090038_INSPECTIONS_20171231

Type of visit A Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ® Routine Q Complaint O Follow up O Emergency Notification O Outer ❑ Denied Access
Facility Number ,38 Date of Visit: Tune: : /�
- O Not rational Q Below Threshold
Permitted [3 Certified © Conditionally Certified 0 Registered Date -Last Operated or Above Threshold:
� a.
Farm Name: .......—�.�..._._. r � � � ,k�` Jr w+ �. a ......_._�... County l-�
Owner Name: _ _ M -T. _e • . ��+ _ _ Phone No: L> S I S3
Mailing Address: _ '� 1 3 a L.3s 6a/ 9X. , om /; A16
Facility Contact: . _ _.........-...._.........._..._—-Titl/e:. ... �.
Onsite Representative-
Certified Operator:
Location of Farm:
Phone No:
1-tegrator:In, �Q/ l - s:� CEw� .�
Operator Certification Number: Ar 9 G S
0 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ` " Longitude ' �0"
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation? ❑ Yes ® 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 gallmin?
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 ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes [21 No
Structure I Structure 2 Structure 3
Identifier:
Freeboard (inches): a6 �r
12112103
Structure 4 Structure S Structure 6
Continued

Facility Number: — 3 Date of inspection
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.) IW
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? [I Yes No �
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes �'j 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/improvement? ❑ Yes No
I I . Is there evidence of over application? If yes, check the appropriate boa below. ❑ Yes No
❑ Excessive Ponding ❑ (PAN ElHydraulicOverload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type S [71 1� r. 4 .� / I% h Gal" l 13e-r r n% Xa �T r �Z I SG
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 P No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt ❑ Yes jM 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 [4 No
Air Quality representative immediately.

Facility Number: Date of inspection 1 pr
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
M No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
CQ No
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
® No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
M No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
P No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes
Qa No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
28. Does facility require a follow-up visit by same agency?
❑ Yes
No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
W No
NI MES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (if no, sldp questions 31-35) JD Yes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ER No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ® No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall MInspection After 1" Rain
❑ 120 Minute inspections ❑ Annual Certification Form
12112103

No
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit o Routine C)Complaint 0 Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: d3' Timc:
Not Operational 0 Below Threshold
Permitted 53 Certified E3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: Pries+ 0.2 County: RyQ a ry
Owner N'2me: / F i e-a 4- . -_S . Phone No: S16 — G qs- — L/.s3�
Mailing Address:„Lir360.�� /riot C.Ou�IJGi % /41C
Facility- Contact: K4 h �i k 3.,
Ai Title: C o,U-jAJ oA-,t __ _ Phone No:
Onsite Representative: �i c r-�ta r" r+/� Integrator:
Certified Operator: Jarw el) S. /r G t J.P . Operator Certification ?umber: 16 9 G s
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Norse Latitude ' 4 4 Longitude �' �• �-
Design Current
Swine rnnarity Ponnlation
❑ Wean to Feeder
rM Feeder to Finish
1 3146 7
❑ Farrow to NVean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Ca acits Population
❑ Laver I I ID Da'
❑ Non -Laver ❑ Non -Dairy
❑ Other
Total Design Capacity 3 L 7a
Total SSLW
Number of Lagoons / I ILJ Subsurface Drains Present
Holding Ponds I Solid Traps ❑ 1\o Liquid Waste Manager
Discharges & Stream facts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Latroon ❑ SDrav Field ❑ Other
a. Ifdischarae 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 eal/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?
Area Spray Field Area
❑ Yes [X No
❑ Yes 91 No
[3 Yes MNo
114
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Wa a Collection 8- Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes ❑ No
❑ Yes No
❑ Yes ® No
❑ Yes (29 No
Structure 6
Continued

•
Facility Number: fJ 9 —
Date of Inspection G-03-O
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ 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?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Aonlication
❑ Yes No
❑ Yes No
❑ Yes EN No
❑ Yes T No
❑ Yes O No
10- Are there any buffers that need maintenance/improvement? ❑ Yes t No
11. Is there evidence of over application? ❑ Excessive Pending ❑ PAN ❑ IHydraulic Overload ❑ Yes [A No
12. Crop type rrrsc/i1a �ra Ze� �_Sr».a// G'ra r N i sans b�,�y Ui� c.mf'
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA WMP)? ❑ 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 [V No
15. Does the receiving crop need improvement? ❑ Yes No
16. Is there a lack of adequate waste application equipment? ❑ Yes No
Reauired
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
0 No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
O No
(ie/ WUP, checklists, design, maps, etc.)
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
[V No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
W No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
C ] No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
[ No
(ic/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
No
25.
jere any additional problems noted which cause noncompliance of the Certified AWMP?
El Yes
[ No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Commeats(referto ' '6•ui3�oemanswe�ndloqueston#Etrons;©r any; other'cLa ogded..
„
Use drawrngs of faciltty4o better e�iplain situatrons-(use addttronal pages as necessary) Field Copv El Final Notes
baste- Snmrl" +akej /a41" w«k a OC? MAI,.
.Sa y j -S.2'P not f c kc � K of 0& fO het a Aj
I� 1
f GA M I is In peep— .. —PG a.—C�J W G d f".oJ4 A - r?
Reviewer/Inspector Name
Reviewer/InspectorSignature: Date:
05103101 6 z Continued

Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 47
Date of Visit: 3—dZ Time: i d�
Q Not Operational Below Threshold
Permitted [3 Certified Conditionally Certified 0 Registered Date last Operated or A ve Threshold: ..».
Farm Name: .. %�! a x f ..... County: ---• �... ht-ery ............................... » . . ......... .
Owner Name:...... ... Phone No:
FacilityContact: ............ ....... ............................................ ............ Title:................................................................ Phone No: ..........». � .» ..» _ .». .» »
MailingAddress: ..........----....... ..................... ......_........................... --- ---
FF
Onsite Representative: _5_S ............................................. Integrator:.... /4 ..... _.................. ...... ....____
Certified Operator:�S
a� ........................ _. ..............................................
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a ` " Longitude • �u
Design. Current Design Curreat - Desrgn Cnrreat
Swine _ - Ci ri `' _ Po tiiatlon ..:. Poetitzy ..Ca ci Po ' elation CatHe Ca _ Po
rFarrow
eder ❑Layer ❑Dairy
inish w ❑Non -Layer :' ❑Non -Dairy
Wean_.
eeder
OtherFinishTOU Deign capacity3 r Tots1:SS 'W
Y Nnniber of Lagoons ❑Subsurface Drains Present Lagoon Area ❑ Spray Field Area
$old i Ponds / Soiid .Traps ❑ No Liquid Waste Management System
`
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray 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 & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3- Structure 4 Structure 5
❑ Yes o
❑ Yes o
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes o
❑ Yes ANo
Structure d
Identifier: ............... ........................................ ........................................................................................._............................. .......................... ..........
Freeboard (inches): p�-
5100 Continued on back

-271
Fackty Number: &— .3S' Date of Inspection /3-O
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
seepage, etc.)
'P�No
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
(No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public stealth or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
$qNo
B. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
g'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
9No
Waste Application
10. Are there any buffets that need maintenance/improvement?
❑ Yes
o
11. Is there evidence of over application" ❑ Excessive Ponding ❑ PAN [I Hydraulic Overload
El Yes
to
12. Crop type p fj
13. Do the receiving crops differ w'(ithose designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
KNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
JPNo
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
[I No
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
P�No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[l� No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
19 No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
[0 No
(iet discharge, freeboard problems, over application)
23.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
10 No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
6Q No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
allo
�tio yigl igtjs;e= dgfrcjep're Y.tm.pQ(edO"g � s604 e;.di futhr
.. • ctiri-esnoridence: about: this �isit� • . • . • ....... . - ... • . � ..... • .. • . " ......... . . . . .

Facility Number: Q — Date of Inspection F - 3-or-
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
AYes ❑ No
❑ Yes MNo
❑ Yes B� No
❑ Yes No
❑ Yes No
❑ Yes 9FNo
,Yes ❑ No
O5103101

- i�isioa ai Wa`ter Resources — -
Fari ty Number I lei i 'ye 0 Division of Sail and Water Conservation
RN-0 Other Agecy
Type of Visit: omph ce Inspection O Operation Review Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral O Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 3 Departure Time: /Q County: C3 14tA"t Region:
Farm Name: , j 0 Pr- j e S 7C., Owner Email:
Owner Name: p�, 1 5�— f ✓h 5 LLB Phone:
Mailing Address:
Physical Address: Facility Contact: C-(1, � 1 S o-J W (W' � Title: Phone:
Onsite Representative: t I Integrator:
--- 0
Certified Operator: [t VA cJ (3, 1 A Certification Number: A 76
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Design Current
Capacity Pop.
7 L D
Wet Poultry
I ILayer
Non -La er
D . l;oultr
Layers
Non -Layers
Design
Capacity
I
I
Design
Ca aci
Gnrrent
Pop.
Current
P.o ,
Design Current
Cattle C►►specify Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes NA ❑ NE
❑ Yes [-]No D-NW ❑ NE
[-]Yes [-]No E "-A ❑ NE
❑Yes
[:]No
[
❑NE
❑ Yes
C3'lq—o
❑ NA
❑ NE
[:]Yes
a-N-o
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facili Number: cl- 3 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
•
❑ Yes
[]-No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): f
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[E'No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
®3S}ior ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
jKo ❑ 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
U-Ne'❑ NA
❑ WE
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): C 6J 13 C' R T
14 P -9 6-
13. Soil Type(s): �(c�, /1/ O
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E j go ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E54o ❑ NA
❑ NE
Require_ d Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
D-<O-
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑yIVo
❑ 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
ED o
❑ 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
P
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[-]Yes
No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection: 5 Tc.
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ED-No NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
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)
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ❑.No NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes Mwo---EI NA ❑ NE
❑ Yes g-M- LJ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes B_<0 ❑ NA ❑ NE
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
a. �
better ezplatn.sittaboas(nse°adt t,onal,paesasrnecessary) ;
No ❑ NA
❑ NE
No❑ NA
[3NE
Ofilow❑ NA
❑ NE
C'X L4*n -3-za— b Sl��j�_ S' � lb-3o- /7
(_ 4s '(377,
c�Il Ito -S f) r -- 6 sI
Reviewer/inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone 10 — 1 Utz 3
Date:
21412014

S Fur i� 1J
iiision of Water Resources
Facility Number j �� O Division otSoil and Water: Conservation
� Other Agency
Type of Visit: Q-eompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: a -Routine 0 Complaint Q Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 7 r Arrival Time: /n Departure Time: r 1D County: I C
�
Farm Name: '�J'I t W Fir 2 Owner Email:
r
Owner Name: K FPS 4I. Phone:
Mailing Address:
Physical Address:
FacilityContact: ]&Lf-W I C. f Title:
Onsite Representative: k
Certified Operator:
t
Back-up Operator: KC L' Lt -eG
Location of Farm: Latitude:
Phone:
Region:
Integrator: M ul~
Certification Number: A ( =
Certification Number: T E-5 7 �l
Longitude:
Design Current
Swine Capacity Pop.
;
Design Curren#
Wet Poultry Capacity Pop.
Design Current
Gable Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Design Current ',
D , P,oul Ga aei l?o
Dairy Calf
Feeder to Finish
?2
sow
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Wean
Farrow to Feeder
i
Farrow to Finish
La ers
Beef Stocker
Gilts
Layers
Beef Feeder
Boars
Pullets
I
113eef Brood Cow
Other
Turke s
Turkey Pouets
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes L"J "'o ❑ NA ❑ NE
[:]Yes ❑ No
[:)Yes ❑ No
❑ Yes ❑ No
❑ Yes Oho
❑ Yes [2-t4o
❑TA ❑ N E
n-NA ❑ NE
[3'NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
\1
Page 1 of 3 21412015 Continued

