090117_INSPECTIONS_20171231

--ice-
Type of Visit: (a -Compliance Inspection U Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: 4Ff r_ Region:
Farm Name: �� �' / �r� Owner Email:
Owner Name: f��y� 51,,,LAJ Phone:
Mailing Address:
Physical Address:
Facility Contact: -J"-d Ljr[" Title: OW t7
Onsite Representative:
Certified Operator:
Bach -up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
e .
Design IE'1�t:urrent
DesigQ
Currentjll
Desiga `Current
Swine
Ca�ac� a
p h
Po P.WetPo
i
CattlePo', Ca aci Po
Wean to Finish
Layer
:,
Dairy Cow
Wean to Feeder
I
iNon-!;,a er
I
Dairy Calf
Feeder to Finish
r
Dairy Heifer
Farrow to Wean
Design
Ca`rre"A"#�
Dry Cow
Farrow to Feeder
D P,oultr
Ca ac'
1P0
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
—
I.Other
TurkeyPoults
Other
Other
Discharges and Stream ImDacts
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 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)
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 Stale other than from a discharge?
❑Yes
❑No
❑NA
❑NE
❑ Yes
C&No
❑ NA
❑ NE
❑ Yes
[3-No
❑ NA
❑ NE
Page 1 of 21412015 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): Z
Observed Freeboard (in): � Y/_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
r�J_No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
0 Yes
El No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
M-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
MNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes B No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): / c} r
13. Soil Type(s):
14.
Do the receiving crops differ froln those designated in the CAWMP?
❑ Yes
23.No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
Yes
[:]No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
fKj_No
❑ NA
❑ NE
acres determination?
17.
Does the facility lack adequate acreage for [and application?
❑ Yes
KNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
JR No
❑ NA
❑ NE
Required
Records & Documents
19.
Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box_
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JEJNo ❑ 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 _5� No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [5j_No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [a.No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes M_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 F�jNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes JANo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes �No ❑ NA ❑ NE
❑ Yes ,&No ❑ NA ❑ NE
❑ Yes JNo ❑ NA ❑ NE
❑ Yes MNo ❑ NA ❑ NE
[:]Yes Eallo
❑ Yes Jallo
❑ Yes 4?1No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA 0 NE
Comments Use drawin(#�rse%offr f„ataNb. nNels,66i7 ,,Explain any -YES -answers andlo�,l1snyiadditioaal recommendations oraany other eom.mentjs. { fI�lr �F�ai Gkili�l *qf -I i61 Klk 11+ 1
cthty:toibeeputons`use'additiittonapages,as ny
` .
% r r F4 ro�'-�"=rc.
✓r-� ��� l��(� tCn o �v � � � �- �Zu v �
��
;7;4 �a
Reviewer/Inspector Name:
Reviewer/Inspector Signatut
Phone: �/pc}�%
Date: J/S�
21412015
Page 3 of 3

I
(Type of Visit: Q'Ooce Inspection O Operation Review Structure Evaluation 0 Technical Assistance [�K O I
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access 11
Date of Visit: Arrival Time: ! c7 Departure Time:J County: P^— Region:
4
Farm Name: _JaHGl i 7 Owner Email:
Owner Name: j i �h� irk J Phone:
Mailing Address:
Physical Address:
Facility Contact: >F i G hgrd Title: Phone:
Onsite Representative: 5,e -- f Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
-Design C►urrent
Design
Current
Design Current
Swine Capacity Pop.
Wet Poulti%
Capacity
Pop.
Caftle . C*apaeity Pop.
Wean to Finish
airy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish__..;
DairyHeifer
Farrow to Wean
Design
@urrent
Dry Cow
Farrow to Feeder
D Poultr.,
gCa acit
P,o P.
Non-Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
`=fir
Turkeys
Other
TurkeyPoults
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 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 [Z No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes 1D No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page l of 3 21412015 Continued

Facili Number: - Date of Inspection: a 4yf-3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�] No
D 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): J/
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 DWR
7. Do any of the structures need maintenance or improvement?
� Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:)Yes
[Z No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
LAYes
❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
g No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes JNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12, Crop Type(s):
13. Soil Type(s): /',, bra
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
M-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
❑ Yes
0 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[RNo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
[. No
❑ NA
❑ NE
Required _Records_& Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'?
❑ Yes
[a No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? I f yes, check
❑ Yes
[A No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements El Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes O No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 14 No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes rg No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

~ Facifi Number: - Date'of Inspection: 3- / 7
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No [] NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below_
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Sf1� /s a 74 /UrctJ puJn z-/
❑ Yes [0 No ❑ NA ❑ NE
[:]Yes ES No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes [Z No
❑ Yes ® No
[-]Yes ® No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Name: SrYl�._ C buy/�-� Phone: 9,03d3-pj-5
Reviewer/Inspector Signature: Date: 1/7: / /�1-;'
Page 3 of 3 21412015

Type of Visit: ompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County;� Region:(7_
Farm Name: %j %7j Xa4 .t
pia
Owner Name: Jz
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: ��, �y 7� 7�, Title: ram— Phone:
Onsite Representative: ���, s Integrator: rz—
r r-'/j
�a
Certified Operator: Certification Number: �q'3sY
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design .Current
Design
Current
Design Current
Swine Capacity :Pap:
Wet Poultry
Capacity
Pop.
Cattle
Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
—�—
!"�Il
".
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dr. P.oultr
Ca aci
Po .
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
FIBeef
Brood Cow
Other
—.Turkeys
Turkey Poults
Other
Other
DiscbarPes and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
2] No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[:]No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[] Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2, Is there evidence of a past discharge from any part of the operation?
❑ Yes
EjNo
❑ NA
❑ NE
3, Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
B No
❑ NA
❑ NE
of the State other than from a discharge?
Page l of 3 21412014 Continued

