090125_INSPECTIONS_20171231

1511 A-LIGI& 13b
s
ie
(Type of Visit: Q'Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: LLBi!_I County: /c �c r Region:
Farm Name: i (C'f 4f Owner Email:
Owner Name: Do �SO.4(A Phone:
Mailing Address:
Physical Address: r
Facility Contact: (1'a+�`'-J �` QAA6 Title: Phone:
Onsite Representative: << Integrator: i�t tj
Certified Operator:
Back-up Operator:
Location of Farm:
6ZU
-I-t1h,0104 D qAtli
q [! 0 ` kO 13 [ � (? Latitude:
Certification Number:y(s
Certification Number: r 0 Q S! b (
Longitude:
Desiga Current
NOR?esign
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Da' Cow
Wean to Feeder
Non -Layer
Da' Calf
Feeder to Finish
O ?- $D
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D Pou
Ca aci
P,o
Non -Dairy
Farrow to Finish
"
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Pouets
Other
Other
Discharges 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 U-NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ 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 E IqA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes Eallo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential'adverse impacts to the waters ❑ Yes e-Mo ❑ NA ❑ NE
of the State other than from a discharge? `
;ems:_ .
Page I of 3 21412015 Contis
r

Facility Number: - Date of Ins ection:
Waste Collection & Treatment
4'. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [[ hi Ej NA 0 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 1—J =Vo ❑ 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
[G]'Ao
❑ NA
[D NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E]o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
IdJ o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C 5 A r)1'" 6,6"0 9-1& _
13. Soil Type(s): Phu Wt,, 0,Wf Oe,, �� ^
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [ffNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? WesT&N'o❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 13<0 ❑ 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 fo ❑ NA ❑ NE
[] Yes [] No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [.j""" [] NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes [3 o ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [ SKo
❑ 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 dNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? E] Yes [?�No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Confinaed

rEaefty Number: jDate of Inspection:
24. -Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Q'go-'
❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
ET 1 'D 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
i/o ^❑
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
[J-
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
❑ Yes [i]' o ❑ NA ❑ NE
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[; 1 oo
❑ 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
To
❑ NA
❑ NE
❑ Application Field. ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[D-M-6
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[3'No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
er to question #� �E�ilain any'YES answers and/©r,any additional recomoendadons or;'.any other connments E"a1
1Commeats (ref
*� . _ , % ,Y
Use drawint s. of.facility�#o. Better expiam;,situahons (use additionaVbsiges as..necessary).
- bj eej Co4-c9 E
G<A� I 10 -
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
or Sr r& I
Pf(XS
0- �,75 P- �. �5
5S07_1>
Phone:qlc)-M 3 -3' 33 �
Date- 1� L 1 U
2144015

- dDi"vi"sio"'�n of Water Resources .,
Facility Number - Z. S O Divisioa of Soil and Water Conservation
+Q Other Agency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up Q Referral 0 Emergency 0 Other Q Denied Access
Date of Visit: U G Arrival Time: Departure Time: County: �3 fC�•'�C� Region:
Farm Name: l
`
-&[q v
f:;J I-1
Owner Email:
Owner Name:
�v It
V�
Phone:
Mailing Address:
Physical Address:
Facility Contact: (o_a d COL CA Title: Phone:
Onsite Representative: t Integrator: fM
Certified Operator: ( Certification Number: 1-7 `s
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design
Current
A
Fhsign Current £� Design Current
Swine Capacity
Pop.<<
WeYPoultry Gapaci Pop Capacity Pop.
„
,,Cattle
Wean to Finish
FIN'on-Layer
a er
DairyCow
Wean to Feeder
Dai Calf
Feeder to Finish Z
Design Current
Daia Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D P,oul Ca' aci ; P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Pullets
'I
Beef Feeder
Boars
Beef Brood Cow
Turkeys
Turkey Poults
Other
Other
Discharees 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 [] No ❑ NA ❑ NE
❑ Yes
[—]No
❑ NA
D NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[—]Yes
[-]No
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facili Number: jDate of Inspection: / 7
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No D'ITK- ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[] Yes
D- i�o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
L_I l"o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q�o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[3-NU-
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E! j hto
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes to ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): L� c.t i'1 560 _l_�7L_f
13. Soil Type(s): av— & s-►r Ce C
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [D-No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [3-No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [3--No ❑ NA ❑ NE
❑ Yes [ o ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [Ej'go ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [a -No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other-
2 1. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes []-No
❑ Waste Application ❑ Weekly freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [l'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 21412015 Continued