Faei lity Number: - 2 8 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [a-MV—❑ NA ❑ NE
a_ If yes, is waste level into the structural freeboard? ❑ Yes ❑ No D A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 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 [3-MU-- ❑ 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 ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑.N1a- ❑ 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 NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [y]-Ne ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [.]'Ivo ❑ 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): to � r��GCk 56
13. Soil Type(s): 9a t�A- 5 Po
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [qztto ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ©Wo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[g-? tt
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�o
❑ NA
❑ NE
Reuuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
®-No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
D-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 E2-wo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [21�0
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [J'No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes e'No
• 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ 0
the appropriate box(es) below.
❑ failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑ NA ❑ NE
❑ NA ❑ NE
26. Did the facility fail 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
E2,W
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [] Yes EJ-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 IVo ❑ 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 fo ❑ NA ❑ NE
pen -nit? (i.e., discharge, freeboard problems, over -application) 31. Do subsurface the drains exist at the facility? if yes, check the appropriate box below. ❑ Yes Ealo/ ❑ 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 C3<o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [211'Vo ❑ NA ❑ NE
Comruei is (refeii to q#Expusbgn at fi
.hII_r.i=#i,.', .':I a_.,C't....per
Use drawings of facility, to better iEtplim situations {use additional pages as necessa 0-tt-C) P'404.'�'
Reviewer/Inspector Name: r Q)LtAk, Phone. 1
Reviewer/inspector Signature: � Date: 'ki
Page 3 of 3 21412015

or
Kevlew
for Visit: eRoutine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Regionr—`�
Farm Name: Vr C > f Owner Email:
Owner Name: P r eog4r Fot--1iA ? Phone:
Mailing Address:
Physical Address:
Facility Contact: C •4,& Q t! �l f Title:
Onsite Representative:
Certified Operator: S P( l` Ce{
Back-up Operator:
Phone:
Integrator:�3
Certification Number: j� G
Certification Number:
Location of Farm: Latitude: Longitude:
NC-—44��" 1--D I L a Do 31 IU 1 " O( S_y
Design Current
Swine Capacity Pop.
Wet Poultry
Layer
INon-Layer
Design
Capacity
Current
Pop.
Design Current
Cattle C►specify Pop.
Dairy Cow
Dairy Calf
Wean to Finish
Wean to Feeder
11
Feeder to Finish
Farrow to Wean
Farrow to Feeder
3762
_ ` '& :- '
D , Poultr ... _ .Ca aci
Nurren
P,o P.
I
Dairy Heifer
Dry Cow
Non-Dai
Farrow to Finish
La ersI
Beef Stocker
Gilts
Nan -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Otfier.mg
Other
Turkeys
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes [2fVo ❑ NA ❑ NE
❑ Yes
[-]No
c[ A
❑ NE
❑ Yes
[) No
I__I A
❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWR) [:]Yes ❑ No &r A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [—]Yes To ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 0No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3
21412014 Continued

Faclili Number: - Date of Inspection: OC
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? E(Yes ICY ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [E�NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): - 7
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
g-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
Q_NQ
❑ NA
❑ NE
8. Do any of the structures 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
❑ Yes
Boo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑-ids
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below.
❑ Yes
❑-NT-
❑ 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): gk';
13. Soil Type(s): &L 60
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
CR*Vo
DNA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[!'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�No
❑ NA
❑ NE
18. 1s there a lack of properly operating waste application equipment?
❑ Yes
L_J No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�' o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[4-'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 [TNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ff No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ["No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

Facih Number: - , Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [5 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 01KO
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes F&q`FTo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [ENo ❑ NA ❑ NE
0 Yes R2"ONo ❑ NA ❑ NE
❑ Yes [3No ❑ NA ❑ NE
O"Te—s
o
❑ NA
❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer twq- ti6tion, ft Explain any YES 4swers'addlor_-any additional recommendations or any other c6mments
t
Use drawings of facility to- fetter eaplain:situattonsl(use addibonalpagesas necessary). r
Reviewerllnspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412014

i ype of visit: tZ7 uompnance inspection v vperauun review t,J Ntructure r,vaivauun v i ecnmcai Assistance
Reason for Visit: J[£outine Q Complaint Q Follow-up Q Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: tfla Departure Time: FS.teip County:
Farm Name: �l P� t S - Owner Email:
Owner Name: Pr r eGj f F-P/U-f !� �[.� Phone:
Mailing Address:
Physical Address:
Region: E9
[� 2 t rl r-f 1
Facility Contact: Kov 3Jd,r t' _ Title: Phone:
R 10
Onsite Representative: Integrator:
Certified Operator: ('1 Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design •urrent Design Current
Swine Capacity Pap. Wet Poultry Capacity Pop.
Wean to Finish Layer
Design Current
Cattle Capacity P.
DairyCow
Wean to Feeder
Dairy Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean
Design Current
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Feeder
Farrow to Finish
Dr. P,oal Ca acl P,o ,
Layers
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes [11�NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ETlYA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No � ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[] Yes
❑ No
❑ Yes
gJ-90
❑ Yes
io
DWX'o NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412014 Continued