Facility Number: - Doinspection:
Waste Collection & Treatment
4' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[:]Yes
[KNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑-Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 46 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
Ej No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
RNo
❑ NA
[] NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. [:]Yes &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):r-+/�--
13. Soil Type(s):
14. Do the receiving crops differ frodthose 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?
❑ Yes
LgNo
❑ NA
❑ NE
❑ Yes
EgNo
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes 21 No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes allo ❑ NA [] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. S Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard K71Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? D Yes Eq No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

�Faeffity Number: - Date of inspection: —
24. Did the facility fail to calibrate waste application equipment as required by the permit?
D Yes
RNo ❑ NA ❑ NE
a
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
D Yes
® No ❑ NA ❑ NE
the appropriate box(es) below.
[] Failure to complete annual sludge survey] Failure to develop a POA for sludge levels
D 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
Q No D NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Yes
0 No ❑ NA NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Upo D 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
O No D NA D 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
[K No DNA NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Yes
54 No ❑ NA NE
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
O No D NA D NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Yes
21 No ❑ NA NE
34. Does the facility require a follow-up visit by the same agency?
Yes
ER No D NA NE
Comments (refer to question ft Explain any YES answers and/orany additional recommendations or a1iy other commeuts.�
Use drawings of facility to better explain situations (use -additional pages as necessary). ,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
a
Phone:
Date:OZiQ—.�7j/(o
21412014
Page 3 of 3

Type of Visit: Q'C'ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: 10 1 J "a Departure Time: S.'3 o County:
Farm Name: I.cc Owner Email:
Owner Name: h n ti y Phone:
I
Mailing Address:
Physical Address:
Region: F-7 0
Facility Contact: Title: Phone:
Onsite Representative: 5, -- Integrator; /0fu1d
Certified Operator: ,$ Certification Number:
Back-up Operator:
Certification Number:
Location of Farm; Latitude: Longitude:
Swine
Design i Current
Capacity Pop.
Wet Poultry
Design
Capacity
.Current
Pop.
Cattle
Design
Capacity
Current
Pop.
Wean to Finish
Layer
_
Dai Cow
can to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
p�
1011
D . P.oultr
I Layers
Non -La ers
JPullets
Turkeys
Turkey Poults
Other
Design
Ca aci
°"' `,°'
C_ urrent
P,o P.
Da' Heifer
Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify 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)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
❑ No
❑ NA
❑ NE
[] Yes
ZI No
❑ NA
❑ NE
❑ Yes
[l No
❑ NA
❑ NE
Page I of 3
21412014 Continued

Facili Number: 29L - 14Z I Date of Inspection: — �—
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in): Z
Observed Freeboard (in): 33
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
43. No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
[]Yes [2 No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
o No
[] NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EINo
0 NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): &,,rn4,Jcl_ rl ®�rlSrY�,
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?
❑ Yes
� No
❑ NA
0 NE
[] Yes
M No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes (ONo ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Renuired _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 Q 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. ES Yes ggfto
[Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:)Yes [ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [] Yes [ No
❑ NA ❑ NE
[] Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

11
Facility Number: - / Z I I Date of Inspection: 3'- - /,
24. Did the facility fail to calibrate waste application equipment as required by the permit'? ❑ Yes ® No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 0 No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ® No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes ® No
If yes, contact a regional Air Quality representative immediately,
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ®- No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ® No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ® No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑NA [:]WE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Comments6(refer to;question #): Explain any YES answers and/or any additional recommendations or any other corrfinents.Psi
w
Use drawings of facilityto better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �M-3 0a
Date: _ .3'-/2— -30/S-
21412011

i ype or v isa: %d-4compuance inspection L! operation Review V structure r,vaivanon V i ecnmc21 assistance
Reason for Visit: t4trtine O Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: ' Departure Time: Q County: Region: 4
Farm Name: ��-.�Owner Email:
Owner Name: h Tye, Phone:
Mailing Address:
Physical Address:
Facility Contact: Ar zkX �_ _ -Title: Phone:
Onsite Representative: ��ow� Integrator: jyJa44 ,,�jrh LU .`.
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design
Swine @apaty
Current
Pop.
Wet Poultry
Design "Curl nt'
Capacty pT�Pop
Design Current
Gattle Capacity Pap.
Dai Cow
Wean to Finish Layer
Wean to Feeder
on -Layer
Dai Calf
Feeder to Finish zrD
Dai Heifer
Farrow to Wean
Current
Cow
Farrow to Feeder
D . P,oul
kl)esign
Ca aci�1P.o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood r_­
b.
Turkeys
Other
Turke Poults
Outer
Other
Discharses and Stream impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 2,No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
RNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
C!jNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: jDateof Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0—No
❑ NA
❑ NE
` a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _ r
Observed Freeboard (in): L3 1
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Callo
❑ 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 management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
S No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
JQ No
❑ NA
❑ NE
maintenance or improvement?
11, Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Callo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
{ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
&I No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
s�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Rea uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
� No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
� No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
B,,No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facili Number: 5 - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes gjNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes [.No ❑ NA ❑ NE
the appropriate box(es) below.
[]Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA [] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ®No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31 _ Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field V1 Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
[—]Yes [,No ❑ NA ❑ NE
0—yes ❑ No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes No
[:]Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations;or.any other comments �� "
Use drawings of facility to better explain situations (use additional pages as necessary)..>
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: /gyp 1 —33')z
Date: 7
21412011

