090070_INSPECTIONS_20171231

Facility Number
19 Division of Water Quality
0 Division of Soil and Water Conservation t
0 Other Agency'
Type of Visit 0 Compliance Inspection 0 Operation Review % Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency gOther ❑ Denied Access
Date of Visit: 'l pt GQ Arrival Time: �G �epparture Time: County: Region: �L�
Q_ 1
Farm Name: Lu LeARL ► C ` v Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Title:
]Phone No:
Integrator• ' ' f k► r h
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ 0 ❑ , ❑ Longitude: ❑ o ❑ , ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
I I 10 Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design CuWeiit
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes E4 No ❑ NA ❑ NE
❑ Yes
❑ No
g-r( NA
❑ NE
❑ Yes
❑ No
[ANA
❑ NE
jo NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
❑ No
® NA
❑ NE
12128104 Continued

`�i
Divtstou'of Water`Qualpty
Facility Number. O Diviuf So►1 and Water Couservation
Type of Visit p Compliance Inspection O Operation Review % structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency ISCOther El Denied Access"
Date of Visit: t7 Arrival Time: 302 4iparture Time: Ro County: V l R n Region: +
Farm Name: UPa U art" v Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
]Phone No:
Onsite Representative: Integrator: ` ' r U42,bu— Ppm:Q Y\
J
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: o M , 0 Longitude: mom,
M +u
Design Current y
Design Curren J Design Current
Swine
Capacity Populations _ Wet Poultry CapacityPopulatton YC Capacity Population
ElWeanyto Finish
: La er
❑Dai Cow
Wean to Feeder
Non -Layer
RE]
❑ Dairy Calf
❑ Feeder to Finish
El Dairy Heifer
❑ Farrow to Wean
'ILI
-
Dry Poultr'Wr
❑ D Cow
Farrow to Feeder
F
z "�'" `' ❑ Non-Dai
❑ Farrow to Finish
❑ La ers
El Beef Stocker
❑ Gilts
❑ Beef Feeder
[I Boars
El Beef Brood Cowl I
Other I`I
st
❑ Other
❑ Other
Number`of ructures:
,
❑ Non -La ers
El Pullets
❑ Turkeys
❑ Turkey Pouets
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation`?
Discharge originated at: El Structure ❑ Application Field El Other
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [X No ❑ NA ' ❑ �1E
1
❑ Yes
❑ No
q NA
❑ NE
❑ Yes
❑ No
RNA
❑ NE
V NA
❑ NE
❑ Yes
❑ No
❑ Yes
®No
❑ NA
❑ NE
❑ Yes
❑ No
®NA
❑ NE
2/18/04 Continued

of Inspection
Facility Number: ajDate
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[XNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
P No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Zip
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
M 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
FA No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No ❑ NA R NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
❑ No ❑ NA NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ No ❑ NA NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No ❑ NA NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑ No ❑ NA 03 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 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
❑ No
❑ NA
IgNE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
API` NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
❑ No
❑ NA
PNE
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
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
AL
Reviewer/Inspector Name AM &) S Phone: _ .�-,l.J0
Reviewer/Inspector Signature: Date: A ftJ 2CO
•�r�ami

Facility Number: Date of Inspection b
Waste Collection & Treatment El
No Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes ElNo ❑ 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): '7 — (h [�JJ�l f v cpQ
Observed Freeboard (in): Z ( — (� (�� ,.� �fo s f u
43
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes M 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 E4 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA W 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 [10 NE
maintenance or improvement?
Waste Aoolication
10- Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [:]No ❑ NA � NE
maintenance/improvement?
IL - 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
4
12- Crop type(s)
13. Soil type(s)
1
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
5& NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
[4 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
)EI NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name NT 111 / S G Phone: U 33
Reviewer/inspector Signature: / Date: ,qA]
.I IrOf Wr %_WE9"srscu

I
1~acifity Number: (? —6 r7 Date of Inspection a
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA IN NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes ❑ No ❑ NA IM NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA [Z NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
IRNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
RNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
(,� NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
F3 NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
_9NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
�ONE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
gNE
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
P NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did ReviewerMspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
rNE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
Additional Comments and/or Drawings:
¢r-� -�o o6U.0, M i cPoJ r 413
Wor �c C{tuf W45 f@Mav % 1'�` 4'0
O. ! rePlac.nS w',�1� C-6 So;I
$-car-'td on G S: Le 0A S CQonCr . Hi nIS 111d 1 s-� 1, 4
r �
CL,% r�vt d u a l on S $11 ode .
— C-Inr-, s Dof IcauYL 4 Deavi mcfri S r lVUS . WCY+c pri S:40 ,r, a % .
ty nC i
S Guy -hn 6irve
Nooses
r13a —11.3a a►•• . and re-larned 310 fAr41g30Qj0&_
8 ��f
12128104

Facility Number: Date of Inspection 7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA [A NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and P Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
ENE
❑ Yes
❑ No
❑ NA
® NE
❑ Yes
❑ No
❑ NA
® NE
❑ Yes
❑ No
❑ NA
® NE
❑ Yes
❑ No
❑ NA
R3 NE
❑ Yes
❑ No
❑ NA
10 NE
❑ Yes ❑ No ❑ NA tg�`NE
❑ Yes ❑ No ❑ NA UNE
❑ Yes ❑ No ❑ NA q NE
❑ Yes ❑ No ❑ NA P NE
❑ Yes ❑'No ❑ NA F_NE
.11
❑ Yes ❑ No ❑ NA [a NE
Additional Comments and/or Drawings:
v t
l<J.]O� �c ifCu,f WQS
QnC ePiGt,,C V3'. [a Soil rti'1CJQr:a(• u r 1
S-�o�r-toy vn L S�G0.} �� Cc�rnCr . �In�S�I.•�� is� 1.1--1 � �u.r,paC-/e�e�
Cn /tvi ova
Or
W�Ic C,nS•+¢Ckt.-S c'M
. r
C R {c1 r� f.n 7 S L'?Uy -fun IIJ+CIL_ UkiV,1 4 a ��r✓C! 1, fiu�i£
`730 - I13a an. . Gn C+ Ke4/tjLaRJI `I3vP
12128104

Type of Visit O Compliance Inspection Q Operation Review WStructure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint Q Fallow up O Referral O Emergency )K Other ❑ Denied Access
Date of Visit: t R fj�& Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Discharges & Stream Impacts
Title:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 n = g = Longitude: [--I o = , = u
Design Current
EiPoultry C�p�adcty Population
❑ Layer
❑ Non -Layer
Dry Poultry ,-�;
❑ Layers
❑ Non -Layers
❑ Pullets
I❑ Turkeys
!❑ Turkey Poults
,❑ Other
Design Current
Cattle Capacity Poopu� l
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
F
ber of Structures:
I
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ No
❑ NA
E ;NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
ONE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
NE
2. Is there evidence of a past discharge from any part of the operation'?
❑ Yes
❑ No
❑ NA
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No
❑ NA;NE
NE
other than from a discharge?
Page I of 3
12128104
Continued

Fox
Type of Visit 0 Compliance Inspection 0 Operation Review &,structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency )10 Other ❑ Denied Access
Date of Visit: E (" Arrival Time: ® Departure Time: County:
Farm Name: CL Owner Email:
Owner Name:
t —
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: = o = I ❑ u Longitude: 0 ° = I =
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish ❑ Layer Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dai Calf
❑ Feeder to Finish
Dry Poultry
❑ Dai Heifer
❑ Farrow to Wean
❑ D Cow
❑ Farrow to Feeder
❑ Layers_
❑ Non-Dai
❑Beef Stocker
❑ Farrow to Finish
.
❑ Non -La ers
Gilts
❑Beef Feeder
❑
BPullets oars
❑ Beef Brood Co
❑ Turkeys
other ❑ Turkey Poults
Number of Structures:
❑ Other ❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ No
❑ NA
qNE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
�ffNE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
1�N1
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
(P NE
2_ is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
❑ NA
NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No
❑ NA
NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Numbe 0 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?
(iel 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 ❑ No ❑ NA �NE
❑ Yes ❑ No ❑ NA 0 NE
Structure 5 Structure 6
❑ Yes ❑ No ❑ NA " NE
❑ Yes ❑ No ❑ NA N 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 10 NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA �j NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) (( __
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA �NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ® NE
maintenance/improvement? `
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA W) 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 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
❑ 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
ElNo
El NA
NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
a
�
Reviewer/inspector Name ST7�Ir i Phone: ! f 3 3
Reviewer/Inspector Signature: Date: � N 9
rV50R/I1d Cnniin,.od