Facile Number: Date of inspection: ''
Waste -Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
es❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No [ IA ❑ 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
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
U 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
L�Jn'o ❑ 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
ONo ❑ 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):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
['Ko'-
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[B'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
EEKo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E�
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
QKo-
❑ 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
o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
U lyo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ZJ No
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facifi Number: - Date of Inspection: ;)
24. Did The facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
E3'11'o ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
<o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes
P�X6 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes
M Ko ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [] Yes Vo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes [:]Xo' ❑ NA D 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 [Bio ❑ NA ❑ NE
El Application Field ❑ Lagoon/Storage Pend ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWW? ❑ Yes Eal<o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [;rlqo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes Q'N'o ❑ NA ❑ NE
Comments (refer to question #) 'Explam any YES"answers and/or. any"additional.recommendations or any other comments
Use drawings of facilityto better explaiWiititations.(use additional pages:as necessary)
77-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: to S3M
Date: j 154
21412014

q I K 5 _ �.s-s-,i- *':voI
Type of Visit: 1 ' om 'ance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: C. Arrival Time:--�-�-- --� Departure Time: County:^ Region:
Farm Name:
✓r
Owner Email:
Owner Name:
f2y
f , J
'-
Phone:
Mailing Address:
Physical Address:
Facility Contact: T ��Q.sl�✓`� Title:
Onsite Representative: L i
Certified Operator:
Back-up Operator:
Phone:
Integrator: _ " "t 6
Certification Number: ,r'8
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Wet Poultry
La er
Non -La er
Design
Capacity
Current
Pop.
Cattle
Dai Cow
Design Current
Capacity Pop.
Dai Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
(
D , Poul
Design
Ca aci
Current
Rio ,
Dai Heifer
D Cow
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts1
Non -La ers
Beef Feeder
Boars
Other
Other
Pullets
Beef Brood Cow
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
EI-Mtr— ❑ NA
[] NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made?
❑ Yes
❑ No N
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
[3No 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 frNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
. [5 o ❑ 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 21412014 Continued

Facility Number: jDate of tns ection:
Waste Collection & 'Treatment����
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Ids° I❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No Q-N7C_ ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): G
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 ❑ N I,waste management or closure plan? T
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes rl�o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes L 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 dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Appfication
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 Q-M ❑ 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): '�r%l/k�A.-��l '� 1eG b _
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes L.1.Ko ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [Etlq'o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0-<o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reouired Records & Documents
❑ Yes 12<0
❑ Yes ❑'No
❑ NA ❑ NE
❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [2"No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [2r�4o ❑ 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 eNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA [] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

dM
[Facility,Number: - Date of Inspect M —
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑moo` ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 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 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes PM ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWNIP?
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?
:Jse drawings**facility to better eip
,_�+ , 11, - C,(-� 4� .4
,q,V.A 4 � i> -,z e - I t(
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
N,:ns necessary),..,-.�
[—]Yes [9<o ❑ NA ❑ NE
❑ Yes ❑-No ❑ NA ❑ NE
[:]Yes ! No ❑ NA ❑ NE
❑ Yes [q-<o ❑ NA ❑ NE
❑ Yes
®No
❑ NA
❑ NE
[:]Yes
E No
❑ NA
❑ NE
❑ Yes
[;?"No
❑ NA
❑ NE
E747Phone:CIP� �
Date: (q
214/2014

Type of Visit: (5)Com lance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I a 64 nrrival Time: rh Departure Time: County: Q t
Farm Name: dvw(j Owner Email:
Owner Name :,( ef� /VA�[1 Phone:
Mailing Address:
Physical Address:
Region: r ' 0
Facility Contact: Ke, '.4 t, gay _ Title: !Tr� Phone:
ti
Onsite Representative: « Integrator:
Certified Operator: Certification Number: � 40
ff
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
_
Design Current
- ,. _ _.
Design Current Design Current
Swine Gagacity Pop.
WetPoultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
La er Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
D = P,.oul Ca aci Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
t� s
Othe
urkey Poults
i
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Oio
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[] Yes
❑ No
E.NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[JKA
❑ NE
e. 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
[[]1�4A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[U.No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
P-<o
❑ NA
[] NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: jDate of Inspection/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E�l ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes [ZPie' ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
��
❑ 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
[2_1Np
❑ 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
�i -No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Eg ANv
❑ 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
❑ NQ
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
[Rl>o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [�Ko ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptal Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 'f� eo!LA—&�- ,- 6 0
13. Soil Type(s): _ _ (1V U K b 0'
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
R<o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[:J-<o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E&N°
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[3,?to
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? [:]Yes Po ❑ NA ❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [—]Yes [:;�M ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [—]Yes 0-,V0 ❑ 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 ETNo ❑ 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 [jY o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [13�No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facile Number: - Date of Insectian:
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 [ice ❑ 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 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes] 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 []j❑ NA ❑ NE
❑ Yes M'GO ❑ NA ❑ NE
❑ Yes [3-Nl< ❑ NA ❑ NE
❑ Yes [;I. o ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [n No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [:]Yes 4—"" ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ImoKo ❑ NA ❑ NE
Comments (refer to _question,.#): Explain any YES answers and/or any additional recommendations or any other comments. -
Use `drawings of facility. to better explain situations (use additional pages as necessary). _x
Reviewer/Inspector Name: b I
Reviewer/Inspector Signature:
Page 3 of 3
- Phonj,S10 , `
Date:
21412011

