090063_INSPECTIONS_20171231

Site Requires Immediate Attention: fJb
Facility No. _ [fir -(a
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
-Farm NamelOwner. I U
I+Iailing Adddress:
County:. "Ic.ae tf - —
Integrator: My ok4
On Site Representative:-Q,!�- C%r H.-
Physical AddresslLocation•
DATE: , 1995
Time:
a
Phone:__ to L__'89 - a i t i
Phone:- - eu na �275 77.9�. Ll )
Type of Operation: Swine x Poultry Cattle
Design Capacity: � Number of Animals on Site: a o0
DEM Certification Number: ACE DEM Certification Number. ACNEW
Iatitude:_2& " _�J_` _C&" Longitude:_ •
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard- of 1 Foot + 25 year. 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No . Actual Freeboard:_Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or&Was any erosion observed? Yes or 1i(seepage was -
Is adequate land available for spray? ''Yes or No Is the cover crop adequate?' Yes or No Not Evaluated
Crop(s) being utilized: (Spray Field' or ' cover crop was not evaluated
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin �ar No
100 Feet from Wells? s? or o
* Is the animal waste stockpiled within 100 Feet of USGS Blue Line ' Stream? Y or
* Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or No
Is animal waste discharged into water of a state by man-made ditch, flushing system, or-bther
similar man-made devices? Yes or gl If Yes, PIease Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No(waste management records were not
Additional Comments: reviewed) _
This brief inaRection�&_g more- tborough inspection wUj bt. ctmducted ja the future.
_ Please contact a- EM should any 'condition-, arise that poses .a danger to surf ace_ waters.
* This farm was not located on a USGS TOPO map to determine ?Blue Line" status.
If you have questions concerning this report please do -not heaftate to -,.contact the inspector
at [phone]. Please contact the,inspector'if the -above information is incorrect.
Inspector Name Signature
ec: Facility Assessment Unit `5�'� ,,�� Use Attachments if Needed.

Site Requires Immediate Attention:
Facility No. - og -G3_
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANDdAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
''Type of Operation: Swine g Poultry . C.alile
Design Capadrjr. r� ec�. - - Number of Animals on Site: - - 42_4, oo onsct-�
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: • All dtY Longitude-- ,•
Circle Yes or No .
Does the Animal Waste Lagoon have sufficient freeboard. of 1 Foot + 25 year. 24 hour storm event
(approximately 1 Foot + 7 inches), Yes or No Actual Freeboard:_!=F . ____Inches
Was any seepage observed from the lagoon(s)'? Yes or T Was.any erosion observed? Yes or (Seepage Was
Is adequate land availabk for spray? Yesor No Is the cover crop adequate?' Yes or No Not Evaluated
Crop(s) being utilized: (Spray Field' or 'cover crop was not evaluated)_ _ _ _ _ _ _ _ _ _ • ,
Does the facility meet SCS minimum setback criteria? 200 Feet from Dweuin s? 1�or No
10Feet from Wens) or o
* Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Y
* Is animal waste land applied or spray irrigated within 25 Fax of a USGS Map Blue Line: Yes or No
Is animal waste discharged into water of a state by man-made ditch, flushing system, orbther
similar man-made devises? Yes or If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover =p)? Yes or No(Waste management records were not
Additional Comments: ux1c=d)
..Bids wSs a very brief inspection; a mox' thoroustb inspection 3d11 be conducted ure-
_Please coutact_DEM should any_ -condition--arise that poses a danger to surface waters.
* This farm was not located onn-a 'USGS TOPO map to determine 'Blue Line" status.
If you have questions concerning this report please do -not hesitate to' -.contact the inspector
at (910)' 486-1541. Please contact the inspector' if the -above 'information is incorrect.
picz,�J
Inspector Name Signature
CC: Facility Assessment Unit 5 �'� ' �� Use Attachments if Needed.

Site Requim Immediate Attention: #40
Facility No.
DIMON OF ENVIRONIVIENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: LozsL F_, IM
Trine: .3-1
-Farm NamelOwner. ��
Wailing Address: ti•:Ock me-2R.311
County:,_ IOAVZ
Integrator: mgr&4 Q.A. Furr,r+s �,..c - _ - Phone:_ (g Lb 1 28q 2 it I On Site RepreseWtive: LPhone:
Physical Address/Location: -�S3.
Type of Operation: Swine _ x Poultry. - Cattle
Design Capacity: - -ZC. e,- Number of Animals on Site: a L ao
DEM`��C�ertification Number. ACB�___�, . DEW Certification Number. ACNEW
Latitude:� ' �' �' Longitude: • 'Z1 •
Circle Yes or No . yd�
Does the Animal Waste Lagoon have sufficient freeboard of i Foot + 25 year. 24 hour storm event
(approximately 1 Foot + 7 inches) ' Yes or No Actual Freeboard: fit.._._ finches
Was any seepage observed from the lagoon(s)? Yes or &Was any erosion observed? Yes or (Seepage Use
Is adequate land available for spray? Yes or No Is the cover crop a&quate?' Yes or No Not Evaluated
Crop(s) being utili(SprgZ Field' or -cover crop was not evaluated
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin s? Igor No
100 Feet from Wells? or,�10
* Is the animal waste stockpiled within 100 Feet of USGS BIue Line Strram? Y i
* Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or No
Is animal waste discharged into water of a state by man-made ditch, hushing system, orbther
similar man-made devices? Yes oro If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spmy irTigated on specific acreage with cover arop)? Yes of NO(Waste management records were not
Additional Comments:^ -- reviewed)
- hig ,y Ag_ & very brief inspection._ a more' thorosa h inspection will be conducted _In the future.
Please contactaEM should any condition- arise that posei a danger to surface waters.
* This farm was not located oa a USGS TOPO asap to determine °Slue Line" status.
If ou have Questions concei-ding this re art pleaset do -not meditate ta-.contact the i=t ector
at [phone]. please contact the inspector, if the -above 'information is incorrect.
Tripe= Name Signature
cc: Facility Assessment Unit `� �`� �,,� Use Attachments if Needed.

Site Requires Immediate Attention:
Facility No. o9 -G 3
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SrM VISITATION RECORD
DATE: � , 1995
:, �.-Timms:".. Sa•�
Farm NamrlOwner• � c�r�eu �� _,6���se�y '�Ca4 Q �4
ldailing Address: `.; W- QL%k C 2 g3 - 9A 4
County: QcAe t j
integrator: ln,a _ r,,•s �rnc . _ Phone: I 1
On Site Representative: Phone:rh,n�245 A it I
Physical Addmsv1ocation: �r�_ 9, 1-, --
Type of Operation: Swine Poultry . Cattle
Design Capacity: 6Q - Number of Animals on Site: a? o0
DEM Certification Number: ACE_,.DEM Certification Number. ACNEW
Latitude: ° —,ILL' _C�Qb" Longitude: •,,"
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard. of I Foot + 25 year: 24 hour storm event
(approximately 1 Foot + 7 inches) - Yes or No Actual Freeboard:__j=_Ft. Inches
Was any seepage observed from the lagoon(s)? Yes' orWas any erosion observed? Yes or fi(seepage Was
Is adequate land available for spray. Yes or No . Is the cover crop adequate?' Yes or No Not Evaluated
Crop(s) being utilized: §2ray Fiela' or,;'cover:;cro ' was not evaluated
Does the facility meet SCS minimum setback criteria?.' 200 Feet from;Dwellin s? Igor No
100 Feet from Wells? or o
* Is the animal waste stockpiled within 10 ,Feet of USGS Blue 1n' c'Strtam? Y or
* Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or No
Is animal waste discharged into water of the state by man-made ditch, flushing system, or-0ther
similar man-made devices? Yes or If Yes, Please Explain.
Does the facility maintain adequate waste,management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crap)? Yes or No(Waste management records were not
Additional Comments: reviewed)
This a v more' thorough i s n-willndu ed in the f ure.
Please contact;-DEM should any 'condition -arise that poses '.a danger to surface waters.
* This farm was not located onn-a USGS TOPO map to determine YBlue Line" status.
If you have questions concerning this report please_ do -not hesitate to --.contact the inspector
at [phone]. Please contact-the-inspector"if the,above'information is incorrect.
q0j-
ci....)
Inspector Name Signature
cc: Facility Assessment Unitb6 Use Attachments if Needed.

