090058_INSPECTIONS_20171231

I1
'type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: 01fooutine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: ; Oct County: ,�j �..-4 Region:
Farm Name: r/ ; rt_ f.—ze �l t 3 Owner Email:
Owner Name: ����� �'al raw Phone:
Mailing Address:
Physical Address:
Facility Contact: r� Cie cad-- Title: LVWn r.e- Phone:
Onsite Representative:
Certified Operator: --
Back-up Operator:
Location of Farm:
Latitude:
Integrator: J7—i r/d
Certification Number: j 75.�4-
Certification Number:
Longitude:
Design Current Design Current .
Swine Capacity Pap. Wet Pouttry Capacity Pop
Design Eurrent
Cattle Ca ty Pap.
Dairy Cow
Wean to Finish
La er
Wean to Feeder
Layer
Dairy Calf
Feeder to Finish
Farrow to Wean
Design Current
D P.oul Ca aei P,o
Dairy Heifer
92 Cow
Farrow to Feeder
Non -Dairy
j!
Farrow to Finish
I-z ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets i Beef Brood Cow
Turkeys
Turkey Poults
Other F;
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes E]-W ❑ NA ❑ NE
❑Yes ❑No DNA ONE
[:]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 � ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3
21412015 Continued

[Facility Number: - Date of inspection: j
Waste Collection & Treatment
14. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2rf4o ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): — --
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[]-Flo
❑ 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?
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[ o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[f] No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[ o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below_ ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop TYpe(s): Z e_e_ "dc
13. Soil Type(s): `,l
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? Mes Io� ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [r]'7Qo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[3-11;to
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[�J-i+l'o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[a'go-
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[3-No
❑ NA
0 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 ❑-Ne ❑ 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 E Flo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ["Flo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection: --/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Er o
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes [ I' o
the appropriate box(cs) 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 0 o
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [alo
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? [fyes, 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?
Reviewer/Inspector Name:
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes D-<o ❑ NA ❑ NE
❑ Yes [3-No ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
[:]Yes [n No ❑ NA ❑ NE
❑ Yes ErNo
❑ Yes �o
❑ Yes [ o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone:
Reviewer/Inspector Signature:Date:
Page 3 of 3 21412015

Division of Water-Resources��,
ty ttmbeservat ton�
Type of Visit: ompHance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up p Referral O Emergency O Other O Denied Access
Date of Visit: r�� %� Arrival Time: Departure Time: ,1 > County:
Farm Name: _ �/ f(; �adrn ��ODoI�. �3 J Owner Email:
Owner Name: S'� /�7 `% F �'TDad�ra.— Phone:
Mailing Address:
Physical Address:
Facility Contact: "Jo( (3TVU-- Title: 0-Wri ram"
Onsite Representative: S-
Certified Operator:
Back-up Operator:
Location of Farm:
Region: (7
Phone:
Integrator:
Certification Number: // -fir%
Certification number:
Latitude: Longitude
Design Current
.
IS
__. _ -
Design Current - .� n{ =
Design Current
.�
Swore
Capacity Pop.
Wet Poultry
�
- Capacity Pope wattle :-
++
Capacity Pop.
Wean to Finish
Layer - Dairy Cow
,y
Wean to Feeder
VC2
Nan -Layer
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design Current _ D Cow
Farrow to Feeder
Ca aci Po = Non -Dairy
Farrow to Finish
Layers
- Beef Stocker
Gilts
f
Non -Layers
- Beef I eeder
Boars
Pullets
Beef Brood Cow
_
-
Turkeys
Qther
Turke l'oults
Other
: i
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State`? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [RNo ❑ NA ❑ NE
❑ Yes [-]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [�j No
❑ Yes IZLNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: - `8' Date of Inspection:
/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
C5-No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
fK 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
[N 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
®, No
❑ NA
0 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
allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ERNa
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Cg,,,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): /_J�/filrrt/ez d tr�7Y
13. Soil Type(s): 5776t % `r7
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [KNo ❑ NA ❑ NE
15_ Does the receiving crop and/or land application site need improvement? aYes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes � No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application'?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ja No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? Ifyes, check
❑ Yes
EkNo
❑ 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
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
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

