090152_INSPECTIONS_20171231

- �v�ion of Water Resources
Facility Number ®- /S' Division of Soil and Water Conservation
i
4�
Type of Visit: �mpliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
leason for Visit: e"i�utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: —'jam Arrival Time: l Departure Time: ,` County: Vioa 2--- Region: tj
Farm Name: Ck, f 5 ��� /�i [./]��� / Owner Email:
Owner Name: G ��r �- ��� -c_ C �O od �.-- Phone:
Mailing Address:
Physical Address:
Facility Contact: /������ Title: e94r,6,-'17 —r/ Phone:
Onsite Representative: J�`--- � Integrator:
Certified Operator: Certification Number: 7 7 !o
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
Design Cnrreni
Swine' Capacity Pop.
Desigu Current
Wet Poultry Capacity, Pap.
Design Current
Cattle Capacity Pop.
Dairy
Wean to Finish
La er
Cow
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 [D N�o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes
❑No
DNA
ONE
[:]Yes
0'14
❑ NA
❑ NE
[:]Yes
[�fNo
❑ NA
❑ NE
Page 1 of 3 2/4/20I S Continued

Facili Number: jDate of Inspection:
Waste Collection & Treatment
1 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �o ❑ 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 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
[3-Ko
❑ 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 hreat,
notify DWR
7. Do any of the structures need maintenance or improvement?
es
4t
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [a'F o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes [3 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Q-<o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
l3. Soil Type(s): /`� u r'd� Fi%r"5 fia�----
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure andlor operate per the irrigation design or wettable
acres determination?
❑ Yes
Ej
o
❑ NA
❑ NE
El"Ves
No
❑ NA
❑ NE
❑ Yes
B-N-
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�`V�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[] Yes
[] No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[] Yes
Ej___No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
0 o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[J_Ni
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
[a-%o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�o
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facili Number: jDateof Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Ewo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes 2_1�o
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [3" o
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes to
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 1. Do subsurface 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?
p. any YES
177 Ow
Reviewer/Inspector Name: -y-/
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes EfrNo ❑ NA [] NE
❑ Yes ❑'No ❑ NA ❑ NE
[:]Yes Lam-N [:]'NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes Ld''VO ❑ NA ❑ NE
❑ Yes [311 0 ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21417015

Ste& -5=5L / 7
Type of Visit: Compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: O'lTo—utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: PDo Departure Time: County: EZIW41+---- Region: J
Farm Name: d-
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: _ rw Title: Phone:
Onsite Representative:Integrator:
Certified Operator: _��� Certification Number: 7�
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current'_' _ Design Current
n jr t g
Desi Cuen
Swine Capacity Pop. Wet Povltty Capacity Pop.
@attle Capacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
O
a
Non -Layer
Dai Calf
W
Dai Heifer
Feeder to Finish_..:
''. Design Current
Farrow to Wean
Dry Cow
Farrow to Feeder
Non -Dairy
DPovltr _ Ca .aci
Farrow to Finish
Beef Stocker
F
La ers
Gilts
on -Layers
Beef Feeder
Boars
Pullets
F Beef Brood Cow
Turkeys
:,_..
:.
Other '4
Turkey Poults
* .
Other
Other
Dischar2cs and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�&No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
?. Is there evidence of a past discharge from any part of the operation`?
❑ Yes
LKNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
ENo
0 NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

' Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
C] Yes
No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
K)l No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6_ Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[R 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
� No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [B.No [DNA ❑ 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):'/Y7l�dr
13. Soil Type(s):-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes KNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? Yes 'or_ ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[a No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[,ANo
❑ NA
❑ NE
Required Records & Documents
& 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
a 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 0 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 M No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes � No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
DNA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number; - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
e
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes RNo ❑ 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 [3 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes S No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [Z No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34_ Does the facility require a follow-up visit by the same agency?
❑Yes ®No ❑NA ❑NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
[:]Yes ® No
[:]Yes No
❑ Yes �No
❑ NA ❑ NE
[DNA ❑ NE
❑ NA ❑ NE
Comments (refer to question_#)ExphAtn any YES answers and/or any additional recommendations or any other comments.:
Use drawmss of facility twbetter egplarn :situations (use additional.pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: f/0 3p3—lS/
Date:
21412015