I -
Facility Number O j Date of Inspection I /P!.o
Time of inspection V- 7 124 hr. (hh:mm)
E3 Permitted E Certified Q Conditionally Certified E3 Registered Q Not Operational I Date Last Operated:
47/461 �
Farm Name: 1F7 �?� /� �' ................... Counh:........
............................... ............q.-- ---- ..r..................
Owner Name: Aye . e EiPts14—. ..- ............................................. Phone No:..- �4� �f - �,( J......................
...... ..... ..................................
Facility Contact: .... A ........ ...... Title: ............................
p s
Mailing Address: ...... J...�....�,F` ....Qr4�...1.'.i4i2"'
Onsite Representative: �3�
..........
Certified Operator:.......(.!Zc�%1....... .1.4:........ 8f•�'�� ......I ................. ................. .........
Location of Farm:
................................... Phone No:...................................................
✓!� �.' ......Q..y� f.11� C-....-tT`.................
integrator: ......... .............
"
..."..............................................
Operator Certification Num/ber: _/lam 7
i..............:................. I....................I.....................................................:.......................................................
...............................................................•.............•_ _......................................................... ........
Latitude Longitude
Design Current _; _ -.- -Design .' Current --. _, Design. Current
}Nnttiber of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Hotdurg Ponds / Solid Traps ❑ No Liquid Waste Management System
�
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑Yes Pj"No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) []Yes X1No
c. If discharge is observed, what is the estitnated flow in gal/tnin'?
❑Yes W7 Nod. Did discharge bypass a lagoon syti[cm. (I1Ycs, notify DWQ) 2. Is there evidence of past discharge from any part of the operation? ❑ Yes OqNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
...//
Freeboard (inches): ..-....... .. ...... ................... ....... ......................................•--....... .................. ....... ................................... ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes M
seepage, etc.) / �
3/23/99 Continued on back

Facility Number: 4 — 6 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan'?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part. of the waste management system other than waste structures require maintenance/improvement?
9_ Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? []Excessive Ponding ❑ PAN
12_ Crop type
❑ Yes
er0
❑ Yes
No
❑ Yes
No
❑ Yes
No
❑ Yes
XNo
❑ Yes
)(No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Platt readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23_ Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
:: 10 yigta[idris'et- deficiencies were noted• jJ46ng this*v. sit' • Y:oit will-r'a&eiye Rio ]Further •: • :
- correspondence abflutk this visit: ..... .. .............. .
❑ Yes o
❑ Yes No
❑ Yes A No
'$Yes ❑ No
l❑lYes XNo
[-]Yes )<No
❑ Yes KNo
❑ Yes No
El Yes 1
❑ Yes No
El Yes No
❑ Yes '%No
❑ Yes No
❑ Yes No
❑ Yes I
a�
Use drawtn of factlr to better ex lain.sftuahons use acldthonal a es as tiecessa
w
�t .-_
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
3/23/99

Facility Number: fate of inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below blU1'es ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24.hours? ❑ Yes XNo
28. 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)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes XNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes JKNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes enNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Ayes ❑ No
do , . otntnents an or rawutgs _
r►
,i6l
3/23/99

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
140 Routine O Complaint O Follow-uE of DAVQ inspection O Follow-up of DSWC review O Other
Date of Inspection ,S II iV
Facility Number o4'
11
Time of Inspection 24 hr. (hh:mm)
13 Registered M Certified [3 Applied for Permit 13 Permitted [3 Not O eratinnal Date Last Operated: ..........................
Farm Name:... Q ..�,tir� County � ......................................................
... '-.--.._'./................................................... .........--..--............
OwnerName:......... --- (ram . .............. ....... Phone No: .......................................................................................
Facility Contact: ..... '. ... � ... f,....... Title: ................... Phone No: .................................................
r .//
.................. ....... .......... ....Mailing Address: ........ tt..... �..............
Onsite Representative:.....,.. �/ .. ....................
"�r.._.. �...........................................:.............. Iniegratair:......,��r�.
Certified Operator ,......-- . ...... Operator Certification Number; -AK.? ?z
Location of Farm:
Latitude ' t « Longitude ' A 46
;Design_ tiCtlrrent ' er�� DeSIgII CllrreIIt �e51gn',' ti-'CIiCIeIIt'`
Capacity Popt>lahIon • "'Poultry ,Capacity Population Cattle Capacity,,Popuistion r'
Wean to Feeder
µ. ❑ Feeder to Finish
`. ❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑Layer
"'
❑ Dairy'
❑ Non -Layer
I
I❑Non-Dairy
�
❑..Other
�`: , , „•, �.., � �
� s,
*3
Total kCapaq'
Design i
`Total SSLW
General
1. Are there any buffers that need maintenancelimprovement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what 'is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes KNo
❑ Yes allo
❑ Yes Wo
❑ Yes No
❑ Yes JNo
❑ Yes *o
❑ Yes No
❑ Yes PNo
❑ Yes XNo
❑ Yes kNo
Continued on back

wZ,
f Fa lity Number:© --�5
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,flolding Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identifier: Freeboard (ft): ......./.1P.....�.................................................................................................................
10.' Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
[]Yes N No
4Yes No
Structure 5 Structure 6
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers'?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type �........................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMI')?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19, Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes O'No
❑ Yes QVNo
Yes ❑ No
❑ Yes At,+ro
❑ Yes *o
❑ Yes
.h� No
❑ Yes
J No
❑ Yes
Wo
❑ Yes
No
❑ Yes
No
❑ Yes
No
Yes
❑ No
0 No.violations or deficiencies were -noted during this.visit.- You.will receive no ft.irther
correspondence about this. visit'.
❑ Yes ;UNo
❑ Yes 91 No
❑ Yes 19 No
Cairn meats:{refer to question #) sExplain S answers and/or any recommendations or any `other coniiitents any ,YE'k
Usetidrawtngs of faethty"t6 better'%xplain situations. (use additional pages as.nece5sar�) 'r
4"a, it �.�.�3' r' .cc.F ,�i�✓.ar/.6"L� �4- .2 ��i�*r.J..
��;Op o,•.d
,ram.-,� ,�(� �',�/ar dam,.,► >>r.� ' p�•�= .oer,� �'�..sa✓a��.
7/25/97
Reviewer/Inspector Name _ A.�
Reviewer/Inspector Signature: /J �r Date:

❑ DSWC A iimai FeedloU peration;Review
InYDW,Q Animal"Feedlot'Opefkion Site Inspecticr.
E.
® Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review Q Other
Date of Inspection G zo
Facility Number O
Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ® Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
❑ Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated: ............................. ........ ......... ........ ..... ...... ................_..J..._ .I..._ ....._ ....._ ...._ ....� .....
Farm Name: 1�.e�.��.....4� lC /�%t. _..,���N ...._. ...._.... ....__.
................... ......... �.... ................�.. ..... ...................... County. p
Land Owner Name:._._.... _�.. Phone No:
Facility Conctact:...__......-, ..... ............ _... Title: Phone No,
1
Mailing Address: _ .... _.. ... _.
Onsite Representative: & Integrator:
Certified Operator: ...'... Operator Certification Number:
Location of Farm:
Latitude LJ•�` ��" Longitude �• C�` C�K
Type of Operation and Design Capacity
Design ` CurrentDe-iin '"Current � � �' ' -` Y Design rCui•reBE `
Swine s.:¢ :.Ca `aci Po alation "Poultry .,C» °aci Po uilatian�.Cattle: kGa aei Pa ut tionw`
Wean to FeedeT Aw O-> La D
❑ Feeder to Finish " ❑ Non -Layer ❑ Non -Dairy
Farrow to Wean 4 '� t•` :4
Farrow to Feeder Total D sign C paC y ` ' '
171 Farrow to Finish �w,� F �� �'
f ,f S �` Total SSLW 0'"
ID Other..,..�.,....,.,,,...,.:..�. - a �x � �.. s ��,.•. k ' .;s r, v ,yap,
77
❑ Subsurface Drains Present _r
�,�,„Number�,of Lagoons ! Holdusg PondAs / ,>� x
❑Lagoon Area �;; ❑ Spray Field Area
n ral
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaVinin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/47 maintenance/improvement?
❑ Yes No
❑ Yes No
❑ Yes $[ No
❑ Yes bd No
❑ Yes
O No
❑ Yes
�jNo
❑ Yes
A(No
❑ Yes
/xNo
Continued on back

Facility Number: ...�,9. 4....
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Sxfuct rCE (Lagoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3
10. Is seepage observed from any of the structures?
❑ Yes JR No
❑ Yes XNo
❑ Yes '® No
❑ Yes .Pq No
Structure 4 Structure 5 Structure 6
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste ARRlicatiou
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .,4.
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management PIan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes 10 No
❑ Yes No
Yes No
❑ Yes XNo
❑ Yes gNo
❑ Yes A.KNo
❑ Yes tTNo
❑ Yes No
❑ Yes XNo
❑ Yes No
❑ Yes ANo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Comments {refer tii'queshon #� _,Explain`any,,YES'answers an any„recommendafi8ns or'any other cornments
'Use graw'm 's of facility to`better exptain situations. (use additional pages as necessary)':
�,Zs � `i¢�ad..1 Ui.C� •✓.F��7"� O.� /�.v.�!/i4 � Gd�.f ,ems
Reviewer/Inspector Name ux _a E? ✓ a ��a.,,
Reviewer/Inspector Signature: _ Date: z���7
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