• Facility Number: - S Date of Inspection:
. 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes MNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes (&No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29_ At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency.)
❑ Yes
M No
[] NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes Eig- No ❑ NA ❑ NE
❑ Yes MIL- No ❑ NA ❑ NE
❑ Yes [�j No ❑ NA ❑ NE
❑ Yes k No
❑ Yes � No
❑ Yes Dg-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).
/Y. f �y w p
Reviewer/Inspector Name:
_may
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412015

Iiype of visit: &-uompuance inspection V operation xeview U structure Lvaivation u t ecnnicai Assistance I
Reason for Visit: outine O Complaint Q Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: —,� /�, Arrival Time: , OC7 Departure Time: : 3a County:_ Region:
Farm Name: Ti ,� i f1 Fa t"M Owner Email:
Owner Name 7— aef-- Phone:
Of
Mailing Address:
Physical Address:
Facility Contact: �$�1�C�i (Tyr�d r��^ - Title: Phone:
Onsite Representative: j' lur— Integrator:
Certified Operator: J' Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design C•nrrent
Swine Capacity Pop.
Wean to Finish
Wet Poultry
I ILayer
I INon-Layer
DP
W
Layers
Non -La ers
Design
Capacity
I
I
Design
Ca pact
Current
Pop.
EEJ
Current
P,o
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dag Heifer
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Wean to Feeder
i_VP
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
JPullets
Turkeys
Turkey Poults
Other
Beef Brood Caw
Other
Other
Discharges and Stream lmnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
CE1,No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
[:]No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
[:]Yes
Callo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
[allo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

IFaciRty Number: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2.No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ®No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a ❑ Yes 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
2a No
❑ NA
❑ NE
8. Do any of the structures lack'adequate markers as required by the permit?
❑ Yes
�No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[—]Yes
allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Ca -No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑
Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12_ Crop Type(s):
13. Soil Type(s): -ham.
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?
0Yes ❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes allo
❑ NA
❑ NE
acres determination?
17_ Does the facility lack adequate acreage for land application?
❑ Yes
®No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
.2 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[]Yes
Lallo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
allo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists []Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Jallo ❑ 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 Callo ❑ NA ❑ NE
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes fa No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facie Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 1A No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes F&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 ❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes FLNo ❑ NA ❑ NE
❑ Yes (A No ❑ NA ❑ NE
❑ Yes EK No ❑ NA ❑ NE
❑ Yes EZ No ❑ NA ❑ NE
❑ Yes [Z No
❑ Yes ® No
❑ Yes 4" U No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Elam any:VYES answers and/ nr�anyaddrtianal recommendations or `auy other comments
Use dravvin s of facilii tabetter explain- srtuat,ons Ise addttronal es as necessa
Ir
Reviewer/Inspector Name: Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412014

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: — 6 / Arrival Time: ; / Departure Time: /; O County:zj'�11/1v_
CFarm Name: ✓' >� i v, ��t✓.•-ti r�•ry-•) Owner Email:
Owner Name: S���xy 71 Phone:
Mailing Address:
Physical Address:
Facility Contact: 40 6_001r1 Title: ,0 W n r
Integrator:x-,_
Certification Number: f %
Region: f2Z D
Onsite Representative: ,sow —.,—
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Design Current Design
Wet Poultry Capacity Pop. Cattle Capacity
Current
Pop.
Wean to Finish
Layer
Da' Cow
can to Feeder
(_O
Non -La er
Da' Calf
a
Feeder to Finish
Design Current
D . P.ou Ca aci Po . _
Da' Heifer
Farrow to Wean
D Cow
Non -Dal
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other •
TurkeysMM
Turkey Poults
Other
Other
Dischar es and Stream Im acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes fZLNo ❑ NA ❑ NE
[-]Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
J&No
❑ NA
❑ NE
[:]Yes
[ANo
❑ NA
[] NE
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
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in): / g
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
® No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes Z No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
CO -No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[a No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
L, No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[3No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Q No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes C21-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 D Application Outside of Approved Area
12. Crop Type(s)-. Al'" W/1:27
13. Soil Type(s): AZE j-; g2 ;
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 .Z 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?
Reouired Records & Documents
❑ Yes [0 No ❑ NA ❑ NE
❑ Yes [�JNo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
R7 No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[allo
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
INo
❑ 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
EKNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
W No
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® 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 to provide documentation of an actively certified operator in charge? ❑ Yes Callo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes iE No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes R"o ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes C.No ❑ NA ❑ NE
❑ Yes [3-No ❑ NA ❑ NE
❑ Yes F;d No
V__j_
[:]Yes INo
❑ Yes f&No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #):;Explain any YES answers and/or any additional recommendations or any other. commentsi�
Use drawings of facility to better explain situations: (use additional:pagesas necessary).
.. ..,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
,%-ve _ Phone:
Date:
21412011

