090066_INSPECTIONS_20171231

I ype of visit: Wc.:ompttance inspection V operation xevtew V structure Evaluation U lechnical 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: c7 County:
Farm Name: _ r �1 n �Zr. €x%r,4Lf!= Owner Email:
Owner Name: ✓ 6 �,� Phone:
Mailing Address:
Region:x-0
Physical Address:
Facility Contact:`r- y�Y Title: Phone:
Onsite Representative: Integrator: A& F), _�Jp tJ
Certified Operator: Certification Number:
Back-up Operator: I Certification Number:
Location of Farm: Latitude:
Longitude:
Discharees and Stream Impacts
1 _ Is any discharge observed from any part of the operation? ❑ Yes 2 No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
I
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
Design Current
❑ NA NE
Design
Current
Design Current
Swine
Capacity Pop.
Wet:Poultry
"'r;
Capacity
Pop.
. Cattie Capacity Pap:
Wean to Finish
2. Is there evidence of a past discharge from any part of the operation?
La er
No
❑ NA
- Dairy Cow
Wean to Feeder
❑ Yes
Non -La er
❑ NA
❑ NE
Dairy Calf
Feeder to Finish
!
p'
Dairy Heifer
Farrow to Wean
Desigu
Current
Dry Cow
Farrow to Feeder
D , Moult ,.,'�;,
Ca aci
Pio
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
on -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
•
Turkeys
;
Other
Turkey Poults
Other
OtherU
Discharees and Stream Impacts
1 _ Is any discharge observed from any part of the operation? ❑ Yes 2 No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
I
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
[:]No
❑ NA NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than. -from a discharge?
Page I of 3 2/4/2015 Continued

[Facility Number: - Date of Inspection:
A
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 l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): T
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 which are not properly addressed and/or managed through a ❑ Yes &jNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? [&Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes JZ 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 ayes Poo ❑ 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 9No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,Ln, 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 fo No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? &jYes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes t�j No ❑ NA ❑ NE
acres determination?
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
0 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
%. 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. N Yes [—]No
0 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 2 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 2/4/2015 Continued

[Facility Number: jDate of Ins ecdon:
❑ Yes
No
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
allo DNA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
allo ❑ NA ❑ NE 16, .
the appropriate box(es) below.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ Failure to complete annual sludge survey E] Failure to develop a POA for sludge levels
❑ NA
❑ Non-compliant sludge.levels in any lagoon
permit? (i.e., discharge, freeboard problems, over -application)
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
EjSNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
B No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
E4No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
❑ NA
❑ NE
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 I . Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[:]Yes
® No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes ,Y� No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #)„ Ezglam e-ny: ES answers and/or : any addiflanal om uendatinns,or any other corE =meets. M k;
h p ( p R ry).,...
llse:drawu► offacilL to better ex Iain setuations use_additional pages as necessary
N,
mj, !/ lZ � ►w La /� C. �1� � ��` .��/,� ?� �� �?/,�J'�-- 1.fJ� ► � �G Gr -t c� z - '
you ai7- 0,P12 ts ) ,7 PJI) L/
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �/U - 3DB Dt✓`!/
Date: 2" =fir 1 %
2/4/2013 1 1 ,'4

!i
44
iy�visit. v.^-ompuance inspection v uperatton meveew u �trucrure Evaivanon V iecnmmcai Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: E_7tEg Arrival Time: '3o Departure Time: 'p c? County: Region: )9Zb
Farm Name: Ala ✓z Cpl / e- Aborerz Owner Email:
Owner Name: �4Z-a"I/,f/4z Phone:
Mailing Address:
Physical Address:
Facility Contact: f�,.b.�' f�Y ji Title: C G Phone:
T
Onsite Representative: cry_ Integrator: �4d►�Qdi7C�1LIl?
Certified Operator: '--A Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Dischar gs 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 12No ❑ NA ❑ NE
❑ Yes
DesignVZOurrent
❑ NA
Design
CurrentDesign
Curren#
" Swine
Capacity Pop.
Wet Ponitry
Capacity
Pop.
Cattle Eapaeity Pop.
Wean to Finish
La er
I
ai Cow
Wean to Feeder
jpp p
Non -La er
airy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
ffi.jrP,ault ,
Ca aci
Pio
Nort-Dairy
Farrow to Finish
Layers
Beef Stoeker
Gilts
Non -Layers
Beef Feeder
k�Y
r Boars
Pullets
Beef Brood Cow
Turke s
. Other
Q
Turk Points
Other
Other
Dischar gs 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 12No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes [:]No
❑ Yes El No
❑ Yes MNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page J of 3 21412015 Continued