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 1 Structure 2 Structure 3 Structure 4
❑ Yes ❑ No ❑ NA [�'NE
❑ Yes ❑ No ❑ NA 0 NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
❑ No ❑ NA 69NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
❑ No ❑ NA N NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
❑ No ❑ NA �D 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 I�INE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
❑ No ❑ NA NE
maintenance/improvement? I
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
❑ No ❑ NA W NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
� NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
1P NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[-] Yes
❑ No
❑ NA
�Z[-NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
1P NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
0 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):
Reviewer/inspector Name S� C, hone:
Reviewer/Inspector Signature: L Date: 7

Facility Number: -. -0-10 Date of Inspection { Q 0
Required Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
WE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
[P NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
ONE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
I NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
R NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
PINE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
[�jNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
® NE
Other Issues
/�
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
" NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
❑ No
❑ NA
ONE
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
M 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
RIVE
General Permit? (ie/ discharge, freeboard problems, over application)
II
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
RNE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
CS6VE
Additional Cam meh'tslandlorRDrawmgs `.
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PYIa4aS i YC
Page 3 of 3 12128104

Facility Nurnber:01 Date of Inspection 1 4 b
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA 'gNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA [ NE
the appropirate box. ❑ WUP [I Checklists El Design El Maps El Other /�
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
N NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
1�NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
Q NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
QNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
19NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
[� NE
`�
Other issues
/
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
10 NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
6P-96NE
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
0 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
�'N E
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
VNE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
[�LVE
Additional C©n�cnents aodlor�Di wings
UW4n\)"Cl On
✓� Vlf t `e o.�k e . �j c ,�� �w� 00 r \ U3O r 'a- V -f 0 5 a,-,
+S-�
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�l
t4
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{ f
(}��rp`AoY �t u c,u-� 5r^at� �i2 Lei oh1 0.S � e Q� y1'�L-k,F�V0 �U- 1 G'
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a r �t � � —{ � � • S
S
,.1
Cy r W S� � e_ vZ-ev- Q"_J 0.r u%).Y, 2 v�J
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ll P . , c� : 0.K I , � ov-v S ��n.0 a �� w 0.�'j'a'%'t C, ti
;4 c.4 4
Page 3 of 3 12128104

Type of Visit p Compliance Inspection O Operation Review Structure Evaluation O Technical Assistance
Reason far Visit O Routine O Complaint')*Fotlow up O Referral O Emergency 0 Other ❑ Denied Access
Date of visit: r Arrival Time: �Iq t� Departu a Time: County:
Farm Name: IV Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o = I = 11 Longitude: = o =' E__1 u
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
n-La er
❑ Dairy Calf
El Feeder to Finish
:__
r�l�v�,.� �. - ._
Dairy Heifer
❑ Farrow to Wean
;,Dry-Pouliry�;=-�'•
El Dry Cow
❑ Farrow to Feeder"""'
`El
Non-Dai
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑Non -Layers
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ T urke s
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ No
❑ NA
I�,I]NE
ff"
Discharge originated at: El Structure El Application Field El 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
�INE
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
ONE
2. Is there evidence of a past discharge from any part of the operation`?
❑ Yes
❑ No
❑ NA
�INE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No
❑ NA
NE
other than from a discharge?
Page I of 3
12128104
Continued

Type of Visit Q Compliance Inspection 0 Operation Review 3ple5tructure Evaluation O Technical Assistance
Reason for Visit Q Routine O Complaintll44E!9IFollow up 0 Referral 0 Emergency 0 Other ❑ Denied Access '
Date of Visit: f i'6 O Arrival Time: �� Depart a Time: County: Regioni 1` `-'
Farm Name: f :+tom i �+ Owner Email:
Owner Name: _
r
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =O =1 = 1f Longitude: 0 o 0 , = N
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle C►apacity Population
❑ Wean to Finish
❑ La er
❑ DairyCow
El❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
❑ Feeder to Finish
mµ. ' _ ' II
❑ Dairy Heifer
El Farrow to Wean
Dry 1Pou1
El Dry Cow
El
Farrow to Feeder
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑Yes
❑ Na
❑ NA
RNE
Discharge originated at: ❑ Structure ❑Application Field El Other
A
a. Was the conveyance man-made?
El Yes
❑ No
❑ NA
NE
b. Did the discharge reach waters of the State? ([f yes, notify DWQ)
El Yes
❑ No
❑ NA
f�)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)
[:1 Yes
❑ No
❑ NA
0NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
❑ No
❑ NA
�INE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
❑ No
❑ NA
1�NE
other than from a discharge?
Page 1 of
12/28/04
Continued

Facility Numbe —MC� 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?
4fn,rnare. 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes ❑ No ❑ NA 1W NE
❑ Yes ❑ No ❑ NA NE
Structure 5 Structure
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
❑ No ❑ NA NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
❑ No ❑ NA NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
❑ No ❑ NA 1! NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
❑ No ❑ NA NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
❑ No ❑ NA NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
❑ No ❑ NA [ NE
maintenance/improvement?
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 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 ❑ No ❑ NA V] 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
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name i �� Phone: co( 0 y�� f ��
Reviewer/Inspector Signature: Date: /0
12128104 Continue

t.'N-'.j Fac0hy NTumbe �
Date of Inspection t
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA 1W 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
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA 1�NE
8. Do any of the stuctures lack adequate markers as required by the permit? El ❑ No ElNA y
NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA Mt NE
maintenance/improvement?
II. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA P NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA [N NE
15. Does the receiving crop and/or land application site need improvement`! ❑ Yes ❑ No ❑ NA �INE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes ❑ No ❑ NA P NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑ No ❑ NA
❑ Yes ❑ No ❑ NA
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
NE
NE
Reviewer/inspector Name 14 k k I Phone: ` 10 V DD VQJU
Reviewer/Inspector Signature: Date: l0
12128104 Cantinued

Facility Number Date of Inspection I
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA4-NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA �NE
the appropirate box. ❑ wuP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA t�LNE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
P6NE
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
PJNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
P NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
WNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
1�NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
`Q NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
*E
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
E
If yes, contact a regional Air Quality representative immediately
r
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
E�6NE
General Permit? (ie/ discharge, freeboard problems, over application)
❑
❑
❑ NA�NE
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Yes
No
E
Page 3 of 3 12128104

Lq
Facility Number -..()I -MC) IDate of Inspection 1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WU P []Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA [�LNE
❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30_ At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit'? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
&tNE
❑ Yes
❑ No
❑ NA
1�NE
❑ Yes
❑ No
❑ NA
RNE
❑ Yes
❑ No
❑ NA
41NE
❑ Yes
❑ No
❑ NA
R NE
❑ Yes
❑ No
❑ NA
® NE
❑ Yes
❑ No
❑ NA
r
�
❑ Yes ❑ No ❑ NA 1�NE
❑ Yes
❑ No
❑ NA
NE
❑ Yes
❑ No
❑ NA
NE
❑ Yes ❑ No ❑ NA 1 NE
❑ Yes ❑ No ❑ NA [�ANE '
r
❑ Yes ❑ No ❑ NA [ANE
[]Yes []No ❑ NA 0,NE
Page 3 of 3 12128104

Facility Number
°bivision of Water Quality
Q Division of Soil and Water Conservation
O Other Agency
Type of Visit '* Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival'fime: � � Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: 4�4J 1�� v � � Phone: �
Mailing Address: 0 !� 35 Loh d� - �[A2537
Physical Address:
Facility Contact:
Onsite
Certifii
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
can to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Title:
Phone No:
Integrator: `
Operator Certification Num : t Lo 1 L
Back-up Certification Number:
Latitude: = o [= Longitude: ❑ ° ❑ ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ Laver
52t'JC�10 Non -Layer
Dry Poultry
❑ Layers
T
❑ Non -Layers
❑ Pullcts
❑ 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 Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
b_ Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
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 VNo El NA El NE
❑ Yes
❑ No
�DNA
❑ NE
❑ Yes
❑ No �aNA
❑ NE
�r
,NNA
❑ NE
❑ Yes
[--]No
❑ Yes
R No
❑ NA
❑ NE
❑ Yes
3j No
❑ NA
❑ NE
12128104 Continued