M
type of Visit: A�®rmplince Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ne 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: Owner Email:
Owner Name: T41111 Phone:
Mailing Address:
Physical Address:
Facility Contact: �ay ,i� ,4.,� Title: 69W&,,e ✓ Phone:
Onsite Representative: -�' �-! Integrator:
Certified Operator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Design Currents
Capacity Pop
_ -, Design Current Design Current
Wet Poultry Capacity Pop �Catt3e vapac= Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
0
Daig Heifer
Farrow to Wean
7r '
Design
t►urrent- .
Dry Cow
Farrow to Feeder
nD P,oul
Ca aci
P,o -
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
;
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
F .
Qther _
;_
Turkey Poults
Other
Other
Discharges and Stream Impact
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes allo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
®No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - / Date of Inspection- —
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [21-No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 i-
5. Are there any immediate threats to the integrity of any of the structures observed?
(i_e., large trees, severe erosion, seepage, etc.)
❑NA ❑NE
❑ NA ❑ NE
Structure 5 Structure 6
[:]Yes © No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
®. No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
[9 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 ❑ AppIication Outside of Approved Area
12. Crop Type{s}:�__
13. Soil Type(s); �' Ic
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes GqNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes P No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [-]Yes a No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 10 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. 4#e"'s No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis oil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ®No DNA [:]NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0[ No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - f 7 1 Date of Inspection: j
24. Did the facility fail to calibrate waste application equipment as required by the permit? [—]Yes S No ❑ 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
❑ Nan -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? ❑ Yes KI No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the [:]Yes ® No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Z No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
FNo
❑ NA
❑ NE
Comments (refer to quest,on #) Explain any YES a»swe s `and/or any additional recommendations or any other commeM
,, ., -` Use drawiags;of facility.to better explam�situations(iiseadditional pages as necessary). �k,:
1C%j7<� �' �� ✓�� o�r�dl tiJc3t' %�'`� /�/Z 1,, v�a9h h�V � 13 T`t- L e �,Pt 1
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: `W-0-- 3 ��
Date: 20
21412011
Page 3 of 3

I
L.
Type of Visit
Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
,,Commpliance
�
� Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: 1,;2-3—J] Arrival Time: - T. 197 Departure Time: County: Region:
Farm Name: '3•ti b ��`'''- / �"�- Owner Email:
Owner Name: Z 1) Phone:
Mailing Address:
Physical Address:
Facility Contact: ,� TZ4=^--- Title: Phone No:
Onsite Representative: -s^--'� Integrator: iti`
Certified Operator: %��ss�-�- Operator Certification Number: f 3 I 0
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o [--] 1 = u Longitude: ❑ U ❑ I ❑ u
5 _ Design Cliiurrent
Design Current
Design Current
Swine Capacity Population
Wet Poultry
Cap_acityP p lation
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑Dai Calf
(a Feeder to Finish (n0& l�
"°�Dairy
Heifer
❑ Farrow to Wean
D . PoultL
ry ry
.
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑Gilts
❑Non -La ers
❑Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Co
❑ Turkeys
Other
❑ Other
El Turkey Poults
❑ Other
Number of`Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
5 ] No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State'? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
9No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
C5No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

5
Facility Number: — Date of Inspection IL��LJ
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
IgNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): c%
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
ayes
❑ No
❑ 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
� 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 th}rreeat, notify DWQ
7. Do any of the structures need maintenance or improvement?
15-Yes
ONo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
Pq 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
dyes
No
❑ NA
El 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 )dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) J t1t,t, 117U C�`4�
13. Soil type(s) Cyr
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes C&No ❑ NA ❑ NE
❑ 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
Jallo
❑ NA
❑ NE
e C7 l� �y `�i n (JU oYd' /y! i X r►� C.0 �I`z J` L4.b�-r d'� -
iFor,rrL W,r 0 rz-c,i✓r- cX_ i� o✓
Reviewer/Inspector Name �-�.� Phone: 33ad
Reviewer/Inspector Signature: Date:
Page 2 of 9 IZIZ U4 Continued

Facility Number: — Date of Inspection _ 'S1
• Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAVrW readily available? If yes, check ❑ Yes [A No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes O No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
14 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑Yes
[ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
S No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
12�No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
&No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
J3No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
53No
❑ 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
10 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
L� No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did ReviewerAnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
2� No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
S.No
❑ NA
❑ NE
Additional. Comments.andlor Drawings:
QNa
O; �' L- "'k 'j- 7 h `- 49 ,*51 x f-D r z• f�fl uS e r.] rXt �o
k
Page 3 of 3 12128104

m
Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit. 1} Arrival Time: p Departure Time: County: w Region:
Farm Name: // 7�t�G�� ,E,fe_A Owner )Email:
Owner Name: D,(7y`� Phone:
Mailing Address:
Physical Address:
Facility Contact: zr� Title:
Onsite Representative: S�
Certified Operator:
Phone No:
Integrator: V /
Operator Certification Number: / & 3 ! 0
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = e = d ❑ ,, Longitude: ❑ ° = f ❑ u
Design Current
Swine Capacity Population
Wet Poultry
Design Current
Capacity Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
1QLayer I
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dal ry
59-Feeder to Finish Ito 0 a I ZQQ
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Layers
w t
❑ Farrow o Finish
❑ Gilts ❑Non -La ers
❑ Pullets
❑ Boars
❑ Turke s
Oti ❑ Turkey Poults
❑ Other 10 Other
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
-
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? (Ifyes, 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 Q�.No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
E&Vo
❑ NA
❑ NE
❑ Yes
Cg-No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: -- %
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): g
Observed Freeboard (in): _ _ r
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ,LNo
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes E,No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes RjNo ❑ NA' ❑ NE
8. Do any of the stuctures 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 23-No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes R -No ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes KLNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or lO 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 RNo ❑ 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 2 ,No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes 0-No ❑ NA ❑ NE
Comments (refer to question #f): Explain any YES answers andlor any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
.4/�-7LG " �syr RR t FirAL
C
ra� % e-J
-_40Q %� �Uvf
Reviewer/Inspector Name«� L �--- Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 I2128104 Continued

