090157_INSPECTIONS_20171231

t
I ype of visit: S0,Uomp ante Inspection U Vperation Review U Structure Evaluation U Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: L!2:: , —I Arrival Time: Da Departure Time: County: _� Region:
Farm Name: Gc / Owner Email:
Owner Name: n Phone:
Mailing Address:
Physical Address:
Facility Contact: -Cr7 y Title: ��r` Phone:
_T
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design
Swine Capacity
t?urreut
Pop.
Design E©rre©t Design Current
Wet Poaltry Capacity p,. Cattle Capacity Pap.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
�' Dai Heifer
Design Ccfrrent D Cow
Cspa 1 Mop- Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
eeder to Finish
Farrow to Wean
Farrow to Feeder
D , Pqn
Farrow to Finish
Gilts
Layers
Non -Layers
Boars
Pullets
Turkeys
Turke Poults
ElOther
Other
Other
Dischames and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[—]Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
[] No
❑ NA
❑ NE
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does he discharge bypass the waste management system? (If yes, notify DWR)
[:]Yes
❑ No
❑ NA
❑ NE
2. Is there evidence f a past discharge from any part of the operation?
❑ Yes
RNo
❑ NA
❑ NE
3. Were there any ob rvable adverse impacts or potential adverse impacts to the waters
❑ Yes
[>�No
[] NA
❑ NE
of the State other th from a discharge?
Page I of 3
21412015 Condnued

acili Number: JDate of Inspection:
—
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ONo
❑ 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): 33-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
allo
❑ 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
ONo
❑ 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
29-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
JZYo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No
11
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
allo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved
Area
l2. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ
those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
XVNo
❑ NA
❑ Yes
[F[ No
❑ NA
❑ Yes
,LNo
❑ NA
❑ Yes
® No
❑ NA
❑ Yes
,6 No
❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
Reguired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes RNo [DNA ❑ 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 13a No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes oNo ❑ NA ❑ NE
Page 2 of 3 21417015 Continued

Facie Number: Date of Ins ection-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes P No
'. 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes jo No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [:]Yes ® 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 Rr No ❑ NA ❑ NE
❑ Yes IR No ❑ NA ❑ NE
❑ Yes 12 No DNA ❑ NE
❑ Yes C&No ❑ NA ❑ NE
❑ Yes [RNo
❑ Yes No
❑ Yes [ No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (referito�questron #1) ExplarnanyYdES�answers and/or any additional recommendations or any other��oommen.� 4
Y
Use: drawrngs of tacili to,betfer ex lain Mtuatious use additional es as necessary).:"
Reviewer/Inspector Name:
Phone: >I—
Reviewer/Inspector Signature: �/ -- Date: 1
Page 3 of 3 21412015

r
.Q I
n
for Visit: outine O Complaint O Fallow -up O Referral O Emergency O Other O Denied Access
Date of Visit: /L Arrival Time: ' 0 Departure Time: ,' County:
Farm Name: �h n I��! i �arN'L- Owner Email:
Owner Name: .1 Phone:
Mailing Address:
Physical Address:
�1
Region: F (7
Facility Contact: e? T� A u Title: Phone:
OnsiteRepresentative: S«� Integrator:
Certified Operator: J Yf Lrk A- Ait Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swiae
Wean to Finish
Design
Capacity
Current
Pop.
Wet Pouttry
La er
Non -La er
D . P,o-it .
Layers
Desiga
Capacity
EURign
Ca aci
Current
Pop.
Cnrrent
P.o
Design Current
Cattle Capacity Pop.
Da Cow
Da Calf
fer
Dry Cow
Non -Da'
Beef Stocker
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
Boars
Other
Other
__
Turkeys
Turkey Poults
Other
Discharges and Stream Imoacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[ff-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 DW R)
❑ 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
allo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

laacili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate? ❑ Yes jo No D NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 r
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
["0 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[:]Yes
Eg 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?
D. 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 or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
Fgj 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)/`�1��C�r��f
0. Soil Type(s):
14. Do the receiving crops differ from those desi ated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop andlor land application site need improvement?
❑ Yes
� No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
®' No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[ANo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [—]Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes �No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection: 6
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [3 No ❑ NA ❑ NE
. 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 0 No ❑ NA ❑ NE
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ER No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [&No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes O'No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
Eallo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[] Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
KA No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Ca No
❑ NA
❑ NE
ReviewerAnspector Name: f �s
Phone: 2ZQ —Y-li33 cc,
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412015

Type of Visit: er-Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Orlioutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: LJ Departure Time: rj County:- Region:
Farm Name: Owner Email:
Owner Name:/7 Phone:
Mailing Address:
Physical Address:
Facility Contact: _Tl�-xn�iTu-/r Title: e�?wri Phone:
Onsite Representative: ,�2�� Integrator:
ic4
Certified Operator: Certification Number: (o
Back-up Operator: Certification Number:
Location of Harm:
Latitude:
Longitude:
Design
Capacity
rPFeeder
Current Design Current
PopFinish La er
Design Cnrrent
Dai Cow
Feeder
Nan -La er
Dai Calf
Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D . P,on1 Ca aci P.o
ILavers.
Daiy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Non -Layers
Boars
Pullets
Turkeys
Other TurkeyPo Its
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
D. Yes ETIN"o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
[:]No
❑ Yes
0' 0
❑ Yes
0No
❑ NA ❑ NE
❑NA ❑NE
DNA ❑NE
Page 1 of 3 21412015 Continued

+� Faciliq Number: - Date of Inspection: Igg
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
0 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):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[3No
❑ 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
[?j`&o
❑ 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
[A�o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[`No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soii
❑ Outside of Acceptable Crop Window' ❑ Evidence/of Wind Drift ❑ Application Outside of Approved
Area
12. Crop TYpe(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated m the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
B 5c,
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
e`�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
r Rio
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑-i4"o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
Q No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑moo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22_ Did the facility fail to install and maintain a rain gauge? ❑ Yes allo
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes �o
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ONE
❑ NA 0 NE
Page 2 of 3 21412015 Continued

