090134_INSPECTIONS_20171231

—�_��'.---•Q...x...-..._,,..,�..:�,...yrx:.,,�p,��-a�.�T"'w'"'-.-: �.��a+.t�"- :.-:•_. +: �_ c--••.. .. � �. ...�-r.-s ..n-.r^-i�1 .- .-...- _�"-..-`-_ ...
Type of Visit: (Dr -Compliance Inspection O operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: r'p Departure Time: /D.'��� County: Region:
Farm Name: /Jfr�,�� w JJu{fe-,-�• Owner Email:
Owner Name: �Z2&1111Phone:
Mailing Address:
Physical Address:
Facility Contact: �`jRG�,�r��Y,� Title: Phone:
Onsite Representative: ,�cr-vim Integrator:
Certified Operator: 7-n--�:7 Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Design Current
Capacity Pop.
Destgn Current`
WetiPoul @specify Pop.
�' "Cattle
u
Design Current
Capacity Pop.
Wean to Finish
La er
Dairy Cow
i�KWeantoFeeder
i?a
Non -Layer
Dairy Calf
Feeder to Finish
Daia Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
-Layers
113eef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turk` s
Turkey Poults
� �
Qther
DischaEges. and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field
a. Was the conveyance man-made?
❑ Other:
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 pan 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 D 1"o ❑ NA ❑ NE
[] Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
[:]Yes
[:]No
❑ NA
❑ NE
❑ Yes
�o
❑ NA
❑ NE
[] Yes
[s�o
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facili Number: V - 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. Ifyes, 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 D 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'No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4fi 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 �o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:)Yes DNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes [}-No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes D-I io
❑ NA
❑ NE
❑ Excessive -Pond ing ❑ 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): In
13. Soil Type(s): }� � vU
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 EJ-W6❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑-No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
D-No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
EJ-No
❑ NA
❑..NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
D-No
[] NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes QfiNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
[:]Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [2-No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes El No
❑NA []NE
❑ Weather Code
❑ Sludge Survey
[]NA ❑NE
❑NA []NE
Page 2 of 3 21412015 Continued

tFacility Number; - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes O'No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes EJ�No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes I '4o
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 E_I ""'
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes �No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes [2-1,ao
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [+- o
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes CTN_ o
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [ -1V
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Commegts (fifer to question # Explain any YESlanswers and/or any addrhoual:reoommend$tions or any'ottier comments.:;; ,
F a,r , k .
Use drawings.of:faciLty'.to betfer°explain situations (use iWdltronal,pages as uecesss
Reviewer/Inspector Name:
Reviewer/inspector Signatui
Page 3 of 3
Phone: 2e
Date:
21412015

Type of Visit: f3rtomplia ce Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: outine 0 Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time: 'per Departure Time: Q; f�ii County: Region:'
Farm Name: Owner Email:
j
Owner Name: U iJ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator: lm yr�,
Certified Operator: �'� Certification Number: Z1, �-L
��% l�f/r�1�r
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design CurrentDesign
Ceirrent
Design Current
Swine Capacity Pop. Wet Poultry
CapactPop.
Cattle Capacity Pop.
Wean to Finish Layer
Dairy Cow
Mean to Feeder Non -La er
I
, ..
airy Calf
Feeder to Finish
'',
Da Heifer
Farrow to Wean
Design Current
Ca ace =Po
D Cow
Farrow to Feeder
D , i;ouIt >
Non -Dairy
Beef Stocker
Farrow to Finish
Layers
Gilts
Non -Layers
Pullets
Turkeys
Beef Feeder
Boars
Beef Brood Cow
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (If yes, notify DW R)
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 0- No ❑ NA ❑ NE
[:]Yes [:]No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes [] No
❑ Yes E-No
❑ Yes 2!-No
❑ NA ❑ NE
[] NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: - Date of Inspection:
t Waste Collection & Treatment
f 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z31
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes �,No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes MNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 5kNo
❑ 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 VNo
❑ NA
❑ N E
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 3� No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes IB-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. Crap Type(s):
13. Soil Type(s)yC
:9-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ELNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ®. No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ETNo ❑ NA ❑ NE
acres determination`?
17. Does the facility lack adequate acreage for land application?
❑ Yes
El No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
K No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
®_ Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard -Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
0 Yes
fZ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
fj�-No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facili Number: -13it jDate of Inspection: ITI
r 24. Did the facility fail to calibrate waste application equipment as required by the permit? aYes ❑ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey El Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 I. 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 ®No ❑NA ❑NE
❑ Yes R No ❑ NA ❑ NE
❑ Yes ® No ❑ NA [] NE
❑ Yes [,g No [DNA ❑ NE
[—]Yes [}]( No
❑ Yes F>j No
0 Yes ES -No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to_queshon #):'4Eaplain any, .ES answers and/or any additional recommendations or any other comments'w
Use drawings `of facilityjc b tter e Eatn situations (use additional pages ,as necessary)„'�
Reviewer/Inspector Name:
Phone:
Reviewer/]nspector Signature:
Page 3 of 3
Date:
r
21412015