Type of Visit: omptiance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Vdreoutine O Complaint O follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: '� County: �[iRegion:
0-L
Farm Name: PP S *_ Owner Email:
Owner Name: i- r l -e S ( L, f _ Ci Phone:
Mailing Address: is
Physical Address:
3
Facility Contact: Xf-re-- Title: 1 Phone:
Onsite Representative: Integrator: f v t ! 7 F
Certified Operator: �3 P r I e c�-- Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
SwineMapacity Pop.
Design Current - Design Current
Wet Poultry Capacity Pop. CattleNGapacity P.
Layer DairyCow
Wean to Finish
Wean to Feeder
t
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Design Current
Dr> l;oul Ca aci Po
DairyHeifer
Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
$oars
Pullets
Beef Brood Cow
11111 MEN
Other
Other I
Turke s
Turkey Poults
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 2 No ❑ NA ❑ NE
❑ Yes 0v No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes allo
❑ 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 o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes VNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

jiacihty Number: - vom Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes O No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [3-No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): �!
Observed Freeboard (in):-
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes Io ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a [:]Yes [a-W ❑ 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 [DNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [>6 ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) '
9. Does any part of the waste management system other than the waste structures require ❑ Yes [2,NW ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �b ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [R,56 ❑ 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. Crap Type(s):
13. Soil Type(s): 406 60
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑'N—o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ YesD<o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes �o
❑ Yes [;�No
❑ NA ❑ NE
❑NA ❑NE
Re wired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Ejj<o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[g'Nlo
❑ 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
EErN—o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
El Yes
[No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Cjj'f�o
0 NA
❑ NE
Page 2 of 3 21412011 Continued

Facili Number: 35 Date of Inspection:Ll.c717
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ELNe— ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes ❑- o— ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [q"No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes B^Iqo— ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [:INo ❑ 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 Es3 ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31 _ Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes [!]�o ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [:]Yes Q'''o ❑ NA
❑ NE
31 Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes tD' oo ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [�J❑ NA
❑ NE
Comments (refer to question:#): Explain any YES answers and/or any additional recommendations or any other: comments:;
Use 'drawtngs`of facility to better explain situations (use additional pages as necessary). .' «
��(C' 0 e'C 31 ­-Z'014(
C
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
A
PhdneV + I3 3
Date:
21412011

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 0 Denied Access
Date of Visit: jc,_ Arrival Time: 3 [7 Departure Time: ' c S County: �_cx r-�^� Region:
Farm Name: /-' je%' f �vr rL a Owner Email:
Owner Name: cl r ; ej Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:�� . SlJrG, Phone:
Onsite Representative: ,� ,��r-✓ //� 1 �S t Integrator• it ,.•,
Certified Operator: 7-L' Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design) Curren
BMeWstgn Current
Design Carrent
Swine x Capacity Pop.
W#P,o�iltry Capacity Pop. Cattle
Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Layer Dai Calf
Dai Heifer
Feeder to Finish T
3
Farrow to Wean
FTC Design Current Dry Cow
Farrow to Feeder
Dr. 1'oultr Ca .aci P,o , Non-DairZ
Farrow to Finish
La ers Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Other _
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify D WQ) ❑ 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 M No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 21 No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility N6Zer: I -I Date of Inspection:
p
Waste Collection & Treatment
- 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No
❑ NA
❑ NE
a_ If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure
4 Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): moo_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
S 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
M No
❑ NA
❑ NE
8. Do any of the structures 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
Z 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
[a No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of/Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �8�/I a.vs r��/ 10�,! =t��:
13. Soil Type(s): _ { CL
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [Fj 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 O_No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[�No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? li'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 ®,No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes U&No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

' Facility Number: - Date of Inspection
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes KNo ❑ NA ❑ NE
* 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 provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ®' No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes P 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?
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.
PC 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 O No ❑ NA ❑ NE
JoYes ❑ No ❑ NA ❑ NE
❑ Yes
® No
❑ Yes
kchk No
[:]Yes
54No
❑ NA] NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments {refer to uestion # Ex 'lain an }�"ESIfiswers . ,... k y p� y F ip a IitS.
Use drawings of facility to: etter.explam_s�Eaations (us additional page sas oeces ary+) ? ations or an er comme
Reviewer/inspector Name:
Reviewer/inspector Signature:
Phone: /D 3 33bo
Date: �� D ` t /
21412011
Page 3 of 3

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: tine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: L Arrival Time: c7 Departure Time: + c'a County:
Farm Name �/"J �.s ]� "v2- Owner Email:
Owner Name: d f [' ) S-11 Phone:
Mailing Address:
Physical Address:
Facility Contact: Az �rr7�z-✓ Title: -z e
Onsite Representative:i2` Ly ,Uet✓/�,a�`��/-�� �� f _ Integrator:
Phone:
_11W
Region: )4_'*_ _Q
Certified Operator: I/ ► 7 5, Fj"; C:!s f Certification Number: ZZ 2�
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
Design C►►urrent
Swine
Capacity Pop.
MEMW
Pou!Itmry(.apacity
Pop.
Gattle Capacity Pap.
Wean to Finish
FNon-La
La er
er
DairyCow
Dairy Calf
Da4y Heifer
Wean to Feeder
Feeder to Finish
%
(,
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , P■oultr
Layers
Ca aci
Po ,
Non-Dany
Beef Stocker
Farrow to Finish
Gilts
Non -Layers
Beef feeder
Boars
Pullets
Beef Brood Cow
Turke s
C)ther
Turke Poults
Other
Other
Dischar es and Stream Im acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes OR No ❑ 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 ® No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ® No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

