090146_INSPECTIONS_20171231

Type of Visit: aKompliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0-f outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: UIYL a Arrival Time: 0 a Departure Time:F 7,9 S County
Farm Name: • ac 00u aM' 11 "— t. Owner Email:
Owner Name: -2--L GPV o Phone:
Mailing Address:
Physical Address:
i
Facility Contact: , C�V `5 �3 t.✓`W tf C Title: Phone:
Region: ri-z—o
Onsite Representative:
l
Integrator: f/11.S
nn
Certified Operator: la ���
j
NDIJ'J`[`S
Certification Number: ;
--7 LlL b
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
C•nrrent
Pop.
Design C►arrant
C•attte Capacity Pop.
Dairy Cow
Wean to Feeder
G ZC0 516
Nan -La er
D , P,oul
Layers
Design
Ca aci
Current
P,o
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Turke s
Furkey 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 lid'Ko ❑ NA ❑ NE
[]Yes [-]No ©,Q'A ❑ NE
[—]Yes [:]No 0-NA ❑ NE
❑ Yes
❑ No
❑ Yes
[ o
❑ Yes
[fNo
u A
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facili Number: -Lq 6Date of inspection:
Waste Collect -an & Treatment
4. Is storage ciFacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [f]-fo'❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [2-NA— ❑ NE
Structure l 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 [R-No ❑ NA ONE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a es1Qo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or7Yes
mental threat, notify DWR
r
Vbo any of the structures need maintenance or improvement? ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Y � o [DNA ❑ 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 1 =1 oo ❑ NA ❑ NE
• maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [D-Tqo^ ❑ 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 Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C w e
13. Soil Type(s): S tu-1 11,
14. Do the receiving crops differ from those
in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
[D" o
❑ NA
❑ NE
❑ Yes
to
❑ NA
❑ NE
❑ Yes
EDNo
❑ NA
❑ NE
[] Yes
No
❑ NA
❑ NE
❑ Yes
[�io
❑ NA
❑ NE
❑ Yes B-I o ❑ NA ❑ NE
[:]Yes [A --No ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
2 l . Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q..N6' ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Wcather 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 0'No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EaXo- ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: T- Date of Inspection: 3 T-v --c.-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C9-ld6-_❑ NA ❑ NE
25. Is th'e facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes []Pvo ❑ NA D NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes Eg'Ko ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. 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?
.t _ V, rt-�
IL)- 3 1 -1�
t9-- V7 a 7.
ctk( Ct'(0 - 3 U
❑ Yes 0-ITo ❑ NA ❑ NE
❑ Yes 0Iqo- ❑ NA ❑ NE
❑ Yes [K Io ❑ NA ❑ NE
❑ Yes UD No ❑ NA ❑ NE
❑ Yes
EZKo
❑ Yes
❑ Yes
[j]'No
DNA ❑ NE
❑NA ❑NE
❑NA ❑NE
Reviewer/Inspector Name: ?j i l V A � Phone: 1 j o_ "I 3 3`33 � Y_
c
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412015

Type of Visit: Q-Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: tdxoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1 IrwP171 Arrival Time: ! Departure Time: r� S b County: Lt�� `� Region:
Farm Name: h CZ 2 4 ' Oao_Vtc I ( «�/"``f Owner Email:
Owner Name: Cha. ( Phone:
Mailing Address:
Physical Address:
Facility Contact: �u,wT fi s�3r.� k; Title: Phone:
Onsite Representative: ( Integrator:
Certified Operator: G f ell -I �i?at-s(x Certification Number -
Back -up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
I jLayer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
$ 3- 0-0
I L`V
]Non -Layer
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Design
Ca aci
P,o
Dairy Heifer
Dry Cow
Non-Dai
Beef Stocker
Beef Feeder
Gilts
ers
Boars
py..l
BeefBrood Cow
her
H
oults
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 [3-Mo ❑ NA ❑ NE
❑ Yes
[:]No
Q'NA
❑ NE
[:]Yes
[:)No
r
[j'NA
❑ NE
❑Yes
[:]No
❑NA
ONE
❑ Yes
❑-No
❑ NA
❑ NE
0 Yes
fNo
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Pacili Number: - - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[3 Ko
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
�
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?_
Designed Freeboard (in):
—1
Observed Freeboard (in): 2—I q
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[. [' 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
r
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify 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
0No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
[3"No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[fNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [ rNo ❑ 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): CAJ is
13. Soil Type(s): S ( LG s
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes e No ❑ NA _ ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [3 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [E j�_o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E3'lgo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑<
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[] Yes
�Io
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
s No
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes []'l�o
❑ 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 [5No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [r No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Facility Number: Date of ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
2--N"o
❑ NA ❑ NE
25. Is.the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[B"No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
[240
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
Eal�o
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
if yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
laic -f� ova f�— 3 Hb
s fk t 5
Reviewer/Inspector Name: 3k
Reviewer/Inspector Signature:
Page 3 of 3
G 7,6 t . /I- �' C_'_%�
t4(,,�
❑ Yes ®Jhio ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes [n-No ❑ NA ❑ NE
❑ Yes E;J�o ❑ NA ❑ NE
❑ Yes Gkilo
❑ Yes EA -No
❑ Yes [;�No
r)�—t_S—Ti a ;37
o- It s
-Ir.e1— q(0 3 0,k-- t, t-s r
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
PhoneRfo'1113 23 %J3
Date: ( .
2144015