Facili Number: IDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
S 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): T
Observed Freeboard (in): {�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
2 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
[Z No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
O 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
[a Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
P No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect ]and application? If yes, check the appropriate box below. ❑ Yes ER 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):/F
13. Soil Type(s): �it/7'-e-
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? S Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes � No ❑ NA ❑ NE
❑ Yes S No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily availab] e? ❑ Yes C4 No Q 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. S Yes ES"No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ZWeather Code
❑ Rainfall 0 Stocking ❑ Crop Yield ® 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ®No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes C2 No ❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facill Number: - /r jDate of Inspection: }-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo ❑ NA ❑ NE
t
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes �&No ❑ NA ❑ NE
❑ Yes [ No
❑ Yes &No
❑ Yes 10 No
00
y
[Z' / %� Y�s�r�� l Dom/
Reviewer/Inspector Name:
Reviewer/]nspector Signatui
Page 3 of 3
❑ NA [] NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone:
Date:
21412015

l'ype of Visit: CJCompfiance Inspection U Operation Review Q) Structure Evaluation (.) Technical Assistance I
Reason for Visit: Orgo—u- tine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:—� / Arrival Time: p Departure Time: 3 ; /S County:
Farm Name: HQ'-V>�X e0j1, Owner Email:
Owner Name: ?L�e-d� �O� l
Mailing Address:
Phone:
Region:
Physical Address:
14
Facility Contact: 4, Title: G� rG Phone:
Onsite Representative: (`rj�yp Integrator: 'Oksz"'/"' / N.. Z'V44-
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Pmou�tryCapacity
Pap.
Cattle Capacity Pop.
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Wean to Finish
❑ No
La er
❑ NE
aig Cow
Wean to Feeder
p
Non -La er
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
airy Calf
❑ No
Feeder to Finish
❑ NE
-, , , .. est _._ ...._..
❑ Yes
Da' Heifer
Farrow to Wean
❑ NE
"' '` Design
Current
Cow
❑ NA
Farrow to Feeder
of the State other than from a discharge?
Dr nP,oulCa aci
P,o
Non -Dairy
Farrow to Finish
I a ers
Beef Stocker
Gilts
-Layers
Beef Feeder
Boars
Pullets
Beef Brood Co—
owTurke
Turkeys
s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
allo
❑ 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 the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
allo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
�K No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 1/412011 Continued

FaciliNumber: -C Date of Inspection: — f
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[LNo
❑ 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): C
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[0 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
R] 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?
ER Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
5jNo
❑ 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
5g No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
JKNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window Evidence of Wind Drift D Application
Outside of Approved
Area
I❑
12. Crop Type(s): epe vL /W t"-J
13. Soil Type(s): lei
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
0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
O No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® 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 ❑ Desigm ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below, ❑ Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes El No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2o11 Continued

Facility Number: -LL Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Callo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Eg 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 fust survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes �No E] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 0 No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ® No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes EA No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Use
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:)Yes
[&No
❑ NA
❑ NE
Comments
(eff�rj Question.�:..Explain any YES answers and/or any additional recommendations or any other comments.
drawings ,
facility to better explain situations (use additional pages as necessary).
'V,Al'" z---- q-!! -- Py'
YL�
/`rDFS `' lyre �1fS LUO, A,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9,-YD—`133-3M0
Date:
2/4/2011

,f
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 01foutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: /3 Arrival Time: Departure Time: ! p County: Region:
Farm Name: ..'V el
Owner Name: airy
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: �1 Title: Ole, _ _! Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number: % 79L/ (�
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design Current
[:]No
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
CattEe Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I INon-La yeT
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D , $ouI# .
Ca aei
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
113eef Feeder
Boars
Pullets
113eef Brood Cow
-
Turkeys
Other
Turkey Poults
Other
Other__JzE
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ER No ❑ NA ❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes to No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

