090040_INSPECTIONS_20171231

9
Type Of Visit: <D Co Hance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint Q Follow-up Q Referral O Emergencv O Other 0 Denied Access
Date of Visit: + -r�� y ]�, Arrival Time: Departure TimeN� County:_ Region:
Farm Name: ! e o�e c F 1u lC� e u �Qv"ut Owner Email:
Owner Name: N oc � d a S G o yd e-A Phone:
Mailing Address:
Physical Address:
Facility Contact: C„ vjr y 6 c.J`a1 t o k Title: Phone:
Onsite Representative: tc
Certified Operator: /~
Back-up Operator: %`� I "LG�it7� �L^__
Location of Farm:
Latitude:
Integrator: IRS
Certification Number: I
Certification Number: `i Ct s 73 (o
Longitude:
Design Curren#
Design
Current
Design Current
Capacity
Pop.
Cattle Capacity Pop.to
Finish
r[F
La er
Da Cowto
Feeder
Non -La er
Dai Calf
to Finish
p 5
Dai Heifer
to Wean
Design
Curren#
Cow
Farrow to Feeder
D . Pout
Ga act
P.o
Non -Da'
ry
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
TurkEX Poults
Ff
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify 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?
Page I of 3
❑ Yes E " ' ❑ NA ❑ NE
[:]Yes ❑ No NE
❑ Yes ❑ No []" iA ❑ NE
❑ Yes ❑ No % lA ❑ NE
[:]Yes NA ❑ NE
❑ Yes No ❑ NA ❑ NE
21412015 Continued

Facili Number: q - 410 Date of Inspection:
Waste Collection & Treatment
4. Is storage: capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes GN ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No C3-NA_­❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ 4W— ❑ 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
L —K_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
[ - 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
l]""'- ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�--,�
lam o ❑ 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 ❑ Falure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window D. Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C 15 — �6
13. Soil Type(s): No G o
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[jJ Ko ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
L1 kKo ❑ NA
❑ NE.
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[:],NIS'_ ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
© ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[DIZ ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes E3<o ❑ NA ❑ NE
❑ Yes ffN. ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q' ]�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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑Yes []No ❑NA ❑NE
[:]Yes E(No ❑ NA [] NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of inspection: 5
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the fac.Vity out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
thg.appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
SCt� at SC'
ok, 4W
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
❑-1qo— ❑ NA ❑ NE
No ❑ NA ❑ NE
❑ Yes NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes [34io ❑ NA ❑ NE
❑ Yes No [DNA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
[]Yes 10
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone.110JM
Z
Date: K
21412 15

Date of Visit: Arrival Time: 4 b a Departure Time: cap County: $-t 4� 4'__t
Farm Name: C�of1.�K_ �iV ILY, kC -� _ Owner Email:
Owner Name: t` A L L2o o f (,, Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: C. if k Els Title: Phone: ,p
Onsite Representative: t t Integrator:
Certified Operator: �L r�Certification Number: q?,S 73
Back-up Operator:
Location of Farm:
Latitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field
a. Was the conveyance man-made?
❑ Other:
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)?
Certification Number -
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
❑ Yes E3 <o ❑ NA ❑ NE
[:]Yes ❑ No
[:]Yes ❑ No
❑ Yes [:]No
❑ Yes [ o
[-]Yes �No
ONA ❑ NE
aNA ❑ NE
[] NA
❑ NE
❑NA
❑NE
❑ NA
❑ NE
Paige I of 3
21412015 Continued

lFacilfty Number: Pt - Q JDateof Inspection: -7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Ea_Ne,-❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 2- A ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes CEJ� ❑ 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 0 Yes [R'Iqo— ❑ 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 D-No
❑ NA
❑ NE
$. Do any of the structures lack adequate markers as required by the permit?
❑ Yes E3-90
❑ 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 E3-No
[] NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [�JNo
❑ NA
❑ NE
maintenance or improvement?
/
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Eg- 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):
is
Fol
7 'go g"',
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
BIN' o
❑ NA
❑ NE
15_ Does the receiving crop and/or land application site need improvement?
❑ Yes
[gNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[Rlo
❑ 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
[21To
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [A'90 ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [allo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Desip ❑ Maps ❑ Lease Agreements ❑Other:
21. oes record keeping need improvement? If yes, check the appropriate box belo Yes o ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis - Soil Analysis [] Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking.EI'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 [tfNo ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E:fNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: 9 - Lf D I jDate of Inspection: G
2?. Did the facility fail to calibrate waste application equipment as required by the permit? �esc*t4o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [73<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:
26. Did the facility fail provide documentation of an actively certified operator in charge? Cl Yes 0 1VO
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Q No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [g-w
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 EKO
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 10
permit? (i.e., discharge, freeboard problems, over -application)
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes Q- ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [R o ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 0-1Qo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [_r,. -N-o ❑ NA ❑ NE
its (refer to
n
IM
' ''LJ - 8'_+G -
lC
,
42-1 "4& app(C4,0-)
0—*?1)-&-- E&sr
Reviewer/Inspector Name:
CV0
Phone:'Try 'S3.3-:33W
Reviewer/Inspector Signature:
Page 3 of 3
Date: WlelL�
21412015