H
Type of Visit: Q Compliance Inspection V Operation Review U Structure Evaluation Q Technical Assistance
Reason for Visit: Router 'ne0 Complaint O Follow-up O Referral O Emergency O Other O Denied Access IJ
Date of Visit: ✓lam Arrival Time: f , t7 c'�I Departure Time: 3 ; County: Region: --�
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: t.G1Gt d P, z 7_-' WQDd_Title: Phone: O qq
Onsite Representative: 5z�� Integrator: ?17
Certified Operator: ow G /,-- n it &hwri S Certification Number: .27 yyL
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current Design Cnrrent
Swine Capacity Pap. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish La er Dairy Cow
Wean to Feeder
D
Non -La er
Dairy Calf
-
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Dairy Heifer
Design Current Cow
D , P,oul Ca aci P,o Non -Dairy
Layers Beef Stocker
Farrow to Finish
_
Gilts
Non -La ers
Beef Feeder
Boars
Other
Pullets
Beef Brood Cow
Turke s
Turke Poults
Other
Other
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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 53�No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
C3,No
❑ NA
❑ NE
❑ Yes
�-No
[] NA
❑ NE
Page 1 of 3
21412014 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
O—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):_ - g
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
FK[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
JK 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
MNo
❑ 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
allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
allo
[DNA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes [3.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 / 0 Evidence of/Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): er).-4--
13. Soil Type(s):`�e
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes Q No ❑ NA ❑ NE
❑ Yes ELNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ENo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Q No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [�j No
❑ 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 [!�No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes JED No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili number: -Iq t I Date of Inspection: T y
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes CO -No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 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)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes (. No ❑ NA ❑ NE
❑ Yes ®,No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
[:]Yes [2-No
[:]Yes [ No
❑ Yes [ No
❑ Yes [allo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to gneshont#) Explain army YES answeesrand/or any additwoual recommendations or..any other comments.
Use dfawin�s ©fYfacility tolbef6i explain srtuahons {use:add�t onaFpa�es as?necessary);
/7
". Cr4 / T Z''r �� [tl �CY A ff�� G�f +pXrr ¢
!v��rm.
d"j
(T' l4•nn )LJz)tt i5 uJ -0 J b, %-m„7 Q--c-e- u»rl�, It tN-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
3�3
Phone:j`D
Dater
21412014

- — -- � i�i'sion of Water Resources --
Facility Number ®- %li 0 Division of Sort and Water Conservation
Q Other Agency
Type of Visit: 7D7=mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ` ' Arrival
Time:Departure Time: County:
Farm Name: /Vf�/35,7
f . I��Owner Email:
Owner Name: L� �vtEl cy �sr` Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: Vic✓ r^I� Title: h r'-- Phone:
Onsite Representative: _ s��..�_ Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Curren#
Pop-
Cattle
Dairy Cow
Design
Capacity
Current
Pop.
Wean to Feeder
po
Oo
Non -La er
I
Daig Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Dr. PMaultr.
ILayers.
Design
Ca aci
Current
Po
Dairy Heifer
Dry Cow
Non -Da'
Beef Stocker
Beef Feeder
Boars
Other
Other I L
—.Non-Lavers
Pullets
Turkeys
Turkey Poults
Other
Beef Brood Cow
Discharims and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes allo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ .Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes ❑ No
❑ Yes ®.No
❑ Yes 0 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3
21412014 Continued

Facility Number: a I Date of Inspection:
i Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes CB 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 r 3.No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
Y[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
D4.No
[] NA
❑ NE
8_ Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[Z No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[![ No
❑ NA
❑ NE
maintenance or improvement?
Waste Apptication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below_
❑ Yes
C.-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 Cr/op ❑ Evidence of Wind Drift ❑/Application Outside of Approved Area
Window
12. Type(s): �ept
Crop
13. Soil Type(s):.
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
� No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Eg-No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Ig No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
8 No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
[a No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
O No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
U 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 25 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [-]Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ®-No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of Inspection
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ENo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �0
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 fast survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? 0 Yes [ANo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [ANo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
P"o
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
allo
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 file drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[LNo
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
JNo
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
KNo
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
&No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ONE
❑NA ❑NE
❑ NA ❑ NE
[DNA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question # Egp1I any YES answers and/o!fiy additional recommendationst6rxanyrother comments.Q .
Use drawin s of f Wit to< etter ea lain ,srtaaitoask nse�additionai:.a er as necessa �
Reviewer/Inspector Name:
Phone: �j�Wc_
Reviewer/Inspector Signature:
Page 3 of 3
Date:—�3d+
21412014