,S if"Z- S 11R914
t,
Type of visit: eYtompliance 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: 3 / Arrival Time: 'flp Departure Time: / ;_3?} County: ¢mow
Farm Name: C/-egF y Owner Email:
Owner Name: ��j p� /`��rl ,� // vl� ��GG/- Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: ��C��P Title: ©war t- Phone:
Onsite Representative: ' ! Integrator: Sjyt% ry�
Certified Operator: _!5 Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
=- Design Current
Swine ,Capacity Pap.
Wean to Finish
Wet Poultry
jj
La er
Non -La er
Dry l'.ouit .
Design
Capacity
Design .
Ca acl
Current
Pop.
Current
Po
Design Current
Cattle Capacity Pop.
DairyCow
DairyCalf
Dairy Heifer
Dry Cow
Non-D
Wean to Feeder
DO
p
Feeder to Finish
-
U.
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Lavers
Beef Stocker
Gilts
Boars
I
Non -Layers
Pullets
Beef Feeder
Beef Brood Co —
Other
Other I I J1
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
[3-No
0 NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[:]Yes
❑ No
❑ NA
[] NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
® No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[ja No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

• Facility Number: 1 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes CE�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
%No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
P 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
JZ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
fZ 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 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):
13. Soil Type(s): �/���/-�-•-�� �u-ir—�
14. Do the receiving crops differ from those designated in the CAWMP? [—]Yes ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? 2 1'es No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
l7. 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
C!�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
C2fNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
[&No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [a No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes M No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - i Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [—]Yes lZ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes CR 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 [M No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes JR 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
DNA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes 4K No ❑ NA ❑ NE
❑ Yes (Z No ❑ NA ❑ NE
❑ Yes E4 No ❑ NA ❑ NE
❑ Yes [,No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes Co No
❑ Yes 01 No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question. ExplaW any;YES answers and/or -any additionalrecommendations or any other comments."
Use driwin of facility to better ex Ianti situations useaaciditronal: a es as necess
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2✓412014

C IN3
J
I ype of visit: C!jrCom Hance inspection t) operation Review U Structure Evaluation V Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other Denied Access
Date of Visit: Arrival Time: Departure TimeCounty:Region:
Farm Name: j Prl _ _ _ Owner Email:
Owner Name: �� (GLT.1rqALL - Phone:
Mailing Address:
Physical Address:
Facility Contact: el Ds
Onsite Representative: f l
Certified Operator:
Back-up Operator: 13 fr�4
Phone:
'�
Integrator: ,,j/� (JS��
Certification Number:
Certification Number:.:'p Ms
Location of Farm: Latitude: Longitude:
Design Gurreut
Swine Gapacity Pop.
Wet Po iltry
Design
Eapacity
Current
Pop.
Design Cnrrent
Cattle Capacity Pop.
Wean to Finish
ILayer
I
P.o
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Wean to Feeder
Nan -La er
I
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Design
D , P,oW Ca aci
I a ers
Farrow to Finish
Gilts
Non -Layers
Boars
Pullets
Other
Other
Turke s
Turke Poults
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[]moo '
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
�'A
[a A
0 NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
[ A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
GaolNo
0 NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ETNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Con inued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes j:jbi�❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NA ❑ NE
Structure 1 Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes L o ❑ NA [] NE
❑ Yes ❑ NA ❑ NE
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
[
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Qwo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
EJ.N -
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
L_ 7 o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
M 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): i•� �`�-�c� S
13. Soil Type(s): (,f p
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2<V ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[2 o ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
ar<o ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[.]'No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[],Kbo" ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
EaNo ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes t (DNA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of tns ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? C] Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
0.M6_ ❑ NA ❑ NE
CT5o ❑ NA ❑ NE
❑ Yes
Eg-M
❑ NA
❑ NE
❑ Yes
E <_
❑ NA
❑ NE
❑ Yes
[Q-14a
❑ NA
❑ NE
❑ Yes [tJ-3do ❑ NA ❑ NE
❑ Yes Ek<o ❑ NA ❑ NE
❑ Yes V7 ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
I�] ❑ NA ❑ NE
❑ NA ❑ NE
T
o ❑ NA (] NE
Reviewer/Inspector Signature:
Page 3 of 3
21412014

