090165_INSPECTIONS_20171231

Facflity Nu,aber. 0 9. 1(a 5
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Date:�----
Sgnernl Infuadom
Farm Name:_ -f%,`C. ko v z, Fl,' I _ COySty; A d eW
OwnerName- phone No G 5-S-- 9!'7_3 z
On Site Representative: S P . ,•. I. _ _W_-.y,r,�_,i_Sntegtataor.?r._
Mailing Address: o G r IV'_//
,Gila 6ca 7�vw,J _ AI Cr zg 33 -7
Physical Address&ocatian:
Latitude: !__I_ Longitude: j
Qneration )esed tp ioe� (based on design cbamctetstiv)
Type ofSwbie No. of Animals, Type ofPoulny No.ofAnimals type of Casale No. of Animals
O Sow O Layer O Daisy
O Nursery O No* -Layer O Beef
O Feed's - f ; N ^ 5A S 8O .�.
OtheL7 pe of Uves ock Number of Animals:
Number of Lagoons' r (include in the Drawings and Observations the freeboard of each lagoon)
Fadf ix InsRecdow
Lagoon
Is lagoon(s) freeboard less than 1 foot + 25 year 24 hour storm storage?:
Is seepage observed from the Iagoon?:
Is erosion observed?:
Is any discharge observed?
O Man -malt C Not Man node
Cover Crap
Does the facility need more acreage for spraying?. -
Does the cover drop need improvement?:
(list the crops which need bnprownm)
- -r4 Yes O
No i'
Yes O
No Cr
Yes O
-No t'
Yes D
No 0"'
Setback Cruerfa
Is a dwelling Iocated within 200 feet of waste application?
Is a well Iocated within 160 feet of waste application?
Is animal waste stockpiled within 100 feet of USGS Blue Line Sawn?
Is animal waste land applied or spray irrigated within 25 feet of Blue Line Stream?
AOI — January 17JM
Yes O
Yes 0
No
Now
Yes O
No C ,
Yes ©
Yes L7
No a
Yes O
No 0--'.

Facility Number O GS— Date of Inspection
Time of Inspection �5 c 24 hr. (hh:mm)
Farm Status; ❑Registered ❑Applied for Permit Total Time (in fraction of hours
(ex:L25 for 1 hr 15 min)) Spent on Review
®Certified ❑ Permitted or Inspection (includes travel and processing)
❑ Not Operational Date Last
Operated:........./........................._.................................................................................................................
Farm Name:........,14/14.F welen.S/..f_ Lt4R�"�+ G�PfS !✓! � County:... B/rd,�.✓
/./ S.Z _ ../.........................................__.............................................
Land Owner Name: ... z{(��.._4A.44/1......._........._......_...._._....._........ Phone No:(F
Facility Conctact:... .... if.✓ �?,GC/S ................ Phone No:...............................-------- - -
_............................................ Title:,._.............................
Mailing Address:
W
....................................
Onslte Representative:...... lT��i�"� ................?........................................... Integrator:../,7
Certified Operator: ...._.!%./l f /oQ/el ...... Operator Certification Number:...... qe.Z3_-
Location of Farm:
.................................................................._................................_.................................................................................................................................................................... 4
................... _............................................................................................................................................................................
Latitude =*='=" Longitude =0='� lu
%zeneral
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes kNo
❑ Yes XNo
❑ Yes )KNo
❑ Yes No
❑ Yes
P(No
❑ Yes
No
❑ Yes
No
❑ Yes
I
Continued on back