I ype of visit: U Compliance Inspection V uperation Review U Structure Evaluation U I ecnnical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: / ; 3 O County: oxowl.. L
Farm Name: art ��, �'�/` u!'S>r+"i 5�'f `C I�% Owner Email:
Owner Name: CQ ffl'r✓� Phone:
Mailing Address:
Region:
Physical Address:
Facility Contact: 412i LU ,c y �-6 r rr' Title: 69UJ ri r- ✓✓ Phone:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Design Current��`
Design
@urrent
Design Current
Capacity PWet
Poult y pacity
Popsh
t
La er
Dai Cower
rWFarrowtoFeeder
Nan -La er
Dai Calf
ish
°s
..an�Design
Dai Heifer
Current
D Cow
der
I) .P.oul aCa aci
P,o
Non -Dairy
21
Farrow to Finish
ILayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
ars
Putlets
Beef Brood Cow
Wit
Turke s
her
Turkey Poults
01 Other I I
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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes Eil-No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes ;g No
[—]Yes N No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: I - jDate of Inspection: ,' D a
Waste Collection & Treatment
` 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _ 19 A19-
Observed Freeboard (in): pZ (o
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 5? 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 0,No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes RNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes RNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes JS No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes FNo
❑ 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 WindowL ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Ca/n-
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Ig No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes CS -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 Ej]-No D NA ❑ NE
[:]Yes 2[No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes 2jNo ❑ 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 0 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 �C , No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ®.No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: j9_ — T
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [K No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [A 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 5�,No ❑ NA ❑ NE
2T Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Callo C] NA ❑ NE -
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes J�jNo ❑ 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 EjNo ❑ NA ❑ NE
❑ Yes SjNo ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
❑ Yes � No
❑ Yes 2 ,No
❑ Yes [3 No
❑NA []NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question # ): Explain any YES answers and/or any additional recommendations or any other comments,
Use drawintzs of faciliwt&better explain situations (use additional pages as necessarv).
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone:
Date: -3-
21412011

a
n
Type of Visit: WCom nee Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: ('Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: a Arrival Time: a ; a Departure Time: v County: � Region: �n
Farm Name: �TT'Q�C���/5.�� Owner Email:
i
Owner Name: j9eJA- f �/`� Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
z —
Back-up Operator:
Phone:
,D,i� Car r' Title: © fiLJne
Integrator: m66zlwr,
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
SwineN
ffi7sign
city
Current
Pop.
Wet Poultry
Design Current -
Capacity Pop
Design Current
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
a
3 jt�
Non -La er
Dai Calf
Feeder to Finish
"
DairyHeifer
Farrow to Wean
Design Current=_
Cow
Farrow to Feeder
D . P,ault ,
Ca aci l?o^ .,R ,;
Non -Dairy
Farrow to Finish
ILayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
_
Other
Turkey Pouets
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes El 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 fo No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ® No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [&No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA 0 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 [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 [21,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 q No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes F-A 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 ELNo
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes � No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window :] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): eD,rn. Ioa,,--5
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 21 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 10 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes R No ❑ NA ❑ NE
Reguired 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 tia No ❑ NA [] NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design 0 Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ® No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Condnued

0
Facility Number: (/ Date of Inspection: J
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ® No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? [:]Yes [g No
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the [:]Yes ® No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ® No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ® No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes E4 No
[] NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #); Explain any YES answers and/or any additional recommendations or. any other'comments %1
Use drawings of facility to better.explain. situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: AIR'
21412011

Type of Visit: O Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: (>W64tine 0 Complaint 0 Follow-up. 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Timed ! 3= Departure Time: County: Region: [�
Farm Name: r/�� N[C/✓��/"Jsi OwnerEmail:
OwnerName: +-tom /¢! I Gr Phone:
Mailing Address:
Physical Address:
Facility Contact: ��f�j! C.�7"llil% Title: J��rr Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
i
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
'4Vet 1?onitry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
O
La er
Non -Layer
"
='
Design
Current
Dairy Cow
DairyCalf
Dairy Heifer
Dry Cow
Wean to Feeder
Feeder to Finish
Farrow to Wean
n==',
Farrow to Feeder
Non -Da'
ow to Finish
La ers
Non -La ers
Beef Stocker
Beef Feeder
s
rs
Pullets
urke s
Beef Brood Cow
1wr
er
Turke Poults
10ther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes EA -No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes [—]No ❑ NA ❑ NE
d_ Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NB
2. Is there evidence of a past discharge from any part of the operation? [] Yes QJ�No ❑ NA ❑ NE
3_ Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes UjI-No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection: _ --
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ®.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 0 No ❑ NA ❑ N E
(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 0 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 3-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 [3 No ❑ NA ❑ N E
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 JE�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 ibs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window / ❑/ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15_ Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes (allo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E� No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E5 No
❑ NA
❑ NE
Required Records & Documents
19_ Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
2�No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
allo
❑ 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 allo
❑ 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 allo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes 2!J'No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Ins ection: — �—
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [?�No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
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)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes pg.No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes U�[No ❑ NA ❑ NE
0 Yes Imo, No ❑ NA ❑ NE
❑ Yes �No
❑ Yes ® No
❑ Yes C�]-No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #.) Explain any YESaanswersaand/or any additional recommendaby ons ortany other commeats.
Use drawings of -facility to better expla�ri situations,{usetaiitiotial: a es as necessa r
p g �3-
.. _._. _
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ,Zf1%��33`r�
Date: -
21412011