51-t&- 7--45- 4---
- Divis`ion of Water Resources
Facility Number ® Division ofilo-ila—RdwatermonservatioAge
Type of Visit: ompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: c��icoutine O Complaint O Fallow -up 0 Referral 0 Emergency O Other O Denied Access
i
Date of Visit: Arrival Time: '® Departure Time: County: --- Region: O
Farm Namel�J �r /1 , G % t a v-7► Owner Email:
Owner Name: G�a�-%h `' ����� 4, L, , - hone:
Mailing Address:
Physical Address:
Facility Contact: T__m�,�Jj _ Title: ®turn a Phone:
Onsite Representative: Integrator: yf� 1-0Uj f- -
Certified Operator: Certification Number: /'795-4y
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design Current
Design Current
Swine Capacity Pop.
Wet Poultry Capaci0
MLapacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
&co
n-La er
Da' Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
D . P.oultr Ca acit Po .
Non-Daity
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
7urke s
Other
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[-]Yes
CE�No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[:]Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
C3,No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
Ej�_No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facility Number: - / Date of Inspection: r 1 jo 7S
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
[gNo
❑ 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
CZ 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
[S No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
O No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Eg No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):iysa_ �ir�s,ce
13. Soil Type(s): j ors /}=V✓
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes .S No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes JZNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [g 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 4E. No ❑ NA ❑ NE
❑ Yes '0 No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes a No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Jallo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �No
[DNA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: jDateof Inspection: — to
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes CgNo
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 to provide documentation of an actively certified operator in charge? [] Yes fallo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [] Yes .0 No
Other Issues
2& 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?
[]NA NE
NA NE
NA NE
(DNA NE
Yes LB No [D NA NE
Yes M.No [] NA ❑ NE
❑ Yes B No ❑ NA ❑ NE
❑ Yes 0 No [:] NA E] NE
❑ Yes No
Yes ® No
[:]Yes No
[] NA NE
NA NE
NA NE
Comments (refer to question ft Explain any YES -answers and/or any additional recommendations or any.other comments— k
Use drawings of facility to better explain situations':(use additional:..pages as necessary).
Reviewer/Inspector Name:
Phone: 2T_14_9j
Reviewer/Inspector Signature: Date: 14— 1
�—
Page 3 of 3 21412011

Type of Visit: Com ance Inspection 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: Arrival Time: •3F Departure Time: County: �rr
Farm Name: �t,U i_r�,G` r y Owner Email:
OwnerName: ���rp%� ��-Dp�� Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: %�$n����rr► Title: Phone:
Onsite Representative: �_ Integrator:v Xe
Certified Operator: 5�-- Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design
esign
Current
DesiSwinery
NEWMet1poult"
Pop.
Cattle - k -
Capacity Pog.
1;Capacity
Wean to Finish
La er
DairyCow
Wean to Feeder
(� Non -La er
DairyCalf
Feeder to Finish
" _ tom..::_
Da' Heifer
�.�rDesign
D ,. PLoul ,.:Ca aci
Current
P,o P.
D Cow
Farrow to Wean
Farrow to Feeder
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
TurkeyPoults
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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ®No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
[—]Yes ❑ No
❑ Yes ® No
❑ Yes Z No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Faciti Number: jDate of Inspection: 3 D/
y 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):�� 1
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 5INo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ®. No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes P�No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes P No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes ® No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ®, No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): ] _ ZQ
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 RNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[:]Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes qNo ❑ 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 K No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall 0 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 No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: o%?
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 �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 g No ❑ NA ❑ NE
❑ Yes H No ❑ NA ❑ NE
❑ Yes fa No ❑ NA ❑ NE
[:]Yes E�J_No ❑ NA ❑ NE
❑ Yes
� No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments..,*. { "5
Use.drawines of facility to better ex.Wain situations (use additional Daizes as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
'� -- - Date:
21412011

Type of Visit: ompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: e-90"utine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: / Arrival Time: p c7 Departure Time: / ; > (D County:
Farm Name: �W i, Sfiro� }- ,G k 4ry Owner Email:
Owner Name: /7��14 ,,. ��n, ,e,� Phone:
Mailing Address:
Physical Address:
Facility Contact: _R1-11 Title: Phone:
Onsite Representative: 5A:�6&, Integrator:
Certified Operator: s'�r.4,�� _ Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Region: � "D
esiDgnCurrent
Design
Current
Design Gnrrent
Swine
Capacity Pap.
Wet Poultry
@apacity
Pop. ` +
Fettle Capacity Pop.
Wean to Finish
ILa
er
Dj'y Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current:
Dry Cow
Farrow to Feeder
Di, P.oult .
Ca aci
Po .
Non -Dairy
Beef Stocker
Farrow to Finish Layers
Gilts
Non -Layers
Beef Feeder
Pullets
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [a 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)
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 allo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/2011 Continued