Facili Number: IDate of Inspection; AD
24,Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �0
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �o
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? Yes �o
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �o
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes Cn ❑ NA ❑ NE
❑ Yes [ go' ❑ NA ❑ NE
❑ Yes []rNo ❑ NA ❑ NE
❑ Yes [3`90 ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [�J'No
❑ Yes E l No
Ise" drawings of fAd ity to better: ezplain'situations'(use addits. ional pages e's' necessary). "' li N_S 6 17 6
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Ctt( cfI°-—� 3o&-6851
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
t Phone: — 93-339
X It A t
Date:
21412015

Type of Visit: pliance inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: aCh Region:
FPJ
Farm Name: l Owner Email:
Owner Name: (¢/` Phone:
Mailing Address:
Physical Address:
Facility Contact: ®/\� fir, Title:
Onsite Representative: t (
Certified Operator: .IL
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: g 5 u f
Certification Number: IVJ
Certification Number:
Longitude:
Design Current
Destgn Current Design Current
$wine
Gapaeity Pop.
Wet�Poult I 1!!!1 city Pop. Cattle Capacity Pop.
:..
to Finish
La er Dairy Cow
NWean
Wean to Feeder
Non -La er
'z
Dai Calf
Feeder to Finish,
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D 1?otil Ca aci
PRo
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther Turkey Poults
Other Other
Discharees and Stream Imuacts
1. Is any discharge observed from any part of the operation?
❑ Yes
O-MT— ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[—]No
Ej'1�A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
ETN—A
❑ 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
EJ'NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3
21412011 Continued

Facih Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [&Ko ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No [j]-1 A ❑ 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
Q-K-o—
[DNA
❑ 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
E�4o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[ ,?o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�Z<o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[ No
❑ NA
❑ NE
maintenance or improvement?
Waste AvUlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
IS o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below, [:]Yes Ta ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. 0 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): tt f ` V*_V�
13. Soil Type(s): ti, n _.....,. -
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [! "o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [? go ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Eff No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes ETNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes E34- o ❑ NA ❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes L l�o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E3 110 ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E j lq ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes M No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes Ej'_N'o❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection:foes'..-L
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E-147 ❑ NA 0 NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [a�-1 o � ❑ 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 aj� ❑ 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
rC4'l_o 0 NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
M1No ❑ 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
[ fo 0 NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[]Al'o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Q5�Ro ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
NA ❑ NE
'Comments (refer to question ##): Explain any YES answersand/or any additional recommendations or,any other comments:
Use drawings of facility to better explain situations (use additional pages as necessary).
�
Reviewer/Inspector Name: [
Phone:
r �
r
Reviewer/Inspector Signature:
Date: O [
Page 3 of 3
2/4l20H

Type of Visit: [}"Compliance Inspection O Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: outine_ O Complaint Q Follow-up Q Referral Q Emergency O Other O Denied Access
S r�� � � n n
Date of Visit: Arrival Time: Departure Time:L1 County: I1' cj'�N_ Region.:"—'
Farm Name: �� G•�
Owner Name:
Mailing Address:
Physical Address:
Facility Contact
Title•
Onsite Representative:
Certified Operator: >'!�
Back-up Operator:
Owner Email:
Phone:
Phone:
Integrator: 4_'.
Certification Number: ? LIJ
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes 5,"'" ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes 10 ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes [,4o ❑ 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 o ❑ NA ❑ NE
2. is there evidence of a past discharge from any part of the operation? ❑ Yes ® ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Rio ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: I Date of Inspection. 3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes io
a. If yes, is waste level into the structural freeboard? ❑ Yes 0 No
Identifier:
❑ NA ❑ NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Spillway?: _
Designed Freeboard (in): ► 'l
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes 024o ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [] 1 o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify
DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [&K
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E3,Ko—
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9_ Does any part of the waste management system other than the waste structures require ❑ Yes Q>e'
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EaNv
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes []l<o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
'
COP �4
12. Crop Type(s):
r
13. Soil Type(s): NOV- wtoo
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [6,<o❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Ala ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes M<o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[VXo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[t 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
05 No
[] NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design O Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes
o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
rs
❑ NA
❑ NE
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: - Date of Ins ection.
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[g'No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
CD'Ko—
❑ 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
E3 o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
fo_
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[gd<
❑ 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
QG o
❑ 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
[Zj4_o
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
[:]Yes
Q j o
❑ NA ❑ NE
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes0 ❑ NA ❑ NE V
33. Did the Reviewerfinspector fail to discuss review/inspection with an on -site representative? ❑ Yes [WrNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes Ej�'<o ❑ NA ❑ NE
Comments (refer to question #): Explain any. YES answers and/or any additional recommendations: or any other commefi6n;-'!*': -
Use drawings of facility to better explain situations use additional pages as necessary).
C"'t-, Gojeo-j 1*�L -3(
�( 0 gal ct_v� -
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 3
21412011