Facility Number: C9 - Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes );kNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? El Yes ElNo '21:NA El NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:"-"C' l ! -
Spillway?:
Designed Freeboard (in):
DA
Freeboard (in):
there any immediate threats to the integrity of any of the structures observed? ElYesIVo ❑ NA ElNE
large trees, severe erosion, seepage, etc.)
6_ Are there structures on -site which are not properly addressed and/or managed ❑ Yes L^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? 0 Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes %t Vo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes O No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 13No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ImNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop types)%t/A� A IV - �YI U C-1 V Qb -
}
13. Soil type(s) o' C.� , �"�M NoAenowtv
- -
-
14. Do the receiving crops differ from those designated in the C MP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�fo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
[INo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[XNo
❑ 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 and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
r ."a�K ba c.t cn-\cu'iA
e �rd ,or�a� a e+�� -�o �rrw�, ant- v �S
aC�`7 ,
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Phone: r
Date:J�
12128104
3
Continued

Facility Number — tol Date of Inspection 1p r/ �►�1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 1ANo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps
p El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes'""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 No ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No X�NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes Wo ❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes J!�No ❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes gNo ❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No `KNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Commeuts'and/6r Drawings':: -; i
Cy v- r o4b r t r CA"OLv
0 C_ 5 +Z) S; tYN a
SQ9_hQhS . U
&L�-j aJA�L_o 6,y-." t_�L_ v3v-� 0CV '1® (W ousu&j mo,
40 540
#�
V vei
T 4z_ia_0 's v�b 4v-C { �j C�j T "'d
Page 3 of 3 12128104

0
Facility No.y -C;7:z Time In 0 /el) Time Out ate
Farm Name integrator
Owner Site Rep
or
Operator
IM
Back-up No. -
COC Circle: (Gen or NPDI=S
Design
Current
Desi n
Current
can — F
Farrow — Feed
ash
Farrow — Finish
Feed , Finish
Gilts 1 Boars
Farrow — Wean
Others
FREEBOARD: Design
udga .ciun ay
Crop Ylekl,t�
Vug
it Te PLAT
Wee eboard Daily Rainfall ./
Spray/Freeboard Drop
Weather Codes
Waste Analysis:
Date
120 min Inspections
Nitrogen (N)
/ /P-z
Observed
Calibrationic-P1V I
Waste Transfers
Rain Breaker
Wettable Acres
1-in Inspections
Date Nitrogen (N)
Pull/Field Soil Crop Pan Window
+v. Ir.
��

Type of Visit �_o Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit Routine 0 Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: {p b Arrival Time: I--I--I� Departure Time: � County: Regionr—_w_,^
Farm Name: c Owner Email:
Owner Name: I m. Q_lDOi.Q � Phone:
Mailing Address:
Physical Address:
Facility
Onsite Representativ( t c
Certified Operator `(-
Back-up Operator:
Phone NoQ kL q 2aDDD1_)
Integrator,
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o = ` ="
Longitude: = ° = I = "
igCuirreatWet
HER,,
Poultry
acity Population
❑ La er
❑ Dai Cow
❑Nan -La er
❑ Dai Calf
'r"
❑ Dai Heifer
❑ D Cow
❑ Non-DaiEy❑
❑ La ers
Beef Stocker
❑ Non -La ers
Beef Feeder
❑ Pullets
❑ Beef Brood Cowl ITurke
sTurke
PoultsOther ❑ Other
Number of Structures:
ulation
❑ Wean to Finish
can to Feeder
7�
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow [o Feeder
❑ Farrow to Finish
Gilts
❑ Boars
Discharges &Stream Impacts
1.
Is any discharge observed from any part of the operation?
El Yes
❑ No
❑ NA
Discharge originated at: ❑ Structure El Application Field El Other
a. Was the conveyance man-made?
El Yes
❑ No
❑ NA
V_VE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑Yes
❑ No
❑ NA
§�JNE
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
XNE
2, Is there evidence of a past discharge from any part of the operation?
El Yes
❑ No
❑ NA
A NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑Yes
❑ Na
❑ NA
ANE
other than from a discharge?
Page I of 3
12/28/04
Continued

Facility Number 7P Q Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA WE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA I$NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA VLNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA J14NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA y
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes El No ❑ NA NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ��r«r
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ;1NE
maintenance or improvement? i "
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA �VE
maintenancelimprovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ANo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) -�.� GE
13. Soil type(s)
14. Do the receiving crops differ from those designated in thd.OAWMP?
❑ Yes
❑ No
❑ NA 4NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA IO'NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes X No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA 0 NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA_ANE
ji­
Comments (refer to question i): Explain any YES answers andlor any recommendations or any otlaer.coiuments
Use drawings, of facility to better explain situations. (use additional pages as necessa tY)�
AL
Reviewer/inspector Name k Phone:
Reviewer/inspector Signature: Date: 0
Page 2 of 3 12128104 Continued

Facility Number. � Date of Inspection IG, jo 10
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 "KNo ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes VNo
❑ 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
4'NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
MNA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes YLNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ❑ No
❑ NA
XNE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes �LNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
�4 NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes I�No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
J�jNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
'52�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 1 . 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)
11
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
Wo
❑ NA
❑ NE
Additional Comments and/or Drawings:
GLIJ a U' t S f e.rra' nQn� (>-Vu a �� rr : rip �i t Ij
SuY Zug.
Need � suy--Q�e As A P .
12128104

Facirty No. Ln - (:f)v Time In Time
Farm Nam - �1�f1�'( � �Z,EII M?
Owner
Operator
Back-up
COC
C
)ut Date
Integrator i y }
Site Re u �-
No.
No. _
Circle: Gen al or NPDES
Design
Current
Design
Current
Wean — Feed
Farrow — Feed
Farrow — Finish
Feed — Finish
Gilts 1 Boars
Farrow — Wean
Ot
FREEBOARD: Design
Observed
Crop Yield
Rain Gauge
Soil Test
Weekly Freeboard
Spray/Freeboard Drop
Weather Codes
Wettable Acres V
Daily Rainfall
120 min Inspections
Waste Analysis: c
Date itrogen {I t
;o i
Sludge 5urve C�I]r1 U4_
CalibrationlGPM � �D
Waste Transfers
ZAT,e3ker
1-in Inspections
Date Nitrogen (N)
Pull/Field Soil Crop Pan Window
ckkD-
+„� a
3/a��2, y(q � 1,

Type of Visitnpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ,,..,, r�toutine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: V
Arrival Time: I Z�/,?Z) j Departure Time: �/ r,3 � County: Region:
Farm Name: _��1G[;. 11 r__a llrSffr-' Owner Email:
Owner Name: lA _ 7`b �'�-- Phone: l
Mailing Address: �/. 7,6aX
Physical Address:
Facility Contact: ffe--O 2 - d Title:
Onsite Representative:
Certified Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = e 01
= u Longitude: = 0 0 t 0 u
Design Current Design Current
Design Current
Swine
Capacity Population Wet PoWtry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dai Cow
® Wean to Feeder
OD S
❑ Non -Layer
D,: Poultry
`' '
❑ Dairy Calf
Dairy Heifer
El Dry Cow
❑ Feeder to Finish L
❑ Farrow to Wean'
❑ Farrow to Feeder
K�
❑ Layers
Non -La ers
` ❑ Pullets
❑Non -Dairy
BeeFStocker
❑ Beef Feeder
El Beef Brood Cowl
w to Finish❑
rOBoars
_--- �a
❑ Turkeys
Other
'`
❑Turke Pouets
❑ Other
El Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
W No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
MNo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[Z 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
jNo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge'?
Page I of 3
12128104
Continued