Facility Number: - /. Date of inspection:
1
Waste Collection & Treatment
1 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E 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): Z—
Observed Freeboard (in): az_. I-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
S 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.
54No
❑ 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
W No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
®No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[!5 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 5g 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): ! !/`�� YYd•
13. Soil Type(s): /�ji►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 [0 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
19. Did the facility fail to have the 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
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
N 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
P 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

Facffity Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
2$. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes Z[No ❑ NA [] NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below,
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes al No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 1 No
❑ Yes [ No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA 0 NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.: 41
Use drawines of facility to better explain situations (use additional naizes as necessarv).
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: 3
Date: a �/33-330,0
21412011

0
Type of visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of visit: Arrival Time: [� Departure Timer County:
Farm Name: Owner Email:
Owner Name: j�/-%� r�r/y`B(r��/`r Phone:
Mailing Address:
Region:
Physical Address:
Facility Contact: Title: ��� vr' Phone:
Onsite Representative: ��-t.4� Integrator:
Certified Operator: SG _ Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
° Design Current
Design
Current
Design C+urrent
Swine
Capacity Pop.
Wet Poultry
C►►specify
Pop.
Cattle Capacity Pop.
an to Finish
La er
Non -Layer
"� °
Dai Cow F==1
Dai Calfeeder
DairyHeifer
P
ean to Feeder
p d
to Finish
Design
Current
D Cow
Farrow to Wean
Farrow to Feeder
D. , P,oul
C•a aci
P,o ,
Non -Dairy
Farrow to Finish
La ers
Non -Layers
Pullets
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Boars
Turkeys
Other
Turkey Poults
Other
LLOther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[]Yes O No DNA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[]Yes
S No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
E@ No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: -j Date of Inspection:
—
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[S No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[] No
O NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):^
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
[DNA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[Q 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
® 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
Z No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 5a No ❑ NA 0 NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > t0% 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): 4 .>✓/'JyLF[�er A22a1- f-,24 g-of
13. Soil Type(s): Z 7—XX
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes RNo ❑ NA ❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18_ Is there a lack of properly operating waste application equipment?
❑ Yes
[Z No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements []Other:
21. Does record keeping need improvement'? If yes, check the appropriate box below. ❑ Yes g[ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ONo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes � No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

+ Facility Number: CIV JDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Nan -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 M No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes �0 No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31 _ Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [S No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
[:]Yes ®.No ❑ NA ❑ NE
❑ Yes " No
❑ Yes [B-No
❑ Yes � No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (referto question #). Explain any .YES aiasK'ers and/or any additional recommends bons or:any other comments.
Use drawings of facility to better explain situ.ahons (use-additional..pages as necessary)..
Reviewer/Inspector Name:
�.-- Phone:
A /
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412011

Type of Visit 7FCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint Q Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �'''jj''Arrival Time: O U Departure Time: {� ; 3 D County: r'r_ Region:
Farm Name: 7tj11S i'n'-d Kid`% Owner Email:
Owner Name: CAa P�7-J �r'�`-- Phone:
Mailing Address:
Physical Address: rr
Facility Contact: Title: _ a Uj n Phone No:
Onsite Representative: Integrator: �/Zu.Z3
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 I Q fl Longitude: = ° =' = 4
ign Current Design
11Des-7tr
Swine Gapaci�t3Papulakon Wet Poultry Capacity
Current Design Current
Population Cattle Capacity Population
❑ DairyCow
❑ Wean to Finish
El er
can to Feeder D
-,5Z�0
❑ Non -La er
Dry Poultry
❑ Dairy Calf
Feeder to Finish
Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Co
Number of Structures:
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Layers
El Farrow to Finish
❑ Non -Layers
El Pullets
❑Turke s
❑ Gilts
❑ Boars
Other
❑ Other
❑ TurkeyPoults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
RNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[�R.No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
ENo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — Date of Inspection /1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
fallo
❑ 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): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
RNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
q 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
CRNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
RNo
[I NA
El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0,No
❑ NA
❑ NE
maintenance or improvement?
Waste App_I1Cat1oR
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
9LNo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop types)�I? uc�,[� l flr/�r►'S
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Iallo ElNA ElNE
15. Does the receiving crop and/or land application site need improvement? ElYes E,No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[--] Yes E .No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ,allo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes O.Z10 ❑ NA ❑ NE
Reviewer/Inspector Name ' F__ Phone:
Reviewer/Inspector Signature: Date:
rage 27 of J i L/40/U4 [ UllLlrrueu