rs
t
0
of
Evaluation Q Technical Assistance
Reason for Visit: 01foutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:Region:
Farm Name: �r�&(j o d/.cs� ti� _ -_ Owner Email:
Owner Name: A)c �. Phone:
Mailing Address:
Physical Address:
Facility Contact., K on �a jr( A Title:
� I
Onsite Representative: 't
Certified Operator:o�`�
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: k4 6 � S
Certification Number:
Certification Number:
Longitude:
11
Design C►nrrent Design Current
Design C*urren#
Swine
Ca aci Po Wet PoulttCa aci Po t±aftleCa
ci Po
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
I
airy Calf
Feeder to Finish
airy Heifer
""Nsign
Current
Farrow to Wean
Dry Cow
Farrow to Feeder
Dr P.oultr,
Ca acity ._P�o P.
Non-Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
Nan -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
..
j�4.F,
Other
Turkey Poults
W
er
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No C3 NA ❑ NE
b. Did the discharge reach waters of the State? (If yes. notify DWR)
❑ Yes
❑ No
LJ 1 A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
✓❑—No
❑ NA
❑ NI
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
E 'NNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: - Date of Inspection: t7o A Dd
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Qom- ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑-NOr ❑ 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 [! 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 [?'Vo ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E3<o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [J 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?
l I . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes dNo ❑ 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
I rc 12. Crop Type(s): 6 e er '5 1; l9 1 if
13. Soil Type(s):
A,O ao t
114. Do the receiving crops differ from those designated in the CAWMP?
4.
QDoes the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes - o ❑ NA ❑ NE
eo ❑ NA ❑ NE
❑ Yes CE11Z ❑ NA ❑ NE
[:]Yes �Ko ❑ NA ❑ NE
[:]Yes [�JNo ❑ NA ❑ NE
❑ Yes C3�<o ❑ NA ❑ NE
❑ Yes [3 No ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [ITN o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis 0 Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Ef o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes YNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection:
24. bid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [9-116— ❑ NA ❑ NE
25_ Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑cNT ❑ 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 Pa'lqo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0< ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
l
G
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes [ 1�o ❑ NA ❑ NE
❑ Yes [go<o ❑ NA ❑ NE
❑ Yes h10
❑ Yes dNo
❑ Yes [fNo
❑ Yes [j"No
❑ Yes [j"No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: u 33 " D
Date: 0— 1 e oU b
21412015

I"ype of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Orkoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: c s Arrival Time: '<<?J Depar[ure Time: ® County: K�CPy+J Region: t
Farm Name: Y fc(Z 6�'o.pth r1c,L 1c4 Owner Email:
Owner Name: V cy-fC & L. C"Oee4 Phone:
Mailing Address:
Physical Address:
Facility Contact:Title: Phone:
Onsite Representative: Integrator: 46
Certified Operator: /V tcc!t (j c>u Pr-' Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design C►urrent
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity D.
Wean to Finish
Layer
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish Z
DairyHeifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
D . Paul
Ca aci
Po
Non -Dal
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
II
Other
'TurkeyPouets
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[:]No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[:]No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ 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 21412014 Continued

. Facility Number: 7 jDate of inspection: fS
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
�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
[cfio
❑ 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 DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[?rNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[] o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
2' o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
C!
❑ NA
❑ NE
maintenance or improvement?
I I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [y]'No DNA ❑ 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):Rg"A. s (. C7
13. Soil Type(s): p -'
14
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 [TNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes [ErNo ❑ NA ❑ NE
❑ Yes [3No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ['No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes YNo ❑ 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 [2No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
[:]Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [] Yes �No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [!TNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA [] NE
Page 2 of 3 21412014 Continued

acili Number: - Date of Inspection:
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 �o
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 E�<o
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 21"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 0 NE
❑NA ❑NE
DNA ❑ NE
❑Yes [,-KO ❑NA ❑NE
[—]Yes [_(No ❑ NA ❑ NE
❑ Yes [ *&o ❑ NA ❑ NE
❑ Yes [TNo ❑ NA ❑ NE
❑ Yes
�No
❑ Yes
[ rNo
[:]Yes
ffNo
❑ NA ❑ NE
❑NA ❑NE
[] NA ❑ NE
Comments (refer to question #) Explatnkany,YES answers and/ror--RM
aay,additional recommendations or.any other comments: r
Use drawings of facility to Better. eapiain�sttaations (use addtttonal ioat=es-as,necessarv). .. _ . 'M��_ :�.. a.
C�K)o 64 ten
cj"A�'-A_ &"'j
Reviewer/Inspector Name:
Reviewerllnspector Signature:
Page 3 of 3
Cl _16N
Phone: `G -33 3
Date:. L S
21412014

Type of Visit: Quoin ance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: 11 YI%/ llyrlTi Departure Time:1 . �/Q � County: Regio
Pu
e..- 1- Farm Name: by+h/!�C '—^— Owner`Eimai`l::
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: ��iI itle: Phone:
Onsite.Representative: Integrator: 108 20 ` 7 -
Certified Operator: Certification Number: ~ty t S
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design Current
Design Current
Swine Capacity Pop.
WetPoultry.
:. Capacity Pop.
Cattle Capacity Pop.
n,
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
"" `¢
Dairy Heifer
Farrow to Wean
Design
Dry Cow
Farrow to Feeder
D , P.oult ..t.
Ga aci P.o .
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
UTurkey
Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [T'55 ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? []Yes ❑ No [�A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
LJ 1 A ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[:]Yes
[:]No
NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
�o
&/A ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
[j,No
❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued .

44
IFacilky Number: - Date of ins ection: vo'C_
)4 aste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No �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 M-Ko ❑ 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
�o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[3-N"o-
DNA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
E rNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance altematives that need
[:]Yes
[glTo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes PEr5o ❑ 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 ❑ Evidenncee of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Ke ca"" rX
13. Soil Type(s): �. 1909oft— i 'I:e 6'—C+Z0'
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [! 110 ❑ 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 [:kNc ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[]'�o
❑ 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
[]3'l�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Jo
❑ 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 ❑ 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 WN�o
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Ins ection: --,-r
24_ Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �` ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes CrNo [] NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes �Na` ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [3'95' ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
��,
[3
❑ 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
El"No,
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[TNo
❑ 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
CfN_a
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[:]Yes
6o
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[:]Yes
6No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
eNo
❑ NA ❑ NE
Comments (refer to question #) Explain any YES answers and/or any additional recommendations orauy other comments: -'
Use drawings of facilityto better explain situations'(use°additional pates as necessary)
7d Eix.Y-$t^� 9'Gwu1+,p
cIc,�,,--Uf okA,6r'()
Ir-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
qfn
PAW -
Date: k I
Page 3 of 3 k 1 21412011

iyPe VI V l,u: �.ompuauce 1nNpeci1Uu v uperauun xevIew LJ aLruciure r,vaivauun V i ecumcai 1XSSIS anue
Reason for Visit: utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:] C,"r 1l �Rrrival Timer DepartureTime: Or! County:
Farm Name: -*— AA Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
v
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Region_
Design Current
Design
Current
Current
Designlaj
Swine Capacity PoWWWw
,inp.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
IN
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 . PoW
Ca aci
P,o P.
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
.. - ..
t?ther
Turkey Poults
Other I
10ther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes & No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes L_J 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)
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
[� N
❑ NA
❑ NE
❑ Yes
[]T<
❑ NA
❑ NE
❑ Yes
[5No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

. z
Of
Facili Number: jDate of Ins ection
Waste Collection & Treatment (er V
4. Is storage capacity (structural plus storm stora a 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): r ��
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.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Structure 5
u 1V u ❑ NA ❑ NE
g�X6 ❑ NA ❑ NE
Structure 6
❑ Yes rtWo ❑ NA ❑ NE
❑ Yes E! o ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes To ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [ ❑ 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 to ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes `ZJ ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes LiY 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 Cg<o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes FB<O ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes Fk<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?
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. -
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes io
❑ Yes [A,KO'
❑ Yes No
❑ Yes [D'No
❑ Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes M40
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes y o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

(Facility4Number: jDate of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Q'No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3o 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 Blo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Qd'o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes EKo ❑ 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
EZ
❑ 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
[tX6-
❑ 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
[&Xb
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[�- o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[ <o
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any..othe.r comments:, r
Use drawingsof facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phon.
Dat
21412011

-
v-Facility Ntitnlier f, �Q Division of Soil and Water Conservation
O Other Agency
Type of Visit: ompliance Inspection 0 Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: outine, O Complaint 0 Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ; Up Departure Time: County:
Farm Name: u r Owner Email:
Owner Name: rlal IwL, .DS/�-�ittvX Phone:
Mailing Address:
Region:
-
Physical Address:
Facility Contact: I Title: ,QCf�/�s� - Phone:
Onsite Representative: l,'�,� 4� Integrator: '
aAxool
Certified Operator:gs � _ Certification Number: /? 13�- !�
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
��'et Poultry
Capacity
Pop.
Cattle
Capacity Pap.
Wean to Finish
I
ILayer
I
ai Cow
Wean to Feeder
Nan -La er
I
airy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
A
Farrow to Feeder
D F Qo_ultr.
Layers
Ca aci
Plo P.
Non -Dairy
Beef Stocker
Farrow to Finish
Gilts
Non -Layers
Pullets
Turke s
Beef Feeder
Beef Brood Cow
Boars
Othe
urkey Poults
Other
Other
Discharges and Stream ImDacts
1. Is any discharge observed from any part of the operation? [:]Yes KNo [DNA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [-]No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (1f yes, notify DWQ) ❑ Yes [] No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA [:]NE
2. Is there evidence of a past discharge from any part of the operation? []Yes [&No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes M-,,No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued
4

[Facility 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 I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in): 1
Observed Freeboard (in): r_
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
® No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
0 Yes [@No ❑ NA [] NE
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?
JS Yes
❑ No
[] NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
,� No
NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
1cl-No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:)Yes
23.No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes MNo ❑ 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): /D i"-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes 12�No [] NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0-No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes EZ[ No ❑ NA ❑ NE
❑ Yes [3,No [] NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check []Yes P31-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 o ❑ NA ❑ NE
L&Mste 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 CKNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes g[No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued �-
f ,

P'acili Number: jDate of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E.No ❑ NA ❑ NE
` 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
[ANon-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: 3
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes S, No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ 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?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑Yes foNo ❑NA ❑NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [!�[No ❑ NA ❑ NE
❑ Yes Z No
❑ Yes ® No
[:]Yes Pq_No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments refer to questionanswers4 ;recommendations or, any,other comments: ,
Use drawin( of:;facifi to better exp a n's to flans addittonal$ a esa aeces
. Ex 1 Y ,Y
I Oaf' / 6 L� - ' ' %G[ r ►•_ G�J rd'�
1�
�)/ -
, 4f4lr
GflD�z`� atJ b cdusc '0�7a! jrmop"-&do'}
a� add 153A4 ir�'�`� 'd�$
0"�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
�,r-v�- T . s7op P44 �Y yYo � 7 0 �rpl� Frcv�t F
Phone:JC�-�j'3�
Date:
21412011 ,