a
Type of Visit: QMompliance Inspection V Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other p Denied Access
Date of Visit: Arrival Time:1 Departure Time: ! County: rr
Farm Name: O / e E _Tp'-0t ix Owner Email:
Owner Name: '71,�u2�1J/�cX Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: 3u._ 1 _ _
Certified Operator: ri
Zb /i� Title: �GCJ/l Yr
Integrator: 4zJ
T
Certification Number: 1,7
Region:
Phone -
Back -up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current
Design
Current '
Design Cunt
Swine
Capacity Pop.
V0i t Poultry
Capacity
Pop.
Cattle Capacity Prreop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
' i�I,
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dry P,oultr,
C_a achy
l;o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
113eef
Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Imoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ►�-No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA [:]NE
❑ Yes [—]No
❑ Yes ZLNo
[:]Yes Ug-No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: - Date of Ins ection:
Waste Collection & Treatment
y 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes M No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Q No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
allo
[DNA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
ff 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 Pending ❑ 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):ra/rSCu�. —
13. Soil Type(s): to aa& ZC ���r/ /42r "/fg
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes K No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes FA No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes EINo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes No ❑ NA ❑ NE
[:]Yes O'No ❑ NA ❑ NE
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 �o ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Ppes. record keeping need improvement? If yes, check the appropriate box below. ® Yes ❑ No ❑ NA ❑ NE
Vaste Application ❑ Weekly Freeboard EKWaste Analysis oil 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 JR No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes F. No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes CR-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 to provide documentation of an actively certified operator in charge? ❑ Yes El No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? D 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 file 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 E No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes PS No
❑ Yes & No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question # ): Explain any YES answers and/or any` additionafrecommendations or -any o#her commentti "�' ,.
Use drawings of facility to better explain situations (use additional pages as. necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: II�j 1 2
21412011

I Vt.s /I A-0 1 �;t
z
!Type of Visit: O'Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: (D4foutine 0 Complaint 0 Follow-up Q Referral O Emergency O Other O Denied Access jl
Date of Visit: --l=ice Arrival Time: Departure Time: 6 O County: J alect Region:/�
Farm Name: i �.tIf Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: D;)L;Q �j y`oC424 �G Title: ���C Phone:
Onsite Representative: ' Integrator: K
Certified Operator: t ( Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Desi n Current
g
Swine Capacity Pop.
"+ �x `
Design CurrentCo.
. Design urrent
Wet Poultiy Capaci , Pop. rCattle ' °` Capacity Pop.
Wean to Finish
Ga er
airy Cow
Wean to Feeder
Nvn-La er
airy Calf
Feeder to Finish �(
�� � ''}- - -
DairyHeifer
Farrow to Wean
Design Current
Cow
Farrow to Feeder
Ca aci P
D , kl'ouls r .o
Non -Dal
Farrow to Finish
La ers
Beef Stocker
Gilts
-Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
TurkeyPoults
Other
Other
Discharges and Stream Imaacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[DN6'—
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
1 =l rA-
❑ 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
[2-GA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[] Yes
[L3Na,
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Q,Nu
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3
21412011 Continued