Facili Number: jDate of Inspection:
4 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ✓ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �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 No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Q o
Other Issues
28_ Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑'No ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
❑ Yes [5-<o ❑ NA ❑ NE
❑ Yes E31No ❑ NA ❑ NE
❑ Yes ETgo
❑ Yes ❑'lffo
❑ Yes �o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YESFanswers and/or any.additional recommendations or any other cotu nsnts
Use drawings of facility to better expl8in situations,(use.additional pagesas necessary).
Reviewer/Inspector Name: ����_ �vy�i�— Phone:
Reviewer/Inspector Signature: Date: /�q
Page 3 of 3 21412015

`;�'._ it' - (-S
Type of Visit: �Zutdlne
nce Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: G - / Arrival Time: ; D Q Departure Time: County: �r�. Region:
Farm Name: �r—s, ..r .�12 /5Qr''m
Owner Name:,�� �y
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: r7n Z 1 Title: Q CU h Phone:
tl
Onsite Representative: Integrator:
Certified Operator: �� ZA22a 14 r7 Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Potiltry Capacity Pop.
Wean to Finish La er
Design Current
CattleMGapacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Design Current
Dry P,oult Ca aei P•,o .,
Layers
DairyHeifer
D Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Turkeys
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
[B-No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b_ Did the discharge reach waters of the State? (If yes, notify 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
[&No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

I
Facility Number: JDateof Inspection: p
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? JE] Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ES No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Z91-
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E�j 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
Ej 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
fa No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
CR 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
allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
ff No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s): r— l e �r / .
13. Soil Type(s): ,D eZir
ems! Y
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes
No
0 NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[El No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
O No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[ZNo
❑ 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 EINo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [—]Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes C?�No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

Facility Number: - / Date of Inspection: p—
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ®, No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes 2 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 fast survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes foNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes [RNo
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?
[DNA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes [g No ❑ NA ❑ NE
❑ Yes ® No [DNA ❑ NE
❑ Yes [R No ❑ NA ❑ NE
❑ Yes JR No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
[:]Yes E2—No
❑NA ❑NE
❑ NA ❑ NE
NA ❑ NE
Comments (refer to question ft Explain :any:.YES answers; and/or any additi6nal,,recommendations,or any other�commenti:�
Use drawings of facility to better explain situations (use additional pages as n_ecessary). F
v2-11
y �
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
V412014

Itype of visit: tX:omptiance inspection U operation xeview U Ntructure Evaluation U Technical Assistance
Reason for Visit: aoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: L LT Arrival Time: ! p D Departure Time:.3 ! a� County: Region: /W
Farm Name: /�- n ,;7(4 � 1-11 Owner Email:
Owner Name: �{�,! m A(A/- / ��y Phone:
Mailing Address:
Physical Address:
Facility Contact: Air ran r_W z ty � Title: �,� r,r� Phone:
Onsite Representative: - -- Integrator:
Certified Operator: 111/ / a� In Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
.
es1gn;' Currenf Design Current
Design Current
Swine CapastyWet'Poultry Capacity Pop. Eattle
@apacity Pop.
Wean to Finish
Layer
Dairy
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure [3Application 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?
Cow
Calf
❑ Yes UN o ❑ NA ❑ NE
[—]Yes ❑ No
❑Yes ❑No
❑ Yes ❑ No
❑ Yes E5a'No
❑ Yes Q No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number:- �" Date of Inspection:
Waste Collection & Treatment
�. 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes RNo ❑ 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): / 2
Observed Freeboard (in): _ ,3q
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes W 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 CR No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
(--]Yes
[ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
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): f � W_jZ/_
13. Soil Type(s):r�-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Callo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
M No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑Yes
� No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[Z No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑X 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
[5[ 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 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

Facili Number: - / Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ZINo
` 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 5jjNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [Z No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes E2rNo ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
®No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
Comments (refer to.goestion ft Explain any YES answers and/or any;additional recommendations or any other comments: 4
Use:drawings..of:facilit]:to better explain situations (use additional pates as necessary).. `" y
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Ufa-y:3c7�
Date:
21412011

e
Type of Visit: Q.P&mpiiance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: tine O Complaint O Follow-up O Referral O Emergency () Other Q Denied Access
Date of Visit: �//��-�3 Arrival Time: p p Departure Time: ' p County:
Farm Name: yi ct ram► Owner Email:
Owner Name: K n Y't" /7 yPhone:
Mailing Address:
Physical Address:
Region: rR Z)
Facility Contact: %� ��h ��� Title:Phone:
Onsite Representative:_ Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
i
Design Current��
Design
Currentr
Design Current
Swine Capacity Pop.
Wetr,Poultry:
Capacity
Pop
Cattle Capacity Pop.
a.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Nan -La er'.
Da' Calf
Feeder to Finish
= ` ' ,
a
D!'X Heifer
Farrow to Wean'-_'
Design
@urrerit
Dry Cow
Farrow to Feeder
D . ;ml'oulCa
aci
P,o P. T
Non -Dairy
Farrow to Finish
ILayers
I
113eef Stocker
Gilts
Non -Layers
I Beef Feeder
Boars
Pullets
Ineef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA [] NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
• 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
®-No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
0 Yes
❑ No
[] NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in): C -
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Q No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
a 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
[l 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 ❑j Application
Outside of Approved Area
12.Crop TYPe(s)= _D,-/ystejL i8t-rrSrr/1a.,�GLc4�Isi� �/
�✓.t
-
13. Soil Type(s):
14. Do the receiving crops differ from those resignated in the CAWMP?
❑ Yes
JZ] No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® 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
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Z No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[I No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [j� No
❑ Waste Application ❑ Weekly Freeboard []Waste Analysis ❑ Soil Analysis []Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes � No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes allo
❑NA ❑NE
❑ Weather Code
[:]Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 2/4/2011 Continued

Facility Number: - Date of Inspection: 1— —L7
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 Co No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
KNon-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance;
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 0 No [DNA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [A No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field [D 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 [3 No ❑ NA ❑ NE
❑ Yes [0 No ❑ NA ❑ NE
❑ Yes 5P No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
[] Yes Cff No
❑ Yes ®. No
❑ Yes JZ] No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments.(refer to question #): Explain any YES answers and/or any additional recommendations or any other mments co
Use drawings of facility to.better explain -situations (use.additional pares as necessary).
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
W
Phone: qPV : ,'Um
Date: //—/
21412011