Facili Number: q- Date of Inspection: — /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):�
Observed Freeboard (in): !�
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ NA ❑ NE
❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes (0 No ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
Cj�. No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public heaith or environmentai
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
M -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
0 No
❑ NA
❑ NE
maintenance or improvement?
Waste ARplication
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. C' 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! 0 Application Outside of Approved Area \
12. Crop TYpe(s) �l' a _I ®✓�r�,rr�. K�L A,nL — W k f c 0 r✓�- 1
13_ Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes §1 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of property operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
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 ® 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 Ed No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:)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
[DNA ❑ NE
❑NA ❑NE
Page 2 of 3 2/4/2011 Continued

Facili Number: -ja jDate of Ins ection:-- S`_-1 3
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 [Z 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 [S No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes Pj No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [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 ® No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
10 No
❑ NA
❑ WE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
® Yes
❑ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA
❑ NE
lComments (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).
1~r-1 if 4310 a Y /no���. o'Lo 13 .
Th
T h IFAr►r� s ✓ Y � j' /�c �� rrr� /3?e�-sr cam' /ylr` B ' 1 LA
�G,ST��rr1
,, u'�� t� e��, �d� `fig �cl
11f ff , ;t. &--c-
l��'n f• �n��� t� X
�r hof 4-Y-- i yr o
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: t/a— ,33 33,0o
Date:s d�D 1-3
21412011

r
v SOI PG 0 (2
� ivision f Water Quality �.'J.
Macifiliber - 4, Division of Soil and Water Conservation �� ���_
•0 Other Agency
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: / Arrival Time: Departure Time: r,3 County: ffk6 s-•-_ Region: FR a
Farm Name• 9ZYt I 6AJI= Ak S.in!`X
Owner Name:tf eke
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Agier&tW 6044v—, Title: 4*.,'~ %— Phone:
Onsite Representative: /.r fflee&;!� Integrator:
Certified Operator: /y ffr►40rj/ Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pap.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I lNon-Layer
Dt, Paul
Design
Ca aei
Current
P,o
Da'y Calf
Dairy Heifer
Dry Cow
Non -Dairy
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys__
Turkey Poults
10ther
lReef Brood Cow
Other
Other 11
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)
[—]Yes 50 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No [] NA ❑ NE
2. is there evidence of a past discharge from any part of the operation? ❑ Yes ® No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

a
Facility Number: - Date of Cns action:
z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes C!�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): r
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes Qg No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes ' o
❑ NA
E] NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ZLNo
[3 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 F%/_1 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Windo ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): {/ ,i, -pc �(CCI�,�rV_
13. Soil Type(s): 4 T
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E2No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Ia 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 f` No ❑ NA ❑ NE
[:]Yes [n No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Z] 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
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l " 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 2/412011 Continued

lFacility Number: Date of Inspection:
* 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Qj No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes [K 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 EK No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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 IN No [DNA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
(DNA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: -1700
1
Date: ,--3-,;2b / ;'L-
21412011

0
"I
Access
Date of Visit: Arrival Time: Departure Time: %'t�(% County: 'ti Region: 2LED,
Farm Name: 44g, -A -p, Owner Email:
Owner Name:' C�Phone:
Mailing Address:
Physical Address:
Facility Contact: �� �' Title:Phone No:
Onsite Representative: f`��-� Integrator: &.ene
Certified Operator: Sa* <-- Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [� e [�' 1-11,
Longitude: [= ° [= d =06
Discharges & Stream impacts
❑ La ers
❑Non -La ers
❑ Pullets
❑Turke
❑
❑ Other
type of Vistt Q�pliance Inspection (� Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit outine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑ Denied
1. Is any discharge observed from any part of the operation?
Des' n Curre
a %ula nt -
!!Design
Current; Design Current
Swnre
Ca i Po
p ty p hon
Wet Poultry
Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ 1_a er I
I❑Dai Cow
Weanto Feeder
JE1 Non -Layer I❑Dai
Calf
Feeder to Finish
❑ No
[:3 NA
f ❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
El Yes
❑ INUH-LAILrY
❑ Farrow to Finish
El NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Beef Stocker
❑ Gilts
El NA
El NE
10 Beef Feeder
❑ Boars❑
M No
El NA
Beef Brood Co
-
s
-
Other
P
Turkey Poults
Condnued
❑ Other
-K_-.
Number of Structures:
Discharges & Stream impacts
❑ La ers
❑Non -La ers
❑ Pullets
❑Turke
❑
❑ Other
type of Vistt Q�pliance Inspection (� Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit outine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑ Denied
1. Is any discharge observed from any part of the operation?
[]Yes
J&No
[:INA
❑ NE
Discharge originated at: El Structure El Application Field C3 Other
a. Was the conveyance man-made?
El Yes
❑ No
El NA
El NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
❑ No
[:3 NA
El NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
El Yes
11 No
El NA
El NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
N No
El NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
M No
El NA
[:1 NE
other than from a discharge?
Page I of 3
12/28/04
Condnued

• Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 19
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
9JNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6_ Are there structures on-site which are not properly addressed and/or managed
❑ Yes
ELNo
[INA ❑ 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
M No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
9jNo
❑ 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
p Yes
[X1No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
KLNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
2I.No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) wee
13. Soil type(s) g./ ^
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑
Yes
❑ No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA ❑ NE
Reviewer/inspector Name Yom- p-.-- v '"` Phone: O O a
Reviewer/Inspector Signature: Date:
Page 2 of 3 12/28/04 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 5& No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ZNo ❑ NA ❑ NE
the appropirate box.
❑ WIIP El Checklists El Design El Maps [:1 Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes KNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes M No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 01 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
allo
❑ 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
1ZNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
KNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
4No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[--]Yes
allo
❑ 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
MNo
❑ 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
0,No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
ERNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
Jj4jNo
❑ NA
❑ NE
f ditional Coen a or
Jw
Page 3 of 3 12128104

e
I
Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 151foutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time:Q�, I Departure Time: �Q (� County: �� Region:
Farm Name: arr/t�' 4fdX/' Nu/�/ r !� Owner Email:
Owner Name: _ Q iflenf-4 �d D �� - Phone:
Mailing Address:
Physical Address:
Facility Contact: /i���1/cy �O� /� Title.•
Onsite Representative: oca I
Certified Operator: __3
Phone No:
Integrator• r"s'
AV
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =0
= =Sd Longitude: 0 0 [= � =11
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
El Yes 19No 11 NA El NE
❑ Yes
❑ No
❑ NA
❑ NE
Design Current
Swine Capacity Popalation
❑ Wean to Finish
Design Current
Wet Poultry apacity Population
C
❑ La er I
Design Cuulatrrent
Cattle Capacity Popion
❑ Dairy Cow
Wean to Feeder (o00 3 DO
11❑ Non -Layer I
❑ Daixy Calf
❑ Feeder to Finish
Dry Poultry
❑ La ers
ers
❑ pullets
❑ Turkeys
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dai
❑ Beef Stocker
ElBeef Feeder
El Beef Brood Co
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ No
PE]Boars
� No
Other
❑ Turkey Poults
❑ Other FEE]
Number of Structures:
❑ Other
❑ NA
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
El Yes 19No 11 NA El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
� No
El NA
[j NE
❑ Yes
Z1No
❑ NA
❑ NE
Page I of 3 12/28/04 Continued

Facility Number: Date of Inspection
• Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 21 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes (a 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 ERNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [RNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes CKNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10%orf 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)r
r -
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[H No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[N No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
®.No
❑ NA
❑ NE
E lain aiiv YES.ansH?ers and/,
Coi�tments {re#er torquestioh*): xp , '. or any recommendat,ons or any other�comments.
ty. al es as necessary) ,r4
Use drawzn s,of faca>a to better explain sifuahons ns use addttionpag
/Me; �44
Reviewer/inspector Name ggo
1 p.4 Phone:2 74
Reviewer/Inspector Signature: Date:
Page 2 of 3 12/28/04 Continued