Type of Visit: (.:)-Compliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral Q Emergency Q Other O Denied Access
Date of Visit: —/(v Arrival Time: J Departure Time: O County: d Region:
/11
Farm Name: Owner Email:
OwnerName: ��n ,a C�'� /j%/t/�w Phone:
Mailing Address:
Physical Address:
Facility Contact: r�� ,,,.�-- �..: Title: Phone:
Onsite Representative: ��e ..�c— Integrator:
Certified Operator: ,�st ,.� Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
e Capacityto Finish
to Feeder L 00
r
La er
Non -La er
Design
Design
Ca aci
Current
Current
Po
Design Current
Dai Cow
Dai Calf
Daig Heifer
Dry Cow
Non -Dairy
Beef Stocker
er to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P,oul ,
Layers
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Turkeys
Turkey Poults
Other
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes? ®, No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
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
�jNo
❑ NA
❑ NE
❑ Yes
E8-No
❑ NA
❑ NE
Page 1 of 3 21412014 Continued

Facility Number: -Z= I Date of Inspection:
t.
Waste Collection & Treatment
+ 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
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.)
[gNo ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
[:]Yes allo ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[3 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
[:]Yes
[&No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
g 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
K No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ELNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ,21.No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window j ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): el_", /
13. Soil Type(s): L r
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ff[ No D NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [Z No [DNA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No 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?
Required Records & Documents
❑ Yes [ No ❑ NA ❑ NE
❑ Yes [2yNo ❑ 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
JZ[ No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
[&No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[K No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
Callo
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

acili Number: jDate of Inspection: 1 /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No 0 NA ❑ NE
Y
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes [Z No DNA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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
allo
❑ NA
❑ NE
❑ Yes
[N No
❑ NA
❑ NE
❑ Yes
EL No
❑ NA
❑ NE
❑ Yes [a No ❑ NA ❑ NE
❑ Yes 21 No ❑ NA ❑ NE
❑ Yes [&No ❑ NA ❑ NE
❑ Yes ®.No
[:]Yes No
❑ Yes No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Comments (re%i-ato question.#) Explain any YES answers. and/or any addtitonal recommendations or any otlier cowmen,..
Use drawn s of:facili to better ea lain situations" use addthonal= esas riecess = �_ y `-
Reviewer/Inspector Name: frry� C�^lFy��� Phone: 9/,9 3 3�
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412014

Type of Visit: Qi'Com ' nce Inspection U Operation Review 0 Structure Evaluation U Technical Assistance
Reason for Visit: er Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: / O; p Departure Time:[,' County: Region:
Farm Name: /J7��V; �- /Vur^�� Owner Email:
Owner Name: #wow �p/�/fi,`"" Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone.
Ousite Representative: cam• - Integrator: -KV4(0—
Certified Operator. 01 -' Certification Number: %, 72-G _
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
esin Cnt
Swine
Capacity Pop.
Wet Pointry
Capacity
Pop.
apacity Pop.
Cattle JMD
Wean to Finish
Layer
DairyCow
Wean to Feeder
pO
--�
Non -La er
DairyCalf
Feeder to Finish
Dairy Heifer
Farrow to Wean
'
Design
Current
D Cow
Farrow to Feeder
Dr. P,oul
C aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other_jTurkey
Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes C3,No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
( No
❑ NA
❑ NE
❑ Yes
S No
❑ NA
❑ NE
Page 1 of 3 21412014 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in): 9
Observed Freeboard (in): '0120_
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
0 No ❑ NA ❑ NE
[]No ❑NA ❑NE
Structure 6
[:]Yes 0 No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 2] No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes O No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes M No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [a No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land 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 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop ❑/Evidence of Wind Drift ❑ Application Outside of Approved Area
Window
12. Crop Type(s): ��}rrt /!�/1 r /��/ �S /t'n s - 1fh1-1rSe 11j
_
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ONo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes KNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes .0 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[allo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
®, No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
Callo
❑ 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 (Z 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 [2. No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [::]Yes KNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

[Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 1Z 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAW MP?
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
fo No
❑ NA
❑ NE
❑ Yes
� No
❑ NA
❑ NE
❑ Yes
QE�No
❑ NA
❑ NE
❑ Yes jo No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes [&No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes �o
DNA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments {refer to _question #>7: Eiplain any YES answers and/or any additional recommendations or any other comments _:a
Use drawings of facility to better explain situations (use additional pages as necessary), p
Reviewer/Inspector Name:
Reviewer/]nspector Signature:
Page 3 of 3
Phone: �2Ep f�3f
Date: 5 b
21412011

Type of Visit: 7DrCompliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: QKRoutine O Complaint 0 Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: F o 0 Departure Time: County: Region: fx d
Farm Name:_ rjf-e-1 r� �'.r✓S�/� / Owner Email:
Owner Name: x eysr4t %y t V; Phone:
v
Mailing Address:
Physical Address:
Facility Contact: S`j�yr�.� Tr^�✓ Title:Phone:
Onsite Representative: Integrator: pz.o�it
Certified Operator: Certification Number: /[� ��-
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design
Swine Capacity
Wean to Finish
Wean to Feeder O 0
w ,
Current Design Curreut
Pop. Wet Poultry apac Pop,`.
La er
Design Current
Cattle Capacity Pop.
DairyCow
Daig Calf
-p " Non -Layer
Feeder to Finish
Farrow to Wean
Farrow to Feeder
. De gnurrent _
D —Eyl Pio-uIt . Ca act Po
Dairy Heifer
D Cow
Non -Dairy
Farrow to Finish
Layers
Non -Layers
Beef Stocker
Gilts
Beef Feeder
Boars
Pullets
Turkeys
e Poults
Nou'
r
Beef Brood Cow
-
Other
NJ Other
-
Discharges and Stream IMaacts
1. Is any discharge observed from any part of the operation?
❑ Yes
E71 No
�C
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
MNo
❑ NA
El NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
FRNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: V - Date of Inspection:
Waste Collection & Treatment
t 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes a No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® 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
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
RNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
CRNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [S[No ❑ NA ❑ NE
❑ Excessive Ponding 0 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): _3; s,
13. Soil Type(s): L �J
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
jo No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Co No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
5[ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
© No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[::]Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
®No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
f,:;g No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
2-No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: q - /3L I I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes ® 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 [:a No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 10 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [g No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑Yes ®No ❑NA ❑NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes [No ❑ NA ❑ NE
❑ Yes ® No
[:]Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer,tolquestion #): Explain any YES answers and/or any additional recommendations or any other commen". .
Use drawings of facility to better explain situations (use additional pages as necessary).
Ali
Reviewer/lnspector Name:
oe
Reviewer/Inspector Signature:
Page 3 of 3
Phone: `)Ip' 6S-_T311 a
Date:
21412011

i
Ili"vi"sion of Water Quality
Facility Number l zi:-] - 3�f O Division of Soil and Water Conservation
s0 Other Agency
Type of Visit: �mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0'�ooutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 3 }' Arrival Time: I . `3 d Departure Time: O,'317 I County: ff4ol Region:
Farm Name: /%hC.t�y,� JUU✓✓/ / Owner Email:
Owner Name: S jyl;- - Phone:
Mailing Address:
Physical Address:
Facility Contact: O`s^s w Title: 47.e `k . a :� _ _ Phone:
Onsite Representative: ����KKy�-�-���r,,_r� Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design Current
Design Current
Swine Capacity Pop.
Wet Poultry Capacity Pop.
.00
Cattle Capacity P.
Wean to Finish
La er
Non -La er
Da Cow
01- can to Feeder laOD
Da Calf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design Current
D . P,oult . Ca ac' P,o
Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Outer
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[-]Yes rul V7- ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[::]Yes
[:]No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[a No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[::]Yes
[allo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: q - Date of inspection: 3 /3--/,3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / 9
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ® 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? [aYes ❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [K No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0 No
❑ NA
❑ NE
maintenance or improvement?
_Waste 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 [gYo
❑ 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): 49 M'10,
13. Soil Type(s): t- - X
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
allo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[allo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
VS -No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[Z No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
Required Records _& Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
®*No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[2 No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [] Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes EfNo
❑ 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 allo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [B No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facitity Number: q - 3 Date of Inspection: /3 13
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [g 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Stomge Pond ❑ Other:
❑ Yes
LE�No
❑ NA
❑ NE
❑Yes
0No
❑NA
❑NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes Z No ❑ NA ❑ NE
❑ Yes Ej No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[R No
❑ NA
❑ NE
Comments (refer to question,#): Eaplain.any YES answers and/or any additional recommendations or any other comments V
Use drawings of:facility to better explain situations (use additional pagesas necessary)._.;i ,
10 eo"-f'.Z" w 0'_ [��---- z _- /
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 970-!13j-33aV
T�
Date: 2 -/3
21412011