Facili Number: - iDate of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No gD-NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): T
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 0,??o ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes D—Igo ❑ 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 [j"No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes [0, o ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes EJ- o ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [;I-Ko- ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes �o ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, ctc.)
❑ 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): A.- t,.
r
13. Soil Type(s): N 0
- ct _-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [DfNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [�]-W ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑^1qo— ❑ 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?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes E4"Ivo ❑ NA ❑ NE
❑ Yes [E-No ❑ NA ❑ NE
❑ Yes [jkl1 o ❑ NA ❑ NE
❑ Yes EjlNo ❑ NA ❑ NE
O WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [_]KO
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [�No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes RNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili `Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Q_bio ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes EJia- ❑ 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 [gMo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes 0-Ko ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[-]Yes
[3-No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
E go
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
4o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0-lq-o-
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[:TN
❑ 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
l
Phone:
Date: _RYKf�
214 014

e
Type of Visit (Kompliance Inspection O Operation Review U Structure Evaluation O Technical Assistance
Reason for Visit outine O complaint O Follow up Q Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: 11 on —0 1 Departure Time: County: �Region:
Farm Name: ,� 1 Y r04-a44k r►'"�� _ Owner Email:
Owner Name: A d S A: mw-de-et wy _ _ Phone:
Mailing Address:
Physical Address:
Facility Contact: TS /9 id--'A4wx Title: Q U) Phone No:
Onsite Representative:_ Integrator: M
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e [= 5 = Longitude: E] o = [ = u
Design . Current
Design' Current
Design Current
Swine Capacity Population
Wet Poultry . Capaciryx_P,oputat'on
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
iry Cow
❑ Wean to Feeder
iry Calf
eeder to Finish
b
p2
,� i
Dry Poultry
❑Dai Heifer
❑ Farrow to Wean
❑ Dry Cow
❑ Farrow to Feeder
❑ Layers
Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
❑Beef Feeder
❑ Gilts
❑ Non -Layers
❑ Pullets
- ❑ Turkeys
❑ Boars
❑ Beef Brood Co
-
-
Other
❑ Turkey Poults
❑ Other
Number of Structures: 1
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
O 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
SNo
❑ 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
WNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
5jNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

• FacilityNumber: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes IN No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in): _ 2
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 9 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ® 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 10 No ❑ NA ❑ NE
8.
Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[KNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9.
Does any part of the waste management system other than the waste structures require ❑ Yes
Q No
❑ NA ElNE
maintenance or improvement?
Waste Application
10.
Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[4 No
❑ NA ❑ NE
maintenance/improvement?
11,
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[2 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)
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP? [:]Yes
KNo
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? j9Yes
❑ No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
i9l No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
M No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
,�No
❑ NA ❑ NE
3, /��SGu i �` l/t t—r--A L1
A Ilk,
L�LIJas Iy!) � rG� 7-2)
Reviewer/Inspector Name Yi Phone;
Reviewer/Inspector Signature: Date: —
rage _- of i■�icwvy 4UllLlIllIC@

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ®,No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes KNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g El Maps [:3 Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 5Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis Asoil 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
CR No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
91 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
C,No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E4 No
[I NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
fZ],No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
5�No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
allo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E,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
1KNo
❑ 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
[LNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
R.No
❑ NA
❑ NE
Additional Gommeatseindlor Drawings . ``` �'"�wk
+ "R''`;
Page 3 of 3 12128104

Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: �rlll: Ov Departure Time: f r717 County: Region:
Farm Name: _ �_ F �ra� �a�r" Owner Email:
Owner Name: �� UG3 ��S O ���a �cx Phone:
Mailing Address:
Physical Address:
Facility Contact: ' �'1� j2g D &ice ,Y, Title: _j_9W" wPhone No:
Onsite Representative: *R Integrator: Irt 1Zf'A
Certified Operator: _ f'ff:194 — _ Operator Certification Number: 7 �✓r
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: ❑ o = ` ❑ ` Longitude: ❑ ° [=] ' ❑
Swine
❑ Wean to Finish
Design Current Design C►urrent
Capacity Population Wet Poultry Capacity Population
Design Current
Cattle Capacity Population
❑ Layer I
❑ Dairy Cow
❑ Wean to Feeder
I
I
III[j Nan -La er I
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Dry poultry,
❑ La ers
El Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Co
Gilts
PE113oars
Other
on-aersts
❑ Turkeys
❑ Turkey Poults
❑ Other
Number of Structures:
❑ Other
Dischar es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
J,No
❑ NA
❑ NE
❑ Yes
D.No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: E— Date of Inspection v' !
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes MNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
allo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
09No
❑ 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
21No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
JZ No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
QNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
I@ No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
0 No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) �r z�.3(cL faZ42 c:,,_jZ —, ., ,
13. Soil type(s) e-
14. Do the receiving crops differ from those designated in the CAWMP?
RYes
W °VV
❑ 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
4 No
❑ NA ❑ NE
17, Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA ❑ NE
18. Is there a lack of property operating waste application equipment?
❑ Yes
® No
❑ NA ❑ NE
Comments {refer to question #): Explain any YES answers and/or any recommendations or any other comments.
o
Use drawings of facility to better explain situations. {use additional pages necessary):
o?l, farm � ���j W r✓'z'� j'o: ��-na.� ys;s
16 LYL L + > !i �7t i ►� o /rus •. ! ay�►rr i� r G'D�lv�' / 11t�/
Reviewer/Inspector Name y, f _ Phone: /p"6133`'3300
Reviewer/Inspector Signature: Date:TD
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
Re aired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [a No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes .K[ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ 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 IQ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 14No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
J4 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ERNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
allo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[,Io
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
9No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EgNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
IN No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 L
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[0 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[RNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
5allo
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit O�Co`mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: `�Arrival Time: ,Q.' Departure Time: ; f} County: Region
Farm Name: % I� O✓d Q�GlK � -4- Owner Email:
Owner Name: p /����� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: ��/�-�— Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = i = fl Longitude: 0 0 = 1 0 U
sign
yUP-ap
ine ty
ean to Finish
rFE3_Wean
Current ~ "De Curentr�
Population Wet Poultry Capacit} PopulationCattle
❑ La er ❑ Dai Cow
Des gn Current
Capacity Population
to Feeder
❑ Non -Layer I
❑ Dairy Calf
eeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder"
❑ Farrow to Finish
(� O
-
D,ry Poultry �
❑ Layers
�-; ❑ Dairy Heifer
fi ❑ Dry Cow
�,
° ❑ Non -Dairy
❑ Beef Stocker
❑Beef Feeder
Beef Brood Co
=� -
*Number of Structures:
❑ Gilts
❑ Boars
❑ Non -Layers
❑ Pullets
-..
Other
❑ Turkeys
El Turk Poults
❑ Other f- ElOther I
t ...
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
RNo
❑ 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
RNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
WNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12178104
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
❑ Yes [A No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
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
IM No
[INA
ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
,4 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
ANo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
1KNo
❑ 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
RNo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes CRNo ❑ 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) J f
/ &2:40.Z
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?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
19. Is there a lack of properly operating waste application equipment? ❑ Yes
RNo ❑ NA ❑ NE
XNo ❑NA ❑NE
IN No ❑ NA ❑ NE
EqNo El NA ❑NE
(,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):
T
Reviewer/Inspector Name d--� Phone:
Reviewer/Inspector Signature: Date: --1 7,1Z0Cf1
r w,:w v� wrsrsrssscw

e
r,
Facility Number: — Date of Inspection —27
9sguuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes MNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 5(No ❑ NA ❑ NE
the appropiate box.
❑ WUP ❑Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes C9 No ❑ NA ❑ NE
❑ Waste Application [:]Weekly Freeboard ❑ Waste Analysis ❑ Soi] Analysis ❑ Waste Transfers U Annual Certification
❑ Rainfail ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
jkNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
JM No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
®-No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
% No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
P No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ONo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[9No
❑ 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
IgNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 L
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
FNo
❑ 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
1ANo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
C&No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

