090042_INSPECTIONS_20171231

11)iv'ision of Water Mer
on of Soil and Wnservation
OtheAgency
Type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emereencv O Other O Denied Access
Date of Visit: II/pl! IYArrival Time:l Departure Time: County: Region:
Farm Name:I.Avt'.'ePA) %S Owner Email:
Owner [tame: L/%2.�y/y Phone:
Mailing Address:
Physical Address:
Facility Contact: f l �_�� /AWe Title: I, �:!� Phone:
Onsite Representative: 5'+1A E�7 Integrator:AITL/�j[rLl]
Certified Operator: Jiye f Certification Number: /&
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity P.
Wet Poultry
Capacity
Pap.
Catil`e=: ,
Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
Ssi.
Non -La er
DairyCalf
Feeder to Finish
-
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
©: P,oul
Ca aei
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
O .ther , ..:
., .
Turkey Poults
III,
Other
Other
3
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[:]Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

rIFacHity Number: 9 jDate of Inspection: Zpi�
Waste Collection & Treatment
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? E3"Yes [—]No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes �o ❑ NA D NE
Structure 1 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 EfNo ❑ NA ❑ N E
(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 dNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [/(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes 2(No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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): ,�CJ2 LLD
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes []�<o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [3'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [jlo ❑ 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 [] No ❑ NA ❑ NE
❑ Yes [2]'No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑lf o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[a -No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

r'
Facility Number: y- Z jDate of Inspection: 14k A10
2pj ip
24. Did the facility fail to calibrate waste application equipment as required by the permit?
.
[:]Yes
[)j 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
❑ 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
[)o No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
Y, 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?
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.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 I. 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?
1,1,,,S7,' )e,&�Iope7- Al� 7-1X0 /W Al;:-
S,O! L A'9-5 - IVA-
,iel.9ATld ,l/ R-e_401e1) DuL� J.19 16
❑ Yes No
❑ Yes No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes No ❑ NA ❑ NE
❑ Yes [� No ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
►r Vc f v � b
14n �' ► 3'� Gr�M �i'.�-ter iv%zt'I
TVA , r �, —*: civr�7.v 112 /� �r��r�•.� �5`�s 6 t-Y.t c�o-� c-
)Z6�Wos aeV)c--w15P i 3 etc 2e21g
Reviewer/inspector Name-
Reviewer/inspector Signatui
Phone:
Date: / 3 PKEC 20,
21412015
Page 3of3

_ _ � . _ .� ~ • --' Ste- 1 � =� � ''"','�" ._�
Review O Structure Evaluation O Technical Assistance
up 0 Referral 0 Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: ,J(7 Departure Time: ; 5 County: Region:
Farm Name: -1-a �� Owner Email:
Owner Name: ���taSp ­ �yry Phone:
Mailing Address:
Physical Address:
Facility Contact. r.r r jr %t_- Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
e_ Phone:
Integrator:
Certification Number: /Z1
Certification Number:
Longitude:
Swine
Design Cnrrent _
C11
apacity Pop. Wel Poultry
Design
Capacity
Current1!11
Pop.
Cattle '`
Design Current
Capacity P.-
Wean to Finish
La er
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Wean to Feeder
/
Nonla er
Feeder to Finish
Farrow to Wean
_ D : P,anht .
Design
@a ac'
Current
P,o P.
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
17fBeef
Beef Feeder
Boars
Pullets
Brood Cow
Other
Other
furke s
T ey Poults
Other
Ili
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes 64-No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[] Yes
❑ No
❑ NA
E] 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
Z No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[3-No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21417015 Continued