Type of Visit Q)rtompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 040utine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: 116'3dCounty: Region:
Farm Name: GT Owner Email:
Owner Name: c2iw -e Cam �✓Phone:
Mailing Address:
Physical Address: .�
Facility Contact: 4� �4v ife- r+- Title: Phone No:
Onsite Representative: ��G� _ Integrator:
Certified Operator: !S's...— Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [= o = & 0 " Longitude: 0 ° = 6 0
Design Current
Design Current
Design
Current
Swine C•apty Population
Wet Poultry Capacity Population
Cattle
Capacity
Population
❑ Wean to Finish
❑ La er
❑ Dai Cow
Wean to Feeder
❑ Non -La er
❑ Dai Calf
❑ Feeder to Finish
Dry poultry
❑ Dai Heifer
❑ D Cow
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Layers
❑ Non -Dairy
❑ Beef Stocker
❑ Farrow to Finish
ilts
. ,.....
Non -La ersPullets
❑ Turkeys
❑Beef Feeder
❑ Beef Brood Co
boars
Other
❑ Other
❑ Turkey Poults
❑Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
J@_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? (1 f yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
allo
❑ NA
❑ NE
1 Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
U1 No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — l 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 JgNo ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes 4 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes CKNo ❑ 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 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ; No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ 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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No
❑ Yes ®-No
[]NA ❑NE
❑NA El NE
yC mmentsa{refer�to qua ho) R�`n anyYESnswers sndlor�any recommendations or any other comments.
$Use draw of�facihty' to�better�.e�plain�sttuattons{ttse addtttonal pages;as:necessary): r
L
Reviewer/inspector Name � Phone: _
Reviewer/Inspector Signature: Date: ry2 yf f f
Page 2 of 3 12128104 Continued

Facility Number: Or— Date of Inspection — /1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ELNo ❑ NA ❑ NE
20. Does the facility. fail to have all components of the CAWMP readily available? If yes, check ❑ Yes U[No ❑ NA ❑ NE
the appropiiate box. ❑ WDp ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes KNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
RNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
L,No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
PSNo
❑ 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
[KNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�o
❑ NA
❑ NE
Outer Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
54 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
[0 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
21No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
allo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[&No
❑ NA
❑ NE
Additional Comments andlor�Drawm s �''
ate• r„" a w: F r�%a'"'a€k
i
T
Page 3 of 3 12128104

I
Type of Visit g mpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Q16"utine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival "Time: ; [7J Departure Time: jv County:
Farm Name: ✓ r.' 'Ala v vt Owner Email:
Owner Name: _ Le,61J -7 ���T Phone: _
Mailing Address:
Physical Address:
Facility Contact: ���� ��/ r"�__ Title: Phone No:
Onsite Representative: / Integrator:
Certified Operator: it Operator CertifZation Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: 4 F--I Longitude: 0
.
Region JG % D
Design Gurrent
❑ Wean to Finish
Wean to Feeder 00 �
urrentSwineCWet Poultry Capaculation
AiP
❑ Layer
❑ Non -Layer
Cattle Capacity
❑ DairyCow W�
❑ DairyCalf
Population
❑ Feeder to Finish
❑ Farrow to Wean
❑ Narrow to Feeder
❑ Farrow to Finish
Dry Poultry
❑ Layers
❑ DairyHeifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
Non -La ers
Gilts
❑ Beef Feeder
❑ Pullets
E-1 Boars
El Beef Brood Co
Other
❑ Other
❑ Turkeys
❑ Turkey Poults
El Other
Number a# Structures:
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes C3-No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
12128104 Continued

t
Facility Number: — G I Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Stmeture 2 Structure 3 Structure 4
❑ Yes jXNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure i 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
R 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
19 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
[0 No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[9 No
❑ NA ❑ NE
maintenance or improvement?
Waste application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
["No
El NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[ N No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate ManureJSludge into Bare Soil
❑ Outside of Acceptable Crop/Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12. Crop type(s) /lv;�
13. Soil type(s) .I ., ks
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ZLNO
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[9No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
R No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
(Z No
❑ NA Q NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[gNo
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
;V,o/ �vO ka.�-c rrco.-Jv 'Gr �vr v�J`� w I/�/k w,� 7_/,I"
rr
Al
hrr/i4: s C, r� :�--1 i N�1�h u': // A *a 1, 4 Ls�
,�tr�i',' use ,tJt w sL..���.s�.�� �a-.n �v ��•� s t���f--j� /���..-�-r-•�
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
12/2N/U4 Confinued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
0 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
BNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
J0 Yes
❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[9 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other lssues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[3No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours andlor document
0 Yes
[ZNo
❑ 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
[12 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[ZNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[RNo
❑ NA
❑ NE
12128104

Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
-- - 0 Other Agency
Type of Visit ,.om��pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 01 outine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: i7 Departure Time: QiO:;> County: 56Soff' Region:
Farm Name: / d-,2= Owner Email:
Owner Name• r erc Phone:
Mailing Address:
Physical Address:
Facility Contact: �p r iY�/ �Gt f �r Title:
Onsite Representative: Edzi==�
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Soars
Other
❑ Other
Phone No:
Integrator: 40
Operator Certifica on Number:
Back-up Certification Number:
Latitude: =] 0 0' =] u Longitude: =] c =
Design, Current Design Current
Capacity. Population Wet Poultry Capacity Population
[:]Layer
!200 (§V 1 ❑Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑
Et uits
❑ Other
DischarZes & Stream impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current;; ";�:
Capacity :Population'
❑ Dairy Cow
❑ Daja Calf
❑ Dai Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: ®s
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 CS -No ❑ NA ❑ NE
❑Yes
El No
❑NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
C&No
❑ NA
❑ NE
❑ Yes
91 No
❑ NA
❑ NE
12128104 Continued