*Facility Number: Cj — &0 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure -plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuclures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over applicat)on? , ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ with those designateYn the Certified Animal Was(c Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage& General Permit readily available?
18. Does -the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
�'Vo violat�iQtjs'oi- dgficienctes •Wgre poled- O(W.irig •this'vasat; • Y'o(1'*iti•xeegiye lid fuilhof
corres66ndence. a 6'f this visit.
❑ Yes XNo
❑ Yes (YNo
❑ Yes ❑ No
❑ Yes 9( No
❑ Yes [9No
❑ Yes [RINo
❑ Yes [XNo
❑ Yes *0
❑ Yes [(No
❑ Yes [)(No
❑ Yes �No
❑ Yes Q('No
XYes ❑ No
❑ Yes KNo
Oyes ❑ No
❑ Yes j No
❑ Yes No
❑ Yes XNo
El Yes q No
❑ Yes 9No
❑ Yes A No
Comments (refer'to,qu"o'n! #): Explatn,,atny'YE5`answers aadloriAny`'recommendations or'any oilier co' tnents r' €' ( °i'�' r 3
,Use drawings of facility to better eaiplain situatio'nsi {use additional pages as necessary} t ` "eat' u'� ; "' 4 ; ", n
I
?. IQ ��.-7� �`'{-�tr �s,e a►, ewe Ae�vIIV4
�pp ,
►9- ST (, .�.� ina l errs Caro,,,C
Q.ruvmt �? its f eC�--ti 6D O Sri o� �yL
G P
rec I
�� ,1�.e re �n•�t,�,�dt
..r��� 1-�}s d dd
Reviewer/Inspector Name %?. wi► `[ !',A ��@ , ''io i;' I E€
®� i f
Reviewer/Inspector Signature: - �1�.--, Date: - -
3/23/99

Facility Number: ... 9.9... l�s
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes lizNo
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes kNo
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes *No
Structures (UgQons and/Qr_1{olding ondsl
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes )KNO
Freeboard (ft): Structu;e I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
.. .......»».. ........................... ............................ ............................ ............................
10. Is seepage observed from any of the structures?
............................
❑ Yes No
,X\
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes No
I2. Do any of the structures need maintenance/improvement?
Xyes [INo
(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 No
Waste A volication
14. Is there physical evidence of over application?
❑ Yes *No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type,.�Q�rff........................... »....................................... ............. .................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes XNo
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes kNo
18. Does the receiving crop need improvement?
❑ Yes No
19. Is there a lack of available waste application equipment?
❑ Yes [ No
20. Does facility require a follow-up visit by same agency?
❑ Yes KNo
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
Apr Certified Facilities Only
❑ Yes A�`No
'23 Zk'001�w
®w,✓ e ,�� �d ' % ,%/�.s< - ®ci s
Reviewer/Inspector Name r? f»M ,mom
ma's
Reviewer/Inspector Signature: i� Date:
cc. Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

10, �k
Q Division of Soil and Water Conservation Q Other Agency
+Jig Division of Water Quality ' ,A
Routine O Com laint O Follow-u of DW ins cation O Follow-u ofDSWC review O Other
Date of Inspection
Facility Number
Time of Inspection 24 hr. (hh:mm)
Registered 14 Certified g Applied for Permit 13 Permitted 10 Not Operational I Date Last Operated:
ww'' l�.r•�„�..................... Farm Name:.....Ko.r.6.5.......Fao rA�!�!1............................................................... County. ........................
Owner Name: ,..A..�.�.an!......... .............. ... Mi�cchs......................................... Phone No:. !.d�..�Q Jam'.. 1(,d..........................
Facility Contact:.,..:!...---.4rr!.`�........................ Title: ..a.�1.?.!!'.................................... Phone No:...,.e!f'+! ........................
Mailing Address:. , .... ! 41.r-Sra-VI O:. s.......... . 1 &a,4d ............ ..9.�M.7
Onsite Representative:./41.1�& ', ...x-'TJ.t°# .....f t% � 5 InteKrator•....... ��l'� �`
..........................................................................
Certified Operator er . ............................... Operator Certification Number,...... b3..•.........
Location of Farm:
Latitude 00=` =« Longitude =• =' "
)estgn %"' .Current
Design Current ` `
D sin Cnrr.) nt
Swine
Capacity°Population
Poult y�'`
Capacity Population , e Cattle
Capacity ,Population
❑ Wean to Feeder
❑ Layer
❑ Dairy
Feeder to Finish
❑ Non -Layer I
JEI Non -Dairy
❑ Farrow to Wean
x
❑ Farrow to Feeder
❑ Other
y: t
ElFarrow to Finish
Total De9,gn Capacity
❑ Gilts
1'
❑ Boars
Total SSLW'E a
ber of La owns ./ Holdin Pond 'g g' s
.
ID Subsurface Drains Present
❑Lagoon Area
❑Spray Field Area
Et'v
�,.
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes
2. Is any discharge observed from any part of the operation? ElYesINo
No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes Wo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes KNO
5. Does any part of the waste management system (other Than lagoons/holding ponds) require ❑ Yes �No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ONo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ONo
7/25/97