t
i
m ivi§ton of W'wr Quality
. ,. Q
Faeiitty Nutnber / 1 �'-FDivtsion of Soil and Water` Conservation
- ®�Othe�Age� - t�
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Olioutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: V Departure Time: : 0 10 County:. ors
Farm Name: Z Owner Email:
Owner Name: �a5 ST D m'f, -- Phone:
Mailing Address:
Physical Address:
Region:a
Facility Contact: L— Title: d(ym V Phone:
Onsite Representative: ���8i ��r�.� Integrator: r
Certified Operator: &M, w Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design C•nrrent Design Hirren
Swine Capacity Pap. Wet Poultry C city .-Pop.
__..:
IN ige—signaurrenbr
Cattle Capacity Pop.
Wean to Finish'
La er
Dairy Cow
Wean to Feeder
Daja Calf
Da!a Heifer
2g Cow
Non -Da -
Feeder to Finish
Farrow to Wean
Farrow to Feeder
"" `"'' " "
Design' Current
D . P,oul Ca aci .. P_o
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
HOther
Pullets
Other
Other
Turkeys
Turkey Poults
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
[:]Yes
[&No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[:]No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
R No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[RNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: jDateofinsp 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 ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[S 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?
C21Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
El No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
El No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[g No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes J21-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): G!/1r
13. Soil Type(s): Z24
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes r" No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes CJ No ❑ NA ❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes CR 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 No ❑ NA ❑ NE
[] Yes No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Callo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes El No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes � No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes Callo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Ins ection: j)
1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [jj No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ELNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Ej No ❑ NA ❑ NE
Other Issues
29. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
M 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
PU-No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[A No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ED No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E2�No
❑ NA
❑ NE
FComments (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). � _k. 3 �, Z' -
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: -- 0 /�--
214/2011

I
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: 3y Arrival Time: �; Departure Time: r (] : County: Region:
Farm Name: /!/�` "� 1�u✓1-rezz I __ Owner Email:
Owner Name: 72�1-17u-5 `�T2�-chr�iJ; Phone:
Mailing Address:
Physical Address: ,.� r
Facility Contact: `ri " % `''�'r'� Title: Phone No:
Onsite Representative: S Integrator:
Certified Operator: Operator Certification Number: Z& 7,;Zz,
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: = o = 1 0 " Longitude: = o = ` =
' Design
Swine _ Capacity
Current
Population
4. Design Current
'ettP,o [try Cap city Population
Design Current
Cattle Cap�ac�fty Population
❑ Wean to Finish
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
❑ La er
❑ Dairy Cow
V
❑Non -La er
_
Dry Ioultry�
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
ElNon-Dairy
El Layers
El Beef Stocker
❑Non -La ers
❑ Gilts
❑ Boars
Other it
❑ Beef Feeder
❑ Pullets
El Beef Brood Co
❑ Turkeys
Number of Structures:
❑ Turkey Pouets
❑ Other
❑ Other
Discharggs & 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 (R.No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
LgNo
❑ NA
❑ NE
❑ Yes
[3 No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility plumber: '9-- — Ei Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [3No ❑ 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): %g _
Observed Freeboard (in): 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 CkNo ❑ 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 [3 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes LkNo ❑ 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 C&No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes MNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes KNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0-No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
9LNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
2 'No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
53.No
❑ NA
❑ NE
ram-- W) rj �-e-010V-c
Reviewer/laspector Name Phone:
Reviewer/Inspector Signature: Date:
Page 1 o) 1 PZ/Ld/U4 a,onunwru

0
Facility Number: — 3 Date of Inspection 0
Reguired 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 [5 No ❑ NA ❑ NE
the appropirate box. ❑ WDP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stacking ❑ 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
5a No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
allo
❑ 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
RNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[KNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
RNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
1�[No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
KNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[.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
UNo
❑ 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
VjNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[Ado
❑ NA
❑ NE
Additional Comments and/oerxpi aw ngs i"
�j
Page 3 of 3 12128104