F--Facility Number Date of Inspection p ,z�
Time of Inspection ; d*GD 24 hr. (hh:mm)
Permitted M.Certified 0 Conditionally Certified [3 Registered 10 Not OperationalOperationalj Date Last Operated:
Farm Name: .........t. County:.............. �.. ......... ....
..........
Owner Name: .............. FA .................................................................. Phone No:... /4 .. �i�r _-. .�.r ^.......... ..........
.,/Facility Contact: ... Title:. Phone No: •,,,,,,,,,, .......................................
Mailing Address: ...... ... ....1�.e..... ... ........1/f! '.rrE....C.�.d' �c.lK. .-..r' ..` �� ....................
OnsiEe Representative:......'........ZW19 .. ............................................. Integrator:.... Cr1......... .._,.... . �.... .
Certified Operator........ rg{/„ .............. . ',, ................ Operator Certification Number: ................................... ......
Location of Farm:
Latitude • 6 64 Longitude ' I_J4 "
Design Currenf-;
n Poultry = Capacity . Po ulation
QFWean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer ❑ Dai.
❑ Non -Layer []Nor
❑ Other
T:
.Total Des>fgnr Capp
'SS
nt,i
.;.]❑ Subsurface Drains Present 1[❑ Lagoon Area I❑ Spray Field Area
a .
No Liquid Waste Management System4
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes JRNo
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? (Il' yes, notify DWQ) ❑ Yes gNo
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if ycs, notify DWQ) ❑ Yes FtNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes KNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes P?No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Callo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard,(inches): 2
................................................................................................................................ ... . ..........
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �•No
seepage, etc.)
3/23/99 Continued on back

t
1
Facility Number: 49 — Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes RNo
(If any of Questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? JRYes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes JK No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes NrNo
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes (RNo
11, Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes Pil-No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ONO
14. a) Does the facility lack adequate acreage for land application? ❑ Yes PNo
b) Does the facility need a wettable acre determination? ❑ Yes KNo
c) This facility is pended for a wettable acre determination? ❑ Yes L;kNo
15. Does the receiving crop need improvement? 'W1Yes ❑ No
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18, Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc_)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23_ Did Reviewer/inspector fail to discuss review/inspection with on -site representative'?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
E3; -IS-'.Ai, l ati6ris'oi- d0ticiencie9 wjerc potted- during this; visit' You ;will reeeiye r#o ftri-th r
correspondence: about this visit.... ' • .... • ' • . ..:: . .... .
oiiiments`{refer to question #) `Explain°any YES answers and/or any recommendations or any other comments
fse;drawings of facility, ob 'etter. expWri situafttons (use additional pages as necessary) x ' ` '..a _ v
❑ Yes A No
❑ Yes A�No
❑ Yes No
kYes ❑ No
❑ Yes RNo
❑ Yes XNo
❑ Yes No
❑ Yes No
❑ Yes RNo
❑ Yes N No
I T
Reviewer/Inspector Name104
Reviewer/Inspector Signature: Date: %�1

i
}
Facility Number- a —
Date of Inspection 7 Z
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
*Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
09 No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
JM No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
&No
30.
Were any major maintenance problems with the ventilation fan( noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
PO No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
kNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ No
hon _ _ .. _
om�nents`an or raw�ngs
3/23/99

r
"GeDi,,dsion of Water Quality
Facility Number �--® 0 Division of Soil and Water Conservation
0 Other Agency URS
!J:
Type of Visit `it Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: ®0. Departure Time: County: Region:
Farm Name: LiY�Csz)►1�r ` ice r v1 L&A h W\. Owner Email:
Owner Name: �+ �- _-�.oV4�-�_ Phone:
Mailing Address: Qo H�t _ Zk
&c1
Physical Address:
Facility Contact: Von Title: New �Qlr_ _ Phone No: CO �� 03gS '""
Onsite Representative: Integrator: M p"
o Certified Operator: Operator Certification Number: U a Q
Back-up Operator: 1 V 0,A Back-up Certification Number: 9 V 3qq 2
Location of Farm: Latitude: = o = . = g, Longitude: = o ❑ & ❑
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
2 (em I 2�0 1 JE1 Non-Layet
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 Cowl
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 P No ❑ NA ❑ NE
❑ Yes
❑ No P+NA
❑ NE
❑ Yes
❑ No '�RNA
❑ NE
❑ Yes
❑ No NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
12128104 Continued

Facility Number: — 3 Date of Inspection ai
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes CNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No r>NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
E'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
�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
V 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
IONo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[�(.No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable CropWindow ElEvidence of Wind Drtifl [IApplication Outside of Area
12. Crop type(s) kkyMty A(1 —1� 0.Z� c—,, o is
13. Soil type(s)
�i
rr
i4V'r
14. Do the receiving crops differ frbrtf those designated in the CAWMP?
❑ Yes
13No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
_KNo
❑ NA
❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
X No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
N(No
❑ NA
❑ NE
18, Is there a lack of properly operating; waste application equipment?
❑ Yes
A No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
i
T
Reviewer/Inspector Name cA PusT e�icp ONA Phone: 3Q
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 V No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes *V 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 P9 .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
PkNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
ANA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ON
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ANo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
4No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
�kNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
*o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
&No
❑ NA
❑ NE
Additional Comments and/or Drawings:
� l 'C� Y�. r TA q� e,�
Pon nude e_� k,A P.
12128104

Facility18A<
No. Off : Ti In Date 0
me Time Out
#VWK
a Integrator t
Site Rep VO-AC,
Operator i No.
Back-up No.
COC Circle: QGeneraor NPDES
Design
Current
Design
Current
Wean - Feed
o�
Farrow — Feed
— inish
Farrow — Finish
Feed, Finish
Gifts 1 Boars
Farrow —Wean
Others
FREEBOARD: Design
,-34
fudge Sul rey
Crop Yield
tom• •°'17�'
il Test
r
Spray/Freeboard Drop
Observed
Ca!ibrahinn/G. ...
Waste Transfer—s — —
Rain Breaker��
PLAT Wettable Acres
Daily Rainfall
1-in Inspections
(ly
Weather Codes 120 min Inspections
Waste Analysis:
Date Nitrogen (N) Date Nitrogen (N)
3
Pull/Field Soil Crop Pan Window
ev, 'ry,\_
Cyr
1
ti

Type of Visit 0- 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 ❑ Denied Access
Date of Visit: — fI Arrival Time: a Departure Time: ,',j 5 County: v4vi
Farm Name: y ®Q fC 5 A& :i e? Y Owner Email:
Owner Name:��' Phone:
Mailing Address:
Physical Address:
Region: lf?0
Facility Contact: f>�� L,� Title: Phone No:
Onsite Representative: �-�-- _ Integrator: �
Certified Operator: ��"Q— Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 n ❑ ' = ,. Longitude: 0 ° = ' = "
Design Current
Design Current
�gesiguCurren#
Capacity Population
Wet PoultryCapaclty Population
Cattle Capacity Population
n to Finish
❑ La er
❑ Dai Cow
n to Feeder
rEOIFarrow
p? O(7
/l7
❑Non -Layer
❑ DairyCalf
er to Finish
�' '
❑ DairyHeifer
to Wean
outr`f❑
D Cow
ow to Feeder
-''`
El Non -Dairy
6. ❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
" ❑ Gilts
Non -Layers
El$�
❑Beef Feeder
❑Boars
❑ pullets
❑ Beef Brood Cowl
-
El Turke s
R.
Other
❑ Turkey P oults
❑ Other
❑ Other
Number n-, Uructures:
Discharges & Stream Impacts
1 _ is any discharge observed from any part of the operation?
❑ Yes
4 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
JR No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
CR 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
M No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
IN No
❑ 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?
Page l of 3
12128104
Continued