Facility Number: — /l Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Z,No ❑ NA ❑ NE
20. Does the facility fait to have all components of the CAWMP readily available? if yes, check ❑ Yes Eallo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design
. gn 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 i ° Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
§9 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
® Yes
251416
❑ NA
❑ NE
24_
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
IS No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Eff No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
M No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
KNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
M-No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
;9-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 concem?
❑ Yes
MNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
XNo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
9No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
JKNo
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit IS Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Jj;� Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ®Arrival Time:Fi
,570T Departure Time: lac l County: Region: t—wo
Farm Name: 1T22 _T ,.j, Owner Email:
OwnerName: B bb y !Q i U/h Phone:
Mailing Address:
Physical Address:
Facility Contact: B, o 6 bv1Wh/,P1 Title: 1)yyn$- _ Phone No:
Onsite Representative: b 'TMIntegrator: i�f i3
Certified Operator: v TQ`Lt Operator Certification Number: l h310
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: ❑ e ❑ 1 El" Longitude: ❑ ° ❑ , = «
:ram -
�_Design Current Design Current Design
wow
Current
Swine opulation y WetlPoultry Capaci Po elation Cattle Ca aci
- nP P ty
Po elation
P
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
on -Layer
-
.57 Dry Poultry
❑ Dairy Calf
ES Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
,T-S
❑ Dry Cow
❑ Farrow to Feeder
—
❑ La ers
ElNon-Dairy
El Farrow to Finish
❑Non -La ers
❑ Pullets
Turkeys
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
❑ Gilts
❑ Boars
,.
Other 34. �5,
❑ Turkey Poults
❑ Other
p ElOther
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
VNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
EZNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
OTo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes MNo ❑ 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): , Ci
Observed Freeboard (in): `N
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes tgNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes JRNo ❑ 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 ErNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes CE�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 1 yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes tR No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes VNo ❑ 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) coo Hal, PO&2 ` A6 61
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
CRNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
tO Yes
10 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
determination'?[--] Yes
tkNo
❑ 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
RNo
❑ 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):
Reviewer/inspector Name V s et Phone: cf[a q13 3_D X,V3
Reviewer/Inspector Signature: Date: Had a"od
121281041 Continued

-Facility Number: Oq —fi� Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes gNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes UNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n 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 ' a Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections Kmonthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 15kNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No [,�}'NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
CRNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge'?
❑ Yes
� No
El NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
C"NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
N-No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
M-No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
CRNo
❑ 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
1237No
❑ 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
per'
' Itl No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
PNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Q, Piea e vaid) small lea ks j Albj I I
I��se
I'll a.� Ond �s a�O rya IIi,PJ f b( w��e sj°�e�,
Ffa ►� �j„�'' ro��dr 1 % �Sbay ©r� Ti'I l jrnu 6hWIM
Thol last y
irna i� a t� Was
�
~f'qr hu
r
S ra - ejL�S
J%
Cv�i Wire �l4?'�10aF
M
ai aooa
so l (S aT le
cooled -av 11
1
Page 3 of 3 12128104

0
Facility No.-1 ��- - Farm Name P)a� Date
Permit COC OIC_ NPDES (Rainbreaker
PLAT Annual Cert )
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft & %
Liquid Trt. Zone ft
Design
��-------
C[ YR( -e � F) "A)kj —vbe h iy
Soii"T7st Date 3iPl
pH Fields
Lime Needed I
Lime Applied
Cu __L/ z n
Needs P
Crop Yield
Wettable Acres —�
WUP
Weekly Freeboard ,✓
Rainfall >1"-
1 in Inspections
120 min Inspections
Weather Codes ✓
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
Waste Analysis Date
IF
.r r_
000 _
On-pir� Vat?t.a
Pull/Field
Soil
Crop.RYE
PAN
Window
Max Rate
Max Amt
tr-O
sE
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump 'SM
Start Pump S1r5-
1�—
atnh�
App. Hardware
Sproj h�a�

-17_0j[0V,/
i�IN5 o-vf - -
Type of Visit aCompliance Inspection O Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit O Routine O Complaint 1WFollow up 0 Referral O Emergency Q Other ❑ Denied Access
Date of Visit: §
IMIjb*pp Arrival Time:�,l� Departure Time: .o�QQF'i County: Region:
Farm Name: ho bb5/ TQf M Owner Email:
Owner Name: kabbi,Phone:
Mailing Address:
Physical Address:
^
Facility Contact: --7 Title: IJ m6t Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:�i� )010
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 I = u Longitude: ❑ n ❑ t ❑ "
Design Current Design Curre ,� Design Current
li
Swine
Capacity Popula Wet Poultry
Capacity Population' 'Cattle Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean:
❑ Layer
❑ Non -Layer
C.
Dry Poultry
..
❑ Dairy Cow
❑ DairyCalf
❑ DairyHeifer
V ❑ D Cow
❑ Farrow to Feeders=
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
❑ Non -Layers
if ❑Pullets
❑ Beef Feeder
❑ Boars
„ .
❑ Turkeys
❑ Beef Brood Co
Other ; ..
t�
❑ TurkeyPoults
Other x 5
❑Other
-e
w. # Number of Structures:
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
B No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b- Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
5JNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
RNo
❑ NA
❑ NE
other than from a discharge'?
Page I of 3
12128104
Continued