FacRity Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Structure 5
®No ❑NA ❑NE
[:]No ❑NA ❑NE
Structure 6
❑ Yes [4 No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes gj 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 N 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 2,No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): s✓��rs GfJ�r ��r_7'171uda,
l
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® 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?
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
Ua No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
gLNo
❑ 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
RkNo
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
J�QNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[]Yes
No
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Facil Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes U�,No
• 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes M No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes bo 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 rQ No ❑ NA ❑ NE
❑ Yes 2Q No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
[:]Yes J&No ❑ NA ❑ NE
[—]Yes No
[—]Yes ® No
[—]Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to .question-#): Explain any YES.answers and/or any.additional recommendations or any other comments =_ i. -
;`
Use drawings of facility to better explain situations (use additional pages as. necessary).. .
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: & 3
2141201I

$rM5 8-#- 2010
Type of Visit CFCompliance Inspection ()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: % - z% -/O Arrival Time: /2: rifs Departure Time: S.'Ofl County: ��-?We- i Region: /fA'O
Farm Name: ri e 51- Z Owner Email:
Owner Name: r �S Phone:
Mailing Address:
Physical Address:
Facility Contact: I; • Pr ieS �' Title: QWAfW Phone No: vv
Onsite Representative: Integrator: ,rr �1 Ar��'✓
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o ❑ ' =" Longitude: = o ❑' = u
Design Current
In Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Design Current
Wet Poultry Capacity Population
IEJ Layer I I
JE1 Non -La er I I
Design •urrent
Cattle Capacity Population
Dairy Cow
❑ Dairy Calf
Feeder to Finish 1 3 %L
❑ Dairy Heifer
LJ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Layers
❑ Non-Dairy
❑ Farrow to Finish
El Beef Stocker
❑ Gilts
❑ Non -La ers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ Turkey 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?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: OQ7 Date of Inspection LLL[21
Waste Collection & Treatment ,
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes L�f'No El NA El NE
a. If yes. is waste level into the structural freeboard? ❑ Yes EXo ❑ 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 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 20<o ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were ans►vered 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 E No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes LNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require '❑ Yes 0<0 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No NA ElNE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ElYes 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) —,��-w. �. �� �'%fa—j FG� 3 _ S�-.ell�r p�`..� (4. S J G��e��rt
iloc¢.vs
13. Soil type(s)
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
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
Z ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
`N❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
;7No❑ NA
❑ NE
Comments (refer to quesfioin #): Explain any YES answei s and/or. any recointnetidateons or any other comments r
lice drawings:of factlityto better explain situations. (use addttt .
i onal pages as necessary)
T
Reviewer/Inspector NameveZi
Phone:
Reviewer/Inspector Signature:
Date:
12128104 Continued

. Fdcility lsumber: Q ,3 g Date of Inspection 2G—�
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 appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
L`YNo ❑ 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 El 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
L7oo ❑ NA
❑ NE
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
gj o ❑ NA
[I24. NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
01101 ❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
��Co❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
H No ❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E]q o❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes
0.1 lO/❑ 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?
ElYes
9'No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
ElYes
RNo ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El yes
n1lo ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
LWNo ❑ NA
❑ NE
Page 3 of 3 12128104

-B ,A4S 10-a9-Z6aq
ion of Water Quality
Facility Number. 0 , j �j O Division of Soil and Water Conservation
— -- O Other Agency
Type of Visit
ommpliance Inspection
O Operation Review O Structure Evaluation
0 Technical Assistance
Reason for Visit
Erfroutine O Complaint
O Fallow up O Referral O Emergency
O Other ❑ Denied Access
Date of Visit: Arrival Time: .'DD Departure Time: / i O[i County: BA2 WAR/11 Region: �AV
Farm Name: P l --c rw. T-1:- Owner Email:
Owner Name: �• r rt `S f Phone:
Mailing Address:
Physical Address: ✓✓ ��_
Facility Contact: t �� rd ^� _ Title:_"�'"G ' Phone No:
Onsite Representative: 2 PCe^' � � ' t�ru3 � Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = 4 0 Longitude: = ° = I =
Design Current 3 Design Current
SiOne Capp city r Population xAVet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder ❑ Non -Layer
Feeder to Finish %
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
I`
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
[OFTurkeyPoults
] 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 ;Co
Cattle Capacity Popi
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes B'No ❑ NA ❑ NE
❑ Yes
❑ No
LTNA
❑ NE
ElYes
ElNo
011A
❑ NE
ET -NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
El NA
El NE
❑ Yes
,f
L' 9oNo
❑ NA
❑ NE
12128104 Continued

I acilitNNumber: Q g-13
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z-7
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 No ❑ NA ❑ NE
❑ Yes ffNo ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes • No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threpit, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes RrNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes No El NA El 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 ISNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Leo ❑ 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) $eY&4GCCjC , l af-das o ror.J -
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
❑ No
❑ NA
❑ NE
18_ Is there a lack of properly operating waste application equipment? ❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name / j f G% j t/ Phone: VIQ . �133 , 3331V
Reviewer/Inspector Signature: Date: `z4a�l
!l1-75IU4 Lontinuea