Midi
Onsite Representative: f T
Certified Operator: Ad/BI-k-';-ct.
Back-up Operator:
Phone:
Type of visit: ompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:/? - Arrival Time: : oD Departure Time: County:1Region: lei
Farm Name: �Ier r? e, '`` _ 2 j j`t r✓rye Owner Email:
Owner Name: A Z!-rl ✓iz-?Autr- y Phone:
Mailing Address:
Physical Address:
Facility Contact: A,o,,t yt,;-rL 7 7, Z Title: ��.yt-✓
Integrator:
J^
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
_..,,,Design Current
an
Design C�urreat
Design Current
Swine ` Capacity Pop.
Wet PoW36apacity
P.op..
Cattle
Capacity Pop.
Wean to Finish Layer
DairyCow
Wean to Feeder
Non -La er
-
DairyCalf
DairyHeifer
Feeder to Finish
Farrow to Wean
Design ' Current
D Cow
Farrow to Feeder
D , P,oul
Ca aei
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Puliets
Beef Brood Cow
m Igo
Turkeys
nOthlle�err
Turke Poults
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? V,
❑ Yes E[No [] NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
[:]Yes ❑ No
[:]Yes 0 No
[:]Yes EDNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
r
Page I of 3
21412011 Continued

Facifity Number: IDate of Inspection:
Waste Collection & Treatment
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Wo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 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
ID No
❑ NA
0 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
allo
❑ 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
JE�No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
IQ No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes C3-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) 7`s !ram Ian /�,-✓sc 1Gv�� ��v�r��d �fs� --
13. Soil Type(s):
U �
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[&No
❑ NA
❑ NE
15. Does the receiving crop and/or ]and application site need improvement?
❑Yes
�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑Yes
�No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[MNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[. No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes L^J 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 E�No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [::]Yes 0 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: -I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Z] No C] NA El NE
�1V 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 0-Yes o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey El Failure to develop a POA for sludge levels
J[ion -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: dip 8
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 [D No ❑ NA ❑ NE
Other Issues
28_ Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
[—]Yes �o ❑ NA ❑ NE
❑ Yes E No
❑ Yes CZ No
[:]Yes LS-No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question 4): Explain any -YES answers and/or any additional recommendation.rasiony herrtcomments.
Use drawings.of facility to better explain situations,(use;additional pates as necessarv) z. 1xr�r�
Reviewer/Inspector Name:
Reviewer/ rnpector Signature:
Phone: 9"z__9L3U 010
Date: /' --/ ef �— Zpp /;2-
2/4/2011
Page 3 of 3

q
4.44
Facilt Number Devtsion of Soil an�ualtt_y _ W U�
b-_ ivtsion ofaWater
dWater Cons S
fyd erva one,
i1g.AVIN��-
Type of Visit: G<omptiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Gleason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ® Arrival Time: I :Y;J 0= Departure Time: I Ja,"D0 County:
Farm Name:- f (enn AKI�x rat'n, Owner Email:
Owner Name: Kee yl xk A-de-Y _ Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: A-er7rI rqk / � � Title: A{>j?�.—/ Phone:
Onsite Representative: 1jA,r � Integrator: bLJ 1 Ar�yrt _)sw
Certified Operator: TTI( Certification Number: Qj L4gj
Ill
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine Capac ty C Pop nt WettP ultry apa%c ty C Pop nCattle II Capan
C C Pop
_ n
- Wean to Finish La er Dairy Cow
Wean to Feeder Non -La er Dairy Calf
Feeder to Finish Dairy Heifer
Farrow to Wean„ Design Current Dry Cow
Farrow to Feeder Drvl?oultr ,. _ ` Ca aci Po Non -Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non -Layers Beef Feeder
Boars 1pullets;' Beef Brood Cow
- Turkeys � ,
;other:y
Turkey Poults= ==
Other Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes R-No [] NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes [:]No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes R1 No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes MNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection: -j
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):Lr
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [Z No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes RA 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 R] 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 [Z 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):
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?
0—Yes
❑ -No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
DR -No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
M No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2�No
[] NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0 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
[B No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
L![No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
P No
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Facili Number: - 7 Date of Inspection: -- D-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ®No DNA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes V No ❑ NA ❑ NE
the appropriate box(es) below.
[] Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes CKNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes M No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes M No ❑ NA ❑ NE
❑ Yes V1 No ❑ NA ❑ NE
❑ Yes V1 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
� No
❑ NA
❑ NE
Comments -(refer to question #): Explain any -;YES -answers_ and/or any additional recommendations or,any other comments.
Use drawings of facility to better explain'situations use additional pages as necessary).,�`
Reviewer/inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone:
Date: 6 %D
21412011

Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: ; DiD County: Region: Ffi� 1z)
Farm Name: 1'C �?� n�- i f{-/ Y�r+'�� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: rC ran r-t�_. A4 Title: a Gtwr. Phone No:
Onsite Representative: Integrator:
Certified Operator: /La-rD?o'�' y Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = 1 ❑ Longitude: = ° = 6
0�Cin,
n
CurrentSwine
Wet Poultry Capacity Population C►at#le Capacity Population
❑ Wean to Finish =
10 Layer
❑ Dairy Cow
WFeeean to Feeder
❑ Non -Layer
El Dairy Calf
Pder to Finish I 4kSD 1 Da
❑ Farrow to Wean
Dry Poultryk`.?
"t =
❑ Dairy Heifer
❑ Dry Cow
❑ Farrow to Feeder
❑ Farrow to Finish
Gilts
PoBoars
other
❑ Non -Dairy
❑ Layers
Non -La ers
❑ Beef Stocker
❑Pullets Beef Feeder
❑ Turkeys
❑ Turkey Poults
❑ Beef Brood Cow
Number of Structures:
❑ Other ❑ 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)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes Z No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
5� No
❑ NA
❑ NE
[I Yes
®No
❑NA
❑NE
Page 1 of 3
12128104 Continued

Facility Number: — Date of inspection f f7
t Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONo ❑ 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 IN No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes JN 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 2INo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s)
13.
Soiltype(s) el,
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
10 No
❑ NA
❑ NE
15_
Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
® No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
KNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
Reviewer/[nspector Name Phone: C}/8
Reviewer/Inspector Signature: Date: t i]
Page 2 of 3