Facility Number: —/ Date of Inspection I'Y;ia J'
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
2-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
LKNo ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
Callo ❑ 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?
E9 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 0 Yes
91.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
RNo
❑ 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
Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
❑ Outside of Acceptable Crop
11 Crop type(s)
13. Soil type(s) 5'�� L�% �S
14. Do the receiving crops differ from those designated in the CAWNIP? ❑ Yes
[9 No
❑ NA ❑ NE
15, Does the receiving crop and/or land application site need improvement? ❑ Yes
MNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
E4 No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
® No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
&No
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name fir/ Phone: �Z p_/ j3 33a0
ReviewerAnspector Signature: Date: -
r.onanuea

r
Facility Number: Date of Inspection
i
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [,No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ®No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0No ❑ 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 [NNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E.No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E9 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[7No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ONo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[2 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
5d 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
2iNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
KNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
®No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Type of Visit (D-Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: h % O County: ^' Region:�
Farm Name: 7&-a Owner Entail:
Owner Name: Z2 em j � `` Phone:
Mailing Address:
Physical Address:
Facility Contact: U�rll�y C_Q/1'f Title: Phone No:
Onsite Representative: _ ��� — Integrator: �J� _-
Certified Operator: �3""- - Operator Certification Number -
Back -up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = 0 =' E�]" Longitude: = o [� o
Design C•urreni
Design Current
Design Current
Swine Capacity Population
Wet Poultry
Capacity Po
Cattlepulation Capacity Population
❑ We an to Finish h❑
Layer
❑Non -Layer
Dry Poultry
�'��
`"" "
El Dairy Cow
El Dairy Calf
El Heifer
❑ D Cow
❑ Non -Dairy
to Feeder
RWean
Feeder to Finish
❑ Farrow to Wean`..,,
❑ Farrow to Feeder
a< ❑ Farrow to Finish
�._
❑ Lavers
❑Beef Stocker
Gilts
Non -Layers
El❑Beef
Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
- -
❑Turkc s
Other
„
❑ Turkey Poults
❑ Other
Number of Structures
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
V'No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (Ifyes, notifv DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes. notify DWQ)
❑ Yes
❑No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[--]Yes
EgNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
[:]Yes
54No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: — /L Date of Inspection /
i
} 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
10 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
JR 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? 51Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[Rlo ❑ 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
EXNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
VNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Window El Evidence of Wind Drift El Application Outside of Area
/Crop
12. Crop type(s) 5)rrl I J` 2?'94.' c / 1 /��j�� 1 ��-•_
13.
Soil type(s) a ��� y,Ls
14.
10,
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
29 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
E] No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
MNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: d-37Ju
Reviewer/Inspector Signature: Date:

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWW readily available? If yes, check ❑ Yes [allo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [21 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weathcr 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 RNo ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[SNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ZNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
18 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[� No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWW?
❑ Yes
0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[SNo
❑ 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? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
5� No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

C
j
iv'Sion of ..'at Quality _
---- �ofw
IFacility Nu°tuber _ Division of1 1 oil and Water Conservation
- Q Other Agency
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 04outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: © Arrival Time: Q Departure Time: County:
Farm Name: ar µrs�r Owner Email:
Owner Name: r %� Phone:
Mailing Address:
r— Region: L_._'�
Physical Address: �7 /1
Facility Contact: / /T'r.[J�J� Title. Phone No:
Onsite Representative:. ���+-•� _ integrator:
Certified Operator: �Gi��- Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ET = ' = u Longitude: = ° E__1 I = u
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
C*attle Capacity Population
❑ Wean to Finish
❑ La er
❑Dai Cow
II
Wean to Feeder 0 0
❑Non -La er
❑Dai Calf
❑ Feeder to Finish I
Dairy Heifer
❑ Farrow to Wean
Dry poultry
❑ Dry Cow
❑Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑ La ers
❑ Beef Stocker
ts
Non -La ersPullets❑Beef
Feeder
ars
❑Beef Brood Cowl I❑
kEl
Turke s
❑ Turke
❑ Other
Number of Structures:
er
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
t6No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
El No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
JS?No
❑ NA
❑ NE
other than from a discharge'?
Page I of 3
12128104
Continued

Facility Number: —A& I Date of Inspection /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
C.No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): f
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
0 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
,Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
J4 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
X No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑Yes
.� No [I NA [I NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [:1 Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s) C11o/'Il
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ANo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[gNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
R No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
JR No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�RNo
❑ NA
❑ NE
Comments. (refer to question # 'Eipiain any YES answers and/or any recommendations or any other comments
IIse drawings of facility to better explain situations. (use additional pages as necessary):.
do or^-
ReviewerAnspector Name Phone:
Reviewer/Inspector Signature: Date: �� 7
Page 1 of 1 12128IU4 4onnnued

' Facility Number: — Date of InspectionD f
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 25No ❑ NA ❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes J4 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design
g ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. X Yes & No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis 0 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
M No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
(RNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
® Yes
WNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
QRNo
❑ NA
❑ NE
26_
Did the facility fail to have an actively certified operator in charge?
❑ Yes
QfNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
®'No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAW MP?
❑ Yes
(9 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
SNo
❑ 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
P9 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
tg No
❑ NA
❑ NE
Additional Comments ii&6 Diawings: '
1 / �
%iarz 111frcpFif7-,-P do-PU-)
7
Page 3 of 3 12128104