i
Facility Number: - / Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes jj]_No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA D NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): `3
Observed Freeboard (in): ,�z3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
jNo
❑ NA
D 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
Cg.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
oNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
F%X-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
[2cNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
JRLNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below, ❑ Yes [XNo ❑ 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): KIP Ile-
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 allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [allo ❑ 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 E No ❑ NA ❑ NE
❑ Yes allo ❑ 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
allo
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other-
2 1. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
0,No
❑ 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
R No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[—]Yes
[E�No
❑ NA [] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[—]Yes
allo
❑ NA [] NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
RNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
Eg-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?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[INo
❑ 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
[RINo
0 NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAW T?
❑ Yes
Jallo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
M No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
IE�No
❑ NA ❑ NE
Comments (refer to gnestton Eapliiin$any.YES ;answers and/or any addffionai.recommenda#ions or.apy ot>1er mi eeadts: ;
�Gt37�S b!/et/ YrGr.x/ r1to/a2ansr�use additional
itonal.aasnce§sUse drawings offaciltu;
`
Reviewer/Inspector
Name:
Reviewer/Inspector Signature:
Phone: ��-�/S
Date:
2/4/20I4
Page 3 of 3

/-;;?- / -,-2v/
(Type of Visit: B'Com ce Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: er Routine 0 Complaint 0 Follow-up O Referral 0 Emergency 0 Other O Denied Access
Date of Visit: 2 Arrival Time: Departure Time: County:
Farm Name: jpC�f�'�n�Gt rft�' Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Oasite Representative: `��
Certified Operator: rirp__
Back-up Operator:
251 L'�"`— Region: 1� 2�2
Phone:
Integrator:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
C•nIF
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
La er
Dai Cow
a Cr
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
u
Dry Cow
-
Farrow to Feeder
Dr. P,uult
Ca aci
I;o
Non -Da'
Farrow to Finish
Layers
Beef Stocker
-
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
-
Other
Other
Discharees and Stream Imnacts
1. Is any discharge observed from any part of the operation? ❑ Yes JS[ 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 DW R) ❑ 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 Wo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: - I Date of Inspection:
1 Waste Collection & Treatment
1 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes [E�No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes tD-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 Jallo
❑ 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 Wo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes [7,4-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 5�Zl--lo
[DNA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes JE"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): t'-'-1hVj0
l3. Soil Type(s): /`"6rf-D 1 �<-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [2,No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E�No ❑ NA ❑ NE
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.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[:]Yes RNo ❑ NA ❑ NE
❑ Yes E!j.No ❑ NA ❑ NE
❑ Yes ®,No [DNA ❑ NE
❑ Yes [3 No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
[:]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes E�No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes allo
❑ Yes [21-No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412014 Continued
L\

[Facility Number: - - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes JEg-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
❑ 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 �3 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [] Yes BNo ❑ 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?
Use drawings of -facility to better explain situations (use additional pages=as nece
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
❑ Yes j2j-No ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes ;g_No ❑ NA ❑ NE
[:]Yes &No ❑ NA ❑ NE
[:]Yes
JB.No
❑ NA
❑ NE
❑ Yes
EB-No
❑ NA
❑ NE
❑ Yes
S;jPQo
❑ NA
❑ NE
Phone: XD
Date:
21412014

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo
a_ If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Identifier:
❑NA ❑NE
❑NA ❑NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
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
0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[allo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
2 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
M No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Eg-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):��.�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes f o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes E2�No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes [!�No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
[—]-Yes � No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Jallo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[&No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
0—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
ENo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
f�"o
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facifi Number: - Date of Ins ection:
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 E-No [] NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes J]�[No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [2!fT10 ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[3No
[DNA
❑ 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
[8,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
allo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
�No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAW?"?
❑Yes
�No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
O No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
C3.No
❑ NA
❑ NE
Comments (refer to.qu"tion #) Explain any YES=answerstand/ot.i@ additional recommendations orsany other comments
Use drawings of facilityto better explain situations_(use addition!_pagesas necessary).:
rig ►-
u�Y 7`4 e-u
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
v.� Phone:
Date:
21412014