U
Type of Visit 17Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: t' i� * t7 Departure Time: l 3 li County: Y•-- Region: AprNz
Farm Name: .Il �Joi /Q•5 �B /"G► r�LZttK OwnerEmail:
Owner Name: � � _ fl/ ek Lm X Phone:
Mailing Address:
Physical Address: II
Facility Contact: Title: 44zyr Phone No:
47
Onsite Representative: _5 —L Integrator. fl7a"
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = 0 0 1= u Longitude: = o= I= u
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
Design Current
Cattle Capacity Population
❑ Wean to Finislt
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
Feeder to Finish
Dry Poulf
"'"` "ry
Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Dry Cow
❑ Non -Dairy
❑ La ers
- Farrow to Finish
❑ Gilts
Beef Stocker
❑ Non -La ers
❑ Beef Feeder
❑Pullets
❑ Boars
❑Beef Brood Co
El Turkeys
-
Other
❑ Other
Number af�Structures:
❑ Turkey Poults
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes [9 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
14 No
❑ NA
❑ NE
❑ Yes
L8.No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
i
' 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): daL -
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
(9.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
Xf o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
MNo ❑ NA ❑ WE
(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?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
9No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > l0% or 10 lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ER No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[N Yes
®No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? es
{Ig o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
(A No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Comments (refef tQ q[leStlOn_�) E3plalilaq�YESaOSR'BrS�Alli�iOr any rCCAtIIIIleAl�at10n5.Qr SAy-ether CO�Iilent5.
Use drawn s .of facile to better ex lain srtuahons.� usesaddit�ona! a es as necessa >
46
AL
2�C �]//O� G(%c'YIl3 1"LC�'/J?!4d r �-V O $r4-4— u
Reviewer/inspector Name ��-,- Phone: �D-af3S'33 ��
Reviewer/inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: — D Date of Inspection
i
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [5� No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. J4 Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ®. Soil Analysis [:]Waste Transfers [:]Annual Certification
❑ Rainfall ❑ Stacking ❑ 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?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
[9 No
❑ NA
❑ NE
❑ Yes
['No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
®.No
❑ NA
❑ NE
❑ Yes
1 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
(ZNo
❑ NA
❑ NE
❑ Yes
C,No
❑ NA
❑ NE
❑ Yes ELNo ❑ NA ❑ NE
Page 3 of 3 12128104

r
I
V1SEOn Of R'at£T QuaIa
=1==.F_a.1HHty__1S_umber I C(� Q Division of Soil and Water Conservation
Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review tructure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency ether ❑ Denied Access
Date of Visit: Arrival Time: '�J� Departure Time: County: �`�'_ Region:
Farm Name: Cd�t��_Owner Email:
Owner Name: _ Vaua 1&P __ _ _ .a0 /� *tXPhone:
Mailing Address:
Physical Address: �7 /
Facility Contact: C1/ �Y7r L__ C ______ Title: Pwh n t— Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: 0 n 0 I 0 Longitude: [= o[= d a
64
Design Current Design Current
Design Currepm nt
Swine Capacity Population Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish 10 Laver
❑ Dairy Cow
❑ Wean to Feeder I JEI Non -Layer I
❑ Dairy Calf
Feeder to Finish j
❑ Dairy Heifer
❑ Dry Cow
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Non -Dairy
❑ Beef Stocker
❑ Farrow to Finish ❑ Layers
❑ Gilts ❑ Non -La ers
El Beef Feeder
❑ Pullets
❑ Boars
❑ Beef Brood Cowi
❑ Turke s
Number of Structures:
Other ❑ Turkey Poults
❑ Other 10 Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
C,No
❑ NA
❑ NE
❑ Yes
[2�No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — 0 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): /291
Observed Freeboard (in): 2 7
❑ Yes ®.No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ®'No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes &No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA BNE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
❑ No
❑ NA RNE
(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 ELNE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA O-NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA XNE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > t0% or t0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) 1 L�Jvl-o
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA [21NE
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 a NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA BNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA CIE
Comments (refer to Qv&tiai'#} Ezplatn any YES'answers and/or any recommeodattgns or'any otlier+comments;
Use drawtngs of facetity to better explain sitoattons. (use additional pagesessary)`°:
.5 W,0,5 d ; T r� v`� rrc��� �u�; �� �5 �.yr s �!-�rsa.� ; -��� d--
•
V7 T er tea✓ mars
Ive
Reviewer/inspector Name Phone: --y
Reviewer/Inspector Signature: Date: �d/D
Page 2 of 3 12128104 Continued