Type of visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ! t3 Departure Time: County Region: 1:7 0
Farm Name: A; I,c naer✓ — Owner Email:
Owner Name: 15 Q %l y �/ - 6—d p ,-- Phone:
Mailing Address:
Physical Address:
Facility Contact: f�D�z a � ter-- Title: j4 Cf_)n ?— .,'-
Integrator: LA'.4
Certification Number: -21510
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Longitude:
Design Current
�., �� >,x� � Design
Current
Design Current
Swine
Capacity Pop.
Wet PoultrywCapacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Da' Cow
Wean to Feeder
{�
Nan -La cr
Da' Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean`
` �# Design
Current
Dry Cow
Farrow to Feeder
D . ,3I?oui `'_+Ca aci
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
--_---_---- - -- -
Turke s
Other
Turkey Poults
Other
Other
Discharizes and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes � No ❑ NA ❑ NE
❑ Yes
[a No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
[:]Yes
[:]No
❑ NA
❑ NE
❑ Yes
ANo
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Ins ection:
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
D 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
allo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
�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
1K No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[Z No
❑ NA
❑ NE
maintenance or improvement?
Waste AP lication
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 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):-
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 F No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
� No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[KNo
❑ 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 CR No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [Z No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [A No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 21412011 Continued

Facility Number: - Ir I Ds ection: — 3— /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Ig No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes O-No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes M-No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [� No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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 Cq No ❑ NA ❑ NE
❑ Yes fallo ❑ NA ❑ NE
❑ Yes [allo ❑ NA ❑ NE
❑ Yes U1. No ❑ NA ❑ NE
[—]Yes No
❑ Yes No
❑ Yes No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of faciliity to better explain situations fuse additional DaQes as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:�.33C�Q
Date:
21412011

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ORoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: � Arrival Time: Departure Time: .10County: j.-.-• Region: ?�T p
Farm Name: r
K i r .I ��nOwner Email:
Owner Name: ,G �-- Phone:
Mailing Address:
Physical Address:
Facility Contact: 99-I-�,,,�� Title: (,(Jn Y� Phone:
Onsite Representative:Integrator:
Certified Operator: Certification Number:7
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Swine
Desi Current
gn
Capacity Pop.
,�,����RDesign
Wet Paultry�+ Capacity
Current
Pop.
Design C►urren#
Cattle .: Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
on -La er
DairyCalf
Feeder to Finish
Dairy Heifer
Farrow to Wean
�*
ent
Dry Cow
Farrow to Feeder
D , P.oul Gam" aei
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
.W
Turkeys
Other
Turkey Pouets
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 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes � No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes [2 No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection: 1-19
Waste Collection & Treatment
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
1`7 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): .�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
10 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance a]tematives that need
❑ Yes
4 No
❑ NA
❑ NE
maintenance or improvement?
1 I . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ HydrauIic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):� �r�r✓� t— �—�
13. Soil Type(s): S'Z� /l..f
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 0 No ❑ NA ❑ NE
❑ Yes R] No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [] Yes N No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes W No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E] No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ®No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M No ❑ NA ❑ NE
ti
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [RI No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failurc to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [R No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
(0 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
© No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[a No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[KNo
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: 9-IO' /.3-3300
Date:yzrQ`�o
21412011
Page 3 of 3