Facility Number: — j Date of Inspection
* Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes UNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes fgNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNo ❑ 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 P5 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes RNo ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JR 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
F&I 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
®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
MNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
SNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewerllnspector 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
E&No
❑ NA
❑ NE
Page 3 of 3 12128104

T� i45 51aa1oa sv_
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit Q Routine Q Complaint 0 Follow up () Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: 3 IS County: Region: FRO
►l1�1 al
Farm Name: en+'t1/'+/t Owner Email:
OwnerName: 11 it/ I 'i Phone:
Mailing Address:
Physical Address:
Facility Contact: K-P„ A/fitY Title: owl" Phone No•17T 3Y30
Onsite Representative: Integrator: G 101-(
Certified Operator: _ T�pJ�(Y_laL / Operator Certification Number:
Back-up Operator: A�i„ ck _h i Back-up Certification Number: g8g/5
Location of Farm: Latitude: = o I Longitude: Q e _ u
` �� ''�- Desrgn" Current - =
Destgn�Cnrrent
Swine #Cap ci y Popp Iation Wet Poultry C pac ty¢ Population Cattle
❑ Wean to Finish ❑ Layer ❑Dai Cow
Design
Capacity
Current
Population
❑ Wean to Feeder ' ❑ Non -Layer I
Calf
Feeder to Finish f
❑ Farrow to Wean wDry Poultry _ x.
❑ Farrow to Feeder
Farrow to Finish ❑ Layers
❑ Gilts ❑Non -Layers
.: ❑ Pullets Boars y.,
❑
Turke s
r . ,; ❑Turke Poul[s
Other
eoetrP
Dairy Heifer
El Dry Cow
ElNon-Dairy❑
❑ Beef Stocker
❑Beef Feeder
❑Beef Brood Co
_r_
1. +bt+.s I .. uv::: � ": ..-.r:.._: -.
-
Discharges & Stream Impacts
_ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes IRNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
W-No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility \'umber: a Date of Inspection
Waste Collection & 'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 'R 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 (*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 t 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 RNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 15kNo ❑ 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 MNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Wo ❑ NA ❑ NE
maintenance/improvement'?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [RNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
&[No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
N'Yes
❑ No
❑ NA
❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ yes
allo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
D?No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
S�No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name %70 AV $C Phone• �d 33QQ <-
Reviewer/Inspector Signature: Date: Na
121281041 Continued

Facility Number: Q q — Date of inspection a
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 Wo ❑ NA ❑ NE
the appropiate box.
❑ WUP El Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes C9 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes RNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No �JNA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JRNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
15allo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
I
❑ 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
I No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
NNo
❑ 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
SNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 I. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
UNo
❑ 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
CgNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
ONo
❑ NA
❑ NE
µ:
Additional Comments and/or �
7, wor k o , bar- s o-b a.9 0o ,� , Sod rve�- s Fewd- a Sera,'[%i /)I
6)e_ 1 Q* year',
�Fm� r �;Whowi'l o�
1Sf S�reac� i Tor►Iaue o�-f�Pid1 rf) PeclmbPr' Lj' a elk 11 ,`�lo�-sv�ewhy.
n
a qje, sv(ver Ja to T b 00n aT I1�e Showt
v01L)me- P��aae_ CIfA4L,fi` 1� a -6�►v yeaa.
J
{Overall 'Amanqu �A- r� (CVd S­ 4 joad ,rm.
Page 3 of 3 12128104

&(F
I
Racility i4o. 0Q_ `fl1s7 Farm Name keDate
Permit COC OIC_ NPDES {Rainbreaker PLAT Annual Cert )
Pop.Type Design Current
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date 1,: l
d
Sludge Depth ft & %
Liquid Trt. Zone (ft)3,
FA.a rPrnUv,J QVI r7; I-e- , UQ I.tr.-�41
1 Design Flow
Design WWidthth
.'-------I
; Actual
Soil Test Date c7
pH Fields
Lime Needed l-11�1J
Lime Applied
Cu ✓Zn ✓ '
Needs P
Crop Yield
Wettable Acres. 133
WUP
Weekly Freeboard ✓
Rainfall >1" ✓
1 in Inspections �^
120 min Inspections ✓
Weather Codes ✓�_ F`
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
Q1
Waste Analysis Date _LMNAM
M I AM
.� ...f M.
10 7
V ; 1` IMI
NI IIXWLW�
.1 r-
rll -
.
Giylliir'
I-. J Pl f e) W..
�.+i
1J s'�
1 .. MIME
WW�
1 Y
t
��..�.
Verify PHONE NUMBERS and affiliations
�/ Date last WUP FRO `] 104 Date last WUP at farm
FRO or Farm Recordsy
Lagoon # tj
Top Dike'
Stop Pump 5+.7
Start Pump 5�q
App. Hardware C�� `-')C4(
f

WMS 051401 T1r
Type of Visit 12rcompliance, Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 105E3 Arrival Time: QQ' 3 Departure Time: !� + y5 County: Region: o
Farm Name: Ke n tl% Aytni FiZfll Owner Email:
Owner Name: �ftnfl k _ Autry Phone:
Mailing Address: 48(1 M ��n , POL , „ El119befhfoW17
Physical Address:
Facility Contact: Title: _t)iti S= Phone No: L
Onsite Representative: Integrator: __ [Xwra�i., Si4jif IV_
Certified Operator: Beim AV Operator Certification Number: JA 4 16370
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 0 = f = " Longitude: 1:1 ° = I 0 u
DesignCurrent Des go Current.'' Design
Current
Swine CapacttyPopulition Wet Poultry CapacityPopulahon Cattfe Capacity
Population
❑ Wean to Finish ❑ La er ° [] Dai Cow
❑ Wean to Feeder
❑Non -La er
❑Dai Calf
Feeder to Finish
❑Dai Heifer
"aY k °' ❑ Dry Cow
" ❑ Non -Dairy
El Beef Stocker
❑Beef Feeder
❑ Beef Brood Co
:.
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ La ers
❑Non -La ers
❑ Pullets
❑ Turke s
❑ Gilts
❑ Boars
A, _
her
O� - �r
❑ Turkey Poults
1Vusmber of Structures:
❑ Other
❑ 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)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes X[No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes F4 No ❑ NA ❑ NE
❑ Yes NNo ❑ NA ❑ NE
12128104 Continued