Facility Number: T —Al0 Date of Inspection-1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes N 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 ® No ❑ NA [ENE
❑ 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
❑ No
❑ NA
R�4E
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
M_NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
[9QqE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
[.NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
[3 NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
PIKE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
WNE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
DNE
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
BNE
If yes, contact a regional Air Quality representative immediately
31 _
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
RNE
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
33.
Does facility require a follow-up visit by same agency'?
❑ Yes
®-No
❑ NA
❑ NE
Addidouai Comiuents anT3r Drawings
A.
•
Page 3 of 3 12128104

ivision of Water Quality
�Fa"CiGty Nurtlber 4J Ci O Division of Sail and Water CO. f
Other Agency
Type of Visit g5,Grnpliance Inspection Q Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit 0 outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: r p Arrival Time: Departure Time: ; Da County: Region: ��
Farm Name: Owner Email:
Owner Name: 4egZir S /7 . J3t7/'U�d-u Phone:
Mailing Address:
Physical Address:
Facility Contact: Gc �' Title: ✓` Phone No:
Onsite Representative: integrator:
Certified Operator: ��"`"0 Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = O = , = u Longitude: ❑ o = , ❑ Ii
Design Current Design Current
Design Curren#
Swine Capacity Population We# Poultry Capacity Population
Cattle Capacity Population
❑ an to Finish
❑ Layer
❑ Da' Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Da' Calf
Feeder to Finish
Dry ?oultry
❑ Da' Heifer
❑ Farrow to Wean
❑ D Cow
❑ Farrow to Feeder
❑ Layers
El Non -Dairy
❑ Beef Stacker
❑ Farrow to Finish
❑Non -La Non -Layers
❑ Gilts
❑Beef Feeder
❑ Beef Brood Cowl
El Pullets
❑ Boars
❑ Turke s
Outer
❑ Other
Number of Structures:
❑ Turkey Poults
❑Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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 kNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
tNo
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

1
Facility Number: —j1p
Date of Inspection - O
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): �9
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes J& No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
❑ Yes J�j No ❑ NA ❑ NE
❑ Yes ®-No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental) threat, notify DWQ
yre
7. Do any of the structures need maintenance or improvement? Z[Yes �No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 19tNo ❑ 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 MNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ..Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
®..Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) �,�� mrj & Ifi7J/ram S' J
13. Soil type(s) '�JDrFp L k _ g ; pro-._ C-= W JV rn _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ONo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ayes o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 0 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes PNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes _No ❑ NA ❑ NE
Commeii#s,{refer to aesbon°#I)Explatn any YE5'answers andlor any recammendattons or�any other comments..,-
' q
Use driiiwmgs�of facilrty to better e�Qlain sttuafions, (use additional pages as�necessary, , ,� s �., � „,�
I
&?�6sf
l�
AA) r-,et� / -1
Reviewer/Ins ector Name
P�`�
phone:Wv- JJ 33
�=
Reviewer/Inspector Signature:
Date:
Pose 2 of 3 12128104 Continued

Facility Number: Date of Inspection I S !
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes M..No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. a —Yes o N❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis oil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31 _ Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
l
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
$j No
❑ NA
❑ NE
❑ Yes
Eq No
❑ NA
❑ NE
❑ Yes
ELNo
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ELNo ❑ NA ❑ NE
❑ Yes El No ❑ NA ❑ NE
❑ Yes ELNo ❑ NA ❑ NE
[:]Yes JgNo ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
Page 3 of 3 12128104

n
Type of Visit O,U�mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit eutine O Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit:- Arrival Time:; Departure Time: t County:
Farm Name: QS �� Owner Email:
Owner Name: Phone: _
Mailing Address:
Physical Address:
Facility Contact: Y Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Integrator:
I �✓�
Region: �l
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ n = I = " Longitude: = o = i =
16
Z Be
Current�'x
'
Design Current Design Current
�`ine '�" Capacity
Population
Wet Poultry
Capacity Pop lation Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ Wean to Feeder
❑Non -La el
❑Dai Calf
ceder to Finish al
c>0
❑ Dairy Heifer
-
❑ Farrow to Wean
„ Dry Poultry'
❑ Dry Cow
❑ Farrow to Feeder
' ; on- airy
❑ Farrow to Finish
El Layers
ElBeef Stocker
❑ Gilts
.❑ Non-Laers
ElBeef Feeder
El Boars
El Beef Brood Co
3
�S
❑ Other
Other
Number'of Structures:'
El Pullets
❑ Turke s
❑ Turke PHoults
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
El Yes
KNo
❑ NA
El NE
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
❑ Yes
El No
❑ NA
El NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
El No
El NA
El 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
El NA
El NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
X No
El NA
[I NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
&No
El NA
El NE
other than from a discharge?
12128104
Continued

Facility Number: —iqD Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? m.Yes KNo ❑ NA ❑ NE
a_ If yes, is waste level into the structural freeboard? ❑ Yes �9No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): l �_
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [9 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? 9[ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 50 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require [] Yes ,l No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0,No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes SNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) � fill & !'( 6r -, -Ffy--- 1 f Tf9)arls hom
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
allo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
04No
❑ NA
❑ NE
IT Does the facility Iack adequate acreage for land application?
❑ Yes
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
,FkgjNo
❑ NA
❑ NE
Comments (refer to question ff): 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):
MOW A (jjJ"
i
Reviewer/Inspector Name Phone: _'�-% D `y�3_ 3j a O
Reviewer/Inspector Signature: Date: a
12128104 Continued

a
Facility Number: — p Date of Inspection
ReQuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 5INo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 54No ❑ NA ❑ NE
the appropiate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XTo ❑ 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
*RNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
"5� No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
t9 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ONo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[A 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
RNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
EKNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
ERNo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