Facility Number: Date of inspection Lam'
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
XNo
❑ 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
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
J3No
❑ 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?
C9Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 5ANo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ,[ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ONo ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes PNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) �7'F/%IGI0(!# 7'7`��/ �r_ ,')� X Y�
13. Soil type(s) if
.'C7A
f
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
allo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[&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
X-No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers andlor anylrecommendations or
Use.drawings of facility to better explain situations.(use additional pa s necessary):
any othecomments s
Reviewer/Inspector Name w rd� J ::
Phone: %/D
Reviewer/inspector Signature:
Date:
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection ITO
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAW MP readily available? If yes, check
the appropriate box. ❑ Ain T p ❑Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ,Yes EffRo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections UMondily and 1" 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
3 i . Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (iel 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?
Additional Comments aF41o1rDraWmgs:
❑ Yes q No ❑ NA ❑ NE
❑ Yes 9No ❑ NA ❑ NE
❑ Yes
J.No
❑ NA
❑ NE
❑ Yes
O No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
EINo
❑ NA
❑ NE
❑ Yes
IgNo
❑ NA
❑ NE
❑ Yes
,K No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
[:1 NE
❑ Yes
E] No
❑ NA
❑ NE
❑ Yes
JZNo
❑ NA
❑ NE
Page 3 of 3 12/2&04

r
Type of Visit compliance Inspection Q Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: IL-L. Arrival Time: i p , ('� County: ' ii Region:
3 !7 Departure Time:
Farm Name: M& 1." -z- 2' C90, S U I!11 S ie ✓ 7' Owner Email:
Owner Name: Q • it oc 1.. Phone: A0-0 , "� z
Mailing Address: g' l� �%� y oat
Phvsical Address:
Facility Contact: Title:
Onsite Representative: Sf
Certified Operator: _ x9, ! z _—
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number: ,L& _4�Z21=
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = { = u Longitude: = o = , =
Design Current
SwineCapacity Population
❑ Wean to Finish
[ZWean to Feeder
6-A(POD1
1 000
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ uTkey 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)
Cattle
Design Current;,:,`,':
Capacity Population:;.::
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowf
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
E.
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 XNo ❑ NA ❑ NE
❑ Yes
(Z No
❑ NA
❑ NE
❑ Yes
0,No
❑ NA
❑ NE
❑ Yes
rO No
❑ NA
❑ NE
❑ Yes
%No
❑ NA
❑ NE
❑ Yes
[ZNo
❑ 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
EjNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
UNo
❑ NA ❑ NE
Structure f Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _ ._Z
Observed Freeboard (in): a 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
IVNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
gNo
❑ 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?
M-Yes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
XLNo
❑ 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
MNo
El NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
Wo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 100/. or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12. Crop type(s) /] 4?--/N 6 Zff_=/`/YI K�__-
13. Soil type(s) e - — G
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Z�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
RNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
UNo
❑ NA ❑ NE
�G�tDv� �dwrs N�rv� /YI t7u�`h�
Reviewer/Inspector Name V" Phone: t
Reviewer/Inspector Signature: J Date:
12128104 Continued

1
Facility Number: — Date of Inspection
Re wired 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 KNo ❑ NA ❑ NE
the appropirate box. ❑ mp ❑ Checklists ❑ Desig
n El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ®Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard [Waste Analysis ❑ Soil Analysis []Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
® NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
MNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
E-NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[XNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Z 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
WNo
❑ 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
(4 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
EZ No
❑ NA
❑ NE
33_
Does facility require a follow-up visit by same agency?
❑ Yes
PjNo
❑ NA
❑ NE
a�l rAr, 6!/fj7f ,S _s G o
12128104

13 -
Type of Visit 40 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit • Routine O Complaint O Follow up O Emergency Notification O Other © Denied Access
)Facility Number Date of Visit: I !Q Tune: ✓ �
.,. _ 0 Not Operational 0 Below Threshold
13 Permitted [3 Certified 13 Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
Farm Name: T County:
Owner Name: _.. ___ _ _ 'Phone No: _.
an address: 3 'l- Mdiirr
Facility Contaet: _ �d"`f _ p— Title: Phone No:
Onsite Representative: _ — 171 Integrator: , f v` J >= ne nn-
Certified Operator: W . , , .. ., ,,,, . _ Operator Certification Number: �Ql-- a
Location of Farm:
If
P Swine E3 Poultry E3 Cattle © Horse Latitude Longitude • �0"
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes KNo
Discharge originated at ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 12rlqo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) Yes E�p4o
c. If discharge is observed, what is the estimated flow in gavmin?
d. Does discharge bypass a lagoon system? (If yes, notifv DWQ) ❑ Yes ANo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes [KNo
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes RNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes MNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier:
Freeboard (inches): ILA_
12112103 Condnned

Facility Number: — io Date of Inspection I /O
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 ❑ Yes PNo
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancefunprovement? ❑ Yes KNo
8. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑ Yes XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ANo
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes ®,No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes Wo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. crop type Ry a a&neel� dl� pns
v
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 0(No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes KNo
b) Does the facility need a wettable acre determination? ❑ Yes 4 No
c) This facility is pended for a wettable acre determination? ❑ Yes ,® No
15. Does the receiving crop need improvement? ❑ Yes ® No
16. Is there a lack of adequate waste application equipment? ❑ Yes E&No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [&No
19. Is there any evidence of wind drift during land application? (Le. residue on neighboring vegetation, asphalt, ❑ Yes 2!kNo
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 Wo
Air Quality representative immediately.
Commesrt5 (refer m � � YES aas�v�s aad/ar ar; otlia comi�eut5.:����- �-�� -�-
iJse draw�:a�'�a'h�q to bex#erxaplam s�amts.�ase � pages � Y ��ela c ❑Final Notes ��~� =
- f
Reviewedlnspector Name
ReviewerAWspector Signature: Date: 14 l0 LO
77n7m3 r...,a...,ea

Facility Number: 17 — (p 7> I Date of Inspection t I f o D
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes KNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes K No
23. Does record keeping need improvement? If yes, check the appropriate box below. Yes BNNo
0 Waste Application ❑ FreeboW jjjWaste Analysis ❑ soil Samphn*"
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
KNo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
WO
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes
JK No
27. Did Reviewer/Inspector fail to discuss reviewCmspection with on -site representative?
❑ Yes
9,No
28. Does facility require a follow-up visit by same agency?
❑ Yes
OjLNo
29. Were any additional problems noted which cause noncomplismce of the Certified AWMP?
❑ Yes
2LNo
LAMES Permitted Facilities
30_ Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
KNo
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 NPDFS required forms need If yes, check the appropriate box below.
[I Yes
[I No
''improvement?
❑ Stocking Form ❑ Crop Yield Form [IRarnias� f_I Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

t
I Facility lumber Date of Visit: E—z Timc: i
`- - -rO Not Operational 0 Below- Threshold
M Permitted 0 Certified © Conditionally- Certified [3 Retiistered Date Last Operated or Above Threshold:
Farm lame: Z4, Awft Countv:ld'-�
Owner Name: MAPhone No: —I
\lailing address:
Facility Contact:
Onsite Representative:
Certified Operator:
Location of Farm:
Title:
Phone No:
integrator:
Operator Certification Number:
21wine ❑ Poultry ❑ Cattle ❑ Norse Latitude ' 9 0" Longitude '
Design Current
Design Current Design Current
Swine Capacity Population
Poultry
Ca acity Po ulation Cattle Ca acity Po ulation
❑ Wean to Feeder
❑Laver
I
I JE]
Dairy
❑ Feeder to Finish
JE1 Non -Laver
❑ Non -Dairy
❑ Farrow to Wean
El Farrow to Feeder
❑ Dyer
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons ® ❑ Subsurface Drains Present ❑ ULFoon area 12319p. Field area
Holding Ponds I Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream lmoacts
1. Is any discharge observed from any part of the operation? ❑ yes ❑ No
Dischame ori--inated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? El Yes ❑ No
b. if discharge is observed, did it reach Water of the State? (If yes. notify DWQ)
c. If discharge is observed. what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the''aters of the State other than from a discharge?
Wa a Colketion & Treatment
4_ Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure ? Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): 212
05103101
El Yes El No
❑ Yes ❑ No
❑Yes El No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Continued

_._. � ._._,r �-+ _.-_�-r,..r�...,...y;,y'�'rW0}OK- _.ir •- —ram yrt .�..M'.."��Mwr-•.-.'�.�-�'..rv. •.w - ..
r.
W\
Type of Visit 0 Compliance Inspection
0 Operation Review 0111f5g—oon Evaluation ;i•'.
Reason for Visit 0 Routine 0 Complaint t0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
FacilitvNumber D+trntVisit: Timc: i 'rr
-- dOtiBelow Thhl
❑ Permitted 0 Certified 0 Conditionally Certified 0 Reglstered Date Last Operated or Above Threshold
Farm Name: J .� County: —Ad,= "'"
h�
Owner Dame: Phone No:
Mailing Address:
Facility Contact: - Title:
Onste Representative:
Certified Operator:
Location of Farm:
r Phone No:
Integrator:
Operator Certification Number:
[a'9wine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ' 0` Longitude 0 •
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Ca acity Population
❑ Wean to Feeder ❑ Layer ❑ Daijy
❑ Feeder to Finish JE1 Non -Laver I I 1E1 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ goy Total SSLW
Number of Lagoons e7LO I ❑ Subsurface Drains Present ❑ La oon Area 1091fvray Field Area
.Holding Ponds / Solid Traps ❑ No Liquid Waste Management Svstem
Discharges & Stream lmuacts
1. is any discharge observed from any part of the operation?
Dsscharae originated at: ❑ Laeoon ❑ Svrav Field ❑ Other
a. If dischame is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gatimin?
d. Does'dischar6e bypass a lagoon system? (If yes, notifi`DWQ)
2_ Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Wa a Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): r1
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Continued

i
FacilityNumber: —
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
I 1 _ Is there evidence of over application? _ ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12_ Crop type Uly4 %ie'�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design'?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ No
❑ No
❑ No
❑ No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
E � s. ���� � �
Commepts refer'to ueshon d/or any
�
�' J yk ��I{ u'v L0 k � rawings of facility tp better exphun sttuafions: (use,addttsonal pag �nece ry) ❑Field Cony Notes
7Final
7
Reviewer/Inspector Name
Reviewerlinspector Signature: Date:
05103101 y Continued