_ _ - iFi"sion of Water Resources
�FaciLty�Niimber .. r'� � � Division of Soil and Water Conservation
. - - _ ©Other Agency
I -
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: tine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: _ p j Arrival Time: ! a Departure Time: County: Region:
Farm Name: D n r /710"� Owner Email:
Owner Name: 7&'7 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: ` �r �`�k�C Phone:
Onsite Representative: Integrator: oW&"-
Certified Operator. at - S Certification Number: � /60A
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design
Current
Swine Capacity Pop.
Wet Poultry
Capacity
P.
Cattle Capacity
Pop.
Finish
Layer
DairyCow
Feeder
KFeeder
IE
-Layer
DairyCalf
o Finish
Dairy Heifer
'4
Farrow to Wean
Dry Cow
Farrow to Feeder
D , P,oult ,
Ga aci
P,o
Non -Da'
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
jBeef Brood Cow
.I .
.....:... ...
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Imaacts
1. is any discharge observed from any part of the operation?
[:]Yes
4,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
Ig No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facili Number: - Date inspection: /O—
Waste Collection & Treatment
1 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes DNo ❑ 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): _ T
Observed Freeboard (in): Z7 _
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ®, No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
Z No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
T Do any of the structures need maintenance or improvement?
❑ Yes
A No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes L-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �" 42Mr__�
13. Soil Type(s): j(%„rz� fjt
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes D?� No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes P No ❑ NA ❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes iR No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste appli ion equipment?
❑ Yes JR No ❑ NA ❑ NE
❑ Yes J& No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes J2�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes !mil 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 0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ERNo
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? (—]Yes [.No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

fFacHity Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes to No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes Cg-No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes E No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes US No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes I" No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
®.No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
0 No
[] NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
allo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[&No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
M:No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA
❑ NE
Comments (refer to que#) stion I;gphiin-any YES.answers and/ar any additional recommeer comments ndations or auy oth.
Use drawings of -facility to b4r r.explain'situationsOise additional pages as neces"saryj , k ,,
;z"'­'Jj �� 61 -1 ew"I I / q
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9,2[>-4fU-a_
Date: a//__ 12 _///
21412014

i ype of visit•, k=ruompiianee inspection U [)peranon tceview %j btructure t vaivation V i ecnmcai Assistance
Reason for Visit: U Koutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: j3 Arrival Time: p Departure Time: /3 p0 County: Region:
Farm Name: ���-l�+v Zi YS rQ/V-- Owner Email:
Owner Name: L-,a d 4 rr'- rD "-e S Phone:
Mailing Address:
Physical Address:
Facility Contact: ��/ �fla� �- Title:
Onsite Representative:
Certified Operator: -! arA�,,�� }f}-� �S
Back-up Operator:
Location of Farm:
Latitude:
1 Phone:
F:51_�" _0
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Design Current
Swine Capacity Pop. Wet Poultry Ci6aciVE
attle Capacity Pap.
Wean to Finish Layer
Dairy Cow
Wean to Feeder
a
Non -La er
Dai Calf
Feeder to Finish
- �'
Dairy Heifer
Farrow to Wean
_ Design Current
Dry Cow
Farrow to Feeder
D . P,oult . Ca acity P,,o .
Non -Dairy
Beef Stocker
Farrow to Finish
La ers
Gilts
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Boars
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
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 [�JNo [DNA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ No
❑ Yes XLNo
[:]Yes �No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3
21412011 Continued

acitity Number: 9t- Date of Ins ection: —/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P9.No ❑ NA ❑ NE
a_ If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes IR No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
Ea No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
yQ 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
Ea No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
51,No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes D..No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop /Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop TYpe(s)=
13. Soil Type(s): e9/fig L tk .
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes _53_No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes E�No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes KNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Eg'-No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
C4-No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
54-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 2 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes allo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

14
ItI Facility Number:_ jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes j2g 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
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes � No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes % No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWNIP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes §4 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes h No ❑ NA ❑ NE
[:]Yes No
[:]Yes No
❑ Yes No
❑ NA ❑ NE
[:DNA ❑ NE
❑NA ❑NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
f r4'- L' L
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: f
21412011