� f•
Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
�tr etureslLa�oons.HoldingPonds,Fluush Pits. etc)lLa�oons.HoldingPonds,Flush fits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes No
❑ Yes Kj No
Structure 5 Structure 6
Identifier:
Freeboard(tt): ............ f.�....... .................................... ................................... ............ ........................ ....................... ............. .................... ................
10. Is seepage observed from any of the structures? ❑ Yes A No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes No
12. Do any of the structures need maintenance/improvement? [] Yes K
o
(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
KNa
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
ANo
(If, in excess of WMP, or runoff entering aters of the S;e, notify DWQ)
15.
Crop type ..... ..+ ?. � a v-S.... ........ �'lll.fL..a............................................................
16.
Do the receiving crops differ with tho a designated in the Animal Waste Management flan (AWMP)?
❑ Yes
PNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
Klo
18.
Does the receiving crop need improvement?
❑ Yes
UNo
19.
Is there a lack of available waste application equipment?
❑ Yes
20.
Does facility require a follow-up visit by same agency?
❑ Yes:No
No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
9No
22.
Does record keeping need improvement?
❑ Yes
kNo
For
Certified or Permitted Facilities Onl l
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
g'No
25.
Were any additional problems noted which cause noncompliance of the Permit?
Cl Yes
❑ No
No.vidlationsor. deficiencies:wereh6ted-daring this:visit:•:You.will •reeei' no further
coerespo»deke dlioW this: visit'.
Mr, IUD; s Is LA3&rkjj seeg; ,,
_57,(b ea.,.,.s ire cL-J
w epd e&,,L+ry [.
e."A ('e")S 4"
lOgr-c �S PBS � �w
beS� w64j
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: ,(fjjCr.., ( / , $L Date: ��

Structurc I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: [zla
Freeboard (inches): L' ...... .............................
.......................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes [ No
❑ Yes �No
❑ Yes ZNo
N/
❑ Yes No
❑ Yes No
El Yes No
0 Division of Soil and WaEer'Conservatton O} eratio' n Review 3` ' �'
a 3 [.Division of S©iI and WaterECon�servahoni Compbance Inspection :,�
i §
Division of Water Qiiwity Con► Hance -Ins ectton , IL i f.. iti r i'I.'� �i( d!EYk -'ii f3i>3v i.t? 7's`I� I;.kt.a€{§, ¢E : :yil
� � �� i
.'i i y�.i I _ sr,� i i �rJ '.t t �€ k�i! i.�, 9 B{ir } tl ai i i a•I 1 i- S?4 t�
I. l
.Other Agency "'O eratiQ+n $evtew ;rs,
149 Routine O Complaint O Follow-up of DW ins ection Q Follow-up of DSWC review 0 Other
Facility Number Date of Inspection $
�...,.., Time of Inspection �5 24 hr. (hh:mm)
Permitted 0 Certified © Conditionally Certified ❑ Registered JE3 Not Operational Date Last Operated:
rf�la..., ...... .1...... Farm Nstme: ...............5.........,.......'rl........................................................... County:.............d.11.. i'
Owner Name: Al.l, 0
'f-�1�1..........................ik1Y�.......................................... Phone No:................. ...................,.......,.....~................ .............
FacilityContact: ................... A 11.54 1..........1."S Yrf.... ... Title:................................................................ Phone No: ...................................................
,,1
Mailing Address: ...... ..................
!,`.d .. .................. /! s1 .�/.../.�!.0 ........Z3.39 .
Onsite Representative: ......................... r';i1.1...........�r..'.. 1r�...... ..................... Integrator:........ .� ..
Certified Operator; ..................., L...... ,....!..... .............. ['!`?✓ ..S........................ Operator Certification Number:....,.,...................................
Location of Farm:
a
................................ .........................
Latitude Longitude �• �` �«
{, Design Current =" ` Design.,2 Current Design
Swine FoultIrTpCaftleCaacit Poulation Y. . Ca acit
❑ Wean to Feeder
Feeder to Finish-
0-Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts i
❑ Boars
❑ Layer ❑Dairy
❑ Non -Layer ❑Non -Dairy
❑ Other
Total Design Capacity
i� i �';'�� h a Tote SSLW
rent„
atiom
7
�Mimber of Lagoons ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream fmpac_ts
1. is any discharge observed from any part of the operation?
Discharge originated at: []Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made!
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ)
c. ]f discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If ycs, 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 ❑ Yes 0No
Structure 6
...............................
❑ Yes �o
Continued on back