r
Type of Visit V`Compliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit erlioutine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit:-l�yD Arrival Time: / Departure Time: % : �{� County: �D�mOr�'� Region: f=�O
Farm Name: t" -e IOwner Email:
Owner Name: 5 7Gi,,JaJ N". 1 / U G^_� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Y'� _ _ Phone No:
Onsite Representative: 11 Integrator: if eb4
Certified Operator: 0 117e4�2 `"`— Operator Certification Number: 32'_
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = A 0gd Longitude: = o = 4 0 u
Design
Current
Design Current Design Current
Swine Capacity
Population
Wet Poultry Capacity Population Cattle Capacity Population
I I[] Layer I I ❑ Dairy Cow
1 1[] Non -Layer I I ❑ Dairy Calf
❑ Dairy Heifer
❑ Wean to Finish
Wean to Feeder
p
0
❑ Feeder to Finish
❑ Farrow to Wean
Dry Poultry ❑ Dry Cow
❑ Farrow to Feeder
ElNon -Dairy
❑ ers
El Farrow to Finish
El Stocker
N
❑Non -La ers
❑ Gilts
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Turkey Poults
❑ Other Number of Structures
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated ar ❑ 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 [9 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[XNo
❑ NA
❑ NE
❑ Yes
;K No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: — 2y Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ERNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes CK No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
1WAA
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
CR No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
®No
❑ NA
❑ NE
=Comments (refer to'gpestion ff): Eapla1n any YE ans Viers and/or:any recommendations or her com
.Use drawtngs`of facility to better explain situations (Use additional pages as. necessary)
Reviewer/Inspector Name I Phone: 9249 _730v
Reviewer/Inspector Signature: Date: 7=1y -,;;Z��
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection 0
T Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E2 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [3-No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes (9 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
10 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
W No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
99 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
64 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[5No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
R No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately -
31.
Did the facility fail'to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
U No
❑ NA
❑ NE
Additional Gommeuts and/or Drarvgin s "� y ' ' 2 ` + =a
z
t 4V
H
Page 3 of 3 12128104

IU
IV
Type of visit WCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 4<outine O Complaint 0 Follow up 0 Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: ` D Departure Time: ' County: �e"� Region: ��
Farm Name: �!�L/� ''�- N u ar! =! "X _ `-jee- Owner Email:
Owner Name: of�� t LC[z� (�i ''L Phone:
Mailing Address:
Physical Address:
Facility Contact:A2!MrirTitle: Pwb eePhone No:
Onsite Representative: , 42.uA1ja_K. vtif �d� Integrator: MZ414
Certified Operator: f ril Operator Certification Number:
Back-up Operator:
Sack -up Certification Number:
Location of Farm: Latitude: [= o = , = tl Longitude: = o = 4 =
66
Design Current
Swine Capacity Population Wet Poultry
Design
Capacity
Current
Population C►attle
Design Crtrrent
Capacity Population
❑ Wean to Finish
❑ La er
❑Dai Cow
Wean to Feeder to ❑Non -La er
❑ Feeder to Finish
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish ❑ Layers
❑ Gilts ❑Non -La Non -Layers
❑ Boars ❑ Pullets
❑ Turke s
Other ❑Turke Poults
❑ Other ❑ Other
❑Dai Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
CK 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)?
771
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
21No
❑ 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

Facility Number: q-1 Date of Inspection L
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes S No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA ❑ NE
Stnicture I Slntcture 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 42 "/
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes A 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 45No
❑ 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 2 -No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes 5�,No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes &No
❑ NA ❑ NE
maintenance or improvement?
Waste application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes J;LNo
❑ NA ❑ NE
maintenanceJimplovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes D5-No
❑ NA ❑ NE
❑ Excessive Ponding []Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > i0% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate ManureJSludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) e
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes �iLNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes EKNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determ ination': ❑ Yes ' N No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes K No
❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes PSNo
❑ NA ❑ NE
,Comments (refer to question f: Explain any YES answers and/or any recommendations or any other comments.
Use drawings of fadlity to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name run Phone:
Reviewer/Inspector Signature: Date: if-
IZI-15IU4 uonnnuea

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes PSNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ,R 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 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 �SNo ❑ NA- ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes A No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
R No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
19No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
[]Yes
R No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
J.No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
;!SNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LY 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
54No
❑ 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
K No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did ReviewerMspector fail to discuss review/inspection with an on -site representative?
❑ Yes
®No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
XLNo
❑ NA
❑ NE
Comments and/or Drawings:
l2/28104