_ Drv�stonaof'V1'ater Q,r�ality , _j� p� �
!Facility Ntiititier �-�- � _ � � Dt� sio�ftSoilfand �i'ater Consen•ation �'
0 Other Agcncy
e OV O —�C4�1
Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Dale of Visit: Arrlrival "Time: i Departure Time: f County: '�` Region: J�EXD
age:. —Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address: Z�� c¢�tJd�_ aL_-5-3r?
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: 6S P Integrator: Iff�
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = ° Longitude: °
Swine
Design Current Design
Capacity Population Wet Poulirj Capacity
Current
Population Cattic
Design
Capacity
C«urrent
Population
❑ Wean to Finish
❑ Layer
❑ Dai Cow
❑ Dai Calf
❑ Wean to Feeder
❑ Non -Laver
i Feeder to Finish
ElFarrow to Wean
. ❑ Farrow to Feeder
❑ Farrow to Finish
''..
Dr} Poultry
El Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑Bcef Fee der
❑Bcef Brood Cow
Nructures:
❑ Layers
❑ Gilts
❑ Non -Layers
❑ Boars
❑ Pullets
Other
❑ Turke s
❑ Turkey Poults
❑ Other
❑ Other
DischarCes & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
C3 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
10 Yes
❑ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
JJ No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

• Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes XNo ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _ __
Observed Freeboard (in): ,3 ,j
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6_ Are there structures on -site which are not properly addressed and/or managed ❑ Yes O-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? RYes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 13 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 KNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes D?No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E[No ❑ NA ❑ NE
❑ Excessive Ponding ❑ HydrauIic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
MNo
❑ 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
10 No
❑ NA
❑ NE r
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E&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):
pip r~ h ag-,-�.,�
U
Reviewer/Inspector Name Phone: 9`ia-y33 3 3 a
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: - Q Date of Inspection Llff 10,
' Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JZ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ®,No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑ Maps
p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 0-yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard X 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 CANo ❑ NA ❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
KNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
19 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
A Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
!,No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
®.No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
allo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
®,No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30,
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
RNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
JZ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
CR No
❑ NA
❑ NE
Comments and/or
12128104

C
I
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: I / � V Arrival Time: Departure Time: ' County: � Region��
Farm Name: Do q a lz!� IS Owner Email:
Owner Name: D u D `e ti[sc _ Phone:
Mailing Address:
Physical Address: Facility Contact: JDQV;-- :ern 14.,-au vTitle:
Onsite Representative:
Certified Operator:
Phone No:
Integrator
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: = e = 1 = Longitude: = o = A
Design Curren#
Design C►urrent
Design Current
Swine Capacity Population
Wet Poultry_ Capacity Population
Cattle Capacity Population
❑ Wean to Finish ❑ La er
❑Dai Cow
❑ Wean to Feeder
❑Non -La er
iry Calf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean Dry Poultry
❑ Dry Cow
�' ❑ Farrow to Feeder"`"
Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turke s
--__=- --
Other
❑ Other
❑ Turke Poults
ther
`
NumberofaStructures:
Discharges & Stream Imyacts
1. Is any discharge observed from any part of the operation?
❑ Yes
W No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
2qNo
❑ 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 I of 3
12128104
Continued

Facility Number: — Date of Inspection 7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
ElYes
❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
allo
❑ NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 9
Observed Freeboard (in): %
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
19 No
❑ NA
❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[KNo
❑ 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?
JK Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
ER Yes
❑ No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes f<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 ElApplication Outside of Area
12. Crop type(s) ..lyYt2[ V-er<,r,_,,/
13. Soil type(s) AhffD L L Ia Y,fD I'-� ! ,- lbm! ►�
7
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes LKNo ❑ 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 9 No ❑ NA ❑ NE
IT Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
JO No
❑ NA
❑ NE
❑ Yes
4 No
❑ NA
❑ NE
Comments. (refer to question #): Explain any YESranswers and/or any recommendations or any other comments.
Use drawings of facility to better explain situattons.;(use additional. pages as necessary):..
r s trx
i
. yylo�v bac� D � `�i�►I� . �,,� �rvs�� �rv.��P.ri �- �-n�yo�,� ��L-o�on�.
fig. , TF1 3 W, r i iWAA-r Frbr­
r/lnspector Name Phone:
-we
Revi
r/Inspector
Signature: - Date: Z

Facility Number: — Date of Inspection [ J7
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 RNo ❑ NA ❑ NE
the appropiate box. ❑ WUP ❑ Checklists ❑ Design
g ❑Maps El 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
ERNo
❑ 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
EN No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
EffNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
5d No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ONo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
O No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
SNo
❑ 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
ER 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
54 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
(9 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
C3 Yes
❑ No
❑ NA
❑ NE
Additional:Cumments and/�,ar D gs:
lJ' Tdr� ;` ✓ �dr��ti /1I fvC-5 140it LUC7f
1>.17e1 rr i n
t
1212 4

Type of Visit Q Compliance Inspection Q Operation Review structure Evaluation O Technical Assistance
Reason for Visit 0 Routine 0 Complaint ollow up 0 Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: f77 Arrival Time: Departure Time: D O County:
Farm Name: Owner Email:
Owner Name: u j3 D rd-ea i -Y, __ Phone:
Mailing Address:
Physical Address:
Facility Contact: ! Title:
Onsite Representative.
Certified Operator: �—
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region: 6�k)
Latitude: = o = 1 Longitude: 0 0= 6=
Design Current Design Current Design .Current
Swine - Capacity Population Wet Poultry Capacity. Population Cattle Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
Turke s
TurkeyPoults
rEl
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 Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood CoyA
Number of Structures: ELI'
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 IR No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[M No
❑ NA
❑ NE
❑ Yes
Pq No
❑ NA
❑ NE
12.128104 Continued