Type of Visit: ompliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: &I routine 0 Complaint 0 Follow-up 0 Referral 0 Emereency 0 Other 0 Denied Access
Date of Visit: -/ Arrival Time: o ; 3 Departure Time: County:.-` Region:
Farm Name T f- A �itlrn 1(stawl—v- �.3' Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: 7er'la-U ��pa�,�a.-sue Title: �jn ,...— Phone:
Onsite Representative: �_ Integrator: /y�
Certified Operator: 4001j Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current
Swine C►apacity Pop. Wet Poultry Capacity Pop.
Design C•nrrent
Cattle Capacity PopME
Wean to Finish
Layer
DairyCow
Wean to Feeder G
Non -La er
Dairy Calf
Dairy Heifer
Feeder to Finish
l Design Current
Dr, P�oul, Ca aeity Po ,
Farrow to Wean
Farrow to Feeder
D Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
O#her
Turkey Pouets
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 ® No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
[:]Yes No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection: � �,� � /2—
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): _ 9-
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 10 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 Q 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 allo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ®, No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes O.No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes � No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Wind w ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): .fYiyyN�of�! �oRG,r S rY
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [S 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 property operating waste application equipment?
❑ Yes ®, No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes LJ_%LNo ❑ 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 Va No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes rMNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: Date of inspection- 2-- -j
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Ig No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge'? If yes, check ❑ Yes 5D No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ®No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 7No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
allo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
R No
❑ NA
[] NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
ELNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
CZ No
❑ NA
❑ NE
33. Did the ReviewerAnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
M-No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Wo
❑ NA
❑ NE
ReviewerMnspector Name: J�%Ys�`:� C c�j Phone: /�%Q'�� = 3,
Reviewer/Inspector Signature: Date:
Tv —
Page 3 of 3 21412011

Type of Visit IKompliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit aloutine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: � /I{ Arrival Time: �� t?'J Departure Time: j Q r County: G�+�s{c---ti Region:
--L
Farm Name: a—r- K r in r7r1 , Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: _ Mn2&V Title: ,QGlJf7Y/ Phone No:
Onsite Representative: �' Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: [ o = = Longitude: = ° = i
Design Curr. nt..
Design Cu rr ent :- Design Current
Swine
Capacity Poputation
Wet Pouitry
Capes Pop latio'naCattle Capacity Population
❑ Wean to Finish
❑ La er
11< ❑ Dai Cow
Wean to Feeder
❑ Non -La er
❑ DairyCalf
❑ Feeder to Finish
Dry Poultry..
"''" ❑ Da' Heifer
a ❑ D Cow
�`
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Layers
❑ Non -Layers
.: ❑ Non -Dairy
❑ Beef Stocker
El Beef Feeder
❑ Farrow to Finish
Gilts
❑Boars
❑ Pullets
Beef Brood Co
❑ Turke s�
Other
❑Turkey Pouets"'
❑ Other
�
umber of Structures:
❑Other
s
- -
-
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ICiNo ❑ NA ❑ NE
❑Yes
El No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�&No
❑ NA
❑ NE
❑ Yes
G5-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 allo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 19
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes RNo ❑ 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
C3No
❑ 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
0No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application'! If yes, check the appropriate box below. ❑ Yes
®.No
❑ NA ❑ NE
❑ Excessive Pond ing [:]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)il�r(ex-��G`C/SrY�r
t3. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
NNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
[ffNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
JR] No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
g No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
,RZNo
❑ NA ❑ NE
ReviewerlInspector Name jr,_ Phone: ` 49- 0/33 3300
Reviewer/Inspector Signature: Date: f f
rage 1 of -1 1L/L5/U4 uonrinuea

Facility Number: — Date of Inspection _ lr
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes BNo ❑ 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 El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. E9 Yes ❑ No ❑ NA ❑ NE
E9 Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes allo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes (SNo ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
B Yes
@ft.
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ZNo
❑ NA
❑ NE
26_
Did the facility fail to have an actively certified operator in charge'?
❑ Yes
BNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification'?
❑ Yes
21 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
M 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
E.No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
O-No
❑ NA
❑ NE
Additional Comments andLor Brawings-
wm
A6
3M.a ,
Hi
Page 3 of 3 12128104