Facility Number: Date of Inspection /D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �&No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes tRNo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists [I Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EgNo ❑ 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
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
-®No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[0 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
H No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
M 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
U 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
Page 3 of 3 12/28104

ivision of Water Quality
Facility Number O Division of Soil and Water Conservation S �_
E2'
- 0 Other Agency
Type of Visit I2)�,dompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Tecbnical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time:, o}} II Departure Time: County:
Farm Name: N % ifOwner Email:
n
n Pr Nnma� i
• JrrV y A L Y PhnnP-
Mailing Address:
Physical Address:
Facility Contact: Q ! '� Title: Phone No:
Onsite Representative: 0 0Mffi;jC—' f �� Integrator:
Certified Operator: ��'' Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Region: /797 0
Latitude: = =6
Longitude: =0=6
006 [= ag
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ La er
[gWean to Feeder 4OR ❑ Non -Layer
❑ Feeder to Finish
--- -- -
Feanedernish
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -La ers
❑ 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 Co
c. What is the estimated volume that reached waters of the State (galtons)?
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 PQ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[a No
❑ NA
❑ NE
❑ Yes ERNo ❑ NA ❑ NE
12/28/04 Continued
1

Facility Number: _ Date of Inspection 3^ c7
f+ Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): 47
Observed Freeboard (in): �__
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes [ZNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes [4 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ® Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [RNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [3No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes W No ❑ NA [:INE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes NNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > ]0% or I0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidencg of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
(9 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
R No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
R No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
91 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):
/r 1
. iJ .�—s $Ddu AaS 8���
ple-05 1 � a�`�j' Srrat�l'a5.J o r Coil
ReviewerlInspector Name ��� fts /�- Phone: jd--y3_�` Soo
Reviewer/Inspector Signature: Date: '3—'3 0 — O
12128104 Continued

Facility Number: Gf' — Date of inspection
Required Records & Documents
19. Did the facility fail to have 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 JZNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
fgNo
❑ 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
[B No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[ZNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E[No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
allo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CA WM P?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
®No
❑ NA
❑ NE
and, report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® 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
allo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
E3No
❑ NA
❑ NE
Addiitional Commeutsand/oDrawmgs
,-<
•
Page 3 of 3 12128104

Type of Visit C-CoUmpliance 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: Arrival Time: i7 Departure Time: County: r'r`
Farm Name: z G d6/� �r�/ Owner Email:
Owner Name: _^�� N*�y _ �b,� Phone:
Mailing Address:
Physical Address:
Region I Z)
Facility Contact: �o� Title: Phone No:
Onsite Representative: �` Integrator: %✓Ly��'�`�
Certified Operator: r Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o =I = N Longitude: =" 0
Design Curren
Capacity Population
to Finish
n to Feeder Q (0 �t�
rrF
Wet Poultrmy _Capacity Population
❑ La er
❑Non -La er
Design Current
Cattle Capacity Populatn
❑ Dai Cow
❑ Dai Calfer
to Finish
"' "`
Dai Heifer
w to Wean❑
D Cow
ow to Feeder`
a. Was the conveyance man-made?
❑ Non -Dairy
m ❑Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
ElNon-Layers
❑ Beef Feeder
❑ 8 oars
❑ Pullets
El Beef Cow
Li Turke s
Other
❑ Other
❑ Turkev Poults
❑ Other I
umber of Structures:
❑ No
❑ NA
❑ NE
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
/[ No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (Ifyes, 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 systern ? (If yes. notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any pan of the operation?
❑ Yes
[?SNo
❑ NA
❑ NE
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
KNo
❑ NA
❑ NE
other than from a discharge'?
Page 1 oj'3
12128104
Continued

Facility Number:
Date of Inspection57jC-) `,0
Waste Collection & 'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Z No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 19
Observed Freeboard (in): 07
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes [Z 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? H Yes ❑ No [INA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes JANo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes K No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes RNo ❑ NA ❑ NE
mai ntenance/improvement?
. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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. Croptype(s) _73 z, 1 ve Srr
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0,No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? Yes o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 0 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes 9 No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes J No ❑ NA ❑ NE
Comments (refer to question#} Explain any YES answers andLor any recommendations ons' heomments.Y
Use drawns o
g iif facility to better explain situations. {use additional pages as necessary) *� -
sw
Alee-'O 0+12->r�
D A,A, )II !_
N S L-L(� -G ✓ G. /��i l V
Reviewer/Inspector Name �— - _- Phone: 9iO ,712
Reviewer/ Inspector Signature: Date:
Page 2 of 3 12/28/04 Continued