Facility Number: og —Q Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes CRNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 1C 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 H 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 IR No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes tRNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 10 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 lbs ❑ 'Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
19 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
tRNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
tRNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
19 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�? No
❑ NA
❑ NE
e ti s ory� other comments.
@omnaets(�eier to}goes#lion'#}Explain anyYES answers` and/or any recoma�UN
Use drawl of factlt Ito better e * lam sYtnations. (asetaddit,orfa 1,„
�. rY� '7p d 6ifi tpages as necessary.): • ..
Reviewer/Inspector Name �S
��� Phone: 910 y33-3300x3-133
Reviewerllnspector Signature:
Date: 004310 $
Page 2 of 3 V I2128104 Continued

V
Facility Number: () Q — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes WNo ❑ 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 ❑ Desig
n ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes CjNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [:]No 5aNA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
8 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
JR No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
W No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
aNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
NNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Q 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
RNo
❑ 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
JRNo
❑ 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
14No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
;5rNo
❑ NA
❑ NE
Additional Comments andfor Drawings ,��N s k� * 1 {
111P WINE,
;Tu3t add42 �oy I'
0 47a o �'
wetImQiHRUoiek-raiwn q-retmfr.
U"mied- lade. E �45* -(?a I I .
Page 3 of 3 12128104

Facility No. 0 yC(-O IS) Time In Time Out
IC Farm Name Integrator
Owner Site Rep
Operator No.
Back-up No.
COC Circle: General or NPDES
Date
Nmtf ✓
Design
Current
I
Design
Current
Wean -- Feed
Farrow -Feed
Wean - Finish
Farrow - Finish
Feed - Finish
Gilts 1 Boars
Farrow - Wean
Others
FREEBOARD: Design
Sludge Survey Lz- 3155- = 3.44T
Crop Yield
Rain Gauge
Soil TestaTestAlam Wettable Acres ✓
Weekly Freeboard ✓ Daily Rainfall '✓
Spray/Freeboard Drop
Observed
Calibration/GPM 1
Waste Transfers A
Rain Breaker
PLAT
1-in Inspections
Weather Codes ✓ 120 min Inspections ✓ cod wwo-Q�"e, a00C
Waste Analysis:
Date Nitrogen (N)
4111 10t 3-3
a 0. 6
1a101 a• L
Date Nitrogen (N)
PulllField Soil Crop Pan Window
-ql
3
S
Yr I
r

Division of Water Quality 6 -zjtl
Facility Number 2:= O Division of Soil and Water Conservation •/
L
0 Other Agency
Type of Visit &&Ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: f D Departure Time: ; (Q County: �'"—Region:
Farm Name: kErn.a &_&f i ejwt Owner Email:
Owner Name: epi ✓!_ram p 7- Phone:
Mailing Address:
Physical Address:
Facility Contact: �r" Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: bm 1V Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = d = Longitude: 0 ° [� i = "
Design Current Design Current Design Current ;
Swine Capacity Population : Wet Poultry Capacity Population: Cattle Capacity Populat,
❑ Wean to Finish
❑ Wean to Feeder
9 Feeder to Finish
WIVO
LA20 0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Puliets
❑ 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?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
E]Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: ELI
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes R] No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
JR No
❑ NA
❑ NE
❑ Yes
JZNo
❑ 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?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): ! grr
Observed Freeboard (in): �P
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑Yes [9No El NA El NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes �3 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? 0 Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes tRNo ❑ 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 [allo ❑ NA ❑ NE
maintenance/improvement'?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) rdZ6C c N—o
13. Soil type(s)
v -
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
9jNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ffYes
106
❑ NA
❑ NE
l6. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
(4 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
ElNA
❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
e9
Jul No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any otber comments.
Use drawings of facility to better explain situations. (use additional pages as necessary): u
As-
rd
Reviewer/Inspector Name G Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: — Date of Inspection %
+ Reg fired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes RNo ❑ 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 ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
EA Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
0 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Ed No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
59 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
IRNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[KNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
13 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
,9No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
&No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
0 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
O No
❑ NA
❑ NE
Additional Comments and/or
12128104

1
1
Type of Visit
Compliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
outine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: �f Departure Time: 3; Ofl County: Region: Y�
Farm Name: le►R I�a'— Owner Email:
Owner Name: K-r-W7 ►9 rT "� v[ J Phone:
Mailing Address:
Physical Address:
Facility Contact•� `9 Title: /J Phone No: �136
Onsite Representative: fIntegrator:
Certified Operator: _. �� ` u �"`" ' Operator Certification Number: /& ,:;7- 70
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 e = = " Longitude: = ° = ' [--] "
Design Current Design Curren# Design Current
Swine Capacity Population Wet Poultty Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer I
❑ Dairy Calf
19 Feeder to Finish
/
Dty Poultry .'=. ;s:
"
❑ Layers
❑ Dairy Heifer
El Farrow to Wean
El Farrow to Feeder
El D Cow
❑ Non -Dairy
El Farrow to Finish
❑ Beef Stocker
Gilts
Discharges &Stream Impacts
1.
Is any discharge observed from any part of the operation?
❑Yes
&No
❑ NA
❑ NE
Discharge originated at: El Structure ❑Application Field ❑Other
a. Was the conveyance man-made?
El Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[I Yes
❑ Na
❑ NA
❑ NE
c. What is the estimated volume that reached waters ofthe State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
El Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
El Yes
allo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
RNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

1
Facility Number: - Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure i Structure 2 Structure 3 Structure 4
❑ Yes R�No ❑ NA ❑ NE
❑ Yes [SNo ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 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 [N 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 [3No ❑ 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 ® No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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) t—z�-
174
�^1 /SrndfJ�(a/ar%•L�u[�"Sr�c%/ �Y�ixlcd�•rr /GD/Yt �LIU
13. Soil type(s) -�'41
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
QkNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
CZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
R No
❑ NA
❑ NE
Comments (refer to question #): Explain any YE&answers and/or any recomrnendatEons or_any other commeentsrtr;�r,
Use drawings of facility to better explain situations!t(nse additional pages as necessary);
Reviewer/Inspector Name (T 1!7� �: (�- -iT Phone: �1/,9 ` /33 _33 cc7
Reviewer/Inspector Signature: Date: �'2—OG
Page 2 of 3 12128104 Continued