A
Type of Visit OLCo pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral - 0 Emergency 0 Other ❑ Denied Access
Date of Visit: l p Arrival Time: ✓0rc7D 1 Departure Time: O C7 County- Region: 0
Farm Name: Owner Email:
Owner Name: � �l�i w Phone:
Mailing Address:
Physical Address:
Facility Contact: _7Xr,gm1,2!� "L Title: Phone No:
Onsite Representative: ,s*��el)A- La:sz Off Z9 r Integrator:
Certified Operator: 49s''1 & �t/i ' `-- Operator Certification Number: At
Back-up Operator:
Location of Farm.
Design Current -
Swine Capacity Population
❑ Wean to Finish
Wean to Feeder 0 V5xo
❑ Feeder to Finish
❑ Farrow to Wean
i
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ B oars !
Other
❑ Other
Back-up Certification Number:
Latitude: = o = ` ="
Longitude: = ° = ` = u
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -La ei
Dry Poultry
Pullets
Turke
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Curr&i(,_i
Cattle Capacity Population +`.
❑ Dai Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Broad Cowl
I
Number of Structures: �k
b. Did the discharge reach waters of the State'? (Ifyes. 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 WNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
❑NE
El Yes
❑No
El Yes
EZNo
❑NA
❑NE
❑Yes
W1No
❑NA
El NE
12128104 Continued

#. Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
® Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
®-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CA WMP?
❑ Yes
a& No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
®No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
[allo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[4 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ER No
❑ NA
❑ NE
dal
Reviewer/inspector Name Phone: 3�0
Reviewer/Inspector Signature: Date: O To--'V '�
Page 2 of 3 12128104 conanuea

Facility Number: Date of Inspection LC��
Re aired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JR No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes P.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 allo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
IN No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
H No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
91 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
(El No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
0 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
(A No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[1 Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[,No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
JA No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
allo
❑ NA
❑ NE
Page 3 of 3 12128104

Division of Water Quality
Facility Number O Division of Soil and Water Conservation 6"6
Q Other Agency
Type of Visit ommp�pliance Inspection 0 Operation Review 0 structure Evaluation 0 Technical Assistance
Reason for Visit 01 outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 7� p-�j Arrival Time: '3 Departure Time: ! 3 County: �`L Region: F f l
Farm Name: Owner Email:
Owner Name: Q-S _A7_L u + 'L Phone:
Mailing Address:
Physical Address:
Facility Contact: nil Orn/14 Mk- Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: So"--^e-r Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
IM Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Back-up Certification Number:
Latitude: = e= s Longitude: 0° 0 I❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
i?& naW73 10Non-La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Caw
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: FE/
b. Did the discharge reach waters of the State? (If yes, notify D WQ)
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 [RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
®,No
❑ NA
❑ NE
❑ Yes
[KNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — 3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes jVS'4No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes RNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? (9 Yes A No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 10 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 9 No ❑ NA ❑ NE
maintenance or improvement?
Waste -Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [KNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �gNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ I~ailure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ AppIication Outside of Area
I2. Crop type(s)
13.
Soil type� w s} /�
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
94 No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
XNo
❑ NA
❑ NE
6.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
IM No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[,No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
,9No
❑ 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):
Reviewerflnspector Name Phone: p- ,tt-,33DID
Reviewer/Inspector Signature: Date:

r
0
• Facility Number: — 3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ;K 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 appropiate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. IS 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
®.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
E4 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
XNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
5d No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
J4 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
fR No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative?
❑ Yes
0 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[gNo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

(Type of Visit Er —Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: i d� County:
Farm Name: -.,Ow?- Lj/i " �ursr"�Y_ / __ Owner Email:
Owner Name: 22L4*74e.5 _ �1�L1/�` _ Phone:
Mailing Address:
Physical Address: /
Facility Contact:Title: Phone No:
Onsite Representative: Integrator: r
Certified Operator: spa^* Operator Certification Number:
Back-up Operator:
Location of Farm:
=O =u
Latitude:
Back-up Certification Number:
❑o❑1
Longitude:
Region: Z—fir-D_
Design Current
Design C•nrrent Design Current
Swine
C•apatity Population Wet Poultry
Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑Dai Cow
Wean to Feeder
(10D {p ❑ Non -Layer
❑ Da' Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
a,. ~ ©� I,oultry
❑ Layers
: ❑Non -La Non -Layers
El
❑ Pullets
=.:. ❑ Turke s.
t- ❑ Turke Poults
❑ Other
❑ Da Cow
❑ Non -Dairy
El Stocker
❑ Beef Feeder
❑ Beef Brood Co
-
xY Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
P4 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
[4 No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[RNo
❑ 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
j4 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
9 No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