Type of Visit &Compliance
Inspection
0 Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
outine O Complaint
O Follow up O Referral O Emergency
Q Other ❑ Denied Access
Date of Visit: �
Arrival Time: p�
Departure Time:
;
County: W"`~ Region:F�A ID
Farm Name: TGt��!rrf l�;
l iiz"L . Cf -s�t�c .t
3
Owner Email:
Owner Name:
Phone:
Mailing Address:
Physical Address: • l
Facility Contact: ea^ r'%� Title: FGrir— A4a=a,r./ Phone No:
iy
Onsite Representative: �'"r�l C�a�Yw Integrator: 076
Certified Operator: �aY`�— --- Operator Certification Number: 17
Back-up Operator:
Operator:
Location of Farm:
Back-up Certification Number:
Latitude: E p 0 t = " Longitude: 0 ° = , =
jj�@upent Swine ulation
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
JEI Layer I
❑ Non -Layer
❑ Dairy Cow
Wean to Feeder
❑ Dairy Calf
❑ Feeder to Finish L I
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
Other
IF: Other
Ury Poultry
ElLayersLa ers
El Non-Layers
El Pullets
El Turkeys
❑ Turkey Poults
JE1 Other
❑Dai Heifer
❑ Cow
❑
ry
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
iNtsmber of Structures:
Discharges & Stream Impacts
I. 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 RNA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[:]No
❑ Yes
RNo
❑ NA
❑ NE
❑ 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?
a. If yes, is waste level into the structural freeboard?
Structure I Stricture 2 Structure 3 Structure 4
Identifier:
❑ Yes (R No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure: 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
EZNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
RNo
❑ 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
5(No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
[No
El NA [I NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
2�No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2!�No
❑ NA ❑ NE
maintenancerimp'rovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ®, No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 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) /` kz;'r _a9e�
13. Soil type(s) Fj2✓- ,t� f 52Z
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [9No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? RYes l ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'❑ Yes
N No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
[2 No
❑ NA
❑ NE
IS. Is there a lack of properly operating waste application equipment? ❑ Yes
EiNo
❑ NA
❑ NE
Comments (refer to question # ): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/InspectorName Phone: alp—W-33DO
Reviewer/Inspector Signature: Date: JP Lb
I2128104 Conanuea

Facility Number: —.S` Date of Inspection %a
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 [59 No ❑ NA ❑ NE
the appropriate box. ❑ ArUp ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [9,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?
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
CRINo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
E}No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
ES No
❑ NA
❑ NE
❑ Yes
ALNo
❑ NA
❑ NE
❑ Yes
[R No
❑ NA
❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes PNo ❑ NA ❑ NE
12128104

Fatuity Number
* Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
�f
Type of Visit ! Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: v Arrival
Timme: Eo_9—,W1_ Departure Time: County: 8 � Region: FRO
Farm Name: 6-tm(eY' 4-3) Owner Email:
Owner Name: , ��1 '-"u'� Phone:
Mailing Address:
Physical Address:
Facility Contact: Gy Q4en Title: Phone No:
y Onsite Representative: Integrator: Ruhr" i.1 I WC
Certified Operator: Operator Certification Number:
rrNs6
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = 0 0 d Longitude: = ° = .
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
Wean to Feeder
I (0 0
I 3
El Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ La erLa ❑ Nan-er
Pry Poultry
❑ Layers'
ElNon-Laers
El Pullets;
❑ Turkeys
1-1Turke Pouets
❑ Other
Other
❑ Other - -
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field El Other
a_ Was the conveyance man-made'?
Design "Current
Cattle Capacity Populatio-
❑ DairyCow
El Dairy Calf
❑ DairyHeifer
❑ D Cow
❑ Non -Dairy
El Beef Stocker
El Beef Feeder
❑ Beef Brood Cowl
P,
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2_ Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �No ❑ NA ❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes ❑ No NA
❑ NE
❑Yes El No �NA
❑NE
❑ Yes No ❑ NA
❑ NE
❑ Yes o ❑ NA ❑ NE
12128104 Continued

i
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes WNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
90NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 4
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes Q9No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes *h 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 ❑ NE
maintenance/improvement? 0
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes q'No ❑ NA ❑ NE
❑ Excessive Ponding El Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.) l
❑ 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) C [.I &'yytw6 & M S @4.5s, mat ( Dtwjfc�
13. Soil type(s) 't-&" g}ok,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
lia No
❑ NA
❑ NE
13. Does the receiving crop and/or land application site need improvement?
❑ Yes
[�N0
❑ 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
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
ElYes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
C'rOd 'AZ4,.,
Reviewer/inspector Name /Vk6 ig Phone: Q 23
Reviewer/Inspector Signature: Date:

r
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El E El NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes f;�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 B 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
hNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
19No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
6No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
r' No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E] No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
RNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes N[No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
foNo
❑ 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
VINo
❑ 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
91 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
F3 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
allo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

j
Type of Visit 4D Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit IDRoutine O Complaint O follow up O Referral O Emergency O Outer ❑ Denied Access
Date of Visit: S 'Ll Arrival Time: Departure Time: O.`/ County: 61adfen Region: RW
Farm Name: ar 9l in � Owner Email:
Owner Name: P_Yk Phone:
Mailing Address:
Physical Address:
Facility Contact: Zngld LSO C.,n Title:
Onsite Representative: N
Certified Operator:
Back-up Operator:
N
Phone No:
Integrator:
Operator Certification Number: 1
Back-up Certification Number:
Location of Farm: Latitude: = e = I = .1 Longitude: = ° = I = "
10 Design Curren#
�, Dest n Current
Design Current
Swine Capacity Population
WetPoultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
Wean to Feeder LIUT
n-La er
❑ Dairy Calf
Feeder to Finish
-:.
DryrPaultry
Dairy Heifer
❑ Dry Cow
❑ Farrow to Wean
❑ Farrow to Feeder
--'
❑ avers
❑ crs Non -La
El Pullets
❑ Turkeys
❑ Non -Dairy
El Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
z
❑ Farrow to Finish
_' ❑ Gilts
❑ Boars
.._...,
Ot her
❑ Turkey Poults
El Other
Nuf Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
IP No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
E�NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
�YNA
❑ 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
P NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ful No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: G% —
Date of Inspection J
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ja No
❑ NA
❑ NE
a, if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
P NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 33'
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
*o
❑ 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 �IwNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes W 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 7ONo ❑ NA [I NE
maintenance or improvement? [['"'
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EiNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [ & No ❑ NA [:1 NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 01bs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside o/fSAcceptable
-Crop rWindow ❑ Evidence of Wind Drift ❑ Applicationn�OuJtside of Area
12. Crop types) L.OQ.s4y DP�ms� a "56 �, � —ceia U 6 t+ QW-eg
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
OrNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P No
❑ NA
❑ NE
Reviewer/Inspector Name e Phone 33 3 90
Reviewer/Inspector Signature: Date: s Z% g
Page 2 of 3 12129104 Continued

Facility Number: — Date of Inspection •� G>g
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ,$ No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design [3 maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes PjNo ❑ 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
EA No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
6 No
❑ 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
%No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
IS No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Vj No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
IP No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
O No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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)
ff
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
I'No
❑ NA
❑ NE
E
Page 3 of 3 12128104

(Type of Visit 40 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit ORAutine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit. 15{ /t37 I Arrival Time: Departure Time: County: sladeXl Region: FRO
Farm Name: rar Ki In Farm CGcc�en 31 Owner Email:
Owner Name: Phone: dID)062 2551 _
Mailing Address: PD C�(/X ill it I12411P.Y�`f0�.�1N !JC a0332 - �� b�,sya0 1 -
Physical Address:
a
Facility Contact: fRonc, [d exl Title:
Onsite Representative:
�f
Certified Operator: 11
Back-up Operator:
Phone No: 610)'? /2—asn
Integrator: _ -lam - _
Operator Certification Number: 174_S4
Back-up Certification Number:
Location of Farm: Latitude: = o = f = u Longitude: [� o = & = Lf
Design.. Current DesignCurr}erit" Design Carrenf
Sw ne Capacity Population Wet Poultry Capacity Popuiat n Cattie Capacity Population
❑ Wean to Finish ❑ Layer ❑ Dairy Cow
Wean to Feeder 4 t7 e9 73D❑ Non -La er I I Dairy Calf
❑ Feeder to Finish _' ❑ Daia Heifej
❑ Farrow to Wean D l'oult . ❑ D Cow
❑ Farrow to Feeder ❑ Non-Dai
❑ Farrow to Finish ❑ Layers
❑Beef Stocker
;. ❑ Gilts El Non-Layers " ❑Beef Feeder
❑ Boars y' ❑Pullets
ElTurkeys
❑ Beef Brood Co
Other ❑Turke Puults
❑ Other ❑ Other I 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
k4jNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
'Q No
❑ NA
❑ NE
other than from a discharge'?
12128104
Continued