�-� o g
Facility Number: Q 3 Date of Inspection `Zc7—CJ
Reguired Records & Documents ,�
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ L Yes N**o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes LT<o ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design [I Maps ❑Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes [<o ❑ 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
�E] Weather Code
22. Did the facility fail to install and maintain a rain gauge`? ❑ Yes B o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes L'-1`No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes j o ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes 19 two El NA El NE
26. Did the facility fail to have an actively certified operator in charge? El Yes EWo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ENo ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EKo
❑ 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
NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
El Yes
,��
E3 o
❑ NA
❑ NE
General Permit? (iei discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
N�o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
,.,
L-�!'l�to
❑ NA
❑ NE
Additeona,Commentsr D�rawcrngs. T r M ,� * �``
�p "
Page 3 of 3 12128104

zoo $
Type of Visit ff-Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 9<outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time- County: eta CffA/ Region: 10C149
Farm Name: Pk i s i- t4nn _ Z Owner Email:
Owner Name: ;S.'gtri e'a Phone:
Mailing Address:
Physical Address:
Facility Contact: M suat Title: &C- . Phone No:
Onsite Representative: k4g., ->K a B • prt Integrator: Ky l $rM--(A1
Certified Operator: Sat^'sl c- a PhL1_s1_ Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: [� 0 0 , =" Longitude: = ° = 4 0 «
Design.Current liqlp
Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wcan to Finish ❑ Layer iEy Cow
❑ Wcan to Feeder 1110 Non -Layer I i Calf
Feeder to Finish z ❑ Dairy Heifer
❑ Farrow to Wean Dry Poultry ❑ Dry Cow
❑ Farrow to Feeder ❑ Non -Da'
❑ Farrow to Finish ❑ Layers
❑ Beef Stocker
Gilts ElNon-Layers
❑ Pullets ❑ Beef Feeder
❑ Boars JO Beef Brood Cow
R ❑ Turkeys
=Ujother
urke PouIts
❑ Other Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Q@No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
[A 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
[P No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Numher: 17 — 3
Date of Inspection �p
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier.
Spillway?:
Desigmed Freeboard (in):
Observed Freeboard (in): 30
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 0 No ❑ NA ❑ NE
❑ Yes IM No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes [K No ❑ NA ❑ NE
❑ Yes 9 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 14 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 M No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 99
No ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
Wo ❑ 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 of Area
12.
//Outside
Crop type(s) U tr'PA52'<fo- 5- 1C4.V
13.
Soil type(s) M94 RVL
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
LNo ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
[�V No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
[X No ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
[3? No ❑ NA
❑ NE
Comments (refer to question #): Explain any -YES answers and/or any recommendations or -any otherTcomments.
Use drawings of facility to better explain-situt.04 s (use additional pages as necessary) 3 ;
Reviewer/Inspector Name i4 jpj /�LVGtS
Reviewer/Inspector Signature:
Phone: 90 (33.3j3o
Date: ,/ aI/ -za0 6
Page 2 of 3 12128104 Continued

Facility Number: O % — 3 g Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Rj No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes QjNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes V6 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
( 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 El NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes 9f No ❑ NA ❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yesrtw
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
O No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[5 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
WNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
P No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
PtNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

a, L MS 7- n1- O $>
Type of Visit
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
,C,omlpliance
l7 rtoutine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Jr 23-0� Arrival Time: 1J; S. Departure Time: Ij' �S' County: U/414V Region: 11415�f✓
Farm Name: � _ ,pll'!_..S � / � Z Owner Email:
Owner Name: c-�d/_C/ Phone:
Mailing Address:
Physical Address: l
Facility Contact: k4 - .2>.14ti Title: �t�4 . �O�P_f Phone No:
Onsite Representative: &Ty:±j u a A/ Integrator: acta a AJ
Certified Operator: C Alb-e,3 Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: [� o = . Longitude: = o =1 = "
Design G-Orrent
Design Current
Design Current
Swine:.
Capacity Population
Wet Pouitry Capacity Population
Cattle
Capacity Population
❑ Wean to Finish
❑ La er
❑ Da' Cow
❑ Wean to Feeder
❑Non-l_a er
❑Dairy Calf
Feeder to Finish
Dry Poultry
❑ Da Heifer
❑ Dry Cow
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Non -Layers
❑ Beef Stocker
El Beef Feeder
❑ Gilts
❑ Boars
r,_
,d
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ Beef Brood Co
Nurn er of Structures:
Other
❑ Other
Discharses & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
El No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
m 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
O NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
b No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No
W NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: Qq -,347
Date of Inspection
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes B<o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 0-1q'A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 30 2.3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes B'1qo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑< ❑ 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 3<o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ['Vo ❑ 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 -go ❑ NA ❑ NE
maintenance/improvement'?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes u No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
l2. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes EfNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes D<o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes M No ❑ NA ❑ NE
IT Does the facility lack adequate acreage for land application? ❑ Yes ❑'go- ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes 9'5-o- ❑ NA ❑ NE
Reviewer/Inspector Name �j� j �;t/. . 5 ! Phone: �1��. !9�. 33e
Reviewer/Inspector Signature: Date: -5-- Z3 -- 0 049 9
rage z of s 1-11ZO 4 uonnnuea

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes []No E A ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
fNo
❑ 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 El Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
2No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
9<A
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑'Ko"
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ONo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ErNo❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No LI 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
E 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
B<o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[] N
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[i]No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Page 3 of 3 12128104

L',v red 16y R12 W IL - Z44--o 7
Facility Number
® Division of Water Quality
O Division of Soil and Water Conservation
O Other Agency
Type of Visit ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: r'O d 7 Arrival Time: 9` Departure Time: County: �(�� Region:
Farm Name: �•-�f'<<S T ,.&24 Z _ Owner Email:
Owner Name: X_ 'K — Bc i e-5 A Phone:
Mailing Address:
Physical Address: Facility Contact: _ k4g , b4e6 "_1 Title: %� ec d� Phone No: Onsite Representative: Integrator: /�l_!(�r[�. 9ta-111-4/
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ O ❑ 1 ❑ [s Longitude: = p = 6 =
is
Design.- Current Design Current - Design °Current`
:Swine Capacity:Population Wet Poultry ryCa Capacity Population -Cattle �';Ca acitY Po ulation F
10 Wean to Finish
❑ Wean to Feeder
91 Feeder to Finish a
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
FLayer
Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: �k
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?
:f
❑ Yes W No ❑ NA ❑ NE
❑ Yes
�ZNo
❑ NA
❑ NE
El Yes
� No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
JMNo
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
�ONo
❑ NA
❑ NE
12128104 Continued