Facility Nymber: — Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (iel 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
closure plan? "` Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ),'
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Aoolication
10. Are there any buffers that need maintenance/improvement?
1. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type �f-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14, a) Does the facility lack adequate acreage for land application? `
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17, Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
All i
Comments .refer, to question #) E Iatn an YES answers and/or an recommendations,or an)"'the& comments.
� ±'L y ''.,-�i���„
• g ac�ty playa sttttaho°s- (use additional pages as necessary) Field Copy ❑Final Notes
Use drawut s oti to better ex� � = ❑ T
1',_,' �.
J
il
Reviewer/Inspector Name r
Reviewer/Inspector Signature: Date:
05103101
Continued

i «• � i .x •--...... w- _ "�. ':.Y--•-r ...c:.r''� «.._'S �u�.;+.�-�"r"... a ._i K_a- .. _. ... � ...• .. S. � .. ... .. � �.. .:�.r v _ -.•.•
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit' 0 Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility lumber Date of Visit: Time:
>\ot O erational Belo• Threshold
O Permitted O Certified ©Conditionally Certified j] Retiistered Date Last Operated or Above Threshold:
Farm Name: — 1 x ke t, O a ks _PA rA e-.County: __B_ks e_1^
Owner Name. 2c, Phone No: __91 aI g(-
�
hailing Address: ocjLaa�sJL _N , G _3g
Facility- Contact: Title:
Onsite Representative: tZe. S
Certified Operator: i
Location of Farm:
Phone No:
Integrator-
Operator Certification number: 4 Z}Z
®Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 0" Longitude •
Design Current Design Current Design Current
Swine Capacity Population Poultry Ca ackv Po ulation Cattle Capacity Po elation
Wean to Feeder ❑ Laver I I JE1 Dairy
❑ Feeder to Finish I JE1 Non -Laver I I ❑ Non-Dain
T_
❑ Farrow to Wean
❑ Farrow- to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
El Boars Total SSLW
Number of Lagoons !� ❑ Subsurface Drains Present ❑ Lagoon Area IE3SPrav Field Area
Holding Ponds / Solid Traps != ❑ No Li uid Waste Management Svstem
Discharges & Stream Impacts
I _ Is anv discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed. was the convevance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes. notify DWQ)
c. If discharge is observed. what is the estimated flow in gal./min"
d. Does discharge bypass a lagoon system? (if ves. notify DWQ)
2. Is there e,.ridence of past discharge from any part of the operation?
3. Were there any advme impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Wage C_Q1lMtion & Tr�tment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):_ _
05/03/01
❑ Yes P No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [ No
❑ Yes [�-No
❑ Yes 0 No
Structure 6
Continued

Facility Number: — (p3 Date of Inspection l
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
closure plan? ❑ Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? El Yes �No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes �[] No
Waste Annlication
10,
Are there any buffers that need maintenance/improvement?
❑ Yes
No
11.
is there evidence of over application'? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
No
12.
Crop hype rntA J-
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?
Cl 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
W No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
n No
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[2jNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
❑ Yes
Co No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
[91 No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21,
Did the facility fail to have a actively certified operator in charge?
❑ Yes
® No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
® No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/]nspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
24,
Does facility require a follow-up visit by same agency?
❑ Yes
J�jNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[I No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments refer to ueshon Ez lain an YES answers and/or=an} recommendations or any other comments :
{ 9 p y -
drawitt s of facih to etOr explain situations: {nsi addtttonal3pagestas necessary):.
Use'. , Field final Notes
.`. ❑ F Copy ❑ F
b b�__
a* � NV ,-.w.. �wFa
jj' y
T
,_
Reviewer/Inspector Name ,.::.
ReviewerAnspector Signature: Date: Ig e
0510310I Continued

Facilih•,Number: Oci — 1a3 Date of Inspection 1 2 03
Odor Issues
26_ Does the discharge pipe from the confinement building to the storage pond or Import fsil to discharge atior belo t
liquid level of lagoon or storage pond with no agitation?
27. Are there anv dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation. asphalt.
roads, building structure. and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
0. NVere any major maintenance problems with the ventilation fan(s) noted? (i_c. broken fan belts, missinty or
or broken fan blade(s). inoperable shutters_ etc.)
11. Do the animals feed storage bins fail to have appropriate cover?
321. Do the flush tanks lack a submersed fill pipe or a permanent itemporary cover? .
❑ Yes ❑ No
❑ Yes & No
❑ Ycs M No
❑ Yes 14 No
❑ Yes] No
❑ Yes No
❑ Yes ❑ No
05103101

L
of Visit Of Compliance Inspection O Operation Review O Lagoon Evaluation
far Visit j% Routine O Complaint O Follow up O Emergency Notification O Other D Denied Access
y Namber ` �� of Visit: � Tune: iaD
Nat rational 0 BelowAThreshold
Permitted 0 Certified 13 CondkionaNy Certified E3 Registered Date last Operateedgr Abo a Threshold:
Farm Name: (u!�(..1......... �r %fir .... County: ._,(.:� .-- -- -- - -- --._.. J V......5.--._.._-------• -
OwnerName: - _--------- ...!-��---------------•_ Phone No: ------------------------------------------_.
MailingAddress:..................................................................._----.... ....... ............ ..... ........................................ .... ....... ......... ..................
Facility Contact: ,.p......... ....... Title: ............ ..~................. //Phone No: ..........,�1-.........
Onsite Representative .-11�°-- ----- --- - --- ----- ---- Integrator..------- ---------- --------- --
Certified Operator..... (1 / � .... ...... Operator Certification N ber. .....................
Location or Farm:
❑ 5wine D Poultry ❑ Cattle ❑ Horse Latitude i • � � �� Longitude
Discharges & Stream tmflacts
1. Is any discharge observed from any part of the operation? Yes XNo
Discharge originated at: D Lagoon D Spray Field Q 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 o
c. If discharge is observed, what is the estimated flow in gal/min? '
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes qNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 0No
Structure I Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier: ........................... ........... ...........................
Freeboard (inches):._...�:_.._.._.._........_._.._.._.

Facility Number: Q 9 — 3
Date of inspection
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
B. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of uxer application?. ❑ )excessive
12. Crop type
❑ Yes No
❑ Yes D1 0
El Yes � No
❑ Yes o
❑ Yes Amo
❑ Yes No
El PAN El Hydraulic Overload [I Yes o
13. Do the receiving crops differ with those dp95gnated in the Certified Animal Waste Management Plan (CAWMP)?
14. 3) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Recgrds & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
I & Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified A WMP?
❑ Yes o
El yeslNo
o
❑ Yeso
[I Yeso
❑ Yes
10EMMET
❑ Yes J7 No
❑ Yes No
El Yes o
❑ Yes No
❑ Yes No
❑ Yes INO
o
El Yeso
El Yeso
❑ Yes
No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
s
ffl��El eld Copv
El Final Notes
F
FLn
Reviewer/Inspector Name M �:.. �
rr�r ru
'�'�i
Reviewer/Inspector Signature:
Date:
3
Continued

Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ® Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number p Date of Visit: Time:
rO—N—otOperational Q Below Threshold
Permitted M Certified [3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: .............
t' /[/G��C r�4d County a
Farm Name: l....GIR.. � . •.........1................................................................
.... ............................... .............
OwnerName• a%...... �............................. ................................. Phone No:......................................................................................
Facility Contact:
Mailing Address:..
Onsite Representative:..•....._- .,,/1
Certified Operator: ........... zllleo1l...
,sd�
Location of Farm:
Title:
Phone No:. ...................................
................
Integrator:...... .................
Operator Certification Number: ............................. . .........
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • �� �« Longitude • �s �`.
Design : Current Design Cnrrkit._ Design = "Curi^ent 3:
-Swine .Pointry Capacity Cattle Pouiadon Ea ci :y Po tilatiaa ..'
Wean to Feeder Layer ❑Dairy =
❑ Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish
':. Total°DesltgnCapacity
❑Gilts
❑Boars Total SS
LW
Number of Lagoons / ` ❑ Subsurface Drains Present 11OLagoonArea ❑ Spray Field Area =`
rap ❑ No Liquid Waste Management System
Holding Ponds / Solid T s -
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
[XNo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes
allo
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
O No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
IN No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
WNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier ze ��
Freeboard (inches):
5/00
Continued on back