Facility Number: - Date of Inspection
r
Waste Collection & Treatment
t4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[INo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
M_No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: 4
Spillway?, -
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�RNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
9No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
9[ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
[KNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
21 No ❑ NA ❑ NE
maintenance/improvement?
. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
ONo ❑ 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 El Application Outside
of Area
12. Crop types) �,-�1L�./4l/���L i : I,- -
/
13. Soil type(s) � �C r�]�Cn a y _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 19 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? j(.WYes NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes C9 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 KNo ❑ NA ❑ NE
Comments {refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawingofs facility to better explain situations. (use additional pages as necessary):
j�
Reviewer/inspectorName ...ai` `rr/ �?._ �.. .. _ Phone: lfJ3-33��
Reviewer/Inspector Signature: Date: AO' %-3 f (C'
Page 2 of 3 12128104 Continued

Facility Number: ZZ2 Date of Inspection
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 ❑ No ❑ NA ❑ NE
the appropriate box. lR WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. J4 Yes ❑ No ❑ NA ❑ NE
IK Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional;Commeuts an dloi•_Drawings:
SLu� , U) u F sLu�% Wasrrmov�
D � �
❑ Yes
Im No
El NA
[I NE
❑ Yes
J9 No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
E� No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
JR No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
❑ Yes [RNo ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
[RI No
❑ NA
❑ NE
jaYes
RVF
❑ NA
❑ NE
Page 3 of 3 12,18104

f
I'
----- —_- °D[visa on of Water Quality
Facility Number Division of Soil and Water Conservation
1 ther Agency
Type of Visit 0 Compliance Inspection 0 Operation Review tructure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up erkeferral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �"v Arrival Time: D Departure Time: % t) County: kg1al-- Region: 7 d
Farm Name: �JJ¢Lc Ale"7Sr' 4 Owner Email: q
Owner Name: Gh 14; (to r,- Phone:
Wailing Address: E Q . B 'Lx
Physical Address: 3
Facility Contact: r'XQ.-_ /c::k fD"4' _ Title: Phone No-
Onsite Representative: Integrator:
Certified Operator: _R� Yo�JeK _ Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = E--] I 0 fl Longitude: = n ❑ I = U
Swine
j"prpD
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
❑ Non -Layer
❑ Wean to Finish
® Wean to Feeder
Other
❑ Other
Dry Poultry
ElLavers
❑ Non -La ers
[Ell Pullets
ElTurkevs
[ITurke y Poults
ElOther
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure ElApplication Field ElOther
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
El Dairy Cow
El Dairy Calf
El Dairy Heifei
QDry Cow
DNon-Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures
b. Did the discharge reach eaters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes ❑ No ❑ NA ® NE
❑ Yes
Number of Structures
b. Did the discharge reach eaters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes ❑ No ❑ NA ® NE
❑ Yes
❑ No
❑ NA
B�NE
❑ Yes
❑ No
❑ NA
9 NE
❑ NA
NNE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
RINE
❑ Yes
❑ No
❑ NA
KNE
12128104 Continued

Facility Number: — %p Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ® No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? C,Yes ❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 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? 19 Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA JK 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 ONE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA 0 NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ONE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
M NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
[4 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
PQ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
ZINE
7ks 4L Jeo��;`ns S�uJCT W o�s�r)vr`�( s;
.Se6Pal� Bit- be ek` S514- 0 � S%`%UGIur G cLJcvr_. �� 1 O`G . .��fi Ja �i1r/Y T7�L�
/(� %L�� GJrobd G i �"'C_ -1 D %n I'. E L� �i� C`J"L 1 [t7G�C�ZI, ��/yL {� All�i(7L 2r_ / r 1�rf✓et11 ,
AG'�!!!.� t���Z G�:+l1 SCCiU�( VJi9v1. L tJ(./ I' "CJ.
Reviewer/Inspector Name Phone:
Reviewer/I n Spector Signature: Date: 3—,6--0 t"
22/2"4 Continued

Facility Number: — Q Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA (Q NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA RNE
the appropiate box.
❑ WUP ❑Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA 0 NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ 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 0 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
ONE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
5dNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
® NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
J9 NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
ONE
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
[Z NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
®No
❑ NA
❑ NE
General Permit'? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by saute agency?
%KYes
❑ No
❑ NA
❑ NE
0 410,9, 4.,rl3 zffpa��_
12128104

i
Type of Visit 6-Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine O Complaint Q Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: a 4 (3 0 Departure Time: 3 (7 County: Region: 1�
Farm Name: Lt /-e czlOt �iei s cr y Owner Email
Owner Name• . C- �c- �. t" `�D +�-- Phone: j J
Mailing Address: / -. D, ,23z) Y,�3 �►'�- t`' �' 37
Physical Address: NY . _
Facility Contact: � yPt-ce ,S"y- £ Y Title:
Onsite Representative: d
Certified Operator: .S--,tw -,! -
Back-up Operator:
Phone No: 21-o-eu,- y9SS
Integrator: /��r �r .XID ww _
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [=] o = ' = 4 Longitude: F__j o =
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
I [EllLa er
i)O ❑ Non -La et
❑
Wean to Finish
❑
Wean to Feeder
ElFeeder
to Finish
ElFarrow
to Wean
ElFarrow
to Feeder
ElFarrow
to Finish
El
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
ElPullets
❑ Turke s
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure ElApplication Field ElOther
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? ([f yes, notify DWQ)
Cattle
Design Current
Capacity Population
El Dairy Cow
El Dairy Calf
El Dairy Heifei
El Dry Cow
ElNon-Dairy
ElBeef Stocker
ElBeef Feeder
ElBeef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ANo ❑ NA ❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
o No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12128104 Continued

Facility Number: Q 9 — O
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
93 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
El Yes
�No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:.QQ
Spillway?: ed
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
CgYes
[]No
❑ NA
❑ NE
S. 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 (9 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [K No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes '621.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 Drifl ❑ Application Outside of Area
12. Crop type(s) /�i r rm. u cL / f/n � ►'o; i,
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Wo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
(,Yes
KNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`,❑ Yes
2No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
(0 No
❑ NA
❑ NE
Imq" e vw s
I /
r- I/ r✓y /�i�'/` �r
Reviewer/Inspector Named
Phone:
—
Reviewer/Inspector Signature:
Date:
�[?�
12128104
Continued

Facility Number:0 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes PC No ❑ NA ❑ NE
the appropirate box. El WUP El Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. RYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard C3Waste 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
ZNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
X 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
[9 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
KNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[9NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
5TNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[gNo
❑ 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
Callo
❑ 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
EQ No
❑ NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
10, A-Ftk,_, IN zb-fe Sam���j ev, / (P r7 doy5
12128104

Facility ?linmber
Date of Visit: i n Time:
-- — O Not Operational C Below Threshold
OtPernzitted F1 Certified 0 Conditiona`lly Certified ©gis Registered Date Last Operated or Above Threshold: -
Farm Name: ....._S=,V. N v r�.Q.ry_ _ County: _,_,, ��a�.a.r► _� - --
Owner Name . �..,, . „ �� T .. Phone No:
Mailing Address:... _ �O -- &-se � 0 G 2,8 3 .17
Facility Contact: �e.e4 , _- Title: _ Phone No:
Onsite Representative: , , e,� , ,_y_�44_-�_ _, ,� Integrator . M u -1 - r a6.
Certified Operator:-ge"".Sl Operator Certification Number:--- -1 b_ Z---Z----
Location of Farm:
$wine ❑ Poultry ❑ Cattle ❑ Horse Made • " Longitude • `
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ONo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in galimin'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 9[No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 19 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes $,No
Structure 1yy Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
12112f03 Continued

Facility Number: Date of Inspection I 4
JW
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 4 No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or Yes No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste manaaaement system other than waste structures require maiatenanmprovement? ❑Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑Yes No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancehmprovement? ❑ Yes IgNo
11 _ Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ,KNo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type 9- I�►Al�i -�-..A5 +� � Oy+P.rS .�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes EkNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes EKNo
b) Does the facility need a wettable acre determination? ❑ Yes [&No
c) This facility is pended for a wettable acre determination? ❑ Yes KNo
15. Does the receiving crop need improvement? ❑ Yes M No
16. Is there a lack of adequate waste application equipment? ❑ Yes ONO
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes V,No
Air Quality representative immediately.
❑ Field Copy ❑ Final Notes
6rvsk.- ft�- yfTVr ay.Aze s4- Go's1VP..+�ta..1c2
ork +v %e+ +(-0- 1401 Of<' AAA)"
--r --- >-e - -T ^--� - - } - „�
ReviewerAnspector Name �` - - - s�--
Reviewer/Inspector Signature: At Date: lD
12/12103 Centinned