aFacility Number: — 3 Date of Inspection
i Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[9No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
allo
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): %�-
Observed Freeboard (in): 3 ^R
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
El No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
0 No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4fi were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
C9Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [XNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes V�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window
Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 1�cZAIl
' _.
13. Soil type(s) e�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �,No []NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes RNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes I. No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes RNo ❑ NA ❑ NE
❑ Yes JKNo ❑ NA ❑ NE
Comments (refer to question # ): ' Explain any YES answers and/or'any�"recomme`ndations or any other. comin�ents
. x
Use drawings of facility to better explain situations. (use additional #a&s as necessary):
�• �. W o r w� �n �a era �- Jos , u/� /7 -OU.s A,7�,
darn•- �'D k s � ��
Reviewer/Inspector Name I j Phone:
Reviewer/Inspector Signature: Date: `` D—"npa c-,
Page 2 of 3 12129104 Continued

r,
Facility Number: — Date of Inspection b
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ja No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E.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 [3 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
[9 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
CKNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Z No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ONo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
4 No
❑ NA
❑ NE
27,
Did the facility. fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
RjNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
KNo
❑ 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
ESNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
;.No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ELNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
FTo
El NA
El NE
..
Additional Comments and/or}Drawtogs:.,,
p2 5 . S
Page 3 of 3 12128104

y
®Division offWter Quality
Facility umber Q 9� % 0 Division of Soilin 11 Conservation
0 Other Agency
Type of Visit ®'Compliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine 0 Complaint Q Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1)-OZ-O Arrival Time: %0;.3D Departure Time: County: .Q/ a%./ Region:
Farm Name: Affejvliy Nl k -eV u i Owner Email:
Owner Name: ..,%pr d. ,.. _. _ /�i¢.�v/'n! Phone:
Mailing Address:
Physical Address:
Facility Contact: 06f6d It A& Z va4 Title:
Onsite Representative: _ KC "64 ROAi M50AI
Certified Operator: / hemioS
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator: 10'" -,0 — 8ya aLnl-
f or
Operator Certification Number: Ila %Z i
Back-up Certification Number:
Latitude: E:1 n = 1 El" Longitude: = c EJ, = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
2 Z�oDO1 10 Non -La et I Ii
❑ Wean to Finish
[9 Wean to Feeder
El Feeder to Finish
El Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
ElTurke s
❑ Turke Puults
❑ Other
Disci & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
Design Current
Cattle. Capacity Population
❑ DairyCow
❑ DairyCalf
El Dairy Heifej
[ID Cow
ElNon-Dairy
El Beef Stocket
El Beef Feeder
El Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
® No
El Yes
®No
El NA
El NE
❑ Yes
® No
❑ NA
❑ NE
12128104 Continued

Facility Number: 0 _ /3i6 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
tructure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: G 'V1_-7
Spillway?:
i
Designed Freeboard (in): r—1 9
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
DO 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
[X 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
[ffNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
® No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
® No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
® No
❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[NNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drifl ❑ Application Outside of Area
1
12. Crop type(s) .541 4E4 ns 5
13. Soil type(s) L e A.
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
® No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
® No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, ❑ Yes
® No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
® No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
W No
❑ NA ❑ NE
Reviewer/Inspector Name �Ri �K Re. e IFS' Phone: ��i/OJ 1f S(o- /sV/
Reviewer/Inspector Signature: -u i Date: 11--02 - D
12128104 Continued

Facility Number: D —13il 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 10 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
❑ No
® NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
® NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[RNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
N No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[INo
❑ 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
14 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
[A 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
CR No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
N No
❑ NA
❑ NE
12128104

Facilitv Number
to, 9- /3 S/
Name
Farm Name
69-77
fr..,
Date
C.O.C. permitted on hand
Waste plan Soil Test PLAT Deep Soil test
Soil type
Crop types ----5 Z)-ooco�s
t
Designed Freeboard j Observed Freeboard
Rain gauge Rain breakers A Daily Rainfall
Calibration of spray equipment G.P.M.
Sludge Survey_ 1� Crop Yield 120 mtnute tnspecttons
1 in_ rain inspections -"'� Weather code ----'-Weekly Freeboard
Waste Transfers
N�� _ Waste Analysis /(f
Pumping time
Waste Analysis % & Month
Comments-