Facility Number: Q - 6 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
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon?
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.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanenUtemporary cover?
❑ Yes [ No
❑ Yes [KNo
❑ Yes (KNo
❑ Yes WNo
❑ Yes �10
❑ Yes Eygo
P1k ❑ Yes KNO
Additional ommen an or ruvvings ' i i;
n� ��, ! � i Fe 1
. •. .-. ,. -, �� �. t ' .3 � .I^ � . � .ail1 i�.,le`t? �.�..E ....�.,. i.
I
i.l
3/23/99

r I L Divlstori of Watei
Q Division of Soil ai
'Q'Qtheir Agency
iter"Conservatt
3
1 �
(Type of Visit ® Compliance Inspection O Operation Review Q Lagoon Evaluation I
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Datete of Visit: �2� Ol Time: � Printed on: 10/26/2000
� 9 �
Q Not O erational 0 Below Threshold
Permitted -a Certified 13 Conditionally Certified ©Registered Date Last OperatedorAbove Threshold:
Farm Name: ........ .................................................. County: .......
,/4...... ........... ............................... .......................
� c
Owner Name:. ..��/� .....IYr!! /-................................................................ Phone No: .....Ot7�� ....� :.....TIFlF ................
Facility Contact: yfX .........� ew".1......... .ritle:.........................................y.................... Phone No:...................................................
Mailing Address:........./..L....4�'.!i�✓/.r�,Fr�^/CG-s�ir}....� .... �.,1 C •zs%
Onsite Representative: .. 1t.10 ,d/......................................... Integrator* ........ ���� � � ,��r.!s•�..
Certified Operator: ...............1��1!C...,1' Q'!„........................................... Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • + 4. Longitude �• �4 44
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish JE1 Non -Layer I I❑ Nun -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons I0 Subsurface Drains Present I ❑ t,agoon Areu 10 Spray Field Area
Holding Ponds I Solid Traps JE1 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
allo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. II' discharge is observed, was the conveyance man-made`?
❑ Yes
)z No
b. Vdischarge is observed, did it reach Water of the State`? (II'yes, notify DWQ)
❑ Yes
tR No
c. II'discharge is observed. what is the estimated flow in galhnin?
d. Does discharge bypass a lagoon system? (II'yes, notify DWQ)
❑ Yes
XNo
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
ONo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
FtNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
RNo
Structure; I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: ................................................................................ ...........
Freeboard (inches):
5100
Continued
on back