Facility Number: — Date of Inspection
f
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Dg.Vo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes KNo ❑ NA ❑ NE
the approprrate box. ❑ WUP ❑ Checklists ❑ ❑ Maps
Design
g p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q 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
J9 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
P!�No
ElNA
ElNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
, Yes
J910
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Q No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
&No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RN
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
B�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
KNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
ffNo
❑ 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
RN
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[3zuo
❑ NA
❑ NE
Additional -Comments and/or Drawings:
Page 3 of 3 12128104

I .
Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: f?C7 Departure Time: County: r+°"" Region: ��
Farm Name: �LLI ,�T�� / i c-& o jf::Z Owner Email:
Owner Name: &-oo x� t"r Phone:
Mailing Address:
Physical Address:
Facility Contact: /719P4(27_VCd?- Title:
Onsite Representative: 1 - Q_DL C- -
Certified Operator: W'.M"'r'U re&k—
Back-up Operator:
Phone No: 5iP"2lv —,270 14 _
Integrator: _
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0' 0 ' [=] Longitude: = o = 1 = u
Design Current Design
Current Design
Current
SMalwine Capacity Poplation Wet Poultry Capacity
e pacity
Population .12 ttlCa
i�
Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
Wean to Feeder
0
❑ Non -Layer I
Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
Dry Poultry
❑ Dry Cow
❑ Farrow to Wean
❑ Farrow to Feeder
El Non -Dairy
❑ Farrow to Finish
❑ La ers
" ❑ Beef Stocker
El Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowl
❑ Turkeys
E]Turkey Poults
Number of Structures:
Qther_
❑ Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[&No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
RNo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: q — Date of Inspection f �/
Waste Collection & 'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
JR-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
Siructure 6
Identifier:
Spillway?:
Designed Freeboard (in). -
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
®No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
RNo-
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[RNo
❑ 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
RLNo
El NA
El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
X No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes L.No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl [:]Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? 04es
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ Yes
QNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
[?�No
❑ NA
❑ NE
19. Is there a lack of properly operating waste application equipment? ❑ Yes
[RNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
wcr-d� i e" 'l zv/et
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
I2128/W Continued

• Facility Number: — ISA Date of Inspection S"
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 PNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Desig
n El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 10 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[qNo
❑ 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
EgNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
JR 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
59 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
R,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
J4 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
mNo
❑ NA
❑ NE
12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 1_ Departure Time: C i .� County: �+ LIW 25 - Region:
Farm Name: w iS7 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address: �n�
Facility Contact: `� Title:
1t
Onsite Representative:
N
Certified Operator:
Back-up Operator:
Phone No:
Integrator: /+'►[�!-r4� " , uL
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = c = A = « Longitude: ❑ c =
Design
Current Design Current Design Current
SRineCapty
Population et Panitry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
Wean to Feeder
❑Non -La er
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poult
❑ Dry Cow
❑ Farrow to Feeder
❑Non -Dairy
❑ Beef Stocker
El Beef Feeder
❑ Farrow to Finish
L
Ela Layers
❑ Gilts
❑ Non -Layers
❑ Boars
❑Pullets
ElBeef Brood Cowl I
❑Turke
:rw:...
s
Other -
d
EJ Turkey ]'oults
❑ Other
Number of Structures:
❑ Other
Discharges & Stream Impacts
I. is any discharge observed from any part of the operation?
❑ Yes
[�iNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
05NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
50 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
PNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
10No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
hSNo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: Ll
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 Structure 2 Structure 3 Structure 4
Identifier: r
❑ Yes "No ❑ NA ❑ NE
❑ Yes ❑ No P NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �9 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes P 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 environmentW3 hreat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes +o
❑ 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?
11f
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ANo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift f❑l Application Outside of Area
J
12. Crop type(s) COAM( [a r 5s C-PE44,w-
13. Soil type(s) i�s{ Ep-res4*,
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 ([P No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes P No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes RNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other commeais
Use drawings of facility to better explain situations. (use additional pages as necessary,
CQJ
Reviewer/inspector Name [ Phone:
Reviewer/inspector Signature. Date: ig6
12 8/04 Continued

• Facility Number: rl — 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 Po ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps ❑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 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[PNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ONo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
6To
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
FU No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
`J�jNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
UgNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
QNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
)gNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�g 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
19 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
K)No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
E�No
❑ NA
❑ NE
12128104

