090044_INSPECTIONS_20171231

A
Type of Visit 9�eompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I �]/4"J u%f Arrival/Time: 11i - Departure Time: li: j County:
Farm Name: ` f,(2 ✓�7." 6 L� L. sue- �arl'f"�_ Owner Email:
Owner Name: of is1'7_tL 5 %� ��� '� Phone: _
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: �/ -.1 Integrator:
Certified Operator: alG�'� �7� Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Region:
Location of Farm: Latitude: ❑ e = 1 ="
Longitude: = o = I ❑ u
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capaeity Population Cattle Capacity Population
❑ Wean to Finish
La er
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
® Feeder to Finish
717 Z/O
t!vrlfld ❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry ❑ Dry Cow
❑ Farrow to Feeder
❑ Non-Dalry
❑ Layers
❑ Farrow to Finish
❑ Beef Stocker
❑ Non -La ers ❑ Beef Feeder
❑ Pullets ❑ Beef Brood Co
❑ Turkeys
❑ Gilts
❑ Boars
-
Outer
❑ Other
❑ Turkey Pouets
❑ Other Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[[ No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-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
[9 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
1�d No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: Date of Inspection --�
Waste Collection & 'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes KNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes J3 No ❑ NA ❑ NE
Struc re 1 Structuye 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:��irc O
Spillway?:
Designed Freeboard (in): _ 1
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes J4 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 '0 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 ;K No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
[:]Yes 1KNo ❑ 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 RNo ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
14 No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) I CsGGI •ice � �/Jyl4[dwt f ooerl' /-
13.
Soil type(s) R n PC A
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
0 No ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
JZNo ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
R No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
MNo ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
9 No ❑ NA
❑ NE
Comments (refer to question #): Explain any,YES answers and/or any,;r."ecommendations or any otherlcomments ,
Use drawings of facility to better explain situations.' (use. additional pageesjas necessary): t
T
Reviewer/Inspector Name 77'
Phone:
Reviewer/Inspector Signature:
Date:
Page 2 of 3 12128104 Continued

Facility Number: 4 — Date of Inspection-�-yd
Re aired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 14 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes M No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JZ 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 0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes XtNo ❑ NA ❑ NE
24_
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
19 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
BNo
❑ 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
59 No
❑ NA
❑ NE
Other lssues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
KNo
❑ 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
J?jNo
❑ 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
XNo
❑ 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
V1 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
Additional Coniments`and/or Drawipgs.
Page 3 of 3 12128104

.ti
Type of Visit ID -Compliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine Q-16omplaint 0 Follow up Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time:
14; Departure Time:
.� County: r
Region:
Farm Name: ��%�X 4&
& YeQ�/y'r�
_ _ Owner Email:
Owner Name: _ (� 4
_ Z— 04 de
Phone:
Mailing Address: yi `fit_
_ ��
oe
O? ix
Physical Address: .� �� r y ��!!/%3
_�.
4-0a/F all
Facility Contact: if L! �' 5
1!�Lk�i- Title:
Phone No:
Onsite Representative: ���
Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [=0 = ❑,S Longitude: =° ❑i ❑ it
Design Current
Design Current
Design Current
Population
Wet Poultry Capacity Population
Cattle Capacity Population
"[]WeajaCapacity
to Finish
❑ La er
❑
Da" Cow
an to Feeder
❑Non -La er
{]
Da" Calf
to Finish 7010
1
Da!a Heifer
❑ Farrow to Wean
Dry Poultry
El
Dry Cow
Farrow to Feeder
—
❑
Non -Dairy
Farrow to Finish
❑
Beef Stocker
Gilts
Beef Feeder
Boars
IF"OtIler
❑ Pullets
❑
Beef Brood CoTurke
s
❑ Turke PouIts
Number of Structures:
a❑
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
Page 1 of 3
❑ Yes ❑ No ❑ NA ® NE
❑ Yes
❑ No
❑ NA
RNE
❑ Yes
[:]No
❑ NA
RNE
❑ NA
KNE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
IZNE
Yes
❑ No
❑ NA
MOG
12128104 Continued

r
Facility Number: — Date of Inspection
i Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA DINE
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 ❑ No ❑ NA [9NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ® NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA JRNE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA R3 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 CS(NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA (NNE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA 29 NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) _OL�, e
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
[3NE
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
[9 NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
ONE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
® NE
Comments (refer to question # ): Explain any°YES .answers and/or any recommendations or any other comments .0 .
Use drawings of facility.to better explain situations. (use additional pages as necessary): - -J
Reviewer/Inspector Name Y rU Phone: 91P — 3,1 —
33 9
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

9-
Facility Number: Date of Inspection �/ &
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA fffNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA C5NE
the appropriate box. ❑ W`UP ❑ Checklists ❑ Desig
n El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA 9LNE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking [:]CropYieW ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and mamtatn a rain gauge? ❑ Yes ❑ No ❑ NA ERNE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28_ Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
ONE
❑ Yes
❑ No
❑ NA
ENNE
❑ Yes
❑ No
❑ NA
(SNE
❑ Yes
❑ No
❑ NA
EffNE
❑ Yes
❑ No
❑ NA
ONE
❑ Yes
❑ No
❑ NA
91 NE
❑ Yes
E.No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
NNE
❑ Yes
❑ No
❑ NA
ONE
❑ Yes
&No
❑ NA
❑ NE
,-Yes ❑ No ❑ NA ❑ NE
Additional Comments and/or Drawings:
AL
7fi:3 v:s+�- u/as rk �e �e I`r�- �^e�- v ��� .��%rj •z. a r: a.}. s a �' � r
0—;Wi. FC •
7;s r,nt�vo
1ks
p05 ® An ; *n,*L5 y v�l, �cf� say✓
I /f d,,z %/cy u/�/��i� i 7` �a of G GTa�� rP
be fnoOrtAtr4' /
a r�and uJ:' I 1s � G fl �_ � r� r►` n �� r ems, r �� � c .,,.. Ca.y+ ,r � S Sfr
m'y Coneel*l WV
T-13 J
Yy -4 e W �.rs o F - �, ST,- ,,
Page 3 of 3 12128104