I �L 0 3;r
` - "" ` - ivv"i`sibn of Water Quality -
Facility Number ®NDivision of Soil and Water Conservation �I — `�I
® Other AgencyON
Type of Visit: (Z60�p liance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 491foutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: — Arrival Timer �D Departure Time: o t� County:
Farm Name: Owner Email:
Owner Name:-cZrs�+�-.._,.. Phone:
Mailing Address:
Physical Address:
fi
Facility Contact: L?!`a'yrr��+� Title:
Integrator:
Certification Number:
Region: f9zz)
Onsite Representative: rs
Certified Operator: / 01:ep LL c& zt3:
Phone:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current
Design Current
Swine Capacity Pop. Wet�Pury Capacity Pop.
Cattle Capacity Pop.
Wean to Finish La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Daig Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
aci P,o
Layers
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other I
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State`? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[] No
❑ Yes
5ZNo
❑ Yes
® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes R No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? 0 Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes M No [DNA ❑ 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
E[ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): L-rlwf+tk �0v7rfsr�',a�
13. Soil Type(s): "c , Us
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 ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes W No ❑ NA ❑ NE
❑ Yes IM714. No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? Ifyes, check ❑ Yes 1211-1
r" No ❑ NA ❑ NE
the appropriate box.
❑ W U P []Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? I f yes, check the appropriate box below. Ej?[ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis Soil Analysis ❑ Waste Transfers
❑ Rainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge'? ❑ Yes g] No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [Z-No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes ® No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
[]Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30, Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes ® No ❑ NA ❑ NE
[] Yes ® No [DNA ❑ NE
❑ Yes 4 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
14 No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWIVIP?
[—]Yes
® No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss reviewhaspection with an on -site representative?
❑ Yes
® No'
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question { : Explain any answers and/or any additional recommendations or any other comments-= ;
Use drawings of facility to better -explain. situations (use additional pages as necessary). :
a2 [ N o so,t s l{s ro
✓[tJdlf�
Reviewer/Inspector Name:
Phone:j?-J�31p�
/ A
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412011

Type of Visit: ompliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: tine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: : vp Departure Time: p ; ao County: Region:
Farm Name: 4,ar-�f7�,r,K �ix/,�, _ Owner Email:
Owner Name: �.,ijr�p�_h�,i _ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: S' Phone:
Onsite Representative: / of Integrator: r
Certified Operator: rs �, ' �� s _ Certification Number: f911/
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Current
Design Current Design Current
Swine
Capacity
Pop.
Wet Poultry Capacity Pop. Cattle Capacity Pop.
can to Finish
Layer Dairy Cow
can to Feeder
Non -La er I Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
D , Pzoult , Ca act Pso
Non -Dairy
Farrow to Finish
I Layers
Beef Stocker
Gilts
Non -Layers.
Pullets
Beef Feeder
Beef Brood Cow
Boars
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ®,No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No [:]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 [Z No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

r Facility Number: jDate of Inspection:
Waste Collection & Treatment
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[allo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
S. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[ , No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
allo
❑ 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
4g No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes P r>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): )+ ear" ••crs�Y�
13. Soil Type(s):
14_ Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Jallo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [3 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [gNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
[—]Yes 0 No ❑ NA ❑ NE
❑ Yes La No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
®' No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
2 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
Pj No
❑ 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
[?![ No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes CEINo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: y - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of fast survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [F�No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Ig No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [N No ❑ NA ❑ NE
❑ Yes [2 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
[:]Yes 0 No
❑ Yes ® No
❑ Yes 2g-No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question ft Explain any YES answers and/or any .additional -recommendations or -:any other comments.
Use drawings of facili to better. a lain situations use additional g ty ap ( pages as necessary).
70
6(9Lu+_V'_ t/J0.5 CO�t C+dP/j /I sc� 1�uJ �jOr/r-'r lva 8 �{ ice%"
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