Facility Number: — 7— 7o Date of Inspection lr l
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
gYes
❑ No
22. Does the facility fail to have all co�y nents of the Certified Animal Waste Management Plan readily available?
checklists,
1,1c&
Yes
(ie/ desig�/�na btc.)
19
8 No
23. Does record keeping need improvement? If yes, check the appropriate box below.
.Yes
❑ No
gg Waste Application ❑ F mboarp/ffWaste Aaalysi,] soil Samph*,--
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
R No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
5ZNo
26. Fail to notify regional DWQ of emergency situations as rewired by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes
S[No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
JgNo
28. Does facility require a follow-up visit by same agency?
❑ Yes
SkNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
RNo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
J!§ No
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35_ Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Farm ❑ Crop Yield Form ❑ Rainfa]V] Inspection After 1 " Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
L t • 7� GGC,
Mom. tt vt2,c - S : w�rw�-a cry , s ��f Acitts
to or_�_ -t-t-o- cM ` S {�•e re-�-os .
Fief.�s � �2,4, S law►;+e� -�-o '�z ' a.�t; ��-i�..5.
era geG�
(A]sS� t;5 s�3�aY Z•O Z• f
11/zy /04 / . e I. K
z3 . ��. was 0. s �+a.,..
D� 3 w•e�e l�s
�] JAL
a GOB-�,►-e.f
1
a wa-4e- �.� �� s .
Pl Aso. to-Q
see 4-o
6' +w4
�
u've-*�edf . �..� � sQ.�re.«►.L � ��►��;or 'S t� Lo�-e.�oi.
r-
12112103

Facility Number -
*eDivision of Water Quality
0 Division of Soil and Water Conservationf
0 Other Agency G
Type of Visit "R Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: � Arrival Time: I I /Q fj Departure Time: ® County: Regioi_V�C)
Farm Name: -.2gan ok, Dr6e)kc- Vrrn5 Owner Email:
Owner Name: —_ 1_ L1r)nu3 b� kf1 %1(01 � L C _ „ Phone:
Mailing Address: t' 0 ewy_ 1e7 O[ y-I ' V (er
Physical Address: fi 14 W
u`3
Facility Contact: �h Q kw-". Title: U `: (D L)1� Phone No: -1AQ __2�A
M ��� - rl,al(-0
Onsite Representative: WAY' ��� ll'1� �7 + Integrator: I ' '
Certified Operator: Cyoi- Uk Q l`i" 01N Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o [ = 0 « Longitude: = ° = , = .,
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
Eirwean to Feeder a] I 74D D
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La yer
❑ Non -Laver
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
Design Current
Cattle Capacity Populatiion'
❑ Daia Cow
❑ Daia Calf
❑ Dairy Ilei fei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes KNo ❑ NA El NE
❑ Yes
❑ No
4NA
❑ NE
❑ Yes
❑ No
JaNA
❑ NE
❑ Yes
❑ No A NA
❑ NE
❑ Yes
5� No
❑ NA
❑ NE
❑ Yes
�] No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection 5
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes RNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ETNo
❑ NA
❑ NE
cture IStr cture 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: JC'/
rn;'
Spillway?:
iQ
Designed Freeboard (in): ! 1
Observed Freeboard (in): 3 O
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 1,;kNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes IXINo
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �P No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 9 No [INA ElNF
(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 V14o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes XNo ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA XNE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) r_ crlm ", (f Q — -(—f , e:�Tj Yl L5 r OQ
13. Soil type(s),
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15_ Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? [:]Yes ❑ No ❑ NA ``�NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ZNo ElNA ElNE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ANo ❑ 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):
be_ � S7c�,rr�x_
, �1_e� 4 so b n S
o
s 6� s 4 lie- l C
Reviewer/Inspector Name �( % Phone: 7'3 3 7
Reviewer/Inspector Signature: Date: p2
Page 2 of 3 12/78/OA Continued

Facility Number: (��"� Date of Inspection
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes ❑ No ❑ NA
NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes ❑ No ❑ NA
A NE
the appropirate box. ❑ VFUp ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box be19w.
❑ Yes ❑ No ❑ NA
1AjqE
✓ V
❑ Waste Application [:]Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [:]Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stacking ❑ 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 16 No ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No XNA
❑ NE
24, Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ❑ No ❑ NA
XNE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ❑ No ❑ NA,
XNE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes J'No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus foss assessment (PLAT) certification?
❑ Yes ❑ No 19NA
❑ NE
Other Issues
29. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes P 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 PINo ❑ 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 O 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 XNo ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
es [�rNo ❑ NA
❑ NE
Additional Comments and/or Drawings:
11
— 5 { �e.. S LkV C� u�. Qv11�1UL41� o 7n 0.0 � �Q(�oan ,
v ijoy, cA
s�,D( " c.G- � �-IIL r v
- {�Ja-a ►kG- �s ,s • fl-o uAs4 am tW;s e.vtxL) 3 rnp 4e
C5z�qc -f 0'.A e V'4 5 ,
Ge 1 C.L"V"C✓ 4 C O C YG)-vx Cre-t-"C"s Or �incrs
12128104

Facility No. (1� b� fl Time In a / D Time Out Date
Farm Name rzu C W f V,6 Integrator
Owner aDyinvrilrcdo1cp- FL),yyA> JIAR [-LC- Site Rep Q b�-�
Operator No.
Back-u No.
OC Circle: ener , or NPDES
Desi n
Current
Design
Current
Wean - Feed
Farrow - Feed
Wean - Finish
Farrow - Finish
Feed - Finish
Gilts 1 Boars
Farrow - Wean
Others
FREEBOARD: Design [
Observed
�f `
Crop Yield
Rain Gauge
Soil Test
Weekly Freeboard
Spray/Freeboard Drop _
Weather Codes
Waste Analysis:
Date
Wettable Acres _
Daily Rainfall
120 min Inspections
Nitrogen (N)
Sludge Survey
Calibration/GPM /
Waste Transfers
Rain Break
PLAT ` �Y
1-in Inspections
Date Nitrogen (N)
Pull/Field Soil Crop Pan Window
G.

Type of Visit: 0�'C@mpliance Inspection n Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (grkoutine 0 Complaint 0 Fallow -up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: K-101 Arrival Time: `} Departure Time: �0 v . County: Region:
Farm Name: U-tAkeg-g.7k-v'+,-5 Owner Email:
Owner Name: f ( Phone:
Mailing Address:
Physical Address:
Facility Contact: i �� Ga/i`i' Title: Phone:
Onsite Representative: L f Integrator: i l r U`
Certified Operator: C/ AV`crfC-mot Certification Number: Q'71 70f-
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current �j: Design Current Design Current
Swine Capacity Pop. VVet Poultry _C•apacity Pop. Cattle Capacity Pop.
Wean to Finish La er Dai Cow
Wean to Feeder �'0 . UU [ Layer Dai Calf
Feeder to Finish -" Dai Heifer
Farrow to Wean , ;'Design Current D Cow
Farrow to Feeder D P"It Ca aei Po , Non-Dai
Farrow to Finish La ers Beef Stocker
Gilts Layers Beef Feeder
t. Boars Pullets Beef Brood Cow
. Turkeys
Other Turkey Poults -
Oth Other er - - -
;� ...;.:. , �, ._. _— _ �.�-.gin• ___-___ _. _ .. � ,�,.�..,.� _� �..�� - = - -
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes. notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [ 7` o ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑`No
❑ Yes EEr o
❑ NA ❑ NE
[]NA ONE
['NA
❑ NE
❑ NA
❑ NE
❑NA
❑NE
Page I of 3 21412015 Continued