Facility Number: 1571 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZNo ❑ 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
E.No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
C3,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
E.No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
O 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
jK No
❑ NA
❑ NE
29.
Did the facility fail to property 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
W No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[g No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[R No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
14 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

u
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit i Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival 'Time: Departure Time: County: �6) a dgJ� Region:
Farm Name: es gy-A't �- t.��PGf F, I n• Owner Email:
Owner Name: Xe__NeaA ij„�u fry - Phone:
Mailing Address: _ L-Iff I MCILr- -, /-eu.v _ /VC � ��37
Physical Address O o W _ L V-G _.
Facility Contact:
Title:
Onsite Representative: K C rt n
Certified Operator: C. r►, [�_ rn t,-t' 4
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o ❑ , 0 Longitude: ❑ a = ❑ u
Design Current ' Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
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?
Cattle
Design Current
Capacity Population
❑ Dairy Cow
❑ Dai Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
l
❑ Beef Feeder
❑ Beef Brood Co
I
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
Dyes
❑No
El NA
ONE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[&No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
❑ No
O NA
❑ NE
12128104 Continued

Facility Number: 9 — /,�'% Date of Inspection ?7
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA 10 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
❑ No ❑ NA {] NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
❑ No ❑ NA NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
[I No ❑ NA V] 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 [K NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
❑ No ❑ NA [Z NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. [ 'Yes
❑ No ❑ NA ❑ NE
Excessive Ponding [+Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Driii ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
O� NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
[0 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[] Yes
❑ No
❑ NA
© NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
Q NE
18. is there a lack of properly operating waste application equipment'?
❑ Yes
❑ No
❑ NA
NE
4N � �- 2 7^ S' S -�' a '�' -�},}a ,.-�. �' �+ rc. F 12 v p 6 �f C r�
� Q n i r Y i 7 a.t}•'��nn
r4
/
I
( {
r G�(La �
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S�4 Kthq W a TC C_ Vrbl.�r�C� �'�� b4G
�:Cr� w+�T=� ei�Ck 1 y1
A s G 1 {{- , 1A C t C <_ 1
9 to Au a p p �a ✓ c
6� t" o v 1 h q + 6
I
rapCi�C6A.,I
YcSc.v f -L+ �'�{
! 1
TIh,- 0- Q j+e-aT1dw.
Reviewer/Inspector Name fit` G ,� �, �� Phone: Ito y,F.f ' - 15W
Reviewer/Inspector Signature: Date: 7/0S
12129104 Continued

l ,
Facility Number: Date of Inspection / 17 e
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 91 NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA (4 NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA y NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA [0 NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
91 NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
W 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
❑ No
❑ NA
NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
KI NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern'?
❑ Yes
❑ No
❑ NA
V1 NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
[I NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
21 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency'?
Yes
❑ No
❑ NA
❑ NE
Additional .Coinments and/or Drawings:
^h ,
hC waiec- tua> Ca,c.4ainc a :r• -t-kc 5pr5u r1-_cam cr.-9 r-vb rut, O'�'
t'•% d O� Sr C V teQ . �a< r r+� O �+ + rz e✓ 1 Yi r. We-n -I c-+4, I lq e.. r y y ry a: p r e s c r%k e, rte�
b�a�u 4-a d-akc ac�i�"o s+4P fi'�� w��-#z {apP�;cQ�toni. t'rlr.
w a-nr o-aQ v i s /tog { -! a v » . '4 �. z w �.l+ t o r,.Ir C. .k- g �; � k �a r
�or^�toh 0-4� 'F-�.c i-"G1dL dr rG (�y.c.t t� ba1� c-ik L Wa�Tc
s4 c-f-c_wt. w45 4a(et he_ waKloi �ecee_ CA
tVDV Cam+e0nc.Q -Fo w�Ghi�or r-inrt G.(asc (� i� 4'kc ��. ><r�✓tr
1i-'_0IIlaLi-µa w0.J
Gar�diuctc�
aN !-- it-oS c+��Z fi�
wca s-Fc wq�
ems. - qQ
+-t u 1 0 v% g e- r
V r+a h Cali -11 +" C, Sp r a 1
4. Y C_.a ,
12128104

Type of Visit 6'G56pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I e Arrival Time: a`J Departure Time: : 3 D County: Region: �Q
Farm Name: jk� eri n YT�'�„ ,�-u Y _✓Yl-L Owner Email:
Owner Name: r\ e i!1 n ,_-4- Phone:
Mailing Address: � CL r.�.� !1/Jl , �: b Y ty vim_ Ale— _ 3 3 Z
Physical Address: ,:FAj— ``J
Facility Contact: T—�r1 r r `�u-i `/ Title:
Onsite Representative:
Certified Operator: ,-_ l Je,_
Back-up Operator:
Phone No:
Integrator: �st✓la,. Tom/ iy.l^
a
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 e ❑ ` ❑ " Longitude: ❑ ° 1 ❑
Design Current
�3 Design Cnrrent Design Current
Swine C•apaciq Population
`i'et Po^utry' .Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -La er
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean'
Dry Poultry T
^ "' ` D Cow
r ❑
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
rs
❑ Beef Stocker
❑ Gilts;
ElBeef Feeder
❑ Boars:
❑ Beef Brood Co
Other
wE; s
❑ Other
r r
A�Number ofStruetures:
❑ La He
❑ Non -La ers
El Pullets
Li Turke s
❑ Turke Pouets
❑ Other
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
El Yes
4No
❑ NA
El NE
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
El Yes
4 No
El NA
El NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
El Yes
ER No
El NA
El NE
c. What is the estimated volume that reached waters of the State (gallons)?
d- Does discharge bypass the waste management system'? (If yes, notify DWQ)
❑ Yes
[0 No
El NA
El NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[9No
❑ NA
El NE
3- Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
KNo
El NA
El NE
other than from a discharge?
12128104
Continued