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: tr 0, Arrival Time: ;��� / Departure Time. ' County: 1B
Farm Name: ]l �1 Y /�r`�li>cGl/i>''L. Owner Email:
OwnPrName: /S j �1 � fl!`�zac[� Phone:
Mailing Address:
Physical Address:
Facility Contact: 14 e�-aTitle: Phone No:
Onsite Representative: Integrator:
Certified Operator: `s� Operator Certification Number:
Back-up Operator -
B
ack -up Certification Number:
Region:
Location of Farm: Latitude: = o =1 1= Il Longitude: 0 o El =
l= u
Design C*urrent�
''.Design C•'urrent
q Desigu Current
Swine Capacity Population
WetPooltrv,apacity Population
Cdt,tle Capacity Population
❑ Wean to Finish ❑ La cr
❑ Dairy Cow
❑ Wean to Feeder
on -Laver
❑
Dairy Calf
Feeder to Finish &
€_
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
ElD , Cow
❑ Farrow to Feeder
ag `""
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
Gilts
GiltsEl
El
Beef Feeder
Flol Boars
❑ Pullets
❑ Beef Brood Cow
.,
❑ Turkeys
Other
❑ Turkey Po Its
LEE]
ElOther
❑ Other
Structures:
-Numbero„s
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the convevance 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
WNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
14 No
❑ NA
❑ NE
other than from a discharge?
Page l of 3
12128104
Continued

(y Facility Number: — Date of Inspection
• Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
ff 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
LKNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? C.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
JA No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
J,No
❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑. Yes
JD -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)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
J0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
MNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
L&No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
KNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
&No
❑ NA
❑ NE
Comments (refer to question 9): 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 Name67 �� Phone- 330c:�>
Reviewer/Inspector Signature: Date: / 3 D-'_�qD0a-
12128104 Continued

e
E
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 19 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 4 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard [. Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
0 Yes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
JZNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
IgNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
;0 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 concern?
❑ Yes
F<[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? (iel discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
151 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
E[No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

r
11
Type of Visit Im7Routine
pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Complaint 0 Follow up Q Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: b" I I Li , *r1 trLW Owner Email:
Owner Name: _ y4 1 + L,, 9 13 f? rA pdGl - _ Phone:
Mailing Address:
Physical Address:
Facility Contact: (D u � Title:
Onsite Representative:
Certified Operator: �—
Back-up Operator:
Phone No:
Integrator: IWW!'gzx
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: = O = ` [= " Longitude: = o = f = "
Design Current'- Design NI ilia
Current
Design Current
Swine
Capacity Population Wet Poultry Capacity Population
Cattle
❑Dai Cow
❑Dai Calf
Capacity Population
❑ Wean to Finish
❑ La er
❑ Wean to Feeder
❑Non -La er
Feeder to Finish
a
..- „F;
� ��.:, `
Dry Poultry ;
�. ;,. ,
,
Daia Heifer
❑
❑ Farrow to Wean
El Dry Cow
❑ Farrow to Feeder
❑ Non-Dai
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -La ers
❑ Beef Feeder
❑ Boars El Pullets
10 Beef Brood Co
- - El Turkeys
-
Other ❑ Turkev Poults
❑ Other ❑Other
Number of Structures:ILI
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
Page I of 3
❑ Yes JZ No ❑ NA ❑ NE
El Yes El No El NA [I NE
❑ Yes ❑ No ❑ NA ❑ NE
El Yes
❑No
❑NA
❑NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: —
Date of Inspection 1— b- 7
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 ! Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �3
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 19No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ®No ❑ NA ❑ NE
❑ Yes JO 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? U[Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Q 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 JR1 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need []Yes ERNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P[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)
13. Soil type(s) v� for Q
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [gNo ❑ NA ❑ NE
15_ Does the receiving crop and/or land application site need improvement? ❑ Yes CKNo ❑ 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 C,No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes RNo ❑ NA ❑ NE
Comments (referto question #): Explain any YES answers and/orany recommendations or auy'other�comments
d..
Use drawings of facility to better explaiin situations. {use additional;pages as necessary):
AL
ReviewerAnspector Name Phone: �j� D —y33 -T3(]r)
Reviewer/Inspector Signature: Date: / ry2L —D7
Page 2 of 3 12128104 Continued

Facility Number: — Date of inspection �-
-� Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [?No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes ® No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists El Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [&No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
R No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[$ Yes
O ,V O
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[X 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
151 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[d No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Od 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
(fit ,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
EANo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[9No
❑ NA
❑ NE
Additional CommebtscandlorDrsw%ings
12129104