Type of Visit 40 Compliance Inspection ( Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Q� Routine O Complaint O Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time:
Departure Time: County: Region:
Farm Name: t!' uz- S j_u eC 1U ru. Err ,K _ Owner Email:
Owner Name: trvH— S ad /ay'l:�: _ „ pPhone: , r
Mailing Address: f (?(�_ V� bl � S-� -- gl�,l - /V C1 2 3 242L7
Physical Address:
Facility Contact:
Title:
Onsite Representative: �(� � i D Li ct�
Certified Operator:
Back-up Operator:
Phone No:
Integrator: Atmk,w •Ulu_
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o ❑ j = Longitude: 0 0 0 I = "
Swine
Design Current Design Current
Capacity. Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish0°
(D
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other_
❑ Layer
❑ Non -La er
Dry Poultry
. ❑ Layers }
t
❑ Non -Layers
i
❑ Pullets
❑ Turkeys j
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (If ves, notify DWQ)
Design Current
Cattle Capacity Population .+
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
Beef Stocke4Co
El❑ Beef Feeder
El Beef Brood
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: EZ]
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 2 No ❑ NA ❑ NE
❑ Yes
❑ No
I[NA
❑ NE
❑ Yes
❑ No
®§NA
❑ NE
❑ Yes
❑ No
® NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
[6No
❑ NA
❑ NE
12128104 Continued

I:acilltyNumber: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ®,No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No RNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: _ u�
Designed Freeboard (in): f ��
Observed Freeboard (in): `77 ! 7/
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 8 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? E,Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes RNo ❑ 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 K.No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes KNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes KNo ❑ 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) rem Scs-n-=- �vYtLl csLL _�_ S
- tiSLt
--
A,�
13. Soil type(s) 1" CtTy �, 616 A 0 -- -
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E4 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
(RNo
Cl NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'!
❑ Yes
RNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
QNo
[INA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
9No
❑ NA
❑ NE
L.�x/� r► u[ �o
W CC k
Cv� G [-cam` -S t •ti
.A� c-vv S of cr_-,e_
Reviewer/Inspector Name 9.
Reviewer/Inspector Signature.
Phone: 7u - —* 66
Date: j1) /".-Z-
12.118/04

IFacill^umber: — �q 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 [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 29 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
Jq No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
gYes
JoNo
❑ 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
W 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
[ANo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EKNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E9 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
Q 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
KLNo
❑ 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
RNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
BZNo
❑ NA
❑ NE
zt P! ease_ work
Z- . l •�iar-e��r �s v, , �- c e � --o +te necf-
-�� s �rv� v►1�iQ.
12128104
I

M Division of Water Quality
(Facllitv..l�umber 9 y Division of Soil and Water ConservattonY
'------------ ------ - - 0 Other Agency
Type of Visit 0 Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit O Routine 0 Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
[Date of Visit: rf O Arrival Time: ' p � Departure Time: County: _A/adr!7 Region:
Farm Name: �vr f s - L..c��t„s�`fer�..7 Owner Email:
Owner Name: Phone:, 910- SG,4,S—
Mailing Address: _9,0b ✓.Awle-
Physical Address:
Facility Contact: C_vr�s L ✓/.u. Title:
Onsite Representative: �✓d./v_m
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e = I =1 [I Longitude: 0 ° F T = u
Swine
Wean to Finish
Wean to Feeder
'Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
1110Non-I-aver
Dry Poultry
[:1 Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharj!cs & Stream Impacts
1. Is any discharge observed from any part ofthe operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
DDry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
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)?
Number of Structures: I=]
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 0 No []NA 2 E
❑ Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
6<E
❑ Yes
❑ No
❑ NA
[ NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4, is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA O'fiE
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 ❑ No ❑ NA ORE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA []'RE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA 2TgE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA Q NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,_,1,
9. Does any part of the waste management system other than the waste structures require ❑ Yes El No NA LN—E
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA 2 NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ZNE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN 7 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
&$lE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
ONE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination![]
Yes
❑ No
❑ NA
ONE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
O'�E
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
.-. ate. �� P°" r _ -
Reviewer/inspector Name 1rlC�'r��:._>�in, IL Q�� Ys►rrR�q., _.,:'T�'My ,�1, -Phone:
Reviewer/inspector Signature: Date: 7-/ -df-
12128104 Continued

'
Facility Number: —!/
Date of Inspection LL:1J
Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
D<E
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
❑' EE
the approprrate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21, Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
[a'f Th
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste
Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
9-9E
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
O'NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
[3 EVE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑'NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
2'F1E
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
E3"NE
Other Issues
28, Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
[I 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
ONE
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
B �E
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
2'5-o—
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
9'5'E_
kdditiohal Comments and/or Drawings
,d WOSiGv�i� � arw► of Gc 'esvik- ole a ca-Valda:nA mi'^d AtA fA*v
fie% VP1ST1a / n%i� C./ TA C C Fi -►P /Cs i'4 J�iwTS�Q TrJ ��G�� ly rL�Gl�ii.. f
iN'/g�'n,, 9vn was sf►rrj+in�, wasl�ewo.�e� ,',><e %te.Sw:s+-.A� pev� /y1/'. L�a✓�v
1"CgveS �r� �`ja� d Vti/� [ oi., r 4rJ i"iS/arG� S�rbr�, !C.'e ��, �%/, �tro/�v►.r �e �r
$peG y�''� w.s�
� w4 ><r� i n ><e ff `
C ahy� �eFinliiw� 'D G✓Q s/, Are
�, � r1 v � Q,� �`:., of a ✓.'�/e„ r�
d { ` J . wail�t lea[v.,,'
rs e G ✓�: tJ,, wl, r n SPral. ,
�J 4e,
are �l{J
17�P�pr^ rd fl►�'�7r37�
12128104

