finish
Farrow — Finish
Feed — Finish
Gilts / Boars
Farrow — Wean
Others
dia`4tt7? 7.79, I•Ify S.D
FREEBOARD: Design
M � a 0% she a
Sludge Survey 5.1 T 2-13SO
Crop Yield (Q 06 _5 3TD( I ;ISJO
Rain Gauge /
Soil Test �mWettable Acres
Weekly Freeboard ✓
Spray/Freeboard Drop ✓
Weather Codes
Daily Rainfall sz
120 min Inspections
Waste Analysis:
Date Nitrogen (N)
(0q aNjoL-3- I I)z-a
31 r$ 1 it g
3L1r n-)
Observed
Calibration/GPM
Waste Transfers
Rain Breaker
PEAT
1-in Inspections
CQltb a--"K a
Date Nitrogen (N)
3-)11
514-1-- a4ta j Lot ,ev
8104
�-
losa�
Pull/Field
Soil
Crop
Pan
Window
n
- ?y i
PAM a
r
r
e-
.s �rAir
G
0
C
A/
Ir
L
D
�C

loe
%'vision of Water Quality
Facility Number /(o O Division of Soil and Water Conservation
0 Other Agency
Type of Visit
ompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
outine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: y !/�"D Arrival Time: IR I 0 Departure Time: ,' O lJ County: Region:
Farm Name: y ag td _ �y r�Y _. S i Z�:5 Z f— � Owner Email:
Owner Name:. z4" : �l! i� ._ZS G Phone:
Mailing Address:
Physical Address:
Facility Contact: %��C/��/7. /�p5 Title:
Onsite Representative:
Certified Operator: �--�
Back-up Operator:
Phone No:
Integrator: I'
Operator Certificat on Number:
Back-up Certification Number:
Location of Farm: Latitude: [= o = 4 = 11 Longitude: = ° 0 i = u
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
/
CCN5`0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other _
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current:
Cattle Capacity Population,.' ,'
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
M
❑ Yes N No ❑ NA ❑ NE
❑ Yes
❑ No
Cl NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
❑NE
[I Yes
❑No
❑ Yes
J9 No
❑ NA
❑ NE
❑ Yes
JANo
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes KNo ❑ 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 0 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 19 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? [N Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes (9 No ❑ NA ❑ NE
maintenance/improvement?
]I. Is there evidence of incorrect application'? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
® Outside of Acceptable Crop Window ❑ Evidence of Wind Drifi ❑ 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
ERNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
Z No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
LKNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA
❑ NE
18.
is there a lack of properly operating waste application equipment?
❑ Yes
P-No
❑ NA
❑ NE
IComments (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):
�`x a ®-." /7v4p�-a9,
6af&Je "4&`%, to, Jv o b gv � your F
Reviewerllnspector Name ' Phone: — 3CD
Reviewer/inspector Signature: Date: Q
12128104 Continued

• Facility�Number: — Date of Inspection-�—=�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? []Yes [KNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? 1f yes, check ❑ Yes ).No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. [5 Yes ❑ No ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
[]Yes
[ONo
❑NA
❑NE
❑Yes
®No
❑NA
❑NE
❑ Yes
®No
❑ NA
❑ NE
❑ Yes
EgNo
❑ NA
❑ NE
[I Yes
®No
❑NA
[I NE
❑ Yes [S No ❑ NA ❑ NE
❑ Yes
W No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
O No
❑ NA
❑ NE
❑ Yes
[ZNo
❑ NA
❑ NE
❑ Yes
J9 No
❑ NA
❑ NE
12/28/04