Type of Visit 0 Compliance Inspection O Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: I OR. '/ +v Departure Time: County: Blades Region: F;9D
Farm Name: �W 10[ nt�lr V Owner Email:
r �`r
Owner Name: ChQ'rl�� `-��''D�� � Phone: /D� $6 � °� ,CW
Mailing Address:
Physical Address: r��,,�
Facility Contact: Ronald �er) —Title:
Onsite Representative:
Certified Operator: u
Back-up Operator:
Phone No:
A�
Integrator: /"I uryky
Operator Certification Number: lS�
Back-up Certification Number:
Location of Farm: Latitude: = u =, = Longitude: = ° =, = u
Destgtt
ent
Swine Capacity Population WetPoultry',tCap city
Population Cattle Capacity Population
,'
❑Dai Cow
❑ Wean to Finish�sr
❑ La er
Wean to Feeder
❑Non -La er
❑Dai Calf
❑ Feeder to Finish
"`
❑ Dairy Heifer
'
❑ �� Farrow to Wean
��°' �' f Dry Poultry. .�,i �
❑ Dry Cow
❑ Farrow to Feeder
❑
❑ Non -Dairy
❑ Beef Stacker
❑ Farrow to Finish
La ers
❑ Non -Layers
❑ Gilts
❑ Beef Feeder
❑ Pullets
❑ Boars
❑ Beef Brood Co
„. ,_ . inr ❑ Turkeys
Other .. #'- ❑Turke Pouets
❑ O#her ❑ Other
Number ofEStructures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[?INo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
P NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[�NA
ll
[3 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
rNA
ElNE
2. Is there evidence of a past discharge from any part of the operation?
ElYes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[ANo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: R — % a
Date of Inspection S 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3
Identifier: I
Structure 4
❑ Yes 0 No
❑ Yes ❑ No
Structure 5
❑NA ONE
MNA El NE
Structure 6
Spillway'?:
Designed Freeboard (in):
r�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes PNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes PNo ❑ 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? Cl Yes No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ( No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes O10 ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes V3-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 CropWindow ❑ Evidence of Wind Drift El Application OutsideofArea
12. Crop type(s) Cns4-a( 9` rnJQ �ss 6�cts4uo_)rr sna Gem . otgu �t
13_ Soil type(s) ?u4X$
—Fu , Fj"5
-Fl!j
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
91 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?D Yes
W No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application`?
❑ Yes
Eq(No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E� No
❑ NA
❑ NE
Reviewer/Inspector Name
Phone:
Reviewer/Inspector Signature:
Page 2 of 3
Date:
12128104 Continued

Faciiity Number: — of Date of inspection S 21
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 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�d No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes 4§ No ❑ NA ❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[)tNo
❑ 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
49 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
IN 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
IS No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
11 No
❑ NA
❑ NE
Page 3 of 3 12128104

ti
Division of Water Quality
Facility Number r Q Division of Soil and Water Conservation
_ _-- - O Other Agency
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit fRoutine 0 Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ,(� 4% Arrival Time: ;POD Departure Time: D:A� County: Region: EeP
Farm Name: W,S 1 Owner Email:
Owner Name: �^'t0�1 e'er ^6vcdeiN Phone:
��``��
Mailing Address: f�'r�`•9� Izo-1
Physical Address: ,?q0 tU /VC .28331
Facility Contact: !AUQ U C!2229+, Title: Phone No:
t� -
Onsite Representative: Integrator: Ald._—a
Certified Operator: t Operator Certification Number: / 79,�Z
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 e 01 Oft Longitude: 0 o 01 ED "
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
,Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
Q JE3 Non -La et
Other
❑ Other - -
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
Design: Current ` "
..
Cattle Capacity Popuation
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifej
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes TNo ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
El Yes
El No
[�NA
El NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
[� No
❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 1�1 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? El Yes ❑ No INA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes U 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 PNo ❑ 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 6 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [lNo ❑ 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 IPNo ❑ 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 rifl ❑ Application Outside of Area
12. Crop type(s) _rmsw
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CA WMP?
❑ Yes
09 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[PNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
79 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):
ReviewerAnspector Name Phone.
Reviewer/Inspector Signature: Date: D
1 _11Z5/U4 ;� 5nuea

Facility Number: 2-1411 Date of Inspection /
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? []Yes PNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes IQ No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Desig
n ❑ Maps
p ❑Other
21 _ Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes ff 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 P_No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [& No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Vj 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 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
J�tNo
❑ 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
[;9 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
q9No
❑ 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
91 No
❑ NA
❑ NE
12128104