ti
r Facility Number: p — G Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes A No,
seepage, etc.)
6. Are there structures on -site which are. not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ANo
(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 I'No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes $9 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ANa
Waste_AAplication
10. Are there any buffers that need maintenance/improvement? ❑ Yes 9No
IL Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes RNo
12. Crop type se aAiy�/ W
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes'XNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes XNo
b) Does the facility need a wettable acre determination? ❑ Yes F't No
c) This facility is pended for a wettable acre determination? ❑ Yes Wo
15. Does the receiving crop need improvement? ❑ Yes b•No
16. Is there a lack of adequate waste application equipment? ❑ Yes I)s No
Reuuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes[ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? /
(ie/ WU check , design, mapetc.) ✓ ❑ Yes ,RNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes 4NNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes jiNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes �To
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes bkNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes JjNo
24. Does facility require a follow-up visit by same agency? ❑ Yes NNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes RNo
P. �Q.0014 04s.o ftf elejmOM fro WOO, OW169 this'vjsjt; • X00 wlii.lreetriye #o 04*
cori espo deiici about. this visit~
Use:drawlnr~s of faciUty to
Reviewer/Inspector Name u n
Reviewer/Inspector Signature: Date:
5100

Datc of luspection Printed on: 7/21/2000
Facility Number:
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
CwYes
❑ 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
0No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
IV 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
INNo
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
CZNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
RNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
,® No
Additional omments an or rawings:
i
7
5100

Division of Water Quality
O Division of Soil and Water Conservation
O Other Agency
Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit OLRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: T /z - 'I lne: ,� Printed on: 7/2i12000
O Not Operational O Below Threshold
Ape
0 Certified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold:
ti r r'WL -*Z County: .&J641
Farm Name: .... Q.0 f 5................................................................................................... ... ...... ............ I .........
.
�I
Owner Name:..... / .� Pti....................... . (. .C' `.1........................................... Phone No:.......1!p.................... I .......
................
Facility Contact: t° tr" ....'Title: Phone Now- ...........................
................................................................
n� j,� J r J n 1
Mailing Address:.......1... ....... (/9!...1..%1....1�1"GUkI.�N- l.:.li:...:..... ... .li.�Q ....7..n C......... ��` ...3.. �/.
Onsite Representative: , . . . . ,,,, Integrator:.....,;,,,,.0 ,,,, ..,
.........................................
Certified Operator: ,! G 4 . s Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ° .4 Longitude • 6 44
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish ❑Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lagoon Area 10 Spray Field Area
Holding Ponds / Solid Traps 10 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'? ❑ Yes AfNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a, If discharge is observed, was the conveyance man-made? ❑ Yes JINO
b. If discharge is observed, did it reach Water of the -State? (If yeti, notify DWQ) ❑ Yes 0No
c, lf' discharge is observed. what is the estimated flow in gal/tnin''
d. Does discharge bypass a lagoon system? (If ycs, notify DWQ) ❑ Yes R 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
StrUCtUrc; 1 S[ruLtUre 2 Structure 3 Structurc 4 Structure 5 Structure 6
Identifier:.......................................................................................................................................................................................................................
Freeboard (inches):
5100 Continued on back

I Facility Number:Q — Datc of Inspection 19 —/Z=d_D_j Printed on: 7/21/2000
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
closure plan? ❑ Yes [10No
(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? FfYes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 071 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes PNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 0 ] No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes 0 No
12. Crop type 1. A eaT / 5a(i Pe0- tJ-
13. Do the receiving crops differ w/h those designated in the Certified Animal Waste Management Plan (CAWMP)'? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application`? ❑ Yes V0 No
b) Does the facility need a wettable acre determination? ❑ Yes qNo
c) This facility is pcnded for a wettable acre determination? ❑ Yes 9No
15. Does the receiving crop need improvement'? ❑ Yes PP", No
16. Is there a lack of adequate waste application equipment'? ❑ Yes PNo
Reuuircd Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) j�Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design'? ❑ Yes No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes No
22. Fail to notify regional DWQ of emergency situations as required by General Permit'?
(ie/ discharge, freehoard problems, over applica(ion) ❑ Yes QA No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? ❑ Yes RNo
24. Does facility require a follow-up visit by same agency'? ❑ Yes R(No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 5Z'No
' NO •yiola>4igtis'ot• ftrjciencies •mere noted• doing �his•visit; • Yoj: wiii • eetriye "Q futtitgr -
• Cor'ris' ' ridence' about: this visit.'
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):
7 Nee) k Maw I d, ba.L ks . I
-ji-f, f /Ued /V kee_ ioee� �"P� r lede 5 el- 7i e CJe.c��ci.����'t•,7I
P Je/
N�� l�v fee ,S/� LL�ac Sil Gurl^�v+."�'. �e Gt�er ��t�te�?rtis I' Y � y
Not �* 41160
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 5100