Type of Visit I3Tompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: I, Arrival Time: �(00 Departure me:
m?e: County: Region: ?f"d
Farm Name: ZLJQ _���` /� 'y �` Owner Email:
Owner Name:, 12f i- --CGt �/` Phone:
Mailing Address:
Physical Address: �L
Facility Contact: �Gas(/�5/ �Q✓/ t' ,Title: Phone No:
Onsite Representative: Integrator: Ud
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: FT 0 2 ET
Longitude: 0°= I=
Desi.152 Current
Swine Capacity Population
=,MDesign Current
Wet PoultryCpacity Population
Design Current
Cattle Capacity Population
❑ an to Finish
10 Layer
❑ Dairy Cow
Wean to Feeder 'a0
1 3WO
ID Non -Layer I
Dairy Calf
❑ Feeder to Finish
r
Dry PoultryG ��
❑ Layers
❑ Non -Layers
❑ Dairy Heifer
❑ Farrow to Wean
❑ Cow
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Non -Dairy
❑ Beef Stocker
El Beef Feeder
El Pullets
❑ Turkeys
❑ Boars
Utbe
❑ Other
❑ Beef Brood Co
;
Number of Structures:
10 Turkey Poults
❑Other
Discharges & Stream Impacts
I . 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
DQ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
54-No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ yes
0,No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation'?
❑ Yes
KNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
$6No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: — 116 1 Date of Inspection
Waste Collection & Treatment
t 9No El NA El NE
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 AlNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): J f7C%
Observed Freeboard (in): 4 .30
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [g 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 JR 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 [gNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 91 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes igNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes CffNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) GDlr1_AoF,-",r
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
J-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
P No
❑ NA
❑ NE
18.
is there a lack of property operating waste application equipment?
[:]Yes
�5No
❑ 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 gages as necessary):
t
Reviewer/Inspector Name v Gam'• L ------]Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Conffnued

Facility Number: Date of Inspection
r Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes a -No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 15�No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Desig
n ❑Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 54 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 tZ No ❑ NA ❑ NE
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes V[No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
tA 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
[RNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[9No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® 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
RINo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[allo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
0 No
❑ NA
❑ NE
Additional Comments and/or Drawings: >
Page 3 of 3 12128104

Type of Visit ®Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit Q Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other El Denied Access
Date of Visit: Arrival Time: Departure Time: I`i County: elt__ Region:
Farm Name: o4g& Owner Email: 'J
Owner Name: i�r Phone: 9/29__ �
Mailing Address: �a3-5
Physical Address 7"e — t�rp A ,"77e
Facility Contact: _ ��,� - Title: Phone No:
Onsite Representative: _45!:&' _rim____ _
Certified Operator: _ -rr�e
Back-up Operator:
Integrator: C iov iti.
Operator Certification Number:���
Back-up Certification Number:
Location of Farm: Latitude: [= 0 = = Longitude: =1 o = , = u
Design Current .
Design Current a� Design Current
Capacity Population
�'Ve# Poultry
Capacity Popuiat�on =- aCaftle Capacity Population
ean to Finish
rOF
❑ Layer
ean to Feeder ofl
❑ Non -La et
eder to Finish
" =o'.
❑ Farrow to Wean
Dray Poultry
� -`
❑ Farrow to Feeder`
"'�"`
",
❑ Farrow to Finish
❑ La ers
`_
4; Gilts
❑Non -La ers
❑ Boars
El Pullets
Other
❑ Turkeys
El Turkey Pouets
-
w ,
❑ Other
❑ Other
Number of Structures:
❑ Dairy Caw
❑ Dai Calf
❑ Dai Heifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Discharges & Stream Impacts
I. 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
t4 No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
CK No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
❑ Yes
C9 No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
IN No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
� No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Date of Inspection f — .s—
Facility Number: O9'— %
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[KNo ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
(S No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: 7.1
Spillway?: _
p
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
t4 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
�9 No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
'27 No ElNA
LL
❑ 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 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) 4_sl.7_ 1%f7ir�os-ice l3�hr�.t/ L�rvcc : r_
13. Soil type(s) ;
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[RNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ANo
❑ 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
tA No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E.No
❑ NA
❑ NE
Reviewer/Inspector Name Phone:
--�---
Reviewerllnspector Signature: Date: /Q
12128104 Continued

Facility Number:017— (o Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes KNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes R1 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 [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 9No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes RNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? [9 Yes �o El 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 [9 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? 15PYes ❑ No eNA ❑ 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
❑ Yes
EQ 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
W 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
(2 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss reviewfinspection with an on -site representative?
❑ Yes
K No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
J4 No
❑ NA
❑ NE
Additional Co mentsiand/or�]I%TSV1 lIlgS.
U-) d-0 �r c--O�
Q
NI-W
12128104