Facility Number: jDate of Inspection: J
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[: jl io
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
E31NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: S-}
Spillway?:
Designted Freeboard (in):
Observed Freeboard (in): ' 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[3-No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
�No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
J�o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
eNo
❑ 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
CNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
E3"No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs_ ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s): •9 S v
13. Soil Type(s): CCc k4L On ce
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[JNo
❑ 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
❑'Iqo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[3 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
O No
❑ NA
❑ NE
20. Does the lacility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[ lNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box be]ow. ❑ Yes P!fNo
❑ 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 ff No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes E No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Facility Number: 1 - -1 o 1 JDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[] Yes
D-110
❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check
[] Yes
[i]No
❑ NA ❑ NE
,-the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
�o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[3 F4o
❑ 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)
3 1. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes B No ❑ NA ❑ NE
❑ Yes [ 'No ❑ NA ❑ NE
❑ Yes [T No ❑ NA ❑ NE
[:]Yes [f rNo ❑ NA ❑ NE
❑ Yes ff No
❑ Yes Ero
❑ Yes�`No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatu
Page 3 of 3
B - k� �ok I
Ce,d bra 90- - C fiSt
C �l 11 Phone: �y `[ 33-333 y
re: Date: Ig 01V IT
21412015

for Visit: t, Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:' Departure Time: County: Region:
Farm Name:44(mow ck- ,w 7Fce4/-v Owner Email:
Owner Name: & Phone:
Mailing Address:
Physical Address:
Facility Contact: CV,444kGc[J' 104t Title: Phone:
Onsite Representative: ( Integrator: ivy{ 73 —a
Certified Operator: G a L1 f 4Pf't t� Certification Number: F U 7-n
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Des'... Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish La er
Cattle
Design Current
Capacity op.
Dai Cow
Wean to Feeder S .6p
p0
Non -La er
Dai Calf
Dai Heifer
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Design Current
D . P,oul Ca act P,o
D Cow
Non -Dairy
Farrow to Finish
Gilts
Layers
Beef Stocker
Beef Feeder
Brood Cow
Non -Layers
Boars
Pullets 10Beef
Turke s
Turke Poults
Other
Other
Other
Discharnes and Stream lmuacts
1. Is any discharge observed from any part of the operation? ❑ Yes [�o NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [] No ❑,l' A ❑ 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
ff No
❑ NA ❑ NE
of the State other than from a discharge'?
Page I of 3 21412015 Continued

Facili Number: -7 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0-Na—❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No Lg#A' ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [K�- ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a [] Yes �o ❑ NA ❑ NE
waste management or closure plan?
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
[20'Noo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[;j"Noo
❑ 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 ARPUcation
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
E!rNo
❑ NA
❑ NE
❑ Excessive Ponding [] Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN I0% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s): C 13 D
13_ Soil Type(s): W t(r Kh t,. t1z Crk4
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
1i'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[3*"N- o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[:]Yes
[J-lslo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
❑'NIo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
0-'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
LEf'No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design [:]Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall M 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 ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ YesgNo
No ❑ NA ❑ NE
Page 2 of 3 21412015 Cantenued

Facili Number: - Date of Inspection: '
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E5 "" ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes C3'557 ❑ 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 Z?No [DNA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑.Ko ❑ NA ❑ NE
Other Issues
2$. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
M-4o
❑ 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
[,30'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
D;Kio
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below,
❑ Yes
[3*<o
❑ NA
❑ NE
[I 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
Q No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
21-No
❑ NA
❑ NE
Reviewer/]nspector Signatui
Page 3 of 3
X(V �wL�Q
21412015

�P ({ I s pia
Type of Visit: OTompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: 0-1 routine 0 Complaint 0 Follow-up 0 Referral 0 Emereency 0 Other 0 Denied Access lI
Date of Visit: Arrival Time: �JLDeparture Time: County:
Farm Name: J G AW&A Ltilnkc F dVtnc Owner Email:
Owner Name: �t 1, LC Phone:
Mailing Address:
Physical Address:
Region: LJ
Facility Contact: 6Af c.S j Title: Phone:
Onsite Representative: [ Integrator:
Certified Operator: cA re" ✓ 6-TS\Dt4 Certification Number: PC) Q 6 0
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
WetpPoultry Capacity
Pop.
Cattle Capacity Pop.
..
Wean to Finish
La er
Dairy Cow
Wean to Feeder
6
Layer
Dairy Calf
Feeder to Finish"
""'"
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D`l'oul
Ca aci
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
I Pullets
Beef Brood Cow
-
Turkeys
Other
Turkey Poults
Other
Other
Discharees and Stream lmpacts
1. Is any discharge observed from any part of the operation? ❑ Yes Q_NiT� NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No [ad ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) [—]Yes []No E],KX ❑ 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 E�< ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes E2�,No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes �No [DNA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued
1

Faciflty Number: jDate of Inspection: f..7VZ
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
r
❑ Yes
❑.A-e—❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
0 No E3-1qA_C
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:�,ti,�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 0 _
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
B-M O NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[3-NO—❑ NA
❑ NE
waste ranagement or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No ❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[Q-Na — ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[.Die—. ❑ NA
❑ NE
maintenance or improvement?
Waste_ Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:)Yes
[3-NtF- ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Ld o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Is mod` 1 . C (-0
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? /
15. Does the receiving crop and/or land application site need improvement'?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
❑.N"o
[-]Yes
to
❑ Yes
ET<
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes
to
❑ NA
❑ NE
❑Yes
F. o
❑NA
❑NE
❑ Yes [3 No ❑ NA ❑ NE
❑ Yes Q�qo ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [3"<o
❑ 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 dNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes allo
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of -inspection:
24. Didythe facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Q'No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [a-Ntr
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:
❑ NA ❑ NE
❑NA ❑NE
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
©'7qo_
❑ 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?
Icawings'of facility to b"etter explain siWi ioii-s'(aseLad_drtionalnpa€;es as necessary).
k �V�41011 q r
S
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
k it L
❑ Yes � ❑ NA ❑ NE
[:]Yes [3-90 ❑ NA ❑ NE
❑ Yes [o` ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[:]Yes E/ o
❑ Yes ETNo
❑ Yes [T No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Phone: 3v �3
3T
Date:
214 0I4

Type of Visit: (0-e"omp nce Inspection U Operation Review U Structure Evaluation Q Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral ,�0 Emergency O Other O Denied Access
Date of Visit: Arrival Time:16�'f Departure Time:J-/�, f J County•'! Region:
Farm Name: �Aqid an6jj] T Qy�Lr Owner Email:
Owner Name: t( L ", Phone:
Mailing Address:
Physical Address:
Facility Contact: (1,�t att-W f U` Title: �G Phone:
Onsite Representative: ` Integrator: rn ,-
Certified Operator: L2 �/� S Certification Number: ,976t)b
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Design Current
Capacity Pop.
Wet Poultry
Design
Capactty
Current
op
:.�
Design Current
CattEe Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder.
La er
Non -La er
a
D , P,oult ,
Design Current
Ca aci .' Po .. '
Dai Cow
Dai Calf
airyHeifer
Cow
Non -Dairy
Farrow to Finish
Layers
Non -Layers
Pullets
Beef Stocker
Gilts
Boars
Other
Other
Beef Feeder
jBeef
Brood Cow
Turke s
Turkey Poults
Other
DischarPes and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[]Yes
❑ No
[D' IA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[2,KIC
❑ 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
[5IA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
Yes
LJ 110
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
0 Yes
E3 o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3
21412011 Continued

Facili Number: - Date of Ins ection:
Waste Collection & Treatment
4. If storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[—]Yes
[E]-T�1S—❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No B-N7C
❑ NE
Struc 1 Structure 2 Structure 3 Structure 4
Structure 5
Stricture 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0-M-o— ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[—]Yes
�[] 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
Imo o ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
EJ-Ko ❑ 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-go— ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�- ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E],X6- 0 NA
❑ 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): 46 6 K/u.C& S 6 0
13. Soil Type(s): W -1y�rk16 1 14- (-r(1cf`
❑ NE
14. Do the receiving crops differ from those designated in the CAWNIP?
[:]Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Ai5
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑-16-
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
l�"O ,ilJ
NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
fail have
19. Did the facility to the Certificate of Coverage & Permit readily available?
❑ Yes
Rio
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? 1f yes, check
❑ Yes
EJ-15
❑ 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 [§.iGo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
[:]Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? [:]Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

v
Facili!j Number: - Date of Inspection
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25.9s the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately_
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
EZJC��❑ NA ❑ NE
E?15 ❑ NA ❑ NE
❑ Yes
l.d` o-
❑ NA
❑ NE
❑ Yes
Q 110
❑ NA
❑ NE
❑ Yes CD�Ko ❑ NA ❑ NE
❑ Yes Q-No ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
]o
❑ Yes
U41110,
❑ Yes
0<0
❑ NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature:
Page 3 of 3 21412011