Facility Number:
Date of Inspection 17
Waste Collection & Treatment
• 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
JOYes
❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
19Yes
[--]No []NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): q
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
O No ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[a No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
J� Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
a Yes
❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ 0 No ❑ NA NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No ❑ NA 1@ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑ No ❑ NA [ZNE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
ZINE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
[NNE
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
',s a--Fv/1ow u� o irsp� 10�- a*-L �—v� 7, G �rn�nr � `
L.«C &r- �J�%bz-; mod- w�r,e `h � mor1r/�rr . � a� , DGtl f�/? xtuy q
/ ✓tL Lt r7 TOE Its : n �f R.���vrrrt p�'�N7rs An ( �o rrl��`gr� /A./ l�l7ldrSt
N
�o i .J We16 41t k.. -.�{ 127,1A ef- 71,c LpOvh- a-t'35 rz-ac r ti� / g' z-
Reviewer/Inspector Name �+?; ��, ��I��j�yi �� Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12,28104 Continued

Facility Numbers — Date of Inspection LL�L 1
i 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. ❑ WLTP ❑ Checklists ❑ Design ❑ Maps
p ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
4 NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
® NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
® NE
Other Issues
t
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
tKNo
❑ 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
Pq 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
N 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
KNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
[K Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings
c� %r GU Tf�� S Y17u✓�CJjr a�Or+r- a`cx�rOvrr
°f LOwP/�ryp1Ln
-) 'J� , '), jo't Fm
lq-
Page 3 of 3 12128104

I
(Type of Visit 4��fompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 01[R�utine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: j County: eM2-/ew"' Region:
Farm Name:j2UX _/ Owner Email:
Owner Name: ��u n4a 5 Or'�! ira Ltd Phone:
Mailing Address: z;', w't
Physical Address:
Facility Contact: tali Title:
Onsite Representative:
Certified Operator: ss-L
Back-up Operator:
Phone No:
Integrator•
Operator Certifica 'on Number:
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 { ET
Longitude: 0 0 0 ' = "
Swine
Resign C•urrent
Capacity Population
Design Current
Wet Poultry Capacity Population
Design
Cattle Capacity
Current
Population
❑ Wean to Finish
i
❑ Layer
❑ Dairy Cow
Wean to Feeder
P
1
10 Non -Layer
❑ Dairy Calf
CMXFeeder to Finish
L 04D
❑ Dairy Heifer
❑ Farrow to Wean
Dry Pow
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
Non -La ersbullets
❑Beef Feeder
FE]Roars
❑ Beef Brood Co
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
m
Discharges & Stream Impacts
1, Is any discharge observed from any part of the operation?
❑ Yes
D3,jNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
f-No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
RNo
❑ 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
94 No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
[gNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
RNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: - Q
Date of Inspection 1
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?: p
Designed Freeboard (in): /
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ic/ 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 USNo ❑ NA ❑ NE
❑ Yes CKNo ❑ NA ❑ NE
Structure 5 Structure 6
El Yes KNo El NA El NE
❑ Yes PSNo ❑ 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? [9 Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E9 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 [,No ElNA ❑ NE
❑ Yes
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 52 No ❑ NA ElNE
maintenance/improvement? WX
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes RINo ❑ 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 �j❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) �Tr�x�f �� l7 1�/dijT�✓v : ®y �• �S� t-�
13. Soil type(s) r��L k Hari-e vim/ &nQ1 r_a
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? 0-Yes 1 o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 0 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ZNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes Q No ❑ NA ❑ NE
fi u .r T Co3,'�Q L w,- e
Reviewer/Inspector Name
Phone: /O- �3'333-
Reviewer/Inspector Signature:
Page 2 of 3
Date:
12128104 Continued

Facility Number: — 0 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 29No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes allo ❑ 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 ®`No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 ° Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
allo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
NNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
C,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
RI No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
JKNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
9INo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[K No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[RNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3I .
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
J&No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
MNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
Additional Comments and/or Drawings...
Page 3 of 3 12128104

r
Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: I i- OiF-DS Arrival Time: T O ; 3o Departure Time: County: 14 C.1�_ Region: F� O
Farm Name: poLiq let-5 13 oir-
d ek mx Z Owner Email:
Owner Name: bo yo _ 80r1)e xgX Phone:
Mailing Address:
Physical Address:
Facilitv Contact:
Title:
Onsite Representative:—D&"—B.x
Certified Operator: L>B 44_a4yd.LgUe& x,
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator: MA_`/1 � Ya WAZ
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = = « Longitude: = o = i =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish191.72-
1A00
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys _
❑ Turkey Poults
❑ Other
Discharges & Stream ImAacts
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 C6rrenV..
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
b. Did the discharge reach waters ofthe State? (Ifyes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, noti(DWQ)
2. Is there evidence of a past discharge from any part of the operation?
;. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a dischars_,e?
❑ Yes [N No ❑ NA ❑ NE
❑ Yes
H No
❑ NA
❑ NE
❑ Yes
29 No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
9 No
❑ Yes
LKNo
❑ NA
❑ NE
❑ Yes
& No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection / _5-9—a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes X1 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ® No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): ,/9
�r
Observed Freeboard (in): -23.W
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes N 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 ® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
0 No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ yes
Q9 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
tO No
❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
FVJ 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 El Application Outside of Area
12. Crop type(s) (3 zvi.t+_d a,.. f aS,4u,.+1 51"411 6na al
13. Soil type(s) dor- QI K � 6r- fob Aj Go kislo n ►rr)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
®No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
® No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`❑ Yes
5a No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
r" No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
® No
❑ NA ❑ NE
Reviewer/Inspector Name K {fie V C. j,s. ''�� Phone: (910J Y8�iS!Y/
Reviewer/Inspector Signature: Date: (i—OZ{—a S
12128104 Continued