'
Facility Number: —
Date of Inspection �s
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�gNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
VfNo
❑ NA ❑ NE
Structure I 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
Uq 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
[R 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
FPl 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
RNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
M,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 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
V[No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
0-Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
El Yes
JEJ 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
JRNo
❑ NA
❑ NE
tO:QU
/s L% �- � Qs 41al/117� ✓
Reviewer/Inspector Name �. f �d D`ti1 . k; `; ': '� Phone: 4�G lS�%
Reviewer/Inspector Signature: Date: /�
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ONo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes IM No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 53 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
f KNo
❑ NA
❑ NE
23.
If selected, did the facility fait to install and maintain rainbreakers on irrigation equipment?
❑ Yes
21 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
ANo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
kNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment {PLAT} certification?
❑ Yes
RNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
gNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
WNo
❑ 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
4No
❑ 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
allo
❑ 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
Q No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
MNo
❑ NA
❑ NE
Addtt�onal Comments�and/or�•Di-awin s• � ��`
12128104
12128104

a
Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit • Routine O Complaint O Follow up O Emergency Notification Q Other
© Denied Access
Facility Number if i I? /S Date of Visit: N- ?y-ay Time:
Aag"O Not 37ratiajW Q Below Threshold
01;.-tnitted at;rtilied [3 Conditiomily Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: Crrz Far Ln County: -�-ho --- _ Ea
Owner Name: Dr. I. /yid..lfcre-- ..__ _. Phone No: 510 gs6
wiling Address:.. P D. 'got I I? Df 6/ n N G ?
Facility Contact: __ .._��/'^s -.. (_ , _ _ Title:.. Phone No:
Onsite Representative: _-_ o�l�� . .4✓�.y. IMP- Avfry -- . Integrator: G&.Lo e
Certified Operator: Operator Certification Number- / G a? o
Location of Farm:
.,
8tv'rine ❑ Poultry ❑ Cattle ❑ Horse Latitude • �� �46 Longitude • Du
Discharges & Stream hupacts
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) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in ga lmin?
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: ! _ . _ _ . _ _ _ --
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure b
Freeboard (inches):
12112103 Continued

Facility Number: 9 — Date of Inspection
Repaired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
Q.Me
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(fel ts, de,,4<m
❑Yes
QNd—
23. Does recordkeepingneed improvement? if yes, check the appropriate box below.
❑ Yes
Q-Ko
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Q No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
Eg-No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
B-No
27. Did Reviewer/Inspector fail to discuss review/rnspection with on -site representative?
❑ Yes
&M
28. Does facility require a follow-up visit by same agency?
❑ Yes
S-No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
GNP
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
des
❑ No
31 _ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Epk
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
E1.W
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
&W
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
gwe_
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
EWo
❑mom ❑'er��, Oagafall ❑
12112103

Fac city Number: q — /S7 1 Date of inspection - o
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ❑ No
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancetimprovement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenancetimprovement? ❑ Yes ❑ No
9. Do any strictures tack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ❑ No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes ❑ No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. ___r Jim I «/ • J�6// 4/1I �lirlf/V� ���/rIL✓b ��4�_ i O1/Tf/er ! ��IN
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan,(CAWN P)? ❑ Yes 61-M
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes 9Wo
Odor Issues
IT Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attar below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 04RFI,^
roads, building stt=turt, 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 C#b -
Air Quality representative immediately.
fw��4iAnA97�y,BsyDvo
,
Ilse draw gs:p£frt rlp�a (as adi3rt< psi ?-M eId Copy ❑ Final Notes
�Ec-_2�.....G=�-.��r-k�+�--s'c'.-,.- + �.7�:;5•_:_: `.»..re-w�i�,..._.��=-aa '_`�,..,'�"�..�- •"�.� �'-"°='`,�_ �sx=
L
Ale.,, a✓r�rrsr
Li gel M c le,
Me., Ate{„
a
ReviewerAWspector Name r ur�t " a„ ' e: � ..- � �r gas • z� a Am
=
Reviewer/Insp wtor Signature: Date:
12112103 Confinued

13 Division of Soil and Water Conservation Operation Review '•
Division of Soil and Water Conservation Compliance Inspections q
4 3 Division of Water QualityComplrance Inspection - ' q r
OtherA ene ; [) eratzon?Revievv "- //l'
g _ Y p _..-
JQ Routine 0 Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number Date of Inspection of
Time of Inspection .3 : a 24 hr. (hh:mm)
❑ Permitted Certified 13 Conditionally Certified 0 Registered B Not O crational Date Last Operated:
Farm Name: ..............3r.. !.. L' l.rt ..... I `c f w .....-•-.---•-.._ ..... County' .. +�.[............... . ........... ................ . ....
���}} _
Owner Name: ....................�. :../`'•IC Cf�_ Phone No:....................��...r_�'�O1g...-...$....G........
yy��//jj�� f.........................................................
Facility Contact: .................. .... ...........K .4.Y 1M........ Title: .................. .......
Mailing Address: RP -
Onsite Representative: •,.,,.,,►„1,r. ' d..,5 /n.A .......................................
Certified Operator: t /' [C' �✓�_
......... ...J...........:.............._
Location of Farm:
................................... Phone No: ...................................
...1. ,........ ✓c.................... 3
Integrator: ......... (Q�',kj it ...
Operator Certification Number: ......................................
.................................................................•---.----•.------......................................................_._.._.._................................--.----............................._._................-•--------..._.....----...........
Latitude 0 ° •4 Longitude • i «
w_ --Design Current _' Design _Current 1 Design Current
Swine _ :Ca acity Po ulatioii`- :.'Poidtry ••Ca -acity::.Population _. Cattle ` p..
,Ca aci ' Po dilation'
Wean to Feeder ❑Layer ❑ Dairy Fderlo Finish a� 8' L) ; ` ❑Non -Layer ❑Non-Dairyrow to Wean _..
❑ Farrow to Feeder ❑Other :
❑ Farrow to Finish Total Desi n Ca acit O
• P Y
❑ Gilts - -
❑ Boars -Total SSLW
- _ Subsurface Drains Present ❑ La oon Area S ra Field Area
Number of Lagoons �' - g - ❑ F Y
Holding Ponds / Solid�Traps _ ❑ No Liquid Waste Management System _
w
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other t
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
h. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes No
2. Is there evidence of past discharge from any part of the operation`? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 11
Freeboard(inches):........................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
3/23/99 Continued on back