I
Type of Visit ffCompliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit gKoutine Q Complaint O Follow up 0 Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: ; {TD Departure Time: . Q County: Region:
Farm Name: n � � ZY G kE> r'y Owner Email:
Owner Name: t� �rri` �r� _ �Da�^ Phone:
Mailing Address:
Physical Address:
Facility Contact: !TJ724Cj ��^--- Title:
Onsite Representative: -mac_
Certified Operator:
Back-up Operator:
Phone No:
Integrator: Z22ke' ' E
Operator Certification Number: Z 7 96_1-
Back-up Certification Number:
Location of Farm: Latitude: =o E-7 =" Longitude: =° 0' E]
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
Design Current
Cattle C►apacity Population
❑ Wean to Finish
❑ Layer
❑ Dai Cow
Dairy Calf
Wean to Feeder
(o
ILINon-Layer I
❑ Feeder to Finish
❑ Farrow to Wean
Dry Poultry
❑ Dairy Heifer
❑ Dry Cow
ElNon-Dairy
❑ Farrow to Feeder
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts ❑ Non -Layers
El Pullets
❑ Boars Turke s
❑
Other ❑ Turkey Poults
❑ Other ❑ Other
❑Beef Feeder
❑ Beef Brood CovAl
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
M.No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
Ej No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
RNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Wo
❑ NA
❑ NE
other than from a discharge`?
Page I of 3
12128104
Continued

Facility Number: — S Date of Inspection LIA-JTT(o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? ❑ Yes QgNo ❑ NA ❑ NE
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):
Observed Freeboard (in): 3 D
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes allo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 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 ® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
21 No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
C4 No
❑ NA ❑ NE
maintenance/improvement?
I t . Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
allo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) r p
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
D4 No
❑ 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
[KNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
®..No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any. recommendations or any other comments.�`�
�-
Use drawing.. s of facility to better agPlain'situati6ns. (use additional a e.s; as necessary): ='
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: aD
rage c of .s I'VZO/VY i,ununueu

Facility Number: — S` Date of Inspection -�(-
`Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ffNo ❑ 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 El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 29 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes MNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
0 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
14 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
rM No
El 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
[9No
❑ 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
[R No
❑ NA
❑ NE
�.
Additional Comments'aodlor Drawings
Page 3 of 3 12128104

Type of Visit (WCompliance Inspection U Operation Review () Structure Evaluation (-7 Technical Assistance
Reason for Visit O Routine O Complaint Q Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: I Q-' jj A/rrivHl Time: ; DD Departure Time: � ' ,� County: Region:
Farm Nam 01 Gt ►L.~c,V �/r Owner Email:
Owner Na e:/�. j�a/ &i GKti Phone:
Mailing Address: 0E, Y,;L- P /U6 ��337
Physical Address:
Facility Contact: Title:
Onsite Representative: r� (� R i]d �//�
Certified Operator: / &-i' f",
Back-up Operator:
Phone No:
Integrator: rn .-
Operator Certification umber: 12 }�lo
Back-up Certification Number:
Location of Farm: Latitude: 0 e F--T 0" Longitude: Q ° = ` Q "
Design Current
nt
tr
-'' Design Currenine
^apa cityPet
P'oultpry Capacity Population
Cattle 'Capacity Population
❑ Wean to Finish
❑ La er
iry Cow
Wean to Feeder
62&oo
U4.19
❑ Non -Layer
iry Calf
❑ Feeder to Finish
airy Heifei
❑ Farrow to Wean
Dry�Poultry +,
El Dry Cow
Farrow to Feeder
El Farrow
' '"' -
El Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑Beef Brood Cowl
.e�
Other:''
❑ Turkeys
El Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed Thom any part of the operation'?
❑ Yes
MNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
allo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
Pd 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
[3a No
❑ NA
❑ NE
2, Is there evidence of a past discharge from any pan of the operation?
❑ Yes
R No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
HA No
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

Fa6IJ4 Number: t9 — Date of Inspection �L
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
EgNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
® No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
a
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[4 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
Lallo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
0 Yes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
Dd No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ yes
CgNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
5d No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
R) 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) l�G�QS /
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[ZNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
KNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination:
❑ Yes
PQ 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
El NA
El NE
G n u , I-, 1uark ems.' 0'-L
Reviewer/Ins ector Name ` i "='
p i Yv ,�. Phone: 4� —/ ;§���3
Reviewer/Inspector Signature: Date:
12128104 Continued