1
Facility Number: — Date of Inspection 0
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes f4 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: j
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):sl
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
E No
❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
1�No
ElNA [INE
(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�No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
XNo
❑ 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 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence
E,.vidence of Wind Drifi El Application Outside of Area
12_ Crop type(s) C""a4
nn
� M k &-ass IW ...i igy-"j
13. Soil type(s)B1r--p
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P9 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
(
rO No
❑ NA
❑ NE
18, Is there a lack of properly operating waste application equipment?
❑ Yes
(p No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name b Phone: 1 3 Qo
Reviewer/Inspector Signature: Date: S 0"
12128104 e;Z'L p, Continued

Facility Number: �5tDate of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [ANo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Pallo ❑ NA ❑ NE
the appropriate 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 V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
r No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Q,No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
KLNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Wo
❑ 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
Cj�No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
N No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
JpNo
❑ 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
YM No
[INA
ElNE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
FNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[INo
❑ NA
❑ NE
Comments and/or Drawings:
I2128104

Type of Visit ®-Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (7 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: r V Departure Time: 1 , C) County: -n— Region:
Farm Name: L n r,: r� Owner Email:
Owner Name: y� t� % Phone:
Mailing Address:
Physical Address: /n� II
Facility Contact: - Cci�� Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator: _,i24,.. !,z
Operator Certification Number: Z2�
Back-up Certification Number:
�o ❑� =�� g �o ❑' Q
Latitude: Longitude:
�Populraotlilo
ElsigrrntSwine n
Wean to Finish
Wet Poultry
❑ Layer
Design 118.teo
Capacity PoCattle Capacity Population
ma-
❑ Dairy
Wean to Feeder
❑ Non -Layer
❑ Dairy
❑ Feeder to Finish':4"'`-'''
❑ Dairy
❑ Farrow to Wean
Dry Poultry
❑ D
El Farrow to Feeder
`` ❑No
❑ Farrow to Finish
❑ Layers
❑ Bee
[] Gilts
❑ Non -Layers
es
° ❑ Bee❑Bee
❑ Boars
❑ Pullets
- -
MµA
❑Turke s
Other
❑ Other
El Turkey Pouhs
❑ 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
BNo
❑ 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
M No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[(No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
W No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — Date of Inspection o
s
' 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): g
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ER 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
M 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
0 No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
14 No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
UR No
❑ NA
❑ NE
maintenance or improvement?
Waste Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
P& No
❑ 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)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes LN No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
®,NO ❑ NA ❑ NE
No ❑ NA ❑ NE
N No ❑ NA ❑ NE
RNo ❑ NA ❑ NE
Comments {refer to question #}PExplatn�any YES answers and/or any recommendations or any other comments.
Use drawings of facility to bettefij` afn sy4tui tions. (use additional pages as necessary):
Reviewer/]nspector Name ^yz x Phone:
Reviewer/inspector Signature: Date: — a
Page 2 of 3 - 1 1228104 Continued

lm
tir
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 9 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 :S 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
0 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
CK No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
NNO
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
f@ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
t9 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
CK No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
VNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0 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
0 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative inunediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
0 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
CUNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo
❑ NA
❑ NE
Additional Conimeats'and/or Drawings:
Page 3 of 3 12128104

Type of Visit (rf6mpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: a-/ Arrival Time: ; Departure Time: ' f County: Region: --JEZ
Farm Name: tl t'` 'K i 1 r-- Fa -ern I i CAL Owner Entail:
Owner Name: Ief Phone: �2.`l d ` ze 41r— 6/o 9
Mailing Address: ,?0. B v x 8``7 � % �Dc�vl Nth d2 3 7
Physical Address:
Facilitv Contact:
Title:
Onsite Representative: Rt226,
Certified Operator: r,,KE=,z � &-,a
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other _
Phone No:
Integrator: "
OL
Operator Certificatio Number: _/ZZZ
Back-up Certification Number:
Latitude: ❑ o ❑ { =" Longitude: 1--] o = =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ Layer
GND >�2 10 Non -La ei - - - -
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Puilets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population.
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, 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 [4 No ❑ NA ❑ NE
❑ Yes
[R No
❑ NA
❑ NE
❑ Yes
W No
❑ NA
❑ NE
❑ Yes
[2 No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
PQ No
❑ NA
❑ NE
12128104 Continued