I
Type of Visit (2PC'om_pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit toutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 07�Other ❑ Denied Access
Date of Visit: Arrival Time: O� � Departure Time: County: Atmy __ �— Region:
Farm Name: fL [`fir J dew— Owner Email:
Owner Name: „ .,�j, i f ! Y �' 7 I'ryf rzrz u X Phone:
Mailing Address:
Physical Address:
Facility Contact: ut71�.�FLu Title:
Onsite Representative: —-
Certified Operator: _57a_ . r —
Back-up Operator:
Phone No:
Integrator: ✓
Operator Certification Number: ,/,7aq�r
Back-up Certification Number:
Location of Farm: Latitude: = 0 = I ❑ 11
Longitude: ❑ e ❑ fi ❑
gA
Design Current I'l;,sign
CurrenSwine
SCIe
Capacity Population Wet Pointry pacity
Population: ' Capacity Population
❑ Wean to Finish
❑ La er
'' ❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er':
❑ Dairy Calf
❑ Da' Heifer
El Dry Cow
Y .�
"' ❑Non-Daixy
[a -Fe der to Finish 7
,3 4 O
Dry Poultry
«'
�,p_'
El Farrow to Wean
El Farrow to Feeder
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Beef Brood Co
❑ Boars ❑ Pullets
- ❑ Turkeys
Other ❑Turke Points
5 u'_
�"'� "� Number of Structures:
❑ Other ❑Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
KNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
KNo
❑ 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
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
KNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — Date of Inspection 6
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
K No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
9NO
❑ 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
J@ No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
KNo
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify
DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
�d No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
Q 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
KNo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ss❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Nt ,Siil l,C ale: /lc�fs r_ u e
13. Soil type(s) r- , e 'e— e�G
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes P[No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement'? ayes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes a No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes KNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes W.No ❑ NA ❑ NE
LUrcd�f ! n 5far� rri�
Reviewer/Inspector Name k� `' ` '.i'°i' ' i �' Phone: p 33-3
Reviewer/Inspector Signature: Date: /9— to afla i—
Page 2 of 3 11118104 Continued

J
Facility Number: — Date of Inspection 7=17
+ Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes J,No [I NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes U] No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Desig
n ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes J 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 [.No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ZNo ❑ 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
54 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[XNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ZLNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
BNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
UNo
❑ 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
t4 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
PQ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
0 No
❑ NA
❑ NE
Page 3 of 3 12128104

4
Division of Water Quality �,
(Facility Numberj0q�j 2 S on of Soil and Water Conservation11011 Agency
Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: I O :00 Departure Time: County: Region:
Farm Name: B; fi 4 E . O o r cl ea tkx F r VL Owner Email:
Owner Name- 0I—Ae 1-1 ca fn Phone -
Mailing Address:
Physical Address:
Facility Contact: +>a Yq go#.,dl'U u r Title:
Onsite Representative:
Integrator:
Phone No:
Certified Operator:- b0 t j A90rdCOL 44X' Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = ' 0 i/ Longitude: ❑ 6 = F ❑
Design Current
NVesign, Currenine
Capcity Popula#ion
Wet Poultry
Ct�ty Population
$
❑ Wean to Finish
❑ La er'
❑ Wean to Feeder
❑Non -La er
Feeder to Finish;
w _
❑ Farrow to Wean
Dry Eotilti y x r�' x
`'`
❑ Farrow to Feeder
--wc'i5��..
ss �..,�y.,r
r
❑ Farrow to Finish
'
❑ Gilts
❑ Boars
Other
❑ Other
FEE.
Number of Structures:..
, _:
❑ La ers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
n
� .Al 6i
.�C:ittle �
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Neife�
❑ D Cow
❑ Non-Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Broad Co
1. Is any discharge observed from any part of the operation?
❑ Yes
0 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
® No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
® No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

J
Facility Number: Q9 —f�5 Date of Inspection LLl
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [9No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes tB No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
[9 No
❑ NA
❑ NE
Cl Yes
[)§ No
❑ NA
❑ NE
❑ Yes
]0 No
❑ NA
❑ NE
❑ Yes
(Z No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes N No ❑ NA ❑ NE
❑ Yes 9 No ❑ NA ❑ NE
❑ Yes [A No ❑ NA ❑ NE
❑ Yes 19 No ❑ NA ❑ NE
❑ Yes
(9No
❑ NA
❑ NE
❑ Yes
[)D No
❑ NA
❑ NE
Additional Comments"land/or Drawings
A -,;
1 Z128/04