` 1Facilily Number: 9L —f Date of Inspection r7—
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 ❑ Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. )0 Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections L9 Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
10 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
'Yes
❑ No
NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
Yes
ssf�
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
JZNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
15�Yes
No
,NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
' No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
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
[K 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
UQ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
RNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[KNo
❑ NA
❑ NE
Additional'Comments'.and/or Drawings':'.
Rom, vL 5,,r� r. •X-��`'
9-0 b
�prn�ryrjGLte� �ur-t�z'j� '� 9L--alo
d �
12128104

Type of Visit ® Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit ® Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number ,j'a
Date of Visit: /0 27 ay Tune:
0 Not Operational 0 Below Threshold
0 Permitted EP Certified © Conditionall
y Certified 13 Registered Date Last Operated orAboveThreshold: ...------__...._..
Farm Name: ...........—TW.... f�----...G ,t � ~ ......_ ._...._ - County:.._._ &/:5 n ... ......... _W . .. FAc>
Owner Name: 5.�'.a r �.�+at ..6 5 ^........ _- ...... Phone No: ............... - _ _ ........
Mailing Address:
Facility Contact: Title:..... ._— ---- — -- — - Phone No:
Onsite Representative: _-_—� _ e rac +�__WW ..�. Integrator: —&r1—k.jb't-= ,,,_l,.x � ------
Certified Operator:--- o/� g.fC.� �� �oG�e,�t?T- - - - _ Operator Certification Number:._. S6 _.
Location of Farm:
[0 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 1 Du Longitude • 4 «
Dischare & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaYrnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ................. I ............................. ._................ ..................................
Freeboard (inches): 3011
❑ Yes ❑ No
H 1A
❑ Yes ❑ No
❑ Yes ® No
❑ Yes [3 No
❑ Yes ®, No
Structure 6
12112103 Continued

Facility; Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes jR No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes [9 No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
S. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑Yes No
elevation markings?
Waste AaDllcation
10. Are there any buffers that need maintenanoe/improvement?
❑ Yes
P No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type �� i-ry+ a t az�c.4e Z,5_ h- a l t c e - r../
13. Do the receiving crops differ with those'ldesignated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
CO No
b) Does the facility need a wettable acre determination?
❑ Yes
M No
c) This facility is pended for a wettable acre determination?
❑ Yes
M No
15. Does the receiving crop need improvement?
❑ Yes
(M No
16. Is there a lack of adequate waste application equipment?
❑ Yes
M No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
[g No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
I9. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
jA No
Air Quality representative immediately.
n«X s�� t s���S<- P"Y
l�s•��'C �a.. plc s«:-I%- o4-C
Reviewer/Inspector Name
Reviewer/Inspector Signature:
0-y
Feld Copy ❑ Final Notes
Date:
Fiajyrix3
['nM-6MFuA

k'acilit Number: — f' Date of Juspection FA7/
RMuired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23_ Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
27. Did ReviewerAnspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NI MES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Foam ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes 0 No
❑ Yes (` No
❑ Yes No
❑ Yes j No
❑ Yes No
❑ Yes IP No
❑ Yes 10 No
❑ Yes Of No
❑ Yes p No
❑ Yes 13 No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
12/12103

Site Requires Immediate Attention: ND
Facility No.
UmJty cp,1Sl.�c-��aN
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE:- 3 , 1995
Time: 14 : Z 4
Farm NamdOwner: w 4 s +,—J R,—tko v-" ! A I c-I _ a o o de -"I
Mailing Address:_ Po Beer- I zY.L. �!� x a h _ ;,� v /✓G Z7:X3 7
County: 911 dam1y -- _
Integrator: � 4 •.AtS _ Phone:
On Site Representative: - A/ C Gao de-.1 Phone: C 41a) 86 Z — 2 SS4-
Physical AddmslLocation: s2 ioo
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: Z (-eo Number of Animals on Site: z.(-.ao
DEM Certification Number: ACE DEM Certification Number: ACNEW
* atitude: p s w Longitude:—
p s w
Latitude:_ �tt�G L�Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) (�or No
Was any seepage observed from the la oon(s)?
Is adequate land available for spray? or No
Crop(s) being utilized: ROLO Crof!-T. 41
Actual Freeboard: 11 Ft. Inches
Yes ow.� Was any erosion observed? Yes or<IV
Is the cover crop adequate? Or
jP or No
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? (josAor No
100 Feet from Wells? (G� or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes ord§)
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes oRIW
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes ojNfi) If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments: AeL j A P­
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.