[FacilityNumber:07—,�' Date of Inspection 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes KNo ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes LKNo ❑ 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? L&Yes ❑ No [INA ❑ 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
10 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
X No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[4 No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12. Crop types} 1, -c- ()
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
RNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[W No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?
❑ Yes
[4 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
0 No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers andlor any recommendations or any ether comments.
Use drawings of facilifwiwo
ty tv better explain situatio as. (use additional pages as necessary,):
7`v w a < A ` r a 06� L a�vtrn--
` Phone:Reviewerlins ector Name 5,1 f� vZ
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: — Date of Inspection %
Required_ Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [f No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ,9 No ❑ NA ❑ NE
the appropirate box. ❑ W UP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. � Yes ❑ No [I NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections 10 Monthly and I " 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?
AffYes
Z No
® NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
PNes
2 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
10 Yes
14 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
R No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
"Yes
❑ No
r�
NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
W No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
M 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
[I 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
Pq-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
PQ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
14 No
❑ NA
❑ NE
Additional _Comments aDd/Ort iwh '. °m 4 "� z
ire
111a. kr Su ��� -t- a 1►1, i t-i a l /s-;, o ✓-� ���4-r /`a � ►'t_ �.c �I �v�-,-.�
5ir 7 ��L:�d
L'aZibra-`Le W,%'`1'oep 1 r cby
A) 14
12128104

� ..� 1��„ � .aza s.a er• - -i �� "� �Y�._:r �,*?��.«�.,�Y' aw /r �,-. �,t x--',,x„ .a �� � '-`3c gym. sr. -.a 'ems s�'._ir r....
Type of Visit A Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
FFacility Number r Date of Visit: 1704 by Tune:
... O Not Operational O Below Threshold
® Permitted ® Certified 13 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: . .
Farm Name: _ .L �S.t/.n 5 -�� '� _ County-
Owner Name: 5 _ _ T _ jeaXna, . 'Phone No:
Mailing Address:
Facility Contact: ___Ga a'`J - --- Title:
Onsite Representative: n ., o- AJ
Certified Operator: ,� _. �o o-,x __-
Location of Farm:
Phone No:
;integrator:.
Operator Certification Number: z 5? S-4
A6
0 swine ❑ Poultry © Cattle ❑ Horse Latitude • � �49 Longitude • °
Swine - [`an9c�riv . Ponalation
Wean to Feeder
a U
G 2 S
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
r -Current Desa CoriYat'
ry act "Po elation. , Catde .
ryer Dairy -
m-Laver In Non -Dairy 1 1-
Other
—10 Total Design Capacity -
R ..°.:Total'SSLW
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes M 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? M 1A
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 51 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from, a discharge? ❑ Yes [d No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes W No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:—
�c,� f/
Freeboard (inches): /
12112103 Continued

Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
No
closure plan? Yes �
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/unprovement? ❑ Yes j No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes J No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes �] No
elevation markings?
Waste Application
10. Are there any buffers that need maintenanc elimprovement? ❑ Yes [ No
I I . Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes [p No
❑ Excessive Ponn�ding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type />E'r�rtccn�� ArYe Y �� 1 S`r+.aj
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a wettable acre determination? ❑ Yes [ No
c) This facility is pended for a wettable acre determination? ❑ Yes No
15. Does the receiving crop need improvement? ❑ Yes 09 No
16. Is there a lack of adequate waste application equipment? ❑ Yes Ql No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below [j Yes No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building 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 El No
Air Quality representative immediately.

I.FaWt—y Number: _ S f. Date of Inspection / 7/
r
R uired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
ie/ WUP, checklists, design, j�
( gn, 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 0 No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes j" No
26. Fail to notify regional DWQ of emergency situations as required by General Permit? (it/ discharge, freeboard problems, over application) ❑ Yes kj No
27. Did Reviewer/Inspector fail to discuss reviewimspection with on -site representative? ❑ Yes ft No
28. Does facility require a follow-up visit by same agency? ❑ Yes M 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) ❑ Yes ]xJ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103