Facility Number: O 9— 3 Date of Inspection Printed on: 1/9/2001
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
closure plan? ❑ Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes XNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ;R`No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes XNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes 19No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes K No
I4. a) Does the facility lack adequate acreage for land application? ❑ Yes KNo
b) Does the facility need a wettable acre determination? ❑ Yes KNo
c) This facility is pended for a wettable acre determination? ❑ Yes allo
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? Cy�c�,�,c�,;G,.f�.� �.�+✓ ate)
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
{ie/ W yy, check) ,design, maps, etc.)
19. Does record keeping need improvement? (ie/(rrigation, eeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0; o•AQi;atiQds'or- dtrfeienci0 - t�'re it0ted• duririg this;visit: Yoh w�l >rec�iye �}o fu4-t�gr . .
:: .CtiriesootideiRce abauti this visit: ................:...:.::.:....:...... :
❑ Yes Wo
❑ Yes Pj No
❑ Yes RNo
❑ Yes )'No
Ayes ❑ No
❑ Yes XNo
❑ Yes J9 No
❑ Yes P'No
❑ Yes '`No
❑ Yes P No
❑ Yes Wo
llle��-Wxza AL
I y �d,+r� �'���esfyo� yoa c�ir.�f� a.� wi.�• �rE �/�e°oets�
Oc�u.«1 4�' 1vi-- r GA�� its I� /tEsu��o1C 41,C rr 11W
Reviewer/Inspector Name -
Reviewer/Inspector Signature: �.5� Date: /� �/ S/170

Facility Number: O — Date of inspection / a/ Printed on: 1/9/2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below XYes ❑ No
liquid level of lagoon or storage pond with no agitation?
2T Are there any dead animals not disposed of properly within 24 hours? ❑ Yes RNo
28. 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)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes $j No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes JK No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 10 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? KYes ❑ No
5/00

Ms I!� ,d., i 6- W
Type of Visit: Q'Com fiance inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: S rvl Arrival Time: I I1 M-I Departure Time: -p County: �y� Region:
Farm Name: kc Qa f t S A`U�S`'��
Owner Name: Sh a rt d� r3 f c,o l `zi twt L-L&
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: C 01, f -i i wl`�� Title: Phone:
Onsite Representative: Integrator: M i-� - `S
Certified Operator: G 1 LJF U G ri c Certification Number: 0 1fy 2-
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity .Pop.
Wean to Finish
Design Cnrren#
Wet Poultry Capacity Pop.
La er
Design Current
Cattle Capacity Pop.
Wean to Feeder
Z. pp
(jam
Non -La er
EE3Pja
airy
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Design Current
D . P,oult , Ga act P.o
airy er
r="
Farrow to Finish
Layers
er
Gifts
Non -La ers
rBoars
OtIN her
Other
Pullets
Turkeys
d Cow
I
Turkey Poults
10ther
Discharges and Stream Imoacts
1. Is any discharge observed from any part of the operation?
,❑ Yes
[J o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[::]Yes
[:]No
EINA
❑ NE
b, Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
Q>,K
❑ 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
EINA
[] NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[3-1 o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[J�N'o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: - Date of Inspection:
_Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Eg N-b ❑ 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): Z
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
©>ff- ❑ 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
n--Ko ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[3,NcF— ❑ 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
Q-3d'o ❑ NA
❑ NE
maintenance or improvement?
Waste Avolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
io DNA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Lld'N6 ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C 6 //J-IP -S j _ Q
13. Soil Type(s): I iV, tfi ^ "_ _ C -.1~
i
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
0 Yes
[] o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
C -Ko-
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E o
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
Q oo
❑ NA
❑ NE
Reuuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes L_71` o ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes �o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes rNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: jDate of Inspection: u
s
0.24.'Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Q_No-� ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes Ej_b ❑ 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 G2,ble— ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑c -id— ❑ 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 [iie— ❑ NA ❑ NE
❑ Yes [Z[1Na- ❑ NA ❑ NE
❑ Yes [0,Nd ❑ NA ❑ NE
❑ Yes []'1qo ❑ NA ❑ NE
[:)Yes
[3-i-
❑ NA
❑ NE
❑ Yes
❑' o
❑ NA
❑ NE
❑ Yes
No
❑ 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).
) 6 a-05-e- Aa
wt
4-1 l TO - 3 0
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
s!
tk{ r1GD Phone:L 0-433`
Date:
21412015

t �01 rn tj
a _ '- ,Diyiston of°Water Resources � �`
x� Factli Number � � +®�Divi`sto'n�Of Soil and`Water�Conservation
Type of Visit: Q<ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (2rkoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: jQ� n� Arrival Time: , tf Departure Time: County:
Farm Name: �"�`�{oatc WU "-r Owner Email:
Owner Name: _ 6�, ILO" �e f�_v ".5- Phone:
Mailing Address:
Physical Address:
Region: F—Ev
Facility Contact: C,44 1&sv� Ce Title: Phone:
Onsite Representative: < < Integrator: t (5_— S
' g [ -A)0
//�J
Certified Operator: fpov��V'�c f5 c "t Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
.- DestgnCurrentw�
".. Design -
Curren( - - Design C*urrent
�34e f -Capacity Pop „� WetlPoultry-Capac�
Pop '��Cattle Capacety Pop.
F Wean to Finish
M=
La er_
jDairy Cow
Wean to Feeder 400 00
Non -Laver
- Dairy Calf
Feeder to Finish,
Farrow to Wean
' +., �� ' _' Dai Heifer
Design C rru ent Dry Cow
Farrow to Feeder
Dr +Poultry . Ca acity:
Pio Non -Dairy
Farrow to Finish
ers
Beef Stocker
Gilts
on -La ers
Ff
Beef Feeder
Boars
llets
Beef Brood Cow
6. 0.
Ot
Turke s
Turkey Poults
Other
Other
Discharves and Stream Imuacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[3-No-- ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made'?
❑ Yes
❑ No
EE 'NA
❑ NE
b_ Did the discharge reach waters ofthe State? (If yes, notify DWR)
❑ Yes
❑ No
�NA
❑ NE
c. What is the estimated volume that reached waters ofthe State (gallons)?
d_ Does the discharge bypass the waste management system'? (If yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
�No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
&'No
❑ NA
❑ NE
of the State other than from a dischar<(Ye'?
Page 1 of 3 21412015 Continued

Facilih' Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): z
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
�o 0NA ❑NE
❑ No 0 NA ❑ NE
Structure 5 Structure 6
❑ Yes 0-lqo— ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [2'1�10 ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes C1 No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [- No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [] No ❑ NA ❑ NE
maintenance or improvement?
11, Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [3'N10 ❑ 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 [UNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [D I' o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Ea No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes E:j`No ❑ NA [] NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [TNo ❑ NA ❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[�No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check
❑ Yes
[]'No
❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
[ "No
❑ NA 0 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
[ff No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [6No 0 NA ❑ NE
Page 2 of 3 21412015 Continued

1Facili .Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3-M15— ❑ 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 ❑l NT ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly.dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency'?
❑ Yes J ' o ❑ NA ❑ NE
❑ Yes B'31o' ❑ NA ❑ NE
❑ Yes []'No ❑ NA ❑ NE
❑ Yes �o [DNA ❑ NE
❑ Yes C l' o
❑ Yes ENo
❑ Yes Qfi10
❑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).
Reviewer/Inspector Name: Z_w
Reviewer/Inspector Signature:
Page 3 of 3
Phone: `l.tU `q 3 3'3 33 q
Date: ��� `
21412015

type of visit: (eMompliance Inspection U Operation Keview U Structure Evaluation U 'hechnical Assistance
Reason for Visit: tine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: Qa ���'y Owner Email:
Owner Name: ��Cc_6tVt1�'L FF�jV(/l Phone:
Mailing Address:
Physical Address:
Facility Contact: /nt`3 Title:
Onsite Representative:
Certified Operator: _6,4rx �i i91
Phone:
Region:
Integrator: Y( t5 — S
Certification Number: etgl �a
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
(Layer
Non -La er
r ultr.
Design
Capacity
Design
Ca aci
Current
Pop.
Current
P,o
Design Current
Cattle Capacity Pop.
DairyCow
DairyCalf
DairyHeifer
Cow
Non -Dairy
Beef Stocker
Wean to Feeder
W
n,�
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Beef Feeder
Boars
Other
Poults
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ o
❑ NA
❑ NE
Discharge originated at: . ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
E5,KA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
[]No
[!IF —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
[3NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
�o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes dNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facih Number: jDate of Inspection-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
©'tom❑
NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
Ea -NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[] NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
o
❑ NA
❑ NE
waste management or closure plan?
any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environ tal threat,
notify
DWR
7. o any of the structures need maintenance or improvement?
es
FjfNo
0 NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
EE�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
Ef[-'10
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
[r 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): '9 of at i k S(s -0
13. Soil Type(s): rvt-TS 'it a4"fsuS
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Io
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
2<0
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
21 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
O No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ONo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[Ej<o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ETNo
❑ 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
E:rNo
❑ 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
[ 5No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�] No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facili umber: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
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?
3q'o ❑NA ❑NE
0-<0 B-KA_ ❑ NE
❑ Yes F:Ko ❑ NA ❑ NE
❑ Yes [al o ❑ NA ❑ NE
❑ Yes ff'No ❑ NA ❑ NE
❑ Yes [20ONo ❑ NA ❑ NE
❑ Yes [3No ❑ NA ❑ NE
❑ Yes [5'-No ❑ NA ❑ NE
[—]Yes [?)'No
❑ Yes CNo
❑ Yes D No
❑ NA ❑ NE
❑NA r]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).
5we4, , 11 � — 3, 3, P — q , /
t� x4e�4 t o� oc�cw o
7�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: _ 5 1 -
M
Date:
21412011