Type of Visit • Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date or Visit: �/ /.� 0 7 Tune: r==
O Not rational O Below Threshold
EM Permitted M Certified 0 Conditionally Certified 0 Registered Date. Last Operated or Above Threshold:
Farm Name: [. K W. + s,5 4 1'u wt County. , _ . �L. PRO
Owner Name: _ C —,. _ L.�_aQ ... ►,.. W Phone No:...
Mailing Address: 8 D _ I r e— _ _ _ 131 QaQ n iQ_ a • o , IJ __ _ . .
Facility Contact: -__ . __ Title:. Phone No:
Onsite Representative: _ _ _ ka 4-W , __, , _ Integrator. _---- �•
Certified Operator_ , Cu�� s t _ L.� dQ r c Operator Certification Number
Location of Farm:
[a Swine [] Poultry ❑ Cattle 0 Horse Latitude ' u Longitude • 6 �u
. T
Desiza
Swine
:Po"
Wean to Feeder
Feeder to Finish
7 a Spa
7 3 OR
Farrow to Wean
Farrow to Feeder
Farrow to Finish
El Gilts
El Boars
n-Layer I I I Non -Dairy
her_ I ..
Total Digi& ,Ca0adtY
. Total `SSL"W
� Mg -=y
Discharges & Stream IMocts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑Yes_ ❑ No
c. If discharge is observed, what is the estimated flow in gal/min? a I /q
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 0 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes q1 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes IV No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 4 _ A __ .
Freeboard (incites): 31 N 3 3
12112103 Continued

acilit�:Number: — Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage„ etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctu+es lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancrlimprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Cerd
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acne determination?
c) This facility is pended for a wettable acne determination?
ire 16V �v1
❑ Yes j9 No
❑ Yes [M No
® Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
If
Animal waste Management Plan (CAVIN P)? ❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes ® No
liquid level of lagoon or storage pond with no agitation?
M Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ❑ No
Air Quality representative immediately.
Field Copy ❑ Final Notes
7^) C��tCk, �owses
�Fo�
CtaG�! IK
+�t
h�e►�..�a'�Zo� W���s
4�oQ �cip�:R
I
ai r►cte�c.Q. QGp�:rt
cro�c - Q.k
kA,C_
6Aar_ dC ho+..x�
Reviewer/Inspector Name
Reviewer/inspector Signature:
Date:
12112103 /% Cared

Facility Number. 'F y I Date of Inspection
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes JK1 No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes JZj No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes O No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes No
27. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative? ❑ Yes No
28. Does facility require a follow-up visit by same agency? ❑ Yes No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ® No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) 10 Yes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Qj No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ID No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ® No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes [P No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes [Z No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

.T-PCs
Type of Visit ® Compliance Inspection U Operation Review O Structure Evaluation U Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of visit: 7-31 - 07 Arrival Time: 03= /S- Departure Time: Q County: Rl'id" A/ Region:
Farm Name: cit 'S L g 4 LU [!Ayen r f Owner Email:
Owner Name: �it 5_ —odd& Phone:
Mailing Address:
Physical Address:
Facility Contact: KaI4 h I iA a r, AJ Title: -7—e �+ • S��-�— Phone No:
Onsite Representative:
Certified Operator: r« r �S L rtlLm
Back-up Operator:
Integrator•
Operator Certification Number: S
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 1 ="
Longitude: = ° = I 0 u
jjl_��Gu�rren
apacity Population
to Finish
Wet Poultry Capacity Population
❑ Layer
Cattle Capacity
Population
to Feeder
❑ Non -Layer
r to Finish
to Wean
Dry Poultry
w to Feeder
FFa
to Finish
❑ La ers
Non -La ers
Pullets
Turke s
❑ Turke PoulEl Other
Number of Structures:
13
❑ Da� Cow
❑ Dair Calf
❑ Dai Heifer
❑ D Cow
❑ Non-Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
R1 No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
rW o
❑ 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
R No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation`?
❑ Yes
V1 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
X No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number. —
Date of Inspection 7 _ 3/ 7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[� No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
W No
❑ NA ❑ NE
Stru tune Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
,i'
Identifier: SDufGtJ �l�Dr-�►
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
IF 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
0 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
V No
❑ NA ❑ NE
8_ Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
IF 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
IV No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[A No
❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s) 1-e5 G" C, Hzy;"Urf __ (C.. r-6:1 e . C is r ri S
- O ti3 e.-5 u=
-
13. Soil type(s) �4 , Ve___
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
DO No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[91 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[A No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[;4 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
R No
❑ NA
❑ NE
Comments (refer to question #):. Explain any YES answers and/or any recomme`ndations or any other "comiments
Use drawings of facility to better explain situations. (use additional pages as necessary): =`
Reviewer/Inspector Name �; ck 1�e v ¢ Phone: 9/0 . V33 , 330 O
Reviewer/Inspector Signature: R¢w Date: 7 — 3/ — ZQO �o
rage z of -i rti_'61v4 Uvrall rueu

4 . . 0
Facility Number: Q 9- 5 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [�fNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P0 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
4 No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
V1No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
M No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
14 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
[j Yes
R] 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
[A No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[9No
❑ NA
❑ NE
12128104

i
y
Type of Visit: Q<ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (DI outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 7 o Departure Time: County: Region:
Farm Name: edw-- (-gra-4(.e✓f ­,- Owner Email:
Owner Name: '� y�-r,¢.t ��br� Phone:
Mailing Address:
Physical Address:
Facility Contact: CK\-� ocP wt t L Title: Phone:
Onsite Representative: t ` Integrator:`�--
Certified Operator:'�c��-��S �c Certification Number. 7977741,
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design C
nt
A.
wineCapacity
0 0-61
Pop.
We Poultry;;Cap:acity,
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Nan -La er
Dai Calf
Feeder to Finish
nl{�jairyHeifer
Farrow to Wean'
Design C_ urrent
D Cow
Farrow to Feeder
Dry Poult
Ca �aci Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La -Layers
Beef Feeder
Boars
Pullets
13eef Brood CoIr"
Turkeys
Other
Turkey Poults
Other AEL 10ther
Discharges and Stream Impacts
1. Is any discharge observed from any pan of the operation? ❑ Yes [l-40 ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No E3-ItA ❑ 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 ❑'No ❑ NA ❑ NE
of the State other than from a discharge?
Page l of 3 21412015 Continued