i
Facility Number: —
Date of Inspection OR
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Wo ❑ 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): _� q
Observed Freeboard (in): N 0
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[RNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
["No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
U No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
[:]Yes
[RNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
[] Yes
❑ No ❑ NA 9NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No ❑ NA CRNE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
❑ No ❑ NA EgNE
❑ 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
29NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
9NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑ No
❑ NA
RNE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
CKNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
KNE
Reviewer/Inspector Name S �. r - Phone: A)y 433-33M X33-
j
Reviewer/Inspector Signature: Date: OQ
Pape 2 of 3 U I2/28/ 4 Continued

Facility Number: — Date of Inspection is loklog
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA 9 NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA RNE
the appropirate box. ❑ WUP [] Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA qNE
❑ 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 Cik1VE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No JR 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
J'No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
&I NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
J�NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Ed No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[KNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
KNo
❑ 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
ERNo
❑ 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
J�tNo
❑ NA
❑ NE
Additional Comments and/or5Drawtngs.:
.. LIA
7watt was ma fed o)4 rej1Pttd_ cnk
0 Of9goas, GoOk wale
a os�
a S, S1 ��ye S'�-r ve� war d��,
row hoT a I ✓Kvr faitsfzsl
Page 3 of 3 12128104

7f
5
Type of Visit (Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 4kRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ® AE
Arrival Time: r.a Departure Time: 3. County: �i hd�r. Region: �
Farm Name: Bo b ,rV Tkrn Owner Email:
Owner Name: Po{ Y _rt&r" Phone:
Mailing Address: 1�-10 NGa4a, T _ Ifs $a 33ZIN
Physical Address:
Facility Contact:
Title:
Phone No: .558-41.5J
Onsite Representative: �" Integrator:
Certified Operator: Tafi�►, Operator Certification Number: AWA )&3I0
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = = = [I Longitude: = o E__1 I = u
"[[j_Wean
es�gnCurrent
Capac ty Population
Design Currentultry
Cattle Capacity Populationnish
❑ La er
❑Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑Dai Calf
® Feeder to Finish
_
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
.>
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑Non -La era
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
-
❑ Turkeys
Other;
❑ Turkey Poults
❑ Other
❑ Other
Numherof Structures: ED
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
JRNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
NNo
❑ NA
❑ NE
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
E5kNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — Date of inspection dJl>cta�1±J
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): Cl
Observed Freeboard (in): 34
❑ Yes 12 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 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 10 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? 9 Yes ❑ No ❑ NA ❑ NE
8.
Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
IR 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
RNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.
Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
6?No
❑ NA ❑ NE
maintenance/improvement?
11.
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 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) Co&j Dado, Ry f- IS
13.
Soil type(s)
14.
Do the receiving crops dialer from those designated in the CAWMP? ❑ Yes
® No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
19 No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
RNo
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
RNo
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
C9 No
❑ NA ❑ NE
Comments (refer to question°#� Eirpiatntan YES answaers and/oyroah". tecommendations'or any otEter comments.
Use drawings of&facriity to better explain "situatzon.e add sitiooal,pages as aeeessary).
Reviewer/Inspector Name Sch
Phone: q►10 `I33-3yo K3V3
Reviewer/Inspector Signature:
Date•— . -Aa,-0$
Page 2 of 3 V 12128104 Continued

U
Facility Number: 0 Q — 10
Date or Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? RYes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check NkYes PTNo ❑ NA ❑ NE
the appropriate box. ❑ W[.JP ❑ Checklists ❑ Design ❑ Maps p ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes lia 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
JRNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
RNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
jjj'No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
WNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
R No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
EgqNA
❑ NE
Other Issues
2$_
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
IRNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
R 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
19 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
KNo
❑ 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 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
IRYes
*No
❑ NA
❑ NE
Additional Comments and/or Drawings fr.,`*
7, Sev" ins �'d� ar, YvaI s (cad. &k Pd e yva0s ;� 0)4rtj� ha ,,Y—
vl h i � htl
n r arod'i �lea�� sped. s I rn C-
Or o eo � and are � �� � �'
and-'"q�#
a, Pleases 1C�� �21m cei'�icd e 4'FC000-j!je w H`h 0-th-a re (,t0'dJ
s' Vd Jv/ve
as, aao� s[�� Sur+e war da,�. �Pleale have aeo¢ l ye J'
mai l b n 'ins t�1-i+a� ( could nol -Rild 4) wheel j isf M4) •
a �� y �
J1F,DjJoK,vF4,D c ,eck on iiem 7 by 40�) '!J aoo 8
Page 3 of 3 12128104