Facility Number: — Date of Inspection 0 -v0 -PR",
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2�LNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Q No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists
❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes ZLNo ❑ 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 j4No [INA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? . ❑ Yes Z No [INA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
M -No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
RYes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
2LNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P9 -No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
IgNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
allo
❑ 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
[KNo
❑ NA
❑ NE
If yes, contact a regional Air Qualityrepresentative 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
MNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
Additional Comments and/or Drawtngs r Fs. i,.
Page 3 of 3 12/28/04

b Division of Water Quality S�H�
}
[Facility NumberEY:1-1A0J O Division of Soil and Water Conservation 3 -- t.;;- D'7
O Other Agency
Type of Visit 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:`I D v Departure Time: 3 ; 00 County: +"� Region: L—
Ko
Farm Name: � Cly -!lam(/ Co II --l � A` ",-,5 Owner Email:
Owner Name: tea r V ;$!L, � �O� a Phone:
Mailing Address:
Physical Address: f
Facility Contact: A t b C-14- _��a Title:
Onsite Representative: s�-
Certified Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: =0
❑ , Longitude: = ° [--]1 ❑
Design Current Design Current
Swine Capacity Population . Wet Poultry Capacity Population
❑ Wean to Finish I I ❑ La er
RI Wean to Feeder %D 0 110 Non -La et
El Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
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?
Design .Current'
Cattle Capacity Population
❑ Dairy Cow
❑
Dairy Calf
❑
Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: I
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
12/28/04 Continued

r
Facility Number: 9-64 - Date of Inspection 13- 2r-47
' Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure l Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in): 016,
❑ Yes [8�No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [9 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes 0 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? 5? Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
0 No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
Reviewer/inspector Name F_
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
14 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
,KNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of
Area
12. Crop types)&l jn" / 0V eK: �i!� --
—
13. Soil type(s) W- - YY
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
®No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
19 No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
(9No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
WNo
❑ NA ❑ NE
�, ... ., =. gin.,..,.•... ,. -
Comments (refer,ta question :Explain any YES, answers. and/or any recomirdendations or�any,other,comments ` P ,
Ilse drawings offacility.to better explain situations. (use additional pages as necessary):,-,
Reviewer/inspector Name F_
Phone:
Reviewer/Inspector Signature:
Date:
Page 2 of 3 12/28/04 Continued

E
Facility Number: cr — Date of Inspection
Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ yes 10 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes R3 No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes '0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
tO No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
JSNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
j0 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
f0 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
J91NA
❑ 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
O No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ER No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
rNo
[INA
[:1 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
®,No
❑ NA
❑ NE
Additional Comments and/or Drawings:
I 7nRIAd

Type of Visit QMompliance Inspection Q Operation Review O Structure Evaluation U Technical Assistance
Reason for Visit O Routine Q Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: ® Arrival Time: 3 ; Departure Time: f D O County: Region:
Farm Name: Owner Email:
Owner Name: —Q �y GQ�� Phone:
Mailing Address:
Physical Address:
Facility Contact: T¢F��/� ��' _ _. Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: s�'`C Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o =T
=df Longitude: = o = i =16
rent
Ifiallscity Population
Wet Poultry
Design Current Design CurrenSine
Capacity Population Cattle Capacity Population
❑ Wean to Finish
10 Layer
❑Dai Cow
RI Wean to Feeder L9600 1
10 Non -Layer I
alf
❑ Feeder to Finish
❑ Yes
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ No
ElNon-Dairy
[I Farrow to Finish
❑ Layers
❑ Beef Stocker
' ❑ Gilts
❑ Non -Layers
❑ Pullets
❑ Beef Feeder
❑ Boars
❑ Yes
Beef Broad Co
❑ NA
❑10
Turkeys
2. Is there evidence of a past discharge from any part of the operation?
Other =
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes ,[No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
V4No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
YC'o
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28104
Continued