1
IType of Visit Q)-Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit Q,<outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date or visit: Arrival
Time: Departure Time: County: Region:
Farm Name: 1�,�l�Br't- Ll f?�i�ti 1�� Owner Email:
Owner Name: G .0 4� a--�-- �fi"�-� S Phone:
Mailing Address:
Physical Address:
Facility Contact: LG!!:Jz1— 1 ♦n-r-3 Title: ea&m e rl- Phone No:
Onsite Representative: 'sr`L�i> —�- _ Integrator: Y77 jx el a
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 1=10 0 ` 0 " Longitude: = ° = , = "
Design Current Design Current
Design Current
Swine Capacity Population WMJP,,0u1Lr._yJK@apacity Population Cattle
Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
Wean to Feeder ❑ Non -Layer I ❑ Dairy Calf
❑ Feeder to Finish ❑ Dairy Heifer
❑ Farrow to Wean pry Poultry ❑ Dry Cow
❑ Farrow to Feeder ❑ Non -Dairy
❑ Farrow to Finish ❑ Layers
❑ Beef Stocker
❑ Gilts ❑ Non -Layers
El Pullets El Beef Feeder
❑ Boars ❑ Beef Brood Cowl
❑ Turkeys
Outer ❑ Turkey Poults
❑ Other ❑ Other I Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [KNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
®,No
❑ NA
❑ NE
❑ Yes
�&No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ANo ❑ 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?: p
Designed Freeboard (in): / 1
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes L, 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 1❑-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 RNo ❑ NA ❑ NE
8_ Do any of the stuctures lack adequate markers as required by the permit? ryes ❑ 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
[K No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s)
13.
Soil type(s) �J pip L
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
Ej No ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
KNo ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
M No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
EkNo ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
[&No ❑ NA
❑ NE
Continents (refer to quest664): )Explain any YESrans ersian or any r comi latt es or y ther co m
Use drawings of facility to better ex lain sifuattons Use=additional a er as necessan�.
!" rfl-aemum key—
r> `f' ���%��` Gc.� or'k &�-- jo —5 —1 D IV]
Reviewer/[ns ector Name
P Phone: 33�
Reviewer/Inspector Signature: Date:
Page 2 of 3 /L/Zo/u4 urrrmueu

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [3 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [HNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes a No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[RNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[9 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[Z 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
[9No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[gNo
❑ 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
Jallo
❑ 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
C&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
RN
❑ 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
C&No
❑ NA
❑ NE
12128104

I
ffl
d
Type of Visit I&C70mpliance Inspection U Operation Review Q Structure Evaluation U Technical Assistance
Reason far Visit outine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: � Arrival Time: Departure Time: County: Region:
Farm Name: 4aLIt-n— Vane-,; Pi? serj-- Owner Email:
Owner Name: I— AY d D __ ___ 6�-S Phone:
Mailing Address:
Physical Address:
Facility Contact: --Title: k-/­ Phone No:
Onsite Representative: �-sY� %Y'( Integrator:
Certified Operator: lin = Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = , = u Longitude: = o = 5 = `4
Swine
Design Current
Capacity Population
Design Current
Wet Poultry Capacity Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
0 Layer
1
❑ Dairy Cow
❑ Wean to Feeder 1
10 Non -Layer 1
❑ Dairy 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 -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Othe
❑ Other
urkey Poults
❑Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
RNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ 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
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: — Date of Inspection
4
' 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 l Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3�
❑ Yes PINo ❑ 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
1, 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
[4 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
12" 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
9 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
allo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
3-No
❑ NA [__1 NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop ❑ Evidence of Wind Drift ❑ Application Outside of Area
//Window
12. Crop
type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[�No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
K No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ONo
❑ 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):
r
Reviewer/inspector Name Phone: �a
Reviewer/inspector Signature: Date: g
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ®.No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo ❑ 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
R�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
D4 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ERNo
❑ 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
NNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[XNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
C ] 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
9,No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ 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
C4 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[54 No
❑ NA
❑ NE
12128104