Facility Number: ft - 4 1 1 Date of Inspection: lttQ
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
B-1d0
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑-#f--❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): VZ 1�'. r
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑-lqo­
❑ 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
Q­Ko
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement'?
❑ Yes
Q-Ne'
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
LS,Vv
❑ 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
[JJ o
❑ NA
❑ NE
maintenance or improvement?
1 1 _ Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes []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
l2. Crop Type(s): �� >' � i ;l 6 —0 GL-J
U. Soil Type(s): Obiy f C v k Hi S- PE
14. Do the receiving crops differ from those designated in the CAWMP?�
❑ Yes
UE" o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Vo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
io
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[3-�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes El"No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes [] No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes 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 16No
❑ NA
❑ NE
21 if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes eNo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection: D
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the Facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑` °� ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
2& 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?
C. v�r^ -� ►LI�C
Reviewer/Inspector Name: '. 1�
Reviewer/Inspector Signature:
Page 3 of 3
1 z-- 1L -21-�
❑ Yes D-M° ❑ NA ❑ NE
[:]Yes to ❑ NA ❑ NE
❑ Yes [�lo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
LJ o
❑ NA
❑ NE
❑ Yes
[f No
❑ NA
❑ NE
❑ Yes
❑ No
[DNA
❑ NE
r 6)_,,.& F
7'�_ �11- 0 ,.y /0_ sr2
CW 1 lv L(3 3-333 `�
Phone: \4 3 333�
Date:
21412015

M-S C-I 6
Type of Visit: &Com lance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: ORoutine O Complaint p Follow-up Q Referral O Emergency Q Other O Denied Access
Date of Visit: Arrival Time: Departure Time: M1911 ounty: fila r-2 Region��
Farm Name: �� Sul "rf, _ Owner Email:
Owner Name: 13�,I•�I V t� _ _ Phone:
Mailing Address:
Physical Address:
Facility Contact: CV*1 3 a �'w� G Title: Phone: ~
Onsite Representative: I t Integrator: _
Certified Operator: 6 60i Certification Number: f 77 7
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
El Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
t1a
Dr,. P.oultr.
Design
Ca acit
Current
P,o
:.
Dai Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
113eef Feeder
Boars
Pullets
9A
113eef Brood Cow
Turke s
Other Turkey Poults
Other 10therIN
Discharges and Stream Imoacts
1. Is any discharge observed from any part of the operation? ❑ Yes C <o ❑ 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 [2'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 ZI 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 [a Yes �No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili umber: - Date of Inspection: '
Gc-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[3-Ncr—❑
NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
ORA
❑ 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
❑1fo
❑ 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
Ej 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?
B<es
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[3" es
❑ 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
E�'Ro
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
QM
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 10 ❑ 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): � ea' f- � G -0 �W
13. Soil Type(s): '-&
J
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16, Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes
No
❑ NA
❑ NE
[:]Yes
[y7`No
❑ NA
❑ NE
[:]Yes
Q No
❑ NA
❑ NE
[:]Yes
E No
❑ NA
❑ NE
❑ Yes
Ef No
[DNA
❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[jKo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[�-No
❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
U 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
[f No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Pf No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [( '�4o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [✓�No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
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)
[] NA ❑ NE
[] NA ❑ NE
❑ Yes
dNo
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
Wo
❑ NA
❑ NE
❑ Yes [2'1 o ❑ NA ❑ NE
❑ Yes E2'No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
ci,��f;��- 1-a7_11b
1�t l e4{-6ltsh cou6N
(� �_ CA'�104
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
-4-0 - at �
.�L'0_ pq
�D. ,q
[?fNo ❑ NA ❑ NE
ZfNo
❑ NA
❑ NE
Z'No
❑ NA
❑ NE
['No
❑ NA
❑ NE
l � H;
Phone: 33 J
Date:'-
21412015

Type of Visit: ®'Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: O Routine O Complaint Q Follow-up O Referral O Emergency 015�her O Denied Access {!
Date of Visit: L Arrival Time:�� Departure Timer County: Region:f� l�
Farm Name: /fief-►'L Owner Email:
Owner Name: 41-Dp'- �pf_!(.b✓17Y�%//r` ►`� Phone:
Mailing Address:
Physical Address:
Facility Contact: Z / -0 -- %�'j��%�i' Title: Phone:
�� r
Onsite Representative: Integrator: 5 7`" -' e /J _
Certified Operator: Z5 =-= Certification Number: 2-9-y"7-
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.
Wean to Finish
La er
Non -La er
Da' Cow
Dai Cal€
Wean to Feeder
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
Curreut
D Cow
*
Farrow to Feeder
Farrow to Finish
D . Paul
La ers
Ca aci
P,a .
Non-Daiy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Pouets
Other
Other
Discharizes and Stream lm acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure Z Application Field ❑ Other:
0 Yes []No ❑ NA ❑ NE
a. Was the conveyance man-made?
0 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)? /Mild"r�n
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
[a NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
®No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3
21412014 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
Yes
❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): z2
Observed Freeboard (in): li /^
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[S No
❑ NA
[] NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
t" 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
ff] No
❑ NA
❑ NE
8. Do any of the structures Sack adequate markers as required by the permit?
Lrqr Yes
❑ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system otber than the waste structures require
Yes
OfNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [Yes ❑ No ❑ NA ❑ NE
Excessive Ponding 0 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): � 1oL-- /oL.- cIS -e_,—_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 ❑ 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 ® No ❑ NA ❑ NE
® Yes ❑ No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA (Z NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA E[ 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
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [:]No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
[:DNA 2) NE
❑ Weather Code
❑ Sludge Survey
❑NA ®NE
❑ NA NE
Page 2 of 3 21412014 Continued