Facility Number: a O 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 [9No ❑ NA ❑ NE
the approprrate box. ❑ W UP
❑ Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [KNo ❑ 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
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
®No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
IN 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
NJ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 I.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
($No
❑ NA
❑ NE
12129104

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 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: __ —L— --
Freeboard (inches): 31 //
IType of Visit 0 Compliance Inspection O Operation Review O lagoon Evaluation? I
Reason for Visit • Routine O Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 0 Date of Visit: 11 U -o 0 Time: 3'/
[0Not rational Q Below Threshold
Q'Fermitted MCertit'ied [3 Conditionally Certified 13 Registered Date, Last Operated or Above Threshold:
Farm Name: ..... Q._. ovgslas & r ole91 ri Ar -;wg County • ,9 4Ae., _ Ego .
Owner Name: Dig Qor� "Phone No: 9 a 4 q.2
Madmg Address:.. 9., �5 wed ... H22 t. -,A ec c.� _ _. &Pd fbr_c.. /eg--_ALL— -7 Ll 3`1....
Facility Contact: ..... j%" .. R Ar06's ✓ Y Title:
Ousite Representative: 0!t+ -- '�a' /�f••y---------
Certified Operator. 'D a-,' Qa�rl'��►✓sr
Location of Farm:
Phone No:
Integrator: Al✓ramX
Operator Certification Number•
&Kwine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �' ��
Mkshar es & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ago —
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes B o
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) 0 yes 0Ko-
c. If discharge is observed, what is the estimated flow in gal/min:
❑ Yes [ ITO
❑ Yes B14o
❑ Yes Q'go
❑ Yes 01o
Structure 5
12112103 Continued

Facility Number: 47 — q p 1 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes t-7Ka
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes o
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes B-go-
S. Does any part of the waste management system other than waste structures require maintenancefimprovement? ❑ Yes LjrNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes 2f4o
elevation markings?
Waste Application
10. Are there any buffers that need maintenancetimprovement? ❑ Yes [�No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes Erl o
❑ Excessive Ponding ❑ PAN
3 ❑ Hydraulic Overload ❑Frozen Ground ❑ Copper and/or Zinc r
If
12. Crop type s�+a�/ Trr..,i, �Lc�sC der Al ac�ic �//f �� _30' i
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [ -No"
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15_ Does the receiving crop need improvement? [I Yes B-Ko
16_ is there a lack of adequate waste application equipment? ❑ Yes E:],lQo
Odor Issues
IT Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attar 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 Ublo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes EW-
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 B'40
Air Quality representative immediately.
❑ FitW Notes
Tr'!re w•S � ��o� P.; .-t r�t lo9eo�. �/'. �r�ep�� CO,.,...,'//�� )Ce
�Qke— fCc
4 _� x -ter- s ML_6
Reviewer/Inspector Name %rl4�, i� =�
Reviewer/Inspector Signature: Date:
12112103 Continued

Fdcility Number:
Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have ;�Itc
ofthe Certified Animal Waste Management Plan readily available?
(ie! , ch ' s, .)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ �❑Fweebowd ❑ Rtaate-AiMlysis
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32_ Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ &Wkin-Form ❑ Crop Yield Form GRzhM f] n
❑ u ❑
❑ Yes @.lro
❑ Yes
[I Yes EJWo
❑ Yes [}Mo-
❑ Yes ❑ m
❑ Yes Sqq'
❑ Yes �o
❑ Yes [Wo
❑ Yes Q,'-?o-
Des ❑ No
❑ Yes 91CO,
❑ Yes ONo
❑ Yes p'No
❑ Yes 800-
❑ Yes &.W
12/12/03

rr
Farm Name/Owner:
Mailing AddrW:
Is
Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time: / /% 2-3
21
County: _ 1 a-u�
Integrator: Phone: w Z — ZaY Z
On Site Representative: &A , )brQV _ _ _ Phone:
Physical Address/1-ocation:. S-� ,w• _ _ _ T _ _ _ _ _ ._
Type of Operation: Swine f— Poultry Cattle
Design Capacity: _ 2 A%" Number of Animals on Site: 2 _,
DEM Certification Number: ACE DEM Certification N tuber: ACNEW
Latitude: Longitude:
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) a or No Actual Freeboard:�_Ft. Inches
Was any seepage observed from the la oon(s)? Yes or® Was any erosion observed? Yes o'er
Is adequate land available for spray? a or No Is the cover. crop adequate? Yes or No
Crop(s) being utilized
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwell'
� or No
100 Feet from Wells? YSor No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or®
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes OG�
Is animal waste discharged into water of the state by man-made ditch, flushing system,_ or other
similar man-made devices? Yes or l0 If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Y or No
Additional Comments:
,�u �
Inspector Name
Signature r
cc: Facility Assessment Unit Use Attachments if Needed.

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rig
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'ilia Adam-'

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