f
Type of Visit AU —Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit outine O Complaint O Follow up 0 Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: i �(� County: Region:
Farm Name: 1-Wrj e! h,c,< Owner Email:
Owner Name: _ Iar442 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 5G2m 4
Certified Operator: , �aCAa t/ e�
Back-up Operator:
Phone No:
Integrator:((ifL�2�
Operator Certification Number: &alg !
Back-up Certification Number:
Location of Farm: Latitude: = = & = N Longitude: — o
Design Current
Design Current
Design Current
Swine Q&apacity Population
VI'et Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
VILLA3
S
❑Non -La er
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
El Dry Cow
El Farrow to Feeder
-
❑ Non -Dairy
❑ Farrow to Finish
❑ Lavers
❑ Beef Stocker
❑ Gilts
❑ Non -Lavers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turke s
Other
❑ Other11E]
❑ Turkey Poults
Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
❑ Yes
KNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
;@ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Y4 No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — Date of Inspection ��
,t
Waste Collection S Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2qNo ❑ 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): f g'
1
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 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
PQNo
❑ NA ❑ NE
8.
Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
CKNo
❑ NA LINE
(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
[3No
❑ 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 i 01bs ❑ 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) li'Cl' �� -
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
JN No
El NA El NE
15.
Does the receiving crop and/or land application site need improvement?
f O Yes
W'No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
,M No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
jq No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
®.No
❑ NA ❑ NE
Comments {refer to question: Explainany YESanswers and/or any re�commendattiins or any other comments
_*cessaUse drawings of facility to better explain situadons use"additional a. es aSne) r
ff he
Reviewer/inspector Name Phone: 1p--fad —JDO
Reviewer/Inspector Signature: Date:
rage Z uJ a IL/L6/U4 L.onitnuea

Facility Number: Date of Inspection
i
Required Records &_Documents
19. Did the facility fail to have 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 JgNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes C&No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
JKNo
❑ 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
RNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
I, No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
J,No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
RNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
C&No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
C,No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
VINo
❑ 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
VLNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Page 3 of 3 12128104

,6-x WS /z11q/za o 7
V vivision of Water Quality
Facility Number O�j �Z O Division of Soil and Water Conservation
0 Other Agency
Type of Visit G�tompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Gr<utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1 Z /3 `D 7 Arrival Time: 'Z :o Departure Time: 3 ; /S' County: ! , Region: /_-74'o
Farm Name: "ySoN T o"ers Owner Email:
Owner Name: LQv-so" —S-a,4e_s
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: ► u� • S�-� •_ ... _ __. Phone No:
Onsite Representative: G t-e-ct— M -o rc__ Integrator: aja" --��wri
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Design .. Current
awrne capacity' Population
❑ Wean to Finish
Wean to Feeder S Z
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
r--, - 1.
11
Gilts
Other
❑ Other
Back-up Certification Number:
Latitude: = e = • ="
Longitude: 0 ° 0 r = u
Design. Current
Wet Poultry Capacity Population
❑ La er
❑ Non -Layer Ii
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ 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?
Cattle
Design Current
Capacity Population:
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
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 Q] No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[;a No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
W No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
� No
❑ NA
El NE
12/28/04 Continued

� Y
Facility Number: 0?_ /7tZ- Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes R No ❑ NA ❑ NE
a. If yes, is waste level into the structural frceboard? ❑ Yes WrAl No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 ��
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
i 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
P No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered ves, 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
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
17 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
PNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) S , CO ue_✓szeci J
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[ No
❑ NA
Cl NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
1$. Is there a lack of properly operating waste application equipment?
❑ Yes
( No
❑ NA
❑ NE
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name � CIS Phone: 919 , 433 • 3300
Reviewer/Inspector Signature: �Date: la-13 ZW7
12128104 Continued

Facility Number: tO Gf — Z Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [4 No ❑ NA ❑ NE
the appropirate box. ❑ WUP [] Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes � No El NA ❑ NE
❑ Waste Application El Weekly Freeboard El Waste Analysis El Soil Analysis El Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
F No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[;A 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
1 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[P 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
Comments and/or Drawings:
12128104