Facility Number: D q —1 Z.S Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[gNo ❑ 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): f r�
Observed Freeboard (in): ,/3-3
5. Are there any immediate threats to the integrity of any of the structures observed'?
❑ Yes
® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
N No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[9No ❑ 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
ER 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)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
5d No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[]
Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
53 No
❑ NA
❑ NE
18, is there a lack of properly operating waste application equipment?
❑ Yes
(M No
❑ NA
❑ NE
Reviewer/Inspector Name �i'�CL4e V :C'�S r ` r `.` Phone: (9l0J
Reviewer/Inspector Signature: Date:
12128104 Continued

(Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation �
(Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: /Y1-� Tune: 1' �O
I{ acility Nmnber
Q Not Operational Q Below Threshold
8-1�ermitted 8<ertified p Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: _ [� : � / .- - -QL?L"a( eavw. - 10" .— _ County:
Owner Name: /// E, Qar Phone No: 7/0 -fire
Mailing Address:zAia.�n
Facilitv Contact: — 66 _.. Title:
Onsite Representative._ Qggx
Certified operator: Q z* V >< ..
Location of Farm:
Phone No:
Integrator: /_jZg&4 .
Operator Certification Number:
l�
EjSwine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �' �u
Swine
Wean to Feeder
to Finish
G
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Discharges & Stream Impa
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a_ If discharge is observed, was the conveyance rnan-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4_ Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: .. . 1-
Freeboard (inches): 3 _
.12112103
❑ Yes &4'fo
❑ Yes Ugo
❑ Yes 0,90
❑ Yes M*o
❑ Yes EDI�o
❑ Yes Elflo
❑ Yes C3'No
Structure 6
Continued

Faccilft Number: 7— =s- Date of Inspection //• / -� Y
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes Eg-No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes [3-N-6
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 maintenancehmprovement? ❑ Yes �o
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes 01(ro
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes O�Ko
elevation markings?
Waste Annlication
10. Are there any buffers that need maintenancelimprovement? ❑ Yes DNo
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 �
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
IT Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
I9. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
E3-Weld
P/gas L L !,'G 4.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes EKO
❑ Yes ❑ No
❑ Yes [..}.Pro
❑ Yes G244o
Final Notes
Reviewer/Inspector Name ;qr.'�C._ _ :.�a=` �' _ �'.�
Reviewer/Inspector Signature: Date: ! r `/ -U z1
12112103 Continued

+'aci'Uty Number: 2 —1,2 Date of Inspection
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
8- fes
❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/�c , etc.)
❑ Yes
S446,
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
two
❑ West on OpWb5iij ❑ psis ❑£8i4 fiamg]UM_ICSV__
3-_)3 ) 'ZI.8
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
allo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
Gp tT
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
Omit
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
Q-Pia-
28. Does facility require a follow-up visit by same agency?
❑ Yes
Q Nir—
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
aw—
NMES Permitted Facilities
34. Is the facility covered under a NPDFS Permit? (If no, skip questions 31-35) [AEs ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes M-NO
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes O-Ko
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes Q-lb
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 ❑#o
❑ warm ❑ Crop Yield Form [3 k' ". ❑
012e4wfinto-htspeefions ❑
12112103

Farm Name/Owner:
Mailing Address: —
County:_ _ n
Integrator:_r
On Site Representat
Physical
Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT j1
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
Address/Location:
DATE: Q , 1995
Time:
Phone:
Type of Operation: Swine Poultry Cattle
Design Capacity: 22-low-0 Number of Animals on Site: l
DEM Certification Number: ACE~ DEM Certification Num r: ACNEW
r
Latitude: Longitude: 0 ,
Circle Yes or No
Does the Animal Waste Lagoon sufficient freeboard of I Foot + 25 year 24 hour storm event
a (approximately 1 Foot + 7 inches) or No Actual Freeboard: /d Ft. Inches
Was any seepage observed from the la n(s)? Yes or�Was any erosion observed? Yes or F o
Is adequate land available for spray? "or No Is the cover crop a equate? Yes or(l
Crop(s) being utilized: air F ' /9
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin ) Ye or No
100 Feet from Wells. or No
Is the animal waste stockpiled within 100 Feet of USGS Blue -Line Stream? Yes or(l
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or to
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or(G) If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? � or No
Additional Comments:
_i A�'
Inspector Nage
cc: Facility Assessment Unit
Signature
Use Attachments if Needed.

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