Vacility Number:
Date of Inspection 07
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ElYes Le ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes W No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats.to the integrity of any of the structures observed? ❑ Yes 10 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 EfNo ❑ 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 El NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes P No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [A No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes V? No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes PNo ❑ 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 Drifl ❑ Application Outside of
Area
12. Crop type(s) I?ty uda` r�� �_ v�Pa�.s
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
PM No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
V3 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
O No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of faciflty to better explain situations. (use additional pages as necessary):
AL
Reviewer/Inspector Name i �. jC G V 2$ Phone: '%/D, 5`33, 330�
Reviewer/Inspector Signature: _ Date: UVz 6Z zoo 7
12128104 Continued

+ Facility Number: Q 9 $ Date of Inspection Z Q
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes EfNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes IM No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes 'M No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis Cl 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 ONo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes FFNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0 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
�dNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�INo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�No
/TNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ 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
UdNo
❑ 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
�FNo
❑ 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
f � No
❑ NA
❑ NE
Page 3 of 3 12128104

0
Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine Q Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: / Z5 Arrival Time: Departure Time: County: Al Region:
Farm Name: 13 p Plri 1:7xV&.n #b, Z Owner Email:
Owner Name 1 Phone:
Mailing Address:
Physical Address: , /
Facility Contact: K4,>4j-n/ Title: Phone No:
Onsite Representative: ^G Integrator: A/
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = { ="
Longitude: = 0 0 r = u
Design Current Design
Current Design C*urrent
Swine Capacity Population Wet Poultry Capacity
Population Cattle Capacity Population
❑ Wean to Finish
Layer
Discharges & Stream Impacts
CrVI
p
1. Is any discharge observed from any part of the operation?
❑Yes
qNo
❑ NA
❑ NE
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
[I Yes

Facility Number: —g
Date of Inspection /� D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
❑ NA ❑ NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: La
Spillway?:
Alb —
Designed Freeboard (in): / 11 S
Observed Freeboard (in): h,
❑ Yes I$ No
❑ Yes 10 No
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
C�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
q No ❑ NA ❑ N E
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[ No El El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
No ❑ NA ❑ NE
maintenance/improvement?
1 l . 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 Drift ❑ Application Outside of Area
12. Crop type(s) �ma Ae_g6r_-S_ e414
13.
Soil typep� s) �p �
LT /
T
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[UNo
❑ 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
P No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other. comments�z
Use dra'wiu s of facility to better explain situations. use.:additional pages as necessa s : �'
g ty %P ( P g ry):
_ i+•'_::,. Fait : ,ph,G ,
Reviewer/inspector Name e,v Phone: `�/O 33 -33a o
ReviewerAnspector Signature: Date: O a
Page 2 of 3 12128104 Continued

� a
Facility Number: Q —3 Date of Inspection /O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [_Z No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes W—No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 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
VNo
❑ 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
OR 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
[ 4No
❑ 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
qNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
WNo
❑ 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
ONo
❑ 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
PVNo
❑ 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
[XNo
❑ NA
❑ NE
Page 3 of 3 12128104

Type of visit fD Compliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit 4% Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1Z D Arrival Time: : OG Departure Time: Counh': 'e-t- Region: rr�
Farm Name: Fri e-St- T=mQnL Z Owner Email:
Owner Name:6 Phone:
Mailing Address: %sZ L� slcm,- k3 Y
Physical Address:
Facility Contact: Title: Phone No: Q
Onsite Representative: i�-� byaaL,2n,ZAS Frimt—I&tegrator: M
Certified Operator: c� g PC-, eS.:A- -AT - Operator Certification Number: b �S
Back-up Operator: Jane+�P.-S �t i e-5'1— ALL Back-up Certification Number:
Location of Farm: Latitude: = o =' [ « Longitude: = ° = I = u
(�.,ill
Design Current
J�iu
Design Current„ :Design Current
Swine Capactty P,opul�atton
Wet Poultry
Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑Dai Cow
❑ Wean to Feeder
Eayer
on -La et
E=1 ❑ Dairy Calf
® Feeder to Finish 3 6 '�'Z 2
❑ Dairy Heifei
❑ Farrow to Wean
Dry Poultry
❑ Da Cow
❑ Farrow to Feeder
❑ La
❑ Non-Dai
❑ Farrow to Finish
ers
' ❑ Beef Stockei
❑Gilts
❑ Non -La ers
❑Beef Fender
❑ Boars
z :e.
❑Pullets
❑ Turkeys
' El Beef Brood Cowl
Outer
El Turkey Poults
❑ Other e ❑Other
-.,Numbef 5tructu�res: �
h
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
RNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
ERNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[9NA
❑ 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
6NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
UdNo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

acility Number: `r — 7� Date of inspection IL p
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes f-No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [R�NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: f
Spillway?:
Designed Freeboard (in): t 4
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes P No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes &No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [KNo ❑ NA []NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 9No ❑ 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 KNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes U�No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes X No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) er, tJ
pp —
13. Soil type(s) IF * . NO A
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 4 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes KNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes [RNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes U(No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes 91 No ❑ NA ❑ NE
Reviewer/Inspector Name „s Phone: q1
Reviewer/Inspector Signature: � � _ Date: tz-11 S
12128104 Continued

F cility &umber: — 3 Date of Inspection
Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ElYes Nqo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Pq No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑ 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 6 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [9No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permi`t O it? / e q
❑Yes
[ No
❑ NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit? 105
❑ Yes
Q No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
91 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
111 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
59,lVO
❑ NA
❑ NE
I2/2&104