Facility No. O -ftlTime In Time Out Date 0, 1�a Og
Farm Name b6y -rA _ Integrator
Owner^_ - Site Rep
Operator No.
Back-up No.
COC Circle: General or NPDES
Design
Current
Design
Current
Wean - Feed
Farrow - Feed
Wean - Finish
Farrow - Finish
Feed - Finish
Gilts / Boars
Farrow - Wean
Others
4
FREEBOARD: Design C+�Ica�r S ff 3y
6.3
Sludge Survey a�a6107 LZ-
Crop Yield��
Rain Gauge �
Co( toil Test
Weekly Freeboard ✓
Spray/Freeboard�Drop Q�
Weather Code9�
Wettable Acres
- Daily Rainfall ✓
Pv) P coo)
Observed
311y1b1
Calibration/GPM
Waste Transfers
WWQr0
Rain Breaker
�
PLAT
a� (eta.
� 1
1-in Inspections
m� "
t APB —fir fr�l�jL
Te hG is a4�jj, 07
2
120 min Inspections ✓ Qro�Sw$2 ^-a �4�d�a-iQb�Q�-hp )1 6-a�
14Ytf8+1 � 112
Waste Analysis: In�V�°^ 9iA^� /�� ?-
Date Nitrogen (N) I�fAQ'�-sUr, Date Nitrogen (N) OdA-P3
j4 W aalm-- 4bQk a o8- a. 4 m— • g --
wit Idles, 'l
s101 — 4(ci 71110:11 - 1,1 —
. W'' _�i�Ipwa1- -

ivision of Water Quality S/y41- `w__�
Facility Number O Division of Soil and Water Conservation
O Other Agency
Type of Visit
ompliance Inspection
O Operation Review O Structure Evaluation
0 Technical Assistance
Reason for Visit
O Routine O Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: ,�� Departure Time: �r v County: P Region: rW {2
Farm Name: _ ��- Q+r� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: 3-�- Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator: _ _ "n4'el /
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 0 6 = 6{ Longitude: = ° = ' E--] "
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
We der to Finish 1(ooa
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer _
❑ Non-Layet
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Dischar1jes & 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:
CapacityPoplllatio"'Wl
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
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)
Z. 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 ,K No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
(KNo
❑ NA
❑ NE
❑ Yes
WNo
❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of Inspection
0
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
Identifier:
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in): j
Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ffNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes NfNo ❑ NA ❑ NE
❑ Yes ( No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat; notify DWQ
7. Do any of the structures need maintenance or improvement? ('Yes 10t ❑ NA ❑ NE
8_ Do any of the stuctures lack adequate markers as required by the permit'? ❑ Yes J9 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 M No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 14 No ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes
� No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drifl [I Application Outside of Area
12.
�
Crop type /
s) �f l!??![ Qi[- / DV_n
13.
Soil type(s) ( e y-nr
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
WNo
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
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
[W No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
W 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):
Q xas r�s��� 511��
Reviewer/Inspector Name La!/ Phone:
Reviewer/inspector Signature: _ Date:
1ZiZaiv4 uonnnueu

r Facility Number: — Date of Inspection
Rewired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropiate box.
❑ W UF' El Checklists El Design [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. JRYes o ❑ NA ❑ NE
10 Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections CK Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
CgNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
0 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
[NNo
❑ NA
❑ NE
27_ Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
5d 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
0 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[S� No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[$ 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
tallo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
EgNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
�P ��� f � vc a
12/2&04

Type of Visit (YT,ommp�pliance Inspection O Operation Review O Structure Evaluation () Technical Assistance
e
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: / ��(oJ) Arrival Time: D ` Departure Time: j i t7 Q County: ��'� Region:
Farm Name: 7-in y f !! `t�i - �tt►''�'�'� Owner Email:
Owner Name:-- Zd— 4' Phone:
Mailing Address:
Physical Address: � 1 —1---
Facility Contact: z)Qb k;z _ 14--
t4— Title:
Onsite Representative:
Certified Operator: 11
�N *-----
Back-up Operator:
Phone No:
Integrator: r
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =o [= 6 0 Longitude: = n = 6 =
AnGurrehl
Design Current
Design Currenpulation
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
Layer
❑Dai Cow
❑ Wean to Feeder
LONonla er
❑Dai Calf
Feeder to Finish 0(D
Dairy Heifer
❑ Farrow to Wean
poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑Non -La ers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
El 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?
Page 1 of 3
❑ Yes (9 No ❑ NA ❑ NE
El Yes
[MNo
❑NA
El NE
❑ Yes
T No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[4 No
❑Yes
[3No
El NA
El NE
❑ Yes
P.No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection 'I�D
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): 19
Observed Freeboard (in):'_.1
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
[1 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
RLNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
�No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
971No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El 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 Drift ❑ Application Outside of Area
12. Crop type(s) 1AVIrM,Ld AAC11 V1__
13.
Soil type(s) 0,
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[XNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
RNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
Uq No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
{,a No
❑ NA
❑ NE
18.
Is there a tack of properly operating waste application equipment?
❑ Yes
R No
❑ NA
❑ NE
Comments (refer to question #) Explainany YES answers and/or any recommendations ar any other comiuents
Use dr'awin scat facili to' better ex lain situations. use additional. a es as necessa
a1 ����^— t/�r�r�j,� � fi7�r►''r '��d��r- G�� d� IaO+� : ►-._ct�CZr���c� �
Reviewer/Inspector Name ell-e �--- I Phone: 9/�%3-�
Reviewer/Inspector Signature: Date:
rage -, of s 12128104 Continued

Facility Number: — Date -of Inspection O f O
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 Ed No ❑ NA ❑ NE
the appropriate box. L
El WUP ❑Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. P§Yes 01 ❑ 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 9 Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
S'No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[Z No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
CKNo
❑ 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
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
91 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
V4 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
M No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
KNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Additional Comments and/or,Drawln s�?
H,
Page 3 of 3 I21128104
r