M
Facility Number: O9— �j� Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
[� No
R
(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
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
[1pNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level '
elevation markings?
❑ Yes
[XNo
%-'aste application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
11. Is there evidence of over applica ion? ❑Excessive Ponding PAN
Yes
d❑ o
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Pla (CAWMP)?
❑ Yes
XNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
0 No
b) Does the facility need a wettable acre determination?
❑ Yes
[9No
c) This facility is pended for a wettable acre determination?
❑ Yes
[ANo
15. Does the receiving crop need improvement?
[eves
'
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
[A No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
[9 No
I&
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
VNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
[XNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes.
XNo
23.
Did ReviewerAnspector fail to discuss review/inspection with on -site representative?
❑ Yes
9No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
19 No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
P(No
NO—*iolhtigris;ot-deeciencies W4s re :h ed-during this:visit: • You will -receive Rio #'ui•th
correspondence: about this visit::::::::::::::::: :..::::::::::::
Comments -(refer to;question #) $Expiatn-}any YES answers pi4idlorrany reconiiniendat�ons or -any other comments-' "`"� .� 3-
Ose drawings of facii�ty to better explain s�tuatrons {use ad�t�onal.pages.as necessary)
i• ar>1 a Co•>CZ4 cwt k5oc,,7 ob ke5
5.
Ll
U �o Tr".-T_ C62S c"...t gf U'fte (44-J -P Calck >• PnJ 6a �a rcc i�IS4,m� -ffc,
Reviewer/Inspector Name [ s ,'��lji/ fy� /
CO �V_
Reviewer/Inspector Signature: �,��., Date: �Q --zr— fl
3/23199

Facility Number: Date of Inspection �
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. 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)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes �'No
30_ Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 'No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes �' o
Addition omments an or_ rawmgs : z :,.•..' _ _ . _ -
An 1 1!r7,01Irts
L�n�
- A0
!� f`
14 -- Fe-,-v� U (a,�
3/23199

r
'
'�+' Nit• k'^• M' <a-
} .
❑DSWC Animal Feedlot O4peratl evlew� R
on R
� ...:
aYS�?'
a
°Anllmal Feedlot 0 er ton SI#e Ins ectitia
Px p.0
y�
p 4.w1
>•f( �, L`'\ �- .s.�
g
�: i�'. ,.._l'E' �f..,... 5y , 'RRTK�?".�� 'u.Sx4 k
;
.
d Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number
Date of Inspection
7
Time of Inspection U.'OU 24 hr. (hh:mm)
Total Time (in fraction of hours �--�
Farm Status: El Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
❑ Certified ❑ Permitted for Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated* .. __..... ......... .. _ .... _ .
Farm Name: County:
Land Owner Names ... . ` ..`.. ......l!!!. C�t'C .... .... Phone No:
Facility Conctact:...__ .. .� �l C Lam,...._.. Title: Phone No:
Mailin4Address:
Onsite Representative: ......
t-r Integrator:
Certified Operator: J • Operator Certification Number:
Location of Farm: 70
Latitude �•�4 " Longitude • 6
Type of Operation and Design Capacity
�¢' 4'" ` .,,� 7 �vswr?r(a € �s�,.. Z, av: .,, :,.
Design Current Design Cnrrent �. ,Designs Current-
.SWlile x a a A a . <, 4ce�" ,;'5 a . • a M. r. V.
`aa:rr. >ra 'a aCi r,..Po niation r?^ n¢°POliltryr.-�..t4- :3 :. 'P--, CAttle te,.
_ C _ Ca ai i _Po"iilahan '.: �� ,. ,,_��Ca aci Po' nlation
❑ Wean to Feeder La LNoanir-yD
D
i ¢#r<
f Feeder to Finish [� ❑ Non -Laver , a
�•,
Farrow to Wean �� k�
�- uu�aF9,+¢�s5 r`imknm _rr«zm�z
Farrow to Feeder Tat Destgn Capaciiy-
s Farrow t0 Finish GTfEIt SSLW € ' uxv
�r Number of Lagoansfl Hpldmg�Poads / N ` ❑Subsurface Drains Present
10Lagoon Area F.- ❑ Spray Field Area ,
„_,b, u.o-ra�..�w �ay.ra�,sx� �, , .. �;€ „'3+x:P?- � flx:`. � was.•" ............
General
I. Are there any buffers that need maintenance/improvement? ❑ Yes U[No
2. Is any discharge observed from any part of the operation? ❑ Yes ;iCNo
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes X No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes 1KNo
c. If discharge is observed, what is the estimated flow in gal/inin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) [] Yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes lKNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes No
4/30/97 maintenancelimprovement? Continued on back

Facility Number:.- Qg.. Z7 _
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
KNo
Structures (Lagoons and/or Holding ftnds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
O(No
Freeboard (ft): Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
14. Is seepage observed from any of the structures?
❑ Yes
Kilo
H. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
)KNo
12. Do any of the structures need maintenance/improvement?
1WYes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
Xo
Waste Application
14. Is there physical evidence of over application?
❑ Yes
Wo
Of in excess of WMP, or runoff waters of
of the State, notify DWQ)
entering
15. Crop type 4�f`. Ct�6R�. .. ............. ..... _..... �.....-- — ...
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
kNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
N No
18.
Does the receiving crop need improvement?
M Yes
❑ No
19.
Is there a lack of available waste application equipment?
Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
Yes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
For
22.
Qertified Facilities Only
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
J[No
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
24.
Does record keeping need improvement?
❑ Yes
❑ No
Cominents'(refer to°queshoi #ft Expla any YES'answers'and/or`any recommendations or:any other comments':" ,
LJse draW1 s of facili to better ex lain situations use additional a es'as necess
- ,
iz . 72& 1.►9aowQG:br`r ,,, ...i9prry �to�7�.a e..i ire al.s Q
i 8'. T,c X&xA.� pA,4_1r 4e� c�-.�p.�,�il�.� �•-, C is 7A4S3-�.r K&4C�r. Aim -A/
Reviewer/Inspector Name
Reviewer/Inspector Signature: eZ. zo, Date: ?-21 ! 7
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97