fFaciUty Number: jDate of Inspection: ^iDld
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 O No ❑ NA ONE
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 to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
C, Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
JZ] No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
B NE
❑ Yes
❑ No
❑ NA
ONE
❑ Yes JZ No ❑ NA ❑ NE
❑ Yes Ej No ❑ NA ❑ NE
.E�j Yes ❑ No [] NA ❑ NE
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
fA No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
® Yes
[—]No
❑ NA
❑ NE
nswers andlor;an addr#ianal,recom ( YE a mendat,ons orFany�otiter4, omments. ,
Comments re zp y y
¢q „ .. _ f LL` -
Llse dramngsof facthty to.better a lam s tuattons
ap (use addttidnal:paees, as necessary}
�d- Wdr e,,L 7 Was d r I, �']- i S _ AJJ-frG cu�a !-o01�t p C�GL r�
10
`
re r`
��-
r
44-
a "Y
VII 1.1
7-4
G�
/17,C%.Sn Th T r ram'
o�i��r� 1'JTCsr� -tl� '
��
c�aSYc� ®r7,� rft�77�,
T%L�.'.�t-c
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: &,jj-!/33-33VV
ri
Date: %j,.,
Page 3 of 3 21412014

type or visit: t:!�vt:ompuance inspection u uperauon xeview V structure r:valuanon U lecumcat Assistance
Reason for Visit: ()Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: r
Arrival Time: ,3�
Departure Time: County
,�_�
Farm Name
T%�/; •t—
15m5 _Eaznn- _f r
— Owner Email:
Owner Name:
Po'"-~
— g�iva-443
Phone:
Mailing Address:
Physical Address:
Region: �'1� 0
Facility Contact: yy/ pe'+-- /yj� 't; „� Title: e9teir-t -e- f Phone:
Onsite Representative: ,j�t{.�-�� Integrator; 1W q
Certified Operator: 1R...`_ Certification Number: 9�?Vw
Back-up Operator: C Aar�zs /jay — _ _ _ __ Certification Number: g�776
Location of Farm:
Latitude:
Longitude:
Design Current
Finish
rgFe;eder
Design Current
La er
Design Current
Da Gow
Feeder
Non -La er
D Calf
o Finish t? &OV O
Design Current
D . P,oultr Ca aci P,o
Layers
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Lavers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other =§FlOther
Turkeys
Turkey Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes n No ❑ NA ❑ NE
❑ Yes
[] No
[] NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
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
21412014 Continued

Facili Number: - Date of Inspection: —-/�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 S cture 3 Structure 4
Structure 5
Structure 6
Identifier: J3 S
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in).
5. Are there any immediate threats to the integrity of any of the structures observed? ,
❑ Yes
[gNo
❑ 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
[j?[ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
j5DNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
J&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
ELNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
W. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
RNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 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):1L''2_�Ll/�r/ Sz �LY�nr �yw�
13. Soil Type(s): _ �I �p �t-'V
14. Do the receiving crops differ from those designated in the CAW MP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [-]Yes ®, No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [—]Yes E.No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes � No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
KNo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check
❑ Yes
&No
❑ NA 0 NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps 0 Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes
RNo
❑ 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
rUl No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes SNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: �S
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 fast 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 [RNo ❑ 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?
❑ Yes [a No ❑ NA ❑ NE
❑ Yes [a No ❑ NA ❑ NE
❑ Yes gNo ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes
a No
❑ NA
❑ NE
❑ Yes
C,No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
Comments (refer toquestion_#): Explain any YES answers and/or any -additional recommendations or any other -comments..
Use drawines ot_facillty=to;better..egnlain situations (use additional Daees as'necessarv). _
18�
/,,'" & .
Reviewer/Inspector Name:
Phone: XQ-- _T C0'o
Reviewer/Inspector Signature: Date: —,;;E> /3
Page 3 of 3 21412011

Type of Visit: @'Compliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: Gr1koutine 0 Complaint O Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: p Departure Time: O.'3D County: Region:
Farm Name: ' rL 1f/A7 L. L C Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: f3 "y' '0Y A" w Title: /!1?/` Phone:
Onsite Representative: Integrator:
Integrator: JyJ(thr'8u>/L
Certified Operator: alv"'- Certification Number:
r
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
La er
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
,p
Design Current
D , P,oult , Ca aci Po .
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non-Laye
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther -
Turkeys
T urkez 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 JK No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [] No
❑ Yes [] No
[—]Yes CK No
[—]Yes RNo
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - #q Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): f 9, /gyp
Observed Freeboard (in): I!;-- �d3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 2g 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 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 10 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 jo 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 IcrNo
❑ 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 ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
Window
/dU�C�- �?�"5 /St7sv'Wi
12. CropType(s): /L - ,/.9U�/�r
.�ea�r��fpr�`�C�!//•//lrli
13. Soil Type(s): &Z'WWD l ga `r x 4-tit,�d&l.&r,* _.
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes (R No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Callo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes EZ 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 RLNo ❑ NA ❑ NE
[—]Yes allo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes JL No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes r 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 JR No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes LA -No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: l
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 0 No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [. No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes [ o
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
[DNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [,No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [K No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes [No
❑ Yes [E�No
❑ Yes CF No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments, (referto question # • Explain any YES answers and/or any additional recommendations<or an other comments:
Use draw: ings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: /4- �7
Date. 33 OC7
21412011