0 Routine O Com taint O Follow-up of DWQ inspection O Follow-ue of DSWC review O Other
Date of Inspection
Facility Number B / G
Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: El Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
® Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated;
��__ . .
Farm Name:......
Land Owner Name:.. _._ ......_ .... _ . _.... _ .._
County: ............ -E'�_ ...._...
Phone No:1�,!__
Facility Conetact:...... DACE.. Title:Phone No:
Mailing Address:._ 9l �. �1If11��.T7 ........... _ ......... _. ........ _.�...... Onsite Representative: ��. r� Integrator: IZ-a'.�.
Certified Operator: �` p ...........�-...5�......................_................_................_... Operator Certification Number: _.............:���...._..,
Location of Farm:
Latitude Longitude �• �I�
Type of Operation and Design Capacity
u -"-, ..'e,n -x.�
Designer G�irrent Design °« x Current $ s a � De$Igu Current s:
3w�ne� Y
�Ca`rc`aci�` 1?o ulataon Poir![ryCa" aciPo`'`ilationr ..le"' _.,.�Caaci P'o elation
,
® Wean to Feeder 2g [] La ,k ❑ jairy
El Feeder to Finish ❑Non -Layer ❑ Non -
Farrow to Wean'"
Farrow to Feeder Tt}tAl DeSiaII Ca a _:E P s
x, y
i Farrow to Finish
# 1 41 Other
x
Subsurface Drains Present
❑
w ,ar Lagoon Area ❑ pray Field Area
S-. ....... .. ,..�6
flneral
1. Are there any buffers that need maintenance/improvement? ❑ Yes �kNo
2. Is any discharge observed from any part of the operation? ❑ Yes D(No
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ANo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes No
4/30/97 maintenancelimprovement? Continued on back

Facility Number: ... !`1_.V .
6. is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
JVNo
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
A(No
Structures (Lagoons, and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
P No
Freeboard (ft): Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
10. Is seepage observed from any of the structures?
❑ Yes
Callo
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes{
No
12. Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-I2 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures Iack adequate minimum or maximum liquid level markers?
❑ Yes
P'No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
KNo
(if in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop
type �e� ....W .. ^.... __ _ .................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18. Does the receiving crop need improvement?
❑ Yes
No
19. Is there a lack of available waste application equipment?
❑ Yes
W No
20. Does facility require a follow-up visit by same agency?
❑ Yes
W No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
99-No
For Certified Facilities Only
22, Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
®'No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP.
❑ Yes
JgNo
24. Does record keeping need improvement?
XYes
❑ No
Comments (refer to question'#)1✓zplaur any YI;S answers'andlor any recommendations or any,,other men comts f d.
Use drav�nngs;of facility to betterexplam situations (use additional pages.as necessary} F F
v
7zc Sr4� h,E/��.F�4.r Gs/,s�E�iPE--�9d,,►7 � �°��—��'7'Q� �.`p...� �.,�C6,er.�.«-�v,�
/�I7.L/r ��' Uow�p/i�'"✓C'E'
a
Reviewer/Inspector Name .. .4 . n
`"
Reviewer/Inspector Signature: Date: 'g;"5 �7
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

(Type of Visit • Compliance Inspection Q Operation Review O Lagoon Evaluation
for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Q Date of Visit: $ df/ Time• /�� C>�:
�G
O Not Operational O Below Threshold
Permitted © Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ... _. ..
e / r
Farm Name: ....�'`?L4� Cc�r ts2,./Vccr�cry a2......... County: .. 4i 5r�1..._..... _....�..._ .. ....
Owner Name:..
�L,:.�.................._... Cc' �fGL- �..�..._........--------- Phone No........._.�...._..............._...............
Mailing Address:..-- -- .............. .
Facilitv Contact: n...... _ _ Title:.. - ------ -- ... _ .. Phone No:
Onsite Representative:. Integrator:u :�1 ?' .�.C7 _ „ • _
Certified Operator:.......:. _.. .......... ... Operator Certification Number:._ ._..�....�........._.....
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �` �" Longitude �• �' �"
ri §' -DesCun at Desstga Cnrrentr; _ _ Desrgn s Cuireat
Swine Caeantv==Pnonlatien - Pouitry_Y S Cana3city . Ponniatiari -_Cattle = - Cai�aclty %PonWahon -
Wean to Feeder
❑Layer
Feeder to Finish
10
Non -Layer
Farrow to Weany.
-
Farrow to Feeder
_-
Other
Farrow to Finish
71�-
Tota! Deny
El Gilts
❑ Boars
Discharges & Stream Impa
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
m Capac�tyF,
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)
❑ Yes 'M No
❑ Yes ❑ No
❑ Yes ❑ No
N lA
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yesj No
Structure 1 Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier: ................-----------........... ..---a....._..... ... ............................ ........................ ........
Freeboard (inches): - 13 H L _ j '
12/l2103 Continued

Facility Number: 9
Date of Inspection D.l t1
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 markmes?
VFaste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12- Crop type G p a
13, Do the receiving crops differ with trose designated in the Certified Animal Waste Management Plan (CAN MP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
R�uired Records &Documents
17. Fail to have Certificate of Coveraee & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design. maps. etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. 1s facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22_ Fail to notify regional D%VQ of emergency situations as required by General Permit?
(ie' discharge. freeboard problems. over application)
23. Did Reviewer,'inspector fail to discuss review•/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes `i+, No
❑ Yes r-71 No
❑ Yes CP No
❑ Yes � No
❑ Yes t�No
❑ Yes EANo
❑ Yes NNo
❑ Yes (7 No
❑ Yes 19No
❑ Yes [9 No
❑ Yes 4 No
❑ Yes W No
❑ Yes TNo
❑ Yes [�tNo
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
[4 No
EC No
QtNo
No
FKINo
EkNo
EPNo
c4 No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
;.r— . ._4F.�=- ,r s-:m=x, at*.
Comments,'{refer ia'gaestidii Tijglam any -.:YES snswets_at,d/or nay recotumeadalmns or ate* other artnmd�is. a
Use drawings of.facfiity to better ezglatn situatians: (use addittoasl pages as netessar3) G
situatio add pages as ni Field Covv ❑ Final Notes
�r:x-.
/ a 1,4, b a ^ k- O 4,_ 5jp .,t 5 .
Reviewer/Inspector Name ���
; ,. ....z �.� ,. -• .x ., s __ _: .
Reviewer/Inspector Signature: Date: 8 Q
05103101 1 / Continued