S
Type of Visit ,(AC&rnpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 4Tr utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ® Arrival Time: Departure Time: Dt7 County: Region:
Farm Name: L •�t Owner Email:
Owner Name: G Phone:
JF
Mailing Address:
Physical Address:
Facility Contact: %)9u r�5/1 �� �;� Title:
Onsite Representative: _2570117+`
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [= o = 4 = Longitude: E__1 ° = I 0 u
Design Current Design Current
Design Current
Swine
Capacity Population W"PoulmmCapacity Population
ll-
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
Ud Feeder to Finish
30
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
=
El Layers
❑ Non -Dairy
❑ Farrow to Finish
El Stocker
❑Gilts
❑Non -La Non -Layers
El
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
w ❑ Turkeys
Other
_ �- Ej Turkey Pouets
❑ Other
_
❑Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
®,No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man -trade?
❑ Yes
EgNo
❑ 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
CKNo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
§4 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
PNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: — (p Date of InspectionS,,�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [NNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 21 No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / �_ 1 '-
Observed Freeboard (in): _ c4 .3 2
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
0 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
MNo ❑ 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
allo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
P9 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
N No ❑ NA ❑ NE
maintenance/improvement?
1 l . Is there evidence of incorrect application'? If yes, check the appropriate box below. ❑ Yes
RNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Totat Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evide�ncce oof'Wind ❑ Application Outside
,,D�rift 1ofArea
12. Crop types) /�.^.plrt Z.r��rcTI MC—/"Oyrr zY►Ptud�i 1
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
R.No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[Z No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ yes
9 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
K[No
❑ NA
❑ NE
Commen6�(re%rto question #): Explain any YES answers and/or any recommendations or any other comments
9. .;s -. w�r��.y., " , x,`a1r
Use drawings bf faci[ity'to better explain situations. (use addt#ronal:pages as necessary,}: w
Reviewer/Inspector Name a d Phone: 11 D - !�jS— _2 p0
Reviewer)Inspector Signature: Date: `%;22s 00O -
Page 2 of 3 12128104 Continued

. Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes EgNo , ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 19Yes lo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soii Analysis [:]Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking S Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
Cf U5 d- �,Svr� i lX Ica rod 030 ZA S
❑ Yes
(S No
❑ NA
❑ NE
❑ Yes
5.No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
[.No
❑ NA
❑ NE
❑ Yes
[!§ No
❑ NA
❑ NE
❑ Yes
CgNo
❑ NA
❑ NE
E[Yes ❑ No ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes
ElNo
❑ NA
❑ NE
❑ Yes
9No
❑ NA
❑ NE
Page 3 of 3 12/2&04

IType of Visit Qj Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: /b'p o� Departure Time: County: Region: Lpy
Farm Name: I 1/n01r_en__ Owner Email:
Owner Name. ,r Phone:
Mailing Address:
IV
Physical Address: /
Facility Contact: df:g G she lZ iceI Q S Title:
Onsite Representative: zz
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No: ee " tp _ 0///
Integrator: 'y4gz� ./319w
Operator Certification Number:
Back-up Certification Number:
Latitude: = o ❑ 4 = Longitude: 0 0 = =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Other
❑ Other
❑ Layer �.
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
LUT—urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population„
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ DEY Cow
j
❑ Non-Dai
❑ Beef Stocket
i
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters ofthe State
other than from a discharge?
■
❑ Yes K No ❑ NA ❑ NE
❑ Yes
[K No
❑ NA
❑ NE
❑ Yes
LQNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[&No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: — �y Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�Z No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
�&No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�, ,c
5. Are there any immediate threats to the integrity of any of the structures observed?
[] Yes
0 No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc_)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
J0 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
Q) 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
0 Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
4 No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
[:1 NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside
of Area
12. Crop type(s)
`fZ
�/Ysri
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
® Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, El Yes
® No
❑ NA
❑ NE
IT Does the facility lack adequate acreage for land application?
❑ Yes
[ZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
O No
❑ NA
❑ NE
/ K-��p W irk ► w ; i'�'� I►l/'. M pre ;.5 &7t �3o� a 6 44-t �' r LjPq Pi
Reviewer/InspectorName Phone:
}sz,E
Reviewer/Inspector Signature: Date: ps ­
12128104 Continued

. -a
Facility Number: — Date of Inspection —/ a
Required Records & Documents
l 9_ Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. 0 WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [A No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
2T Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
El Yes
-NJNo
El NA
❑NE
❑ Yes
W No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes O� No ❑ NA ❑ NE
❑ Yes �0 No ❑ NA ❑ NE
❑ Yes X No ❑ NA ❑ NE
❑ Yes
K No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
14 No
❑ NA
❑ NE
ND-c- Th %> Y a+ n 0'&5 Maov 4tode-/' AlruJ
Dw4e�5��p
12128104

Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
1,. G.g
Reason for Visit o Routine O Complaint a Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: /b I-TI y Time:
Faciilitn. Number I
.— ...rO Not Operational OBelowThreshold
Permitted © Certified ❑ Conditionally Certified ❑ Registered I bate Last Operated or Above Threshold:
n
Farm lame: K Ce2Jy A-> rC County: �IQ Ae" 1 2Q
Owner Name. e'k94W! Afa.s bA-i Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: Q /
Certified Operator: 09_ ��_� r&
Location of Farm:
Phone No:
Integrator:
Operator Certification number:
Pf Swine ❑ Poultry []Cattle ❑ Horse Latitude ' i " Longitude ' •
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Ca ackv Population
❑ Wean to Feeder ❑ Laver ❑ Dairy
❑ Feeder to Finish ❑ Non -Laver I ❑ Non -Dairy
❑ Farrow to 't'ean
El Farrow to Feeder Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ goy Total SSLW
Number of Lagoons 1 J❑ Subsurface Drains Present Lagoon Area J❑ Sprav Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ SDrav Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. is there evidence of 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?
Waste Collection 8- Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ SDillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 02
�,l
Freeboard (inches): 07 -
05/03/0I
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Continued

F.aciility Number: 9 -- / Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? Cie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ❑ No
cIosrn:e plan?
(If any of questions 4-6 was ayswered yes, and the situations poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelunprovement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenancefimprovement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ❑ No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/unprovement? ❑ Yes ❑ No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
I5. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑Yes ❑ No
roads, building stmucture, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ❑ No
Air Quality representative immediately.

Type of Visit ® Compiiance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ®Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number / Date of Visit: Tune: �
O Not erational 0 Below Threshold
13 Permitted 0 Certified 0 Conditionally Certified 0 Registered
Farm Name: eGtLj6Aj A",,..t,t -/ ' -2
Owner Name:
Mailing Address:
Facility Contact: .. __ �..._ _ Title:
Date. Last Operated or Alcove Threshold -
County: /�olc v ... _ .._ E&
Phone No:
Phone No:
Onsite Representative:Integrator: ��� ���+7 Qro�.� ✓
Certified Operator. _ t& e2%, s -1 .1,�^ Ste' Operator Certification Number:
Location of Farm:
A
I�
fid Swine ❑ Poultry ❑ Cattle ❑ Norse Latitude Longitude
Discliames $ Stream finoa
1. Is any discharge observed from any part of the operation? ❑ Yes PP No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [A No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4
Identifier:_ --
Freeboard (inches): /'9'
❑ Yes R No
Structure 5 Structure 6
12112103
Continued

Facility Number: Date of Inspection.
5.. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenanceru nprovement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenanor-himprovement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancefunprovement? ❑ Yes No
l I - Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes 09 No
❑ Excessive Ponndding ❑ PAN ❑J Hydraulic Overload ❑ Fro en Ground ❑ Copper and/or Zinc
12. Crop type /v�rrrrLfGCd II�N / --Sri � �7c�c+N C✓it tea' �O �'.ti / S C s O %1 GY-)c r-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ® Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes ® No
c) This facility is pended for a wettable acre determination? ❑ Yes m No
15. Does the receiving crop need improvement? ® Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes [%No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes Q,No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes (% No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes M No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes 10 No
Air Quality representative immediately-
[[] Feld Copy ❑ Final Notes
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Reviewer/inspector Name
ReviewerAztspector Signature:
r 4P- L.c r-X;9�.s
Date: /-21a? //141-
12112103 r/ Co11anzced

Facility Number: — /(� Date of Inspection
K'eauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WZJP, checklists, design, maps, etc.)
23- Does record keeping need improvement? If yes, check the appropriate box below.
[Waste Application ❑ Freeboard ErfVaste Analysis [toil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems notc -which cause noncompliance of the Certified AWMP?
NPDES Permitted Faci ifies
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbmakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge smvey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? if yes, check the appropriate box below
❑ Stocking Form [Crop Yield Farm ❑ Rainfall inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
Yes ❑ No
❑ Yes 9 No
0 Yes ❑ No
❑ Yes) No
❑ Yes No
❑ Yes ❑ No
❑ Yes W No
JR Yes ❑ No
❑ Yes M No
M Yes ❑ No
❑ Yes m No
❑ Yes [ No
❑ Yes 10 No
❑ Yes ❑ No
jo Yes ❑ No
JE3 No violations or deficiencies were noted during this visit. You wM remove no further correspondence about this visit I
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