Facility Number: 9 — Gj
Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ®No [INA ❑ NE
Structure 5 Structure 6
❑ Yes jq No ❑ NA ❑ NE
❑ Yes JA No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 4 No ❑ NA ❑ NE
8_ Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Z No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 9 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes )FdVWI No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes V[No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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 h'pe(s)Yrl�f.8ld
13. Soil type(s) �wy7o'
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 9 N ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ,4 Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 29 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 29 No
❑ Yes &No
El NA [j NE
El NA [__1 NE
Comments (refer to question#}: Explain any YES answers.and/or,any recommendations or any other�comments
Use drawings'.ofFfacility to. better explain situations. (use additional: pages as necessary):
Reviewer/Inspector Name �� 1 Phone: J
Reviewer/inspector Signature:
Page 2 of 3
Date:
12/28/04 Continued

Facility Number: Date of Inspection D6
' Required Records & Documents
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes WNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 55 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. A Yes ❑ No ❑ NA ❑ NE
JO Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i " Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 4 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes W No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[& No
[--INA
❑ 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
14 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
5a No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
D Yes
UQNo
❑ 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
S 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
IS 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:.
Page 3 of 3 72/28/04

Division of Water Qualil}
=acifitymber 9 --_' (d T Division of Soil and Water Conservation
1690 Other Agency
Type of Visit Q<_ompliance 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: ; p Departure Time: a County: +'^ Region:
Farm Name: Y ed9ep t e Nu /'.S�IY Owner Email:
Owner Name: //,rldY17 &t /�p_Jj /e _ ___ Phone:
Mailing Address: 0;;?,2 04 _[� -.� y c 1 ' t%. /h- _ 'id. 6 -in /` as ----
Physical
Physical Address:
Facility Contact: L; Title:
Onsite Representative: —�•-� t' _ _ _ _ _ _
Certified Operator:
Back-up Operator:
PhoneNo:
Integrator:
Operator Certification Number: _1po910
Back-up Certification Number:
Location of Farm: Latitude: 0 e [� I [� « Longitude: =0=s
°=s =
Swine
Wean to Finish
VVean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ Laver
&0o I jab fl I' ❑ Non -La et
Other
❑ Other - -
Dry Poultry
❑ Layers
❑ Non -La ers
❑ 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 Heife►
❑ 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 I& No ❑ NA ❑ NE
❑ Yes
[A No
❑ NA
❑ NE
❑ Yes
2ZNo
❑ NA
❑ NE
❑ Yes
PQ No
❑ NA
❑ NE
❑ Yes
In No
❑ NA
❑ NE
❑ Yes
MNo
❑ NA
❑ NE
12/28/04 Continued

Facility Number: — (� (p Date of Inspection a�
® No
❑ NA
Waste Collection & Treatment
17. Does the facility lack adequate acreage for land application? ❑ Yes
N No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
EgNo [INA ❑NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[&No ❑ NA ❑ NE
Structure 1 Structure ? Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):-r;�
S. 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 property addressed and/or managed
❑ Yes
® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
[X Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
PQ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 13ey-M u -J. FAS-
AS-13.
13.Soil type(s) Wo r
14. Do the receiving crops differ from those designated in the CAWMP?
KYes
❑ 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
N No
[INA
❑ NE
I& Is there a lack of properly operating waste application equipment? ❑ Yes
59 No
❑ NA
❑ NE
�l �LGts9/1/r►/` /7? i &-7r - &V Q•5 P1441T'C0; If J*Wl/ 0 wri" "i d . dlle� s er It 0( W.- G w,4 /
C>/r e Ftr�.�BW el overs
7-4er usYd /Ial-r Ra-�� 000'-- //D Bn s,. „•moi//c-7: ���'`
Reviewer/Inspector Name-- S✓Z+ `- Phone: j.
�j%~15y/�73
Reviewer/Inspector Signature: Date:
12128/04 Continued