- - vision of Water Quality
E •Division of Soil and Water Fouservation . .
Factlrty Number Q� 1 7 O
O Other �►geucy � a
Type of Visit
ompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
0 Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: O /-; z'j0 ltrrival Time: Departure Time: 1,312 1 County:`71 pK Region: PR-
Farm Name: t� a- arm Owner Email:
Owner Name: nQ Phone:
Mailing Address: 1 P .3 OD N C� y«_ n.
Physical Address:
Facility Contact: 5.c w -e- Title:
Onsite Representative: -e—
Certified Operator: S, r'; W
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator:
Operator Certification Number: % t-1 % ) 0
Back-up Certification Number:
Latitude: = o = ' 0 « Longitude: ❑ ° ❑ ` ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
[Feeder to Finish
1 14,4919
1 / D
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
i
Dry Poultry
Pullets
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 Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
11
El
1
Beef Feeder
Beef Brood Co;'
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 54 No ❑ NA ❑ NE
❑ Yes
01No
❑ NA
❑ NE
❑ Yes
EN No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
5Q No
❑ Yes
R No
❑ NA
❑ NE
[]Yes RNo ❑ NA ❑ NE
12128104 Continued

I
S
r►
Facility Number: — Date of Inspection D- 7 ,S
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): i
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 5fNo ❑ NA ❑ NE
❑ Yes C4No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes � No [-INA❑ NE
❑ Yes k No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 54 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 5� 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 El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PQ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 14 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ 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
X No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination` ❑ Yes
fiQ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
14 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
flallo
❑ NA
❑ NE
Reviewer/Inspector Name �- lam'— "':�" Phone:
Reviewer/Inspector Signature: Date: /p
12128104 Continued

Facility Number: — date of Inspection s
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes (4 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes [I No [I NA El NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste `transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield 0 120 Minute Inspections 0 Monthly and I" Rain Inspections R)Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
2qNo
❑�NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Yes
❑No
L�9 NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
X Yes
L No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
, J� Yes
bj'No
❑ NA
❑ NE
26.
Did the facility sail to have an actively certified operator in charge?
❑ Yes
FLA No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
es
❑ 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
CQ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[A No
❑ NA
❑ NE
Addiitional,Comments andlor Drawings
j �1.s� fir`
/1lr� 7—, GcJ114111—dr'J1
�7_
/+✓/
X �2_ Arrt►.S
12128104

Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
IReason for Visit O Routine O Complaint • Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: -OY Tune:
O Not rational Q Below Threshold
E Permitted El'fertified E3 Conditionally Certified [3� Registered Date-LastOperated or Above Threshold:
Farm Name: --O!y eJAI, ... l a {y n ! 4r w� County: 619FAC , fz_o__
Owner Name: _ !B. e, cam* ! Phone No:
-Mading Address: „,,,LO o o It/G .� Ya
Facility Contact:
Ttle:
Phone No:
Onsite Representative:... & ,— Ta fr..... Integrator. _ Al"
Certified Operator. _ Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 0` �u Longitude •
Discharges 8 Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/rain?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
Structure 6
Identifier:
Freeboard (inches):
12112103 Continned

FacilityNumber: G] — I !� Date of inspection 3 o y
5. Are there any immediate threats to the integrity of any of the structures observed.? (ie/ trees, severe erosion,
❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ❑ 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 maintenancerimprovement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑Yes ❑ No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancermrprovement? ❑ Yes ❑ No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Odor Issues
17_ Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor 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 our neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ❑ No
Air Quality representative immediately.
Casts {ruder to 3 gmiq*��iE.S � a�araaxry � �-- � ^ - �o anpotimg
her�carn� r ��. ,
L1se drswmgs fsa'Sty to betteramt>aat�o.(uust aaml papa as nec�atyl ❑ Field Copy ❑ Final Notes
�.. :r;:�'�-ram. =, :.� __�-,a �.-�__.�...�. .� r--�...^,.,-,.=r.,.x.r�"f.«��`ar."'?•�°�
L
II / 1 I
-�n9Peter V*Slrol S. T�G it, or, G lean - t;,o ae-1A, • ��tf,
L✓lrrn r'i7 SveecToe G rr, i�� I-Ae s.'�e was T� e S �•.� w
nsy0eelar• fhGle cam( Mr. %u
Are e
Oi+ Gq
-�� .✓... .-..s'.. YY �-ti-..t..'-� �F f'^ ,,..�R .... y�......l-r-'-�i"`•rrC - -��.
E
er/IaSpectorNumeer/[nspector Signature: Date:
12112103 Canfinued

[Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
for visit • Routine Q Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Date of Visit: i 1 - U Tune:
Facility Number
- - - O Not erational O Below Threshold
Dfermitted El Certified © Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
Farm Name: _ Q TA Ice 12 ....Fo . County:
Owner Name: . A..6 6;,-, _ _ T »x . ' Phone No: 710- SS? - fl�U
Mailing Address: _ /o 100 CL. ia,e t6 jg—,n ill C k 23 fZ
Facility Contact: .. Q_.. 0"T ai'03 Title: _ _. Phone No:
Unite Representative: „ �Q1,44, Ta &..., Integrator: Alser n A y
Certified Operator: _ _ T�..r&w Operator Certification/Number:.._
Location of Farm:
�I
[wine []Poultry ❑ Cattle ❑ Horse Latitude Longitude �• Du
Design�� _ :Current :: _ -lam Cult
Swine "on,9. - Po 'on. Caere oa �._ ;qE
y-
PFarrowtoWean
n to Feeder : ,
er to Finish U ayer Non -Dairy _
Otherw to Feeder ,: w to Finish ' TOta1 DeS1gnY
Gilts
10 Boats Total S`SLW -
-
Nub_ er.Ilagoons 7i i
Discharges & Stream ImpC15
1. Is any discharge observed from any part of the operation? Er roes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field [a&er
a If discharge is observed, was the conveyance man-made? ❑ Yes &Pw
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes Mmo
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes MWo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes GWo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? 0 Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: ___ �I ._ _ . _ . _ . _ •-------
Freeboard (inches): SG
12112103 Continued