Type of Visit: UCompliance Inspection U Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: O xoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
a Vc y �L� Date of Visit: Arrival Time: Departure Time: / .v County: okd
Farm Name: , +t'e_UI�j S - L L G Owner Email:
Owner Name: l_ /Y9� �-c,( UI%A Phone:
Mailing Address:
Physical Address:
Region:
r
Facility Contact: U i^ S Qy-tj ( Ul Title: Phone:
Onsite Representative: l t Integrator: r, �'`S
Certified Operator: JV 6-1 Certification Number: to ti13 Z
C Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
ILayer
Design
Capacity
Current
Pog.
Design Current
Cattle Capaclty Pop.
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
airy Heifer
Dry Cow
x
t
Feeder to Finish
Farrow to Wean
Farrow to Feeder
7t qb
Design Current
D , P,oul Ca i Pao
Non-Dairy
Farrow to Finish
Layers
Beef Stocker
k
AS
..-Fa
Gilts
Boars
Other
Other
-
Non -Layers
Beef Feeder
Pullets
Turke s
Turkey Puults
Beef Brood Cow
Other
..••'IKf...3YfilYJYY==-:^:-"'-,•Mpµi.- tmnu..AW:�'-i�"._:ii:9:d0!ealt_
. deL.-
Discharees and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[3-N6--0 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
[]�KA
❑ 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
[3'1gA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[algo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
, No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: IDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [3_N� NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �5
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑_loaf ] 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
❑1No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
Q-N-5 ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑-Na ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[J-ido ❑ NA
❑ NE
maintenance or improvement?
Waste Aoolication
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_3 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs_ ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C 1-4 /
13. Soil Type(s): W 0 .. Z�1
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
'L1� No
❑ NA
❑ NE
Does the receiving crop and/or land application site need improvement?
es
[' 0
0 NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ YesEr-N-o—
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
0-55
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[3'lgo
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E Imo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes
[� 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
[31�0
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [-No ❑ NA ❑ NE
Page 2 of 21412015 Continued

Facili Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes L�1 o NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑Yes o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
. 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?
r15 W "'t C6
3 Z
I o- s ox—� C � 1"
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
❑ Yes [Cj-'K❑ NA ❑ NE
[] _
Yes 0-1 ❑ NA ❑ NE
❑ Yes Ej-N'o ❑ NA ❑ NE
❑ Yes o ❑ NA [] NE
❑ Yes ❑, U NA ❑ NE
❑ Yes E2'No [] NA ❑ NE
Yes
❑ Yes
❑ Yes
NA [] NE
No ❑ NA NE
ff-N ❑ NA ❑ NE
s HRes - emu_ : � ._
M.
fo-3'b-17
L cG �/ 0 a
Phone `
Date: "2111412

Type of Visit: Q"Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: [Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: / 7 I -ArrivalTime: r / 5' Departure Time: County: Region:
Farm Name: ��,.,` �'n.s Q /m� ,/ LG Owner Email:
Owner Name: 3#ryfV-_-wQ Phone:
I
Mailing Address:
Physical Address:
Facility Contact: T3V f'O ,-- IT]Y 1 v K- Title:��7Y�
Onsite Representative:
Certified Operator:
Phone:
Integrator:
Certification Number: 7J6-
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
t�+. ` 'Design
WetFoultry ' rCapacity
La er
Current
Pop.
Design Current
Cattle apacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
=
D'. iPoul
Layers
Non -Layers
Pullets
Turke s
Turkey Poults
Other
Design
Ca acity
Current_DryCaw
P,o
-
Dairy Heifer
Non -Dal
Beef Stocker
Beef Feeder
Beef Brood Cow
-
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Dischar es 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 allo ❑ 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 allo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ® No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection: / —
7"
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Z No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[] No
❑ NA
ONE
Structture Struc kk lure Structure 3 Structure 4
W
Structure 5
Structure 6
Identifier: Ail
Spillway?:
Designed Freeboard (in): 19
Observed Freeboard (in): 3 9-
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
Wo
❑ 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
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
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[M No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes allo ❑ 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 ❑I -Application Outside of Approved Area
12_ Crop Type(s): r Y /yn i��OL ' Byrlls rl-0/ I enrWe" [ I,- hm I-LhXL140e- •'�- _
13. Soil Type(s): uk/ C> f -
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes bCO 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 10 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
fa No
[] NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
10 No
❑ NA
❑ NE
Required Records Documents
_&
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
J�g No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Ig-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 EaWaste Analysis ® Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E]No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: 113ate of Inspection: 7
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C, No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes Q 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 fast survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface 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 CA WMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
[:]Yes ® No
[:]Yes ® No
[:]Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other=comments =
Use drawings of facility to better explain situations (use additional pages as necessary).
Esc -r arr-& 0--._ Z70----�13.�. s.
��r G�i37ir 1T�1�ys �s • �/'J �' �`�`- C� C7 ��S . � �-+�'�'�`'�'
A457e.9ny_�s o,)
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: qV29--OM 33C0
Date: / �a7~p7/�•
21412011
Page 3 of 3

r
Type of Visit: 'Foutine
JQ<ionce Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: —j'— Arrival Time: n Departure Time: County: 4 Region:
Farm Nam V/L ; T Owner Email:
Owner Na e: a Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
a/ Title:
Latitude:
Phone:
Integrator: p
Certification
Certification Number:
Longitude:
Design Current
- =
Design
Current
-_ Design Current
Swine Capacity Pop.
Wet Poultry
C►apacity
Pop.
Cattle Capacity Pop.
Aa
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
' ` '`
Dairy Heifer
Farrow to Wean
;„F�
Design
Current
D Cow
Farrow to Feeder
D P,oultr
Ca aci
P.a .
Non -Dairy
IQ
Farrow to Finish
Layers
Beef Stocker
W_
Gilts
Non -Layers
113cef Feeder
Boars
Pullets
Beef Srood Cow
11
Turkeys
r. _.{T,Ymill
Turke Points
r_ _
r�r -
L
Other
Dischar es 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? j4:5,
Page I of 3 75
❑ Yes P�.No ❑ NA ❑ NE
[] Yes ❑ No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
❑ Yes
❑ No
❑ NA
❑ NE
[]Yes
JS4,No
❑ NA
❑ NE
❑ Yes
1 No
❑ NA
❑ NE
21412011 Continued

FaciliNumber: - Date of Inspection: 7--
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 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 [g 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 E] No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes X] No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes J�n No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes g] 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 or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Ek 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/Siudge 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 E&No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes JQ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
❑ Yes � No ❑ NA ❑ NE
❑ Yes Eg No ❑ NA ❑ NE
Required Records _& Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes R No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes ES -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 K . o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ;4 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes C5� No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
[]NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