x
�.DSWGC AhhfiA1Fb dlot y `
t Operat og Revlew�
. x
,
® MQ Anififi Feedlt;l Operation SIte�Inspechon
f:
� �"' '��� S >u �k•.'•:{S'R�0'� 'mix � � �' # Y ` a4-
<4, k� K,aE+�5`S.a»,� i _
'�44` � '.3 �wm�;k $i,..f6. ,�:,� y .Ar „�v
<��: 3W � '2tc.0 .rt4:.6 "fir •..� .9. �:t ,..#,.� a�rr
0 Routine O Com hint Q Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number
Date of Inspection .2-S
O
Time of Inspection � 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for i hr 15 min)) Spent on Review .0
® Certified ❑ Permitted or Inspection includes travel and processing)
❑ Not Operational Date Last Operated: .. _..... _ .. _._ ., .. ..... �, .. ....... . - _.......
Farm Name:. ...� L�%.. �_ . .. Coautf':.
Land Owner Name: ...,��x... L��}sQ..___. Phone No:
Facility Conctact: _..g!.� L://_ , ..._ Title: ... Phone No.•
Flailing Address:
Onsite Representative:... ! ru ...... _ .
yy7� ....................__....._.. .... �....�....._.... .mot
Certified Operator:Operator Certification Number:
Location of Farm: A4, 701 mr�22Lo A..-
Latitude • 4 Longitude • �• 0 u
Type of Operation and Design Capacity
"•'�{ �� �'�'�ur�"•"`'f ,�:,,,.y,�,� � wdx�ys - � °ee°+ �,�_-y"�cva .�'c -"` s*'x£itX�a^' `say' �-�tf <u 'erg �`"� red:-¢ �s °�" '
a. Des' n Current �'Desr Current �Des�gn ,Current
��Svvine� ��"':�Ca�acl�,,Po ulatlOnF�:.Ponitrys,,�.._�;Ca` aci"Po �ulatton;� ��w'�"Cattle,,,���k'�'�s i°bx:,�"•x•,z��a
Wean to Feeder � « La � ❑ D -
"f ❑Feeder to Finish Non -La er .# ❑ Non-
� _: }�' �:'�` _s .§u. � ''��X �,. r ;�` y�:g..:. `" � " w,��S•,, �"e'cxs�ti°�,x•- �lamka;< � �,ri�r .pa,
Farrow to Feeder Ttftal� Deilgnn paclly � >
Farrow to Finish]
� „,, � � �•, �
❑ Other ��<:�Zo� H».'3.`v-'�"�n,�. �%�bma.a-�•nvGyS• .. '� - `:` .. - �d �_v£%H:hrnfiY.,.a.. �4'�t?.Mfiii.. . n-) «.�Y.r:,...+., ..a�.v.! ', Numi�er�of LagoonslHol�ing Ponds ❑ Subsurface Drains Present
❑ Lagoon Area x Spray Field Area 'z '°,.�,.
I . Are there any buffers that need maintenance/improvement?
2. 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?
b. If discharge is observed, did it reach Surface Water'? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaVmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
S. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes PNo
❑ Yes ® No
❑ Yes ® No
❑ Yes 50 No
❑ Yes
14No
❑ Yes
$1 No
❑ Yes
No
❑ yes
No
Continued on back

Facility Number.
6.
Is facility'not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
8.
Are there Iagoons or storage ponds on site which need to be properly closed?
❑ Yes
-(To
Structure5
(Lagoonjan Hold'na Pon .
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
XNo
Freeboard (11): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
10.
Is seepage observed from any of the structures?
❑ Yes
,M No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
4No
12.
Do any of the structures need maintenance/improvement?
IR Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
R No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
g'No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type _ _ ..... .... ......... .. _..... ..... _ ..........--- ------
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
N No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
fij�No
18.
Does the receiving crop need improvement?
WYes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
�ZNo
20.
Does facility require a follow-up visit by same agency?
❑ Yes
JffNo
21.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
Pd'No
For
Certified Facilities Only
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
MNo
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
. ❑ Yes
CKNo
24.
Does record keeping need improvement?
® Yes
❑ No
C6iiirients (refer to;queshon-# Expia'answers and/or;any recommeudations or any'bthe oinmenks*
Use drawmgstof facility to better explain situations: (use addihasial pages as necessary} R
Z. 7Zri
F it
AF
Reviewer/Inspector Name"IC6.aE.,:,{i¢�F�F`y
Reviewer/Inspector Signature: i`*� f-- / _ Date: Z J 7
cc. Division of Wafer Quality, Water Quality Section, Facilit}, Assessment Unit 4/30/97