00
Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ® Routine O Complaint O Follow up O Emergency Notification O Other © Denied Access
17 FO Facility Number jDateorvisit: Time:
Not Operational Q Below Threshold
Mermitted ErCertified [3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: ......._....------
Farm Name: v ; � , r t� er ........ Coetnty:...... S.?../..9..."7rrs.t.........�...._.�......._....o.........
Owner Name:
U — .� .2 7
...... � ! `5..._. `Z.� 1 .............................
-----_._�..A..t�..�..�...._........�.��? �.�.�+..a..ra...........��......._..__.... Phone No:
Mailing Address:.. r.3rz...... R....Y<..........ALS....._....._..._._...._......._._...
y�......
Facility Contact: Title:
Onsite Representative: .., _ _ e!! rnbkvi n
Certified Operator:_—.�[?a 4.�e ... .... _ /'Ylc% �`.�.........._.
Location of Farm:
Phone No:
Integrator -
Operator Certification Number:
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �4 46 Longitude • 4 "
Swine
Wean to Feeder
1oa
❑Layer
Feeder to Finish:
;
❑ Non -Layer
Farrow to Wean
Farrow to Feeder
Other
Farrow to Finish
Total Des��
r
Gilts
El Boars
Discharges & Stream Impact5
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 man-made?
�`� ijesrgo. uCur,
mCattle Po ul
❑ Dairy
❑ Non -Dairy
u
a ,t°
e h
mr�a i"
©tal`SSLW
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 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: _...................._---.... ........................................................... .......
Freeboard (inches): Ab
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
N /A
❑ Yes ❑ No
❑ Yes ® No
[:]Yes [A No
❑ Yes M No
Structure 6
12112103 Continued

Facility Number. lj —1 '
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7_ Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11. is there evidence of over application? l Excessive Ponding ❑ PAN El Hydraulic Overload
❑ Yes
❑ No
12. Crop type S o y bea � / AA tr_- 7L
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16_ Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ❑ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes []No
24. Does facility require a follow-up visit by same agency? ❑ Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Ca pisin eats {refer ta=question ti) ?Ezany YES.saswers and/©r;aay recommettdattonS or.anv Ot1iii comments. _
Ilse drawrngs of fardrty to iietter ezplam situations (use additional pages as neeessarv) - �--
Field Conv[] Final Notes
SOSAw+�p1�� ,C�7y �av4 p 4C►1 4'akr►i•
f
Q
F 'C"G wolrt- L ov.
_r a-
Reviewer/Inspector Name -_
Reviewer/Inspector Signature: Date:
0.5103101 /� � /1 Continued

toaluy NunAber.�� % 3 T
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Dace: lJ '
Time , 2 ; +f S—
Genera,3nformatjQn:
Fwm Name: M CA r se rM CMLty: V3 F-
Owner Name• d t V, ae No• - LIJI
On Site Representative: (i C. I Integtstor: lie•
MaaiIingAddmss: 5-0`�_
Physical Address/location: (fF
Latitude• / / Lon •tude:_� /
QMration Description: (based on design chamcterWm)
FFeadltYz
ine No. of Animals 7 ype of Poultry No. of Animals I ype of Cattle No. of Mimab
© Layer - D Dairy
O Noa-LOet G Beef
of Lr ermcrt Number of Animals:
Number of Lagoons; (include in the Drawings and Observations the freeboard of each lagoon)
EagilitTnai.QmR
Lagoon
Is lagoon(s) freeboard less than Ifoot + 25 year 24 hour storm storage?:
Yes 0
No
.Is seepage observed from the, lagoon?:
Yes O
N
Is erosion observed?:
Yes 0
No
Is any discharge observed?
Yes 0
No
Q Mananiade O Not Manquade
Cover Crop
Does the facility need more acreage for spraying?:
Yes O
No.
Does the cover crop geed improvement?:
Yes 0 .
No -
(list the craps which need uaprovem")
Clop type:. - - - s :6J Acreage:
Setback Crkenfa
Is a dwelling located within 200 feet of waste application?
Yes 0
-No
• Is a well located within 100 fczt of waft Vplicetion?
Yes O
No
Is. animal waste stockpiled within 100 feet of USGS Blue Line Stream?
Yes O
Nop
'Is animal waste Iand applied of spray irrigated within 25 feet of Bl*ue Line Stream?
Yes O
Nt�l
AOL — Janes 17JM
-
``�

ILAr
*'-w raptartet
Does the face ry n aintenance need isnproVOMCM? Yes 0 No
Is there evidence of past discharge from any part of the operation? Yes O N
Does record keeping need improvenoeai? Yea 0 NoP
Did the facility fail to have a copy of the Animal waste Management Plan on site? Yea 0 Nd
. P
Explain any Yes answets-, ..
cc Faaby Assessor ew Unit
r e
D= L 9/ �
Use Anaduntna jY1Veeded
' ' • " ��� �'� w Saw , _ii�:n • 4 . ;
• it ii�: -"�1 :y"t r _ ... - ,< ww*y ••1� �_r►. ��.r •�r •+.► ��a - . i L- wIn•�.p iMiR•W�+��ay.«wr+ ��•:_
• �1 kir i ,• rti • � wr•cM..�;rq.w ��'w-•. •w •+r,] ��: �• �•�;'�. r j^�. � w � �. -
ADI — l&nuw7 i7jM