U
Facility Number: - 6111 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 first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 5�_No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[Z No
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
allo
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
No
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
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
No
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
VI No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question#): Explain any YES answers and/or any additional -recommendations or any other comments xi
Use drawings of facility to better explain situations°(use additional pages as necessary).
J/ 1JeV-) P-OAer- )V0'1_5U/r-�•
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

I Type of Visit ©'Eompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
IReason for Visit (Dl;routine O Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Arrival Time: r Departure Time: � LrS County: Region: +�
s CL�r'A_ n-..v 1p �H•
Owner Name: 0—lgrkn. LjokL,1Aj,_ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: ) � Phone No:
Onsite Representative: �t k'_-' -i►v1 rator: �Jk__Z>
Certified Operator: 0(. tL*4-LS Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = f = if Longitude: 0 o ='
= u
Design C►urrent Design
Current Design
•urrent
Swine Capacity Population Wet Poultry Capacity
Population Cattle Capacity
Population
❑ Wean to Finish
1E1 Layer
I
❑ Dairy Cow
❑ Wean to Feeder
1E1 Non -Layer
I
I
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
El D Cow
❑ Farrow to Feeder
-
El Layers
ElNon-Dairy
❑ Farrow to Finish
El Beef Stocker
❑ Gilts
❑Non -La ers
❑ Beef Feeder
El Beef Brood Co
❑ Pullets
❑ Boars
❑ Turke s
Other ❑ Turkey Poults
❑ Other ❑ Other
!dumber of 5truetures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge!
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NE
El Yes
El No
,L�`�,"N/A'
LI NA
❑ NE
❑ Yes
❑ NNo
3<A
❑ NE
❑ Yes
& No
❑ NA
❑ NE
❑ Yes
ON.
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: 67 — El Date of Inspection 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes [:]No ❑ NA ❑ NE
tructure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: PorM = 8sq4A=A
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ Nir
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 I0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area C
12. Crop type(s) -C,�- ,e_ 6 V� I _ ,
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
�' - IDS �2 � ,�jbe
�`-�� �e+J rv►
4ke, Le-0
Reviewer/inspector Name I`/`0�' �+�rR i %�; Phone:
Reviewer/Inspector gnature, Date: 3 d
Page 2 of 3 Q V IY28104 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 ❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑ Maps
p ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
0 Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33.
Does facilityrequire a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
— �- -
v:
Addrttonal Comments and/or Drain s y
5011
l•
T
Page 3 of 3 12128104

B'D-is
Type of Visit &�ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: %0 /%Q�-�� /-Arrival Tiime: ���/3U Departure Time: ���County: deslaex, r
Farm Name: C�LYT7 3 �`-�"u 4�h� _ Owner Email:
Owner Name: C �[V7� S .� cldG'G`X�l _ Phone:
Mailing Address:
Physical Address:
Region:.
Facility Contact: Title: j C� • Phone No:
Onsite Representative: ! Integrator: /�luvi A
Certified Operator: �u �f I—gd AAR4 Operator Certification Number:
Back-up Operator: Gh /Gs 'T ' Back-up Certification Number: AUX 997776
Location of Farm: Latitude: [= o = 6 = Longitude: E__1 ° 0 I 0 u
Design
Swine Capacity
Current Design
Population Wet Poultry Capacity
Current Design Current
Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dai Cow
❑ Wean to Feeder
I
1
❑Non -Laver
I
El Dairy Calf
Feeder to Finish
Q
Ipry Poultry
❑ Layers
❑ Non -Layers
El Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other I
El -Dairy Heifer
❑ Dry Cow
❑ Non-Dai
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Co
Dumber of Structures:
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Outer
❑ Other I
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ONo ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
,,__,.,,//
El No
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
ElElE3 Yes
,DNA
No 11A
❑ 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
L o ❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
2IVo ❑ NA
❑ NE
other than from a discharge?
12128104 Continued

Facility Number: 67— Date of Inspection �-- -O
Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ElYes B<10 NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes o ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: AV
Designed Freeboard (in): 19
rr
Observed Freeboard (in): 2- g
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
2<o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
D o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
ONo ❑ 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. El0 Yes
NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [I 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 Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) ye5zde G
13. Soil type(s)
14. Do the receiving crops differ from those• designated in the CAWMP?
❑ Yes
❑ NA
[I NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
,L.�TN��o
❑ NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
,L-d'No
lJ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
El NE
18_ Is there a lack of properly operating waste application equipment?
[IL� Yes
,L�Koo
No
❑ NA
❑ NE
Comments (refer #o question_ i;xplam apy Yl?S answers and/or anyirecommendations or any otheracoutments
lase drawings of facility to better explain situations; (rise additional pages anecessaiy). °� 7 i�R _
1 I �
fZ.33 �333
Reviewer/inspector Name Phone:
Reviewer/lnspector Signature: Date: /O—/9—Zod
12128104 Continued

• Facility Number: —AlDate of Inspection D—J9—D
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 B<o ❑ NA ❑ NE
the appropriate box. ❑ wup ❑ Checklists ❑ Design ❑ Maps
p El Other �
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9 o [I 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
01 o ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
2oo ❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
2 ElNA
ElNE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Ej,lllo❑ NA
El NE
26. Did the facility fail to have an actively certified operator in charge?
El Yes
,�lZ��
I�o� ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
B'I o ❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Ely Yes
,�
L< CI NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Rgo ❑ 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
,�
Cl tvo ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
El Yes
�-,
brio ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[I Yes
�,
C] ivo ❑ NA
ElNE
33. Does facility require a follow-up visit by same agency?
❑ Yes
B71go_❑ NA
❑ NE
12128104