Facility Number:
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
QiQo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
8-10
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
ENo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
Q}No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
Ohio
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/m3provement?
❑ Yes
UNo
11. 1s there evidence of over application? If yes, check the appropriate box below.
❑ Yes
ONO
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
,so /Gq
12. Crop type Sena // �rte �r_ 4ve�<rref � 9&.w W elQ
_
'0
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
01'ro
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
[�3do"
16. Is there a lack of adequate waste application equipment?
❑ Yes
RIZO
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 81�0
19. Is these any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes &I-M
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes @-No
Air Quality representative immediately.
C3-Pteld Copy ❑ Final Notes
Iir. 7a4,n haot a s,p // fro*1 -kAa eeCy,s/ew,
he
lef fhe r--r
r,,q L,, &I,.)
460Vv
—�00
-9uHens
/eff- flit
Sys�s+�,
Tile
Wr,510 Gvaier
lo aoleol Crtivno/
t4e
Jay -se
An0/ waS
n of p1mv, '"j
ofi •Ss /r,
Ta I..,.,
j�o...eOt
rite
; as5tc /ar ��G s : �/
P
/�
it 7� G+�
Sold
GAS
Ae 0 ,,,i„�4„)
Mr,
7-1t/11..1
0,7rl
►`� f/vec�Ir
ar.s C �sstr� ways
a je.",'
A-Ae
f • l e
�P
"II , T,Llvn, dr9 a G.44 6wS;,, Ica., Elie o ce � n
//'c/
u„ a,
S b►np P d""/o /a
Reviewer/InspectorNamea'C.
kt
xssa__„_,.::,rxu i..__ .,�r:;..:, ,� .fie ..c«,. , .s•'........._ i_..,:,,:.,..
Reviewer/Inspector Signature: Date: I f -ay
12112103 Continued

Facility Number: — Date of Inspection a
Renuired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all co nents of the Certified Animal Waste Management Plan readily available?
{ie! checoist�,-de5ig,-s, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑.Freeb=d ❑ �� �
Q �L i,G G-l41 3,0 3 �3 7 �2,1 /
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as rewired by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did ReviewedInspector fail to discuss reviewimspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Wm any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes Milo'
❑ Yes ❑-No
❑ Yes ❑ No
❑ Yes GWO
❑ Yes [No
❑ Yes Rio
❑ Yes UNO
/Gw B-Tes QWo
❑ Yes [¢•lwYo
❑ Yes 04<0
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
I211VO3

.-tL
site Requires Immediate Attention: No
Facility No. 6 9- //7
NamelOwner:
On Site
Physical
DMSION OF ENVIRONMENTAL MANAGEMENT
ANRAAL FEEDLOT OPERATIONS SITE VISITAMON RECORD
�u
DATE: _//-_2 ! - MS
one: / z s�o
0666
Phone:
Phone-_
Fcrr�:� lceWe.(ow —eyrA-
Type of Operation: : Swine ✓ Poultry - Cattle
Design Capacity: _ / ZV SQu1 _ Number of Animals on Site: 170 sow
DEM Certification Number: ACE_ DEM Certification Number: ACNEW
latitude: • Longitude• • 0 a
Circle Yes or No
Does the Animal Waste Lagoon bay-c, sufficient freeboard of I Foot + 25 Year 24 hour storm event
(approximately I Foot + 7 inches) OWor No Actual Fr'eebaard:fit. fiches
Was any seepage observed from the l oon(s)? Yes orWas any erosion observed? Yes or(W ' Id
Is adequate land available for spray? or No Is the cover crop adequate? Yes or No
Crop(s) being utilized: C' -/Q
Does the facility meet SCS minimum setbact criteria? 200 Feet from Dwellings? -ar No
100 Feu from Wells? ja or No
Is the animal waste stockpiled within 100 Feet. of USGS Blue Line Stream? Yes or�a
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes ov�&
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or I) If Yes, please Explain. ft
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes orb tJof
Additional Comments:
rd BucAan 4rz�
Inspector Name Signature
ec: Facility Assessment Unit Use Attachments if Needed.

M
u�
ao
N
i
m
E
v
s
rn
z
af
E
v
a
.n
0
m
rn
3
i
U
H
U
cn
I
V)
U
w
3
0
X
a -
GRAPHIC SCALE
30 0 15 30 BO
( IN FEET )
1 inch = 30 ft
120
4" PERFERATED HDPE G.P.P.
WITH SOCK
1. TOE DRAINS SHALL BE INSTALLED TO CONTROL ANY INTERNAL DRAINAGE WITHIN
LAGOON DIKE.
2_ ALL WATER COLLECTED BY TOE DRAIN WILL BE PUMPED BACK INTO THE LAGOON.
3. LINER SHALL BE REPAIRED BY PLACING COMPACTED CLAY WHERE WAVE EROSION
HAS OCCURED TO RESTORE LINER TO ORIGINAL DESIGN THICKNESS OF 1.5 FT.
``Lti1+Aitiirrrr,r��
L y
D23994
P
'�N
•err++++++' � /� f /1
0
9
IrA