Facility Number L� 1 - © ® Division of Soil and Water Conservation
Other Agency
Type of Visit: C36£6mpliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: 01 routine Q Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: �/ Arrival Time: V Departure Time: f jCounty: ram Region: f
Farm Name : :�4araa�-
Owner Name:
Mailing Address:
Owner Email:
Phone:
Physical Address:
Facility Contact: /��!/ �tr Title: _���• spry Phone:
Onsite Representative: Sls•— Integrator:
Certified Operator: �jtr�r � �����,,, Certification Number: 4o
4
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Des g Current
Swine Ca aci t Mill P.
Design Cnrrent
attle a aci h'Po •
P
Dai Cow
airy Calf
Wean to Finish
La er
Wean to Feeder
on -Layer
Feeder to Finish
X �,:.,,
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Farrow to Wean
De. Poultry
Design; Current
Ca aei :;„�,;Po .
Farrow to Feeder
Farrow to Finish
Layers
Gilts
Non -Layers
Boars
Pullets
Turkeys
Other Turkey Puults
Other Other
Discharmes and Stream Imaacts
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 the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes [] No ❑ NA ❑ WE
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 21412011 Continued

[Facility Number: - Date of Inspection: — -131
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ® No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency? -
❑ Yes fa No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
[:]Yes ® No
❑ Yes ® No
❑ Yes allo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer: to question#): -Explain any YES answers andfor.: any additional recommendations vr. any�other.comment m -`
Use drawings -of facility to better explain situations (use additional pages as necessary). -;,
rC/st8r� G'grl�Cr� >�/5�� jBvr"�17n►'l;(o�,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

acili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ®No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 _
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [, No ❑ NA [] NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® 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.No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
R[ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
K No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [21-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs. ❑ 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): )3en-r-hf , L'Yr
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [.No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? S-Yes D5 ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [Z 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
rZ;1 No
D 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 I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Ed No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes F24 No
❑NA ONE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

IType of Visit: Wompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: (D*outine 0 Complaint 0 Follow-up 0 Referral 0 Emergencv 0 Other O Denied Access
Date of Visit: Arrival Time: /blOt7 arh Departure Time:jrt� County: �Iqa€� Region: Ra
Farm Name _ a4 AnnoN Epp r-Ark5
R L-l-t- _ Owner Email:
Owner Name: t'5hg rjrja n bRao K AKf%,--5 Phone:
Mailing Address:
Physical Address:
Facility Contact: am^Cy—_ 'Title: �Tpm_sn-tt _Q,\ !§&M- Phone:
Onsite Representative: .a-T W Integrator: Mv�t� fey Itew,t)
Certified Operator: A ur-N �}�n,�r3 Certification Number: Q g 107
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
DesignR.Current , . ._. Design Current
Design C•arrent
SwineCapactty _Pop. Wet Poultry Capacity Pap.
Cattle Capacity Pop.
Wean to Finish La er
Dairy Cow
Wean to Feeder
Z a
Non -La er
Dairy Calf
Feeder to Finish
_
Dairy Heifer
Farrow to Wean
--Design Curren#
Dry Cow
Farrow to Feeder
D . Pout Ca aci K ,
Layers
Non-DaiTy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars I A Pullets
Beef Brood Cow
Turkeys
-
Other Turkey Poults
OtherI L 10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[V'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
[jj'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
[5"NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[M'No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[0"No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

�r y
Facility Number: - '? Dinspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [RrNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No N'NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
�Qcarrf�QR� ��IJAl�
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): C1 i
Observed Freeboard (in): 140 :2Lk�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
A
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[;�No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
E3*No
❑ NA
❑ NE
8. Do any of the structures 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
[a"No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [► /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. CropType(s):
13. Soil Type(s): r' F_ nix a
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes GZfNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes gNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [2f No ❑ NA ❑ NE
❑ Yes [v2rNo ❑ 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 E�rNo ❑ 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 dNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections
22_ Did the facility fail to install and maintain a rain gauge? ❑ Yes Ef No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �o
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - -70 Date of Inspection: +
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes dNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes gNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:)Yes ❑ No E�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, frecboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes [Z No ❑ NA ❑ NE
❑ Yes [�] No D NA ❑ NE
❑ Yes E] No ❑ NA ❑ NE
❑ Yes Nf No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes [.� No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Date: ' �-
2/4/2011

Type of Visit: roroutine
nce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: val Time: Departure Time: ' �County: Region: j_"%ZV
Farm Name: 64eMiG
Owner Name: 511ti�Ltr►.Z
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: 5*
1rw
J-
s
Certified Operator: .1446t roh I1S er -
Phone:
Integrator: a
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current
Design
Current
Design C*urrent
Swine CapacityPop.
W_et.,I'oultry
Capacity
Pop.
Cattle Capacity Pap.
Wean to Finish
airy Cow
Wean to Feeder D O
Non -La er
Dairy Calf
Feeder to Finish
airy Heifer
- Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D .Poul. ,• _
Ca aci
P,o
Non-DaiEz
3 Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Dischar es and Stream Impacts .
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [R No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [-]No
❑ Yes [—]No
❑ Yes E, No
❑ Yes [S-No
❑ NA ❑ NE
[] NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in): g
RNo ❑ NA ❑ NE
[:]No ❑ NA ❑ NE
Structure 6
Observed Freeboard (in): 3 o A t{ —
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�a No
❑ NA
❑ NE
(i.e_, large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a
❑ Yes
Jallo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
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
Ej�t No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
El No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
RNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [54_No ❑ NA ONE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):/� _
13. Soil TYpe(s): liCl:i'. �C�d..�c 1CG",t7./ , n a Y
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?
[aYes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[SjNo
❑ 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
allo
❑ 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
[3,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. EaYes ig o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard �aste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [allo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes S No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: —
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
25. Is the facility out of compliance with pertnii conditions related to sludge? If yes, check ❑ Yes ba No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes � No
❑ Yes [3 No
❑ NA Ej NE
❑ NA ❑ NE
❑ Yes [RNo ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes [Z No [DNA ❑ NE
[:]Yes 0 No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes No
❑ Yes EgLNo
NOW
7 p �d ev�T�a ysa
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
yOfI"�Td�oo ry r*15 to -sr s Ialek�iu
�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: g% 1>- 33-33-DD
Date: 5 69 ,ZV r r
21412011

r
Type of Visit Qrtompliance 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: ( 7 1 Arrival Time: / r / Departure Time: County: Region: ! z CJ
Farm Name: _ -s"M (Ofb0 K. TF�Owner Email:
Owner Name: 1 �
: p"f3cm br"ooU _ - rrvti9 ��f 1 Phone: n
Mailing Address: t 4 � � �O7� .�� 1 �- �! A �"i� ��i �l� 33
Physical Address: 4,_4 f
Facility Contact: Title: — � Phone No: ctto -&2--��-
f
Onsite Representative: 4ir - �rJ �U'►�S'[Jr'\ Integrator: a 8rX'- U., Z'7_
Certified Operator: i�r (� �'�" Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = ` 0" Longitude: [=] ° = ' 0 "
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
C►attle Capacity Population
❑ Wean to Finish
❑ La er
❑Dairy Cow
Wean to Feeder
❑ Non -La er
❑Dai Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
n ❑Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
❑ Non -Layers
Feeder
❑ Boars
❑❑Beef
Pullets
❑ Beef Brood Cow
❑ Turke s
Other
❑ Other
❑ Turkey Puults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of 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 93 No ❑ NA ❑ NE
❑ Yes ❑ No R&A ElNE
❑Yes ❑No MNA ❑NE
❑ Yes ❑ No LI NA ❑ NE
❑ Yes Ila No ❑ NA ❑ NE
❑ Yes LklNo ❑ NA ❑ NE
Page 1 of 3
12128104 Continued