Facility Number: Date of Inspection — Z—DZ Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge At/or hplowj 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 ' 1 No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ER
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 ONo
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 *0
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes Po
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? jvYes ❑ No
J
5/00

Type of Visit 0-Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit a Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �Arrival Time: t) Departure Time: OT I County: L�OP f' Region: �'` 0
Farm Name: lv d rT i J �u''��-' v� Owner Email:
Owner Name: _q �! __ I t!rL U r'i� S Phone:
Mailing Address: / a, .
Physical Address:
Facility Contact: Title:
Onsite Representative: _iq 1 1( zrPA- D r rr S
Certified Operator: Sip_
Back-up Operator:
Phone No:
Integrator: /i'1er 4i4z
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e = 6 = tl Longitude: = ° = 1 = 11
Design Current
Design Current
Design C►urgent
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacfty Population
❑ Wean to Finish
10 Layer
I
I
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer
I
I
❑ Daia Calf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
ElNon-Layers
El Beef Feeder
❑ Boars
[I Pullets
ElBeef Brood Cow
El Turkeys
Other
❑ Other
❑ Turke Pouets
❑ Other
Number of Structures:
111111111
Discharees & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
W No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
® No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
XNo
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
R No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
KNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
CR No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — Date of Inspection
.1
' Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
5a No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
5,No
❑ NA ❑ NE
-Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): ^ j g
Observed Freeboard (in): 3 ]
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
C�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
R[ No
❑ NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
CK 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 LINE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
10-No
[I NA El 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 ElApplication Outside of Area
12. Crop type(s) e'22:, 4 / &!! !a474
--
� ,r
13. Soil type(s) A ,�,!`� D
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes XNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? 0-Yes ❑ No ❑ NA ❑ NE
1
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes EX No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
t ,s o Ld a-m d 9, .S Jex*-, trrv� , � ai a� i3 � `37r�
Apr de � k o6 v
S s l-fav� 7� %5 vo rai G� 1j D
arm �rh�caw� odd a-� p//4
Reviewer/Inspector Name Phone: ��/D _11T -15: T _
Reviewer/Inspector Signature: Date:
Page 2 of 3 .41 12128104 Continued

Facility Number: Ct— Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists El Design El Maps [I Other
❑ Yes R No ❑ NA ❑ NE
❑ Yes [9 No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. [&Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard oWasteAnalysis ❑ Sail 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
❑ Yes
Da No
❑ NA
❑ NE
❑ Yes
QN No
❑ NA
❑ NE
❑ Yes
ENNo
❑ NA
❑ NE
❑ Yes
ER No
❑ NA
❑ NE
❑ Yes
ANo
❑ NA
❑ NE
El Yes
w No
❑ NA
❑ NE
❑ Yes (9 No ❑ NA ❑ NE
❑ Yes Z No ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes J4 No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
, No
❑ NA
❑ NE
0 IZ ee j*44 [NVYL 1J'° uJ W0s7r Ana, ys }_'�
Page 3 of 3
12128104