G
a ws
Type of Visit: Q'Com iance Inspection U Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ® Arrival Time: ;T3 Departure Time: County: � Region:
Farm Name: ® Owner Email:
Owner Name: sk aAlt", V "e gw­r Phone:
Mailing Address:
Physical Address:
Facility Contact: CL. J''`-s [ '" ��rjir Title: Phone:
Onsite Representative: �( Integrator:
Certified Operator: C4 f)r(' r S W Certification Number: C? Z O Sr
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
rent
Design
Current
Design Current
wne=�jvuesign%"ur,
apaciPp.
Wet Poultry
Gapac..ity
on.
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
wo
1Non-La
er
Dai Calf
Feeder to Finish
Dr, P,©nl
Design
Ca `aci
"-
Current
Po ..INon-Dairy
Dai Heifer
Dry Cow
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
sz
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
F
Ut e
I
I Turkey Poults
Other I IMF__F0_thcr
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 [ 1ro ❑ NA ❑ NE
❑ Yes
❑ No
E�t"NA
❑ NE
[:]Yes
❑ No
[]'NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No �TA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes [314o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes ENo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facili Number: - Date of Inspection- NO 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑-15—o ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No Q'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?
es OWWo
❑ 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 [[� Vo
❑ 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 environme threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
es o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes [ o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes [2-No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes Eno
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes vo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C-G� `eotA �` _-� s'"" `96 6
13. Soil Type(s):
14. Do the receiving crops differ from those designated in tl'fe CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes
[y►res
❑ Yes
[aRo
gS�o
�o
❑ NA
❑ NA
❑ NA
❑ NE
❑ NE
❑ NE
[] Yes �io ❑ NA ❑ NE
❑ Yes C3 No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
do
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design [:]Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
Q4No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[-]Yes
❑`No
❑ NA ❑ NE
Page 2 of 3
21412014 Continued

Waciflt.t Number: IDate of Inspection. 50
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ J� ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes [}No— ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Q111;ro— ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [2'lgo ❑ 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 [3-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 Lallo ❑ 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
Q'Ro
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ErNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ENo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[a No
❑ NA
❑ NE
Comments (refer to question ff): 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).
.,
ot��c7 � ('Oe
o v e '4"'
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Us_'Us
Date: if) Is _
21412014

It
Y1k5 1:�, Oct, JL1 -9Z
Type of Visit: (Rom Lance Inspection Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: (V outine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
It j� Arrival Time: Departure Time: _ � ^ Date of Visit: l� p County: Region:
Farm Name: Dom" Owner Email:
Owner Name: �^ �� A G Phone:
Mailing Address:
Physical Address:
Facility Contact: e- Title: Phone:
Onsite Representative: < < Integrator: qg-f-'? _
Certified Operator: l Certification Number: ! O fe Z
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current
Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
A &00
S J
Non -La er
I
alf
Feeder to Finish
Da' Heifer
Farrow to Wean
Design Current
Dry Cow
D . P,oul Ca act l'op
Farrow to Feeder
Non -Dairy
k
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
OtI
I
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes ❑ No
[3-'K'A ❑ NE
[3'<A ❑ NE
[:]Yes [:]No E NA ❑ NE
❑ Yes [� ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3
21412014 Continued

Facility Number: 90 jDate of Inspection:
Waste Collection & Treatment
l 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [j4_NrJ"' ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No Q-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
[D-Ner❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[�J�o
❑ NA
C] 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
QX°
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
U '"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
]o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Qgo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [f No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window /j❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): ✓ .cQ� 96- 0
13. Soil Type(s): c UaP
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[�Vo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[D No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[:go
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q 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
B"No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ZNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E!fNo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Fasil—ity Number: - Date of Inspection: 70 DEC,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ -N-o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes [�Ko [DNA ❑ NE
the appropriate box(es) below_
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[:]Yes
�No
❑ NA
❑ NE
[:]Yes
h10
❑ NA
❑ NE
[:]Yes
[ fqo
❑ NA
❑ NE
❑ Yes dNo ❑ NA ❑ NE
[:]Yes �No ❑ NA ❑ NE
❑ Yes ETNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliancc of the permit or CAWMP? ❑ Yes [r No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes Ea No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ZNo
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Phone:
Date:
2/4/2014

Type of Visit: QX-xr6pliance 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: ' /< <$' Departure Time: / j County: �%-
f / 1/
Farm Name:11 )'Q,r/yrShGt Owner Email:
Owner Name: %--� `QrS rir �� Phone:
Mailing Address:
Physical Address:
Region: EI, fl
Facility Contact: 4��ir Title: Phone:
Onsite Representative: Integrator: ,.
Certified Operator: S Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Wean to Feeder
Design C►urrent
Capacity Pap.
OCR
Wet Poultry
Layer
Non -Layer
Design
Capa..city
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
DauyCalf
Feeder to Finish
Farrow to Wean
�+ r �,�
urrent
V . P,oul o A
Wlapaczi
DairyHeifer
D Cow
Non -Dairy
Farrow to Feeder
Farrow to Finish
Layers
Non -Layers
Pullets
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Boars
Other
d0ther
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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 (allo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [—]No
❑ Yes [N No
[:]Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

[Facility Number: - Date of inspection: /
/
`. Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
,[ No
❑ NA
❑ 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): 10�3
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes
EL 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
ja No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
allo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
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 0,No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12_ Crop Type(s): L�7 /`/tlkdd. vr-r -Z.- C i
13. Soil Type(s): G r- 1,4 fp,7-- _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ff No D NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes M. No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 5g No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�No
❑ NA
❑ NE
1$_ Is there a lack of properly operating waste application equipment?
❑ Yes
� No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
2jNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
ELNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes
&No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 oj3
21412011 Continued

[Facility Number: T - Date of lns ection: -f 3 a,D/
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 gl 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? C] Yes 0 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 CA WMP?
33. Did the Reviewerlinspector 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 �Zj No ❑ NA ❑ NE
[:]Yes 2LNo ❑ NA ❑ NE
❑ Yes MNo ❑ NA ❑ NE
❑ Yes 2gNo ❑ NA ❑ NE
❑ Yes E&No
❑ Yes �. o
❑ Yes [.No
❑NA ❑NE
❑ NA ❑ NE
❑NA ONE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name
/a►►—• Phone: O 33Y�3�0
Reviewer/Inspector Signature: Date: p_l3 'Rd/f/
Page 3 of 3 21412011

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: C!2� Arrival Time: i? D Departure Time: ; p County: Region: Y=7 {7
Farm Name: �71� j n f* �—�k 1�wner Email:
Owner Name: %� ; „L,�yft,n c Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: 6,.c+ e Integrator:
Certified Operator: !',.� Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
`Design Current
Wet Poultry z _ Capacity.. Pop...
Design Current
Cattle Capacity OR
Finish
La er
Dai Cow
o Feeder d -o -
Eo
Non -La er
Dai Calf
to Finish
"" -
DairyHeifer
Farrow to Wean
" D sign -urrent
Cow
Farrow to Feeder
D Poul Ca city Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [21 No ❑ NA ❑ NE
❑Yes
No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
JaNo
❑ NA
❑ NE
❑ Yes
E[ No
[] NA
❑ NE
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection:
— /3
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):T
Observed Freeboard (in): 3
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
[a 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
0 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
R] No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
I I - 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): 62LA f r�l�A'_S�r_.�I 1 col-K
13. Soil Type(s): C e %f T T
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
g No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
eo
❑ NA
❑ NE
I & 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
UCr 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
NNo
❑ 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 ELNo
❑ 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 � No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ 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 ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 01 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 DNA ❑ 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, aver -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 [Un No D NA ❑ NE
❑ Yes ram] No ❑ NA ❑ NE
❑ Yes g No ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes No
❑ Yes � No
❑ Yes 0No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ff): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better exnlain situations fuse additional naves as necessarvl.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: W-33yo
Date: T2,�--Z/3
21412011