I
IType of Visit %<ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 040utine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: �A Arrival Time: a_ : (7 Departure Time: �'/ County:
Farm Name: la /�5 ig P-L- ��� _ i nn'`- Owner Email:
Owner Name: 5a n— 1TD'�� Phone: _
Mailing Address:
Region:
Physical Address:
Facility Contact: %rS ()"Ly[ s _Title: Phone No:
Onsite Representative: &n-,. 4y12t7m Integrator: �%7%i'�+y p
Certified Operator: Lau 1 e- lu11 e Operator Certification Number: --
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o = ` = W Longitude: = 0 = I = "
Design Current
Design Current
Rxou1!ry
Design Current
Swine Capacity Population
Capacity Population
CattEe Capacity Population
❑ Wean to Finish
JEJ Layer
❑ Dairy Cow
❑ Wean to Feeder
JEJ Non -Layer I
1
❑ Dairy 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 -La ers
❑ Beef Feeder
El Boars
Pullets.
❑ Pullets
❑ Beef Brood Co
❑ Turke s
Other
❑ Other
❑ Turkey Poults
Irl Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
CgNo
❑ 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
[$No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
9No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: — Date of Inspection 13—
' Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
29 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): f ��
Observed Freeboard (in).
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
J.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
9No
❑ 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
ER No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
& No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
R No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
®,No
❑ NA ❑ NE
maintenance/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)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
C,No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
[&No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination', El Yes
M 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
1�[No
❑ NA ❑ NE
Reviewer/Inspector Name v im:? i ' � "r Phone:
Reviewer/Inspector Signature: Date:
12/28104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
r
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JA No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check []Yes JgNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes L-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
O No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
M No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
BNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
fRNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
M No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[5No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
N No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
KNo
❑ 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
RNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
JKNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[.No
❑ NA
❑ NE
I2128104

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: Arrival Time: g: �sr Departure Time: County:
Farm Name: LA lrSO.J' r6^Je-T Owner Email:
Owner Name: /-q k57l?N 'o'je- s Phone: _
Mailing Address:
Physical Address:
Region:
Facility Contact: La r`Se04 Title: Phone No:
Onsite Representative:._ L o KSO `.f =1.0J I c ___ Integrator: e
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = & = Longitude: = o ❑ 0
'Design
Current
Design ' + Current
All
`' ' Design Current '
Swine Capacity
Population
Wet Poultry Capacity Population
Cattle
Capac ty_ Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
® Wean to Feeder
❑ Non -La et
❑ Dairy Calf
❑ Feeder to Finish
❑ Farrow to Wean
Dry Poultry � 'i ; •
El Dairy Heifer
El Dry Cow
`..i
❑ Farrow to Feeder
..3? �' ``
❑Lavers
❑ Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
„
❑Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Conj
❑ Turkeys
Other t, , Ll Turkey Pouets
❑ Other El Other
Number of Structures
Discharp_es & 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 [9 No ❑ NA ❑ NE
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
(N No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
® No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
W No
❑ NA
❑ NE
12128104 Condnued

Facility Number: 9 —'�LZ 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
[2'No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
(NNo
❑ NA ❑ NE
(ief 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
R No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
CS 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
® No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[A No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
V No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/S9udge
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
CK No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
M 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
[9No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
IM No
❑ NA ❑ NE
.'��'r.;
Comments (refer toSS'gaesh©nl#) Erplaja any NES ;ans"vi ers an 6! any recommendations or any other comments.
Rc.aaa��ar:.,;.as 3.Y.fv..•s,dY:i6�..�,"r, .r_..Y�r,�e.t... _ M_� _ �,ac'�ur..
Reviewer/Inspector Name R, K Phone:( /ah/ 15
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: Q Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropiiate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [XNo ❑ 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
CK No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
O 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
[R NA
❑ NE
2&
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[9No
❑ 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
N No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[RNo
❑ 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
[g No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[X'No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
R No
❑ NA
❑ NE
igs:
12128104