Type of Visit O'Compliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine 0 Complaint O Follow up 0 Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: 401 Region: lr4e'o
Farm Name: NO►-rix &VeEl 4 z- Owner Email:
Owner Name: Z . A iI c-n4 /" a evl-s Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: j4l&,-j
Back-up Operator:
Location of Farm:
Phone No:
Integrator:. __ 0414 ``.� 8ycrt�In./ - ---
Operator Certification Number: AW — 1630.3_
Back-up Certification Number:
Latitude: = Q 0 6 0 Longitude: =° 0 1=
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish S$$O 13
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other - - — — - -
❑ La er
❑ Non -La et
Dry Poultry
Pullets
Poults
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: Ea
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
,® No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
® No
❑ Yes
JZ No
❑ NA
❑ NE
El Yes
®No
❑NA
❑NE
12128104 Continued

//- of —or
Facility Number: O 9—/(per Date of Inspection /—D —4
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2 s
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 9 No ❑ NA ❑ NE
❑ Yes ❑ No 0 NA ❑ NE
Structure 5 Structure 6
El Yes ®No El NA ❑NE
❑ Yes [9 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? ❑ Yes NNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑,, Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) Sp k n/S W� Z'e"_
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
N 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 determinations❑ Yes
NJNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
[XNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
® No
❑ NA
❑ NE
Reviewer/inspector Name +`/ �. Y�� Phone: S
Reviewer/Inspector Signature: Date: //— [7 C! — 0
12128104 Continued

f
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ZNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes (4 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes X No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
"1 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
X No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[9 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
M No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
ElNE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
rR 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
[9 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31,
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[3No
❑ 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
M No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[A No
❑ NA
❑ NE
12128104

Type of Visit • Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit f Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
r Date of Visit: �r�a/o I Time: = 3 O
Facility Number �.� -[ l�70�1
Not Operational 0 Below Threshold
IMPermitted JO Certified ❑ Conditionally Certified © Registered Date Last Operated or Above Threshold: ... ....._...»..
Farm Name: _ . » . �! G� I »...f ! „ A»r._. — ---------------- County: __._.__��
Owner Name: __��rL._.pia,._��it..in....... A�IsLjt.Ct.�:.1.r................�..a 'Phone No: ._.._rl1..I.....t�%..�.YZ.�.........
_._..._.
Mailing Address: ,.W» _.J`.�n►.»rP�rrK..�r�.�tC !1P'� _.__>✓3i1.Ya..4�I]s�..,r._ ....7�
Facility Contact: ......_...feti..__C: _...._..Title:..»......»......._._. .__ ..»».».»......__. Phone No: _.__ . _ .....»..._»......._ __..
Onsite Representative: _._. &f .—..... l !',I». ..„,... Integrator.
Certified Operator:._....A1L9.r.v_1.......____.. ».» .N .f... ...._ . _..._..»_... Operator Certification Number:._..l
Location of Farm:
[Swine ❑ Poultry ❑ cattle ❑ Horse Ladtude • 4 't Longitude • ' "
Design ' �aCurreri
El Wean to Feeder
❑Layer
IX Feeder to Finish
hap
Farrow t4 Wean
_5_40(e❑Non-Layer
�ti Other
[:3 Farrow to Feeder
Farrow to Finish
Total Desi�
i 1
V1✓Cj ts
Bows
4 i
r
Discharges & Stl'ea ImQaCt5
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance than -made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
r �Curreot�;�,
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes Wo
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 MfNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ».» _... 4..»....._._.. _»»»..»» ___ »___ ..__... ...._.._._._.».... _ .. _ _..»...»....».».» .»...»» .»»...... _._..
Freeboard (inches):
12112103 Continued

Facility Number: Date of Inspectiont�
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [KNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ArNo
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes &No
S. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes )6No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes �Wo
elevation markings?
Waste Anolication
10. Are there any buffers that need maintenance/improvement? ❑ Yes 1KNo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes KNo
. ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type .off! ` W in. &,%— '
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes KNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes KNo
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 5No
16. Is there a lack of adequate waste application equipment? ❑ Yes ANo
Odor Issues
I7. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor 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 ;S:No