t ype of visit: we-t'ompuance inspection v vperatiun iceview Lj z5trneture r valuation V i ecunrcai Rsststance
Reason for Visit: routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: ,'f A County: {� Region:
Farm Name: ���:., �t/i1Cs G. Gr r f' C/ AZle,rjf3�ner Email:
Owner Name: �¢ j1 r r) i�Q mains .fin Phone:
Mailing Address:
Physical Address:
Facility Contact: (1 Title: t, -- Phone:
Onsite Representative: fA—.0 Integrator:
Certified Operator: S
Back-up Operator:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
Design Gnrrent
Swine Ca aei Po
• p ty p.
Y
W e t�P�oultr.
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
"° ` .
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . 1?oa!
Ca aci
P.o
Non-Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other.
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes NNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes C&No
❑ Yes INo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: - Ds ection: �
Waste Collection & Treatment
t 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 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
n 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 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
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
[!SNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes M 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): j!r, A!F //��� �t _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [g No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? Yes �� ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ 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 [3 No ❑ NA ❑ NE
❑Yes ®No ❑NA ❑NE
Required Records &_Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes UNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes C No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ® 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: - 4C Date of Inspection: TV /
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 L&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?
15 40/"0're_r3
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑NA ❑_NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ®.No ❑ NA ❑ NE
❑ Yes MNo ❑ NA ❑ NE
❑ Yes [allo ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes [], No
❑ Yes ® No
[:]Yes L&No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Date:
21412011

0
Type of Visit Q-Compliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: .��(� Departure Time: ; L3a 'County: Region: O
Farm Name: J![��f /—,Iv�•
e'*tS �r/1C= ul/[iDd;� /p.,4 er Email
Owner Name: All / ri - rz2A 3 /1 el Phone:
Mailing Address:
Physical Address: -,-7-
Facility Contact: Title: /9//l/1 s9— Phone No:
Onsite Representative: ��-�d Integrator:��`
Certified Operator: Operator Certifiea ion Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e = f = Longitude: = ° = i = N
Design Current IDesign Current Design Current
Swene CapTrcity Popu� lativn Wet Potry�Capa�ity Population Cattle ' Capac"�ty Population
❑ an to Finish ❑ La er El Dairy Cow
Wean to Feeder -Layer El Dairy Calf
❑ Feeder to Finish ❑ DairyHeifer
El Farrow to Wean D Poultry El Dry Cow
rY�
El Farrow to Feeder ElNon-Dai
El Farrow to Finish ❑ La ers
El Beef Stocker
❑ Gilts ElNon-Layers ElBeef Feeder
❑Boars ElPullets
❑Beef Brood Co
,� ❑ Turke s _
Other ❑ �`"--- �_
Turke Poults
❑ Other ❑ Other ;� Number of 5tru_ctures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
J.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 past discharge from any part of the operation?
❑ Yes
J&No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
%-No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — /p3 Date of Inspection
Waste Collection & Treatment
't 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): f }
Observed Freeboard (in): 2
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes J4 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not -properly addressed and/or managed ❑ Yes KNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
19 No
❑ NA
❑ NE
8. Do any of the stuctures 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
5?�No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
®No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Callo ❑ 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) l +< it L Ae
13. Soil type(s) e J- r Z 7-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [A No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? J01yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ yes P No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes 9LNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ®..No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
wI�-'d'
- '-dad
5.
��
Reviewer/Inspector Name I Phone: :33ac�
Reviewer/Inspector Signature: Date: /!
Page 2 of 3 12128104 Continued

Facility Number: — & 3 1 Date of Inspection I Z_/
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 7] No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWW readily available? If yes, check ❑ Yes JZNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑Maps El Other
21 _ Does record keeping need improvement? If yes, check the appropriate box below. j.Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard EffWaste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
B No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
9 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Q�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
ER No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[a No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EgNo
❑ 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
U No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31 _
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
RNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
allo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
12128104

Type of Visit Compliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 49 Routine Q Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: L �7{�I Arrival Time: A� Departure Time: �W�, County: 8 L"'("
Farm Name: �yi U-✓F-�-, a6S �1 Owner Email:
Owner Name:.M S>Gi Phone:
Mailing Address:
Physical Address: 'r
Facility Contact: Ctets„ 1;�_ YatP Title:
Onsite Representative: u
Certified Operator: u
Back-up Operator:
Location of Farm:
Latitude: = n
Region: F-y.
Phone No:
�p
Integrator: I�r uwo"— i& yn I (1C
Operator Certification Number:
Back-up Certification Number:
u Longitude: = ° 0
Design
Current
Design Current
Design Current
Swine Capacity
Population
Wet Poultry Capacii'AP opulation
Cattle Capacity Population
Wean to Finish
❑ Layer
_
❑ DairyCow
Wean to Feeder
❑ Non -Layer
❑ DairyCalf
Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ Cow
❑Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
Non -Layers
❑ Beef Feeder
Boars
❑ Pullets
❑Beef Brood Cowl
❑ Turke s
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of 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
�9NA
❑ NE
❑ Yes
❑ No
PNA
❑ NE
❑ Yes
❑ No
�9NA
❑ NE
❑ Yes
�)No
❑ NA
❑ NE
❑ Yes
PNo
❑ 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 N No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No DR NA ❑ NE
Struct re 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 MNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes W 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 j'=0 No ❑ NA ❑ NE
$_ 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 [l Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes "No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 6No ❑ 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 Windro�w� ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop typenn
s) �Y. -M ula
13. Soil type(s) A qa'/1 S4 0 cecfi , (j
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes (LNo ❑ 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 acre determination ? ❑ Yes � No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes M No ❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment? ❑ Yes ,&No ❑ NA ❑ NE
_..._ _
Comments (refer to. question #): Explain -any YES answers and/or any recotnmendahons ar�asiy other commentsUse drawings of facility to better explain situations (use additionaFpag-es as neeessary)r
G�j Gx"t f-Q Cm-. d
ReviewerAnspector Name � Phone: 10' r33�
Re-*iewer/Inspector Signature: Date: % D
IL/L6/V4 Laminuea

Facility Number: — Date of Inspection Tay
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes t No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes K 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 [fNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes k9 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
J9 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
^%No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
RNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
D Yes
PNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
O)No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
P No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[�No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
(4 No
❑ NA
❑ NE
12128104

Type of Visit i♦ Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: = H Departure Time: rN County: Q en Region:
Farm Name: All Z 1rrn Clz4zltez.. _ Owner Email:
Owner Name: A-1 f �ar/YiS t li /V Phone:
Mailing Address:
Physical Address:
Facility Contact: Cja, De —van Title:
it
Onsite Representative:
Certified Operator:
Le
Back-up Operator:
Phone No:
Integrator: �Uoff_� Q q
Operator Certification Number: / e07 qd`
Back-up Certification Number:
Location of Farm: Latitude: Q c =' = tl Longitude: E__1 ° = A = u
t
Des' n Currenf .
gg
FDesi n Curre nt
„
Design Current
ine.14Capacity
Populat,on
-.-c
Wet Poyltrypaty
1?opulat�on
_,m,
Cattle @opacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
Wean to Feeder
b
�
Non -Layer
El Dairy Calf
El Feeder to Finish
, '
fir,
DairyHeifer
❑ D Cow
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
..;''
❑ La ers
❑ Non-Dai
❑ Farrow to Finish
❑ Gilts
❑ Non -La ers
❑ Beef Stocker
❑ Beef Feeder
❑ Boars
❑ Pullets
ElBeef Brood Co
_..:
Other
❑ Turkeys
Turke Poults❑
Other
PEIDther
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
'FNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
[PNA
+�
❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
El 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
A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — b3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�3 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
PNA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
It
Observed Freeboard (in): yp
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
FZNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
LNo
❑ 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 9No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes `t' 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 El Yes No ❑ ❑ NA NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need []Yes UNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 1ANo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s) Wr qs-6( Strmcida G _c6
13. Soil types) AJL4A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
WNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
9[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
91 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
*No
❑ NA
❑ NE
0=4)
• ml I`n P fro% c s's o'F / , :� -P'v 51 c.,J3
W� W r !�'f /� 1 Gv��4y �►^p1�l�'' 0J7Crt`r C S
�
brb�e . N4._ � f rev K t 4 S 24- sr✓4�� 4
wv
ri_ r
Reviewer/Inspector Name JY Phone: A7/0i111.03 J�A:10
Reviewer/Inspector Signature: Date:
rage L of .s "1461v4 a..uru1"UEU

Facility Number: — Date of inspection 0
Reouired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes F1 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ maps
p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes to 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 P No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes A No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes nNo ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes E,No ❑ NA [I NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
F] No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
FPNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�jNo
❑ 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
FINo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�RNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
RNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ill No
❑ NA
❑ NE
Additional Comments and/or Drawin s �
g - _ YH,
Page 3 of 3 12128104