Facility Number: Date of Inspection
Required Records & Documents
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 4 No ❑ NA ❑ NE
r
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check PSYes DO o ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design RMaps ❑ 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 J4 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
N No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
(R No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
§0 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
RNA
❑ NE
Other Issues
ru , �-�,, an �x p Ga.z �: �,,. �! r!� yp v t ��.� f� � �S� r� •`•r� /H � .�rw•volar s
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EM No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
KNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
R No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
®,No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
IQ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
yr
Additional Comeau and/orDraRtings
IV pt tri fi 4 at'.
o6d It p Sr G 4 M z'n aIW e +�- r T/t iS d-mv e .
e- b /A -3
ru , �-�,, an �x p Ga.z �: �,,. �! r!� yp v t ��.� f� � �S� r� •`•r� /H � .�rw•volar s
a�r ��� !jam✓� pr-rrl d d`:" .S rfr�
® 7� r/�7.c d �T� r`5 �� rn j•S �r D7LG�cs �' `/O.v /r�rt� ar �✓r�.�/ ri'!R�
12/28/04

Type of Visit • 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: Tune: 9: do
O Not rations! Q Below Threshold
Mle'rmitted Q'Ler65ed 0 Conditionally Certified 13 Registered Date -Last Operated or Above Threshold: --
Farm Name: 1P1brVL07e ee6ieNr./.. , , _ County: .. .. ?o
Owner Name: N r e— Phone No:
F -ay e e
Maiumg Address: ,. . _ kyr/aa 18 �y1
Facility Contact:
Title:
Onsite Representative: 1 .y Cog
[ , �l� r. iT91%fC _.S 9!3
Operator. 14141, . . er rd iU
Location of Farm:
Phone No:
Integrator: A- o iz
Operator Certification Number:
ane oultry ❑ Cattle ❑ horse Latitude Longitude • �' �"
Discharges & Stream h_qpacts
1. Is any discharge observed from any part of the operation? ❑ Yes 2f4o
Discharge originated at: ❑ Lagoon ❑ Spray Feld ❑ Other
a_ If discharge is observed, was the conveyance man -[Wade? ❑ Yes Blqo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ON6--
c. If discharge is observed, what is the estimated flow in galimin-? .�--
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ....._^L..._...__ ___ _ �.
Freeboard (inches): ,i S
❑ Yes [3-No-
11
3- io
❑ Yes [moo'
❑ Yes &No
❑ Yes
Structure 6
12/12/03 Continued

114cP-ity Number: D
Date Of Inspection d -U
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 52-K05
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or ❑ Yes Com'
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 maintenancefumprovement? ❑ Yes 92-lro
8. Does any part of the waste management system other than waste strictures require maintenancerimprovement? ❑ Yes B'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid levelYes o
2�
❑
elevation markings?
Waste Anulication
10- Are there any buffers that need maintenancerimprovement? ❑ Yes [ 0
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ZLi-
❑ Excessive Po ding ❑ PAN E] Hydraulic Overload ❑ Frozen Ground [I Copper and/or Zinc
tto Imo
12. Crop type Cd., . " _f , QedH s
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWNIP)? ❑ Yes PNO
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?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
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
Air Quality representative immediately.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes &M
❑ Yes ❑ No
❑ Yes SNo
❑ Yes ❑-iso
❑ Yes E] -No
--�-�� �' r"--� '�: -.--�-�---��- _ .err .�:-�- r•_�--..:z:= -�'�* _
Cam (relfer�`"gsee�um #k��larn asy Yli� was aad/or any vtr anyeo�erts:� ���.� .�- -
�� offae�iy�to bettrr simsticros.� vte uneo�ry D.FrEId Copy ❑Final Notes �
� L I
lhG�Vtie 400'5 a ! VG%Mvpl�C�
r
Reviewer/Inspector Name
- ax.. � a.w..ec.­_M;
Reviewer/Inspector Signature: 2&4a Date: / U- .;� s
11112103 Cawed

Facility Number: ol Date of Inspection 0 -
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/3wr, cl s, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ R=bear& ❑-W e � ❑
.7-q—,>�1
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29_ Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rambreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
es ❑ No
❑ Yes
9 -NY
❑ Yes
[. M
❑ Yes
Sil-o—
❑ Yes
04-10-`
❑ Yes
(sINO -
❑ Yes
19 -lo
❑ Yes
❑-b1e—
Cj Yes
L-No�
❑ Yes ELNer'
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate boa below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
Q No violations or deficiencies were noted during this visit. You wRl receive no farther correspondence about this visit.
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12112103