.i
Type of Visit O'Cqoi pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit `woutine Complaint 0 Foliow up 0 Referral 0 Emergency 0 0ther ❑ Denied Access
Date of Visit: Arrival Time: r0 D Departure Time: County: n Region: ,wd
Farm Name: ��/1 1—I'll 4 Id�AOn, 69✓&L. Owner Email:
Owner Name: of ilI,- S__ _ Phone:
Mailing Address:
Physical Address: 1
Facility Contact: r/Ie 11Title:
Onsite Representative:
Certified Operator -
Back -up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: a o = S = « Longitude: = 0 0 4 =
dg
Design Current ,MEe—si
Stvine Capacity Population Wet Poultry
Current Design Current
Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
❑ Feeder to Finish
❑ Daia Heifer
❑ Farrow to Wean Dom, Pouf,
❑ Farrow to Feeder
El Farrow to Finish ❑ Layers ers
❑ Gilts ❑ Non -Layers
❑ Boars El Pullets
❑ Turkeys
Qther ❑ Turkey Poults
❑ Da Cow
ElNon-Dairy
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
❑ Other ❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
R No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
❑ NA
RNE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No
❑ NA
CK NE
other than from a discharge?
12128104
Continued

1 Facility Number: — Date of Inspection
Wnste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Stricture I Stnucture 2 Structure 3 Structure: 4
Identifier:
Spillway?:
Designed Freeboard (in): 1 •'/�1 ror/ r{*Cjd}� 1'0�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed
through a waste management or closure plan?
❑ Yes *No ❑ NA ;9 NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure i Structure 6
❑ Yes ❑ No ❑ NA NNE
❑ Yes ❑ No ❑ NA M NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA &3 NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes
❑ No El 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
(R NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
❑ No ❑ NA
0 NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. [Z Yes
❑ No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or t0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window0 Evidence of Wind Drift ❑ Application Outside of Area
11
12. Crop type(s)
13. Soil type(s) N
14, Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
❑ No ❑ NA
N NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
❑ No ❑ NA
CRNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[:] Yes
❑ No ❑ NA
DNE
17. Does the facility lack adequate acreage for land application? ❑ Yes
❑ No ❑ NA
KNE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
❑ No ❑ NA
KNE
Comments (refer to question lf): 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):
Gf%%�I� f
-
AA. Y t A e k aJ -e EZ w
_
Reviewer/Inspector Name Phone: 911d ` Z37 -ay0
Reviewer/inspector Signature: Date:
IZl2VO4 Continued

i Facility Number: — Date of Inspection a 9
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA [XNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA [XNE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes ❑ No ❑ NA � NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA-
RNE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
RNE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
CKNE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
Z,NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
02�NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
XNE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
P5,NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
KNE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
[NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
2�NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
5i�4o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[K No
❑ NA
❑ NE
Additional Comments andlor Drawings:
)W ` -r 7L I % i j C. &"life' ' �L� W /1 �4 %� /�i N r'7e-
T
12128104

Division of Water Qualih
Facility Number Q q Q O Division of Sail and Water Conservation
Q (]ther Agency -
Type of Visit 4DI-Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 9<outine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Sf-/7-O$ Arrival Time: /0,04Awt Departure Time: County: B=� Region:
Farm Name: ^Cur+Ls I_ f&d AU M Owner Email:
Owner Name: C u 1-V s_ Phone:
Mailing Address:
Physical Address:
Facility Contact: f1 . i a 4>4t3a. Title: &CLJit (t 5 ?" Phone No:
Onsite Representative: _Ka 4 a D "a Integrator: i� ��// att p, u _ ,E" (-j�
Certified Operator: C Ar5 �D . Lud (tt „vt Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: E=] o El ' = .. Longitude: 0 e E__ = «
Design C+urrent Design C+u I en t
Design Current
Swine Capacity : l'opulatyon Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
El Dairy Cow
❑ Wean to Feeder
10 Non -Layer
I
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
Dry Poultry ❑ Dry Cow
❑ Non -Dairy
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑ Beef Feeder
❑ Beef Brood Cowl
❑ Boars
Other
:a
❑ Other
Number of Structures: L
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation`?
❑ Yes
L"J No
❑ NA
[:]NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
R,ONF A
❑ NE
b_ Did the discharge reach waters of the State'? (If ves, notify DWQ)
❑ Yes
❑ No
ENA
❑ 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
�A
❑ 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
,❑
B A
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: 47 Date of Inspection
Waste Collection & Treatment ,'
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes 'U' No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [�KA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: /&A = 8 Sawlt =A
Spillway?:
Designed Freeboard (in);
Observed Freeboard (in). 3SL
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ['I No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed ❑ Yes 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 CI 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 B No ❑ NA ❑ NE
maintenance or improvement?
Waste Application �,/
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ yes EJ No ❑ NA ❑ NE
maintenance/improvement? �,
I l . Is there evidence of incorrect application? If yes, check the appropriate box below_ ❑ Yes t'_ < ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) ICGSCuP _ �Ged J , ��l+[��-- �Gra , SIKai� &Min!
13.
Soil type(s) Koq, R, At, A- C,6A
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Jf,Noo
ElNA
ElNE
15.
Does the receiving crop and/or land application site need improvement?
ElYes
L'K
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
30"No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
2<o
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
2 o
❑ NA
❑ NE
Comments (refer to question #)c Explain any YES answers and/or any recommendahons or: any other comment s _
:Use drawings of facility to better explain situations. (use'addittonal pages'As necess ntv
ry) ;
Reviewer/Inspector Name F R,`ek Re_vCjS �til�, — F2t Phone: 910. SfS3.3300
Reviewer/Inspector Signature: Date: 7--2 g
Page .1 of S 12116M4 uontlnuea

...
Facility Number: Q 9 —gapr Date of Inspection / O
Re uired Records & Documents
19. Did the facility fail to have 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. ❑ WU, ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes
[ No
❑ NA
❑ NE
❑ Yes
E�No
29A
❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and V
Rain Inspections
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
/El
f No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
9No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
2"No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Lei No
❑ 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
EI'No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
ZNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ErNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
O�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
[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
L�J No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
Q No
❑ NA
❑ NE
Additional Comments and/or Drawings
Page 3 of 3 12128104