F�
Facility Number:cq — �(J
i
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
Identifier: 6L a�I
Spillway?: NV
Designed Freeboard (in): 141
Observed Freeboard (in):
Structure 4
❑ Yes �B NNo ❑ NA El NE
❑ Yes L7 No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2<o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) ,,��//
6. Are there structures on -site which are not properly addressed and/or managed El Yes L'1No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes efgo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑yes
L7 No
El NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
El[a Yes
,�,
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Pfqo
❑ NA FINE
maintenance/improvement?
L Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
eNo
❑ 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) r VV1tA dXL_ C 6, & o ,
13. Soil type(s) W 2 L�_
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
EJ'No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
O No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
a No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
UNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E'No
❑ NA ❑ NE
A4 a CO-,
A -OW
5
Reviewer/Inspector Name ii-E Phone: — 333'7
Reviewer/inspector Signatur Date: ZG O
Page 2 of 3 1 t 12 &04 Continued

Facility Number: —T19 Date of Inspection / /_7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ,I -To El NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElU Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other ��.,�^
21. Does record keeping need improvement? If yes, check the appropriate box below. [IU Yes ��� ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minutc Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes RNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbrcakers on irrigation equipment? ❑ Yes [OTVo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
C],No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
EJ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
®'Ro
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
2No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2No
❑ 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
,,,/
Lrl 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
21No
❑ 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
El NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
—[/No
2<.
❑ NA
❑ NE
Additional Comments and/or Drawings �t 4
Page 3 of 3 12128104

Type of Visit e Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit a Koutine O Complaint 0 Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: lie -0 11 Arrival Time: Departure Time: J `�O County: 67Ja�'y Region:
Farm Name: .511 t' n/n!D JV &t-00 kc- Ai*-m S, L L C _ Owner Email:
Owner Name: SAAA.IAIOAJ 8V �u= S Phone:
Mailing Address:
Physical Address:
Facility Contact: !tea'7- 0/- b SG^J Title: ���• She Phone No:
Onsite Representative Integrator: ,v(uJ'��`y ��'O-JAJ
Certified Operator: 4,1, j No ,5 e-^f T011nJ Sant/ Operator Certification Number: AWm g?16 F--
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 00 =*
0di Longitude: = ° = I = „
Design Current Design
Swine C*apacity Population V1'et Poultry Capacity
Current Design
Population Fettle Capacity
Current
Fopulation
❑ Wean to Finish
❑ Layer
2DQ
El Farrow to Wean
❑harrow to Feeder
El Gilts
El Boars
Wean to Feeder
Feeder to Finish
Cow
❑Dai
❑Non -La Non -Layer Calf ❑Dai
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation`?
Discharge originated at: ❑Structure ❑Application Field ❑Other
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge From any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
Cow
❑Dai
❑Non -La Non -Layer Calf ❑Dai
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation`?
Discharge originated at: ❑Structure ❑Application Field ❑Other
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge From any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
21'1 A
❑ NE
❑ Yes
❑ No
DNA
❑ NE
��A
❑ NE
❑ Yes
No
El Yes
�❑ 'o
L�❑
NA
❑ NE
❑ Yes
L'��,�'No ❑ NA
❑ NE
I2/28/04 Continued

Facility Number: 0 — Q
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes
No ❑ NA El NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
2<o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier. 4A*: / Sk/r�%� /_4.4 2 b'ea_
Spillway?: %io 710
Designed Freeboard (in): I 1 ( I
Observed Freeboard (in): 3.3 2-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ETNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
E No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
E No ❑ NA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
"N. [I NA El NE
2L�No
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
B o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El��,,
Yes
//
3-No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
Yes
ElLi
�,
' o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
[]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s) R,,v t ,!
13. Soil type(s) tjt1G�`
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ElYes
E; o
❑ NA
❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
ElNA
ElNE
17. Does the facility lack adequate acreage for land application?
ElYes
9'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
21 o
❑ NA
❑ NE
Comments
(sU'Ex_ liaYo yeensdaaryj as or any+ a omme�ts
fctnbttr exUse drawings; of s aes ncesai/ d .f/i1/ /� J � )/ � I L _
L NtC 4f/� L ti fi �I/�/r�rr�� r_'.'�f [..`� I.Ye
17 ex, Ili � J w� : S �_ M� G� ee•�...:�
r gL
RcviewerllnspectorName 1. Phone: 910o g33.330a
Reviewer/Inspector Signature: Date: im ZUQ
12128104 Continued

Facility Number: Q —70 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes ETNo ❑ NA ❑ NE
❑ Yes ETNo ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
G'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
DINZ
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o
❑ NA
❑ NE
Did the facility fail to calibrate waste application equipment as required by the permit?
El24. Yes
�,_3_,,
LNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
EKoo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
91, oo
El NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[3 o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
El -No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
,l, NwL3 NA
LA
❑ 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
3<o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
LK
❑ 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
N�o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
,�,3
LNo
❑ NA
❑ NE
Adiiitiiival�Cc►miaents`"�andlor Drawttigs: >�,
12128104
12128104

I Ok5 I 1 U�- l Y ISO
ivisian of Water Resources
Facfity_Namber - '70 O Division of Soil and Water Conservation
O Other Age, ncy
Type of Visit: Q<Ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: j c, j Arrival Time: Spl9 Departure Time: County:
Farm Name: S e 1 telZrVIS�.c�L�a r1 �_ 1 = c k..1 V
16�wn�etEmail:
Owner Name: SA4 e q6V-6.0 kc �10A s I - LC -Phone:
Mailing Address:
Physical Address:
Facility Contact: %.a' arty6c rW W(Title:
Onsite Representative:
l(
Certified Operator: Q CLrtt f 13, �-S 0,
Back-up Operator:
Phone:
Integrator: K(6 — .f
Region:
Certification Number:? l / 70K
Certification Number:
Location of Farm: Latitude: Longitude:
PoultNINEacity Pop. Cattle
Design Current gn Curren7Wean
Finish La er Dai Cow
Capacity Pop.
I
ash
Feeder
I Z06
f
Non -La er Dai Calf
DairyHeifer
Design Current Dry Cow
D . 1'oult Ca aci l;o Non -Dairy
o Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Boars
Non -Layers
Beef Feeder
Pullets
Turke s
Turkey Poults
Beef Brood Cow
Other
Other
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (I f 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 Lam`" 1O ❑ NA ❑ NE
❑ Yes
❑ No
[q-NA
❑ NE
0 Yes
❑ No
[ '1 A
❑ NE
0 Yes
❑ No
L.7'`�t'
❑ NE
❑ Yes
[�Io
❑ NA
❑ NE
[:]Yes
�o
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facili Number: - '7 Date of Inspection:
6
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�6 ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No [ e❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: 64-C ffer�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ y
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E]-N6— ❑ 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
Eq4ib❑ 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
[EI-Na— ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Qle___b NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
E _lei❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
MW0_ ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s): C 6 _ N4 v S (r- 0
—
13. Soil Type(s): ti A?'_V-k .Q- C
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[9-- o 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
Ea-K-b ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑r Pd'- ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ej,?<o ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
to ElNA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ 'Nwo ❑ NA
❑ NE
the appropriate box.
❑ WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other: I
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [3 11� o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes EJ- o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes D- ❑ NA ❑ NE
Page 2 of 3 21417015 Continued

Facility Number: - -7 v Date of Inspection: $` S�Iy
24. Didthe facility fail to calibrate waste application equipment as required by the permit? ❑ Yes l "o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑>d- ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E5-1go ❑ 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 io ❑ NA ❑ NE
[:]Yes [:jXo [DNA ❑ NE
❑ Yes E� 1Vo [DNA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes M' o
❑ Yes 6"N�o
❑ Yes E Tf To
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question ft. Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
UI
C-eA(
Reviewer/Inspector Name: tUVIGO Phone: l 10 ` y 3 3 J,73 y
Reviewer/Inspector Signature: Date:'-5
Page 3 of 3 214120 5