Facility Number
09 ` / Z Date // /S - O S-1
Name ZA ✓Sri, 3 S �-
Farm Name _ 64 1-5 s- ,— , s is y �,—
C.O.C. u�-- permitted
on hand
Waste plan Soil Test PLAT Deep Soil test
Soil type --- Aw / K
Crop types �' ��- �ge �lrr4,4/45:r-- 4 / p-ZkfT&C o�
Designed Freeboard /cJ Observed Freeboard .3 �
Rain gauge 4/ Rain breakers _ Daily Rainfall
Calibration of spray equipment 10 G.P.M.
Sludge Survey Crop Yield 120 minute inspections
1 in. rain inspections `Weather code ,'�Weekly Freeboard
Waste Transfers /Vl�- Waste Analysis
Pumping time
Waste Analysis % & Month
Comments:

Site Requires Immediate Attention:
Facility No. O q - 4 z
oq - g�
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD �`�''�•�� .E
DATE: _5-1 -2-5 , 1995
Time: Z: 5
Farm Name/Owner: �-a�sQ ,}ow-_s
Mailing Address: �-k C-_r rc�ls W c._ - —
County:
Integrator: Phone: sck -o t H 1
On Site Representative:_ Phone: q. L 0
Physical Addres&q-ocation: -1
Type of Operation: Swine Poultry Cattle
Design Capacity: 3s5� Number of Animals on Site: 3s�
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 0Longitude: ' "
Circle Yes or No
.Does the Animal Waste Lagoon h e sufficient freeboard of 1 Foot + 25 year 24 hour storm
(approximately 1 Foot + 7 inches) Yes r No Actual Freeboard: !_Ft. Inches
Was any seepage observed from the� ��n(s)? Yes o� oo Was any erosion oWr
? Yes o No
Is adequate land available for spray?LY r No Is the cover crop adequate? No
Crop(s) being utilized: o tom. 1
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin 9 w
100 Feet from Wells? Ye r
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o>
No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line_ Yes o No
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management rZ
s (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)Yes r No L� ;�
Additional Comments: n%_k( r .i_ a�r_r� � �
M.C-t-�4_a- l Wk.-K r-
Inspector Name
3 (--Cr J a d
CA, S-t err , L� 1 5u c. lit
Signature
cc: Facility Assessment Unit Use Attachments if Needed.
event

NaRT-= CAnLna Dz AR=q_— I OF mrvi e0.�i�, uF -= & I4r T—,jrr.AL RF-s-ounCS
DIVISION 0? �yY��G2t'v?`i"_71L MAUXA WE -EN
Fayettwlle Relic»al Off:cs
An! -al Operatics Ca--pIia==e rnspectier. Fo
in �=12,1
\L $54 , Ar. -
4l b 53 Z .:
All _ questions answered negatively will be disc-sssed izx s::Fficiert detail in
the Cor.ne:its Section to enable the deemed Fe=ittee to perfc= the a:a===.at; c
corrections:
CTIM I
knimi? Operation Tyne:
EOrseS, cattle, spin poultry, or shaep
SZC-"ION I2
Y ) N 1 COMMMEEN:S
1 . Does the aver and type of a*zal meet or exceed
the (.0217) criteria? (Cattle (100 head),
h=ses (75), swine (250), sheep (1,000), and
pcult_-y (30,000 birds with liquid va.ste
system)] •
2. Does L%_- s facility meet criteria fcr
AaiWal Operation REGISTRATION
3. A: a animals confined red or maintained
in thfs facility for a 12-maatb period'? -
4. Does this facility have a CmrzlF *3 AN'DQLL
WASMAMMMENx PLAN.:'
S. Does this facility maintain vase manage=en=
records (volumes of manure, land applied,
spray irrigated on specific aceage with
specific cover =zp)7
6. Does this facility meet t1he SCS minim
setback criteria for neig:_hcr.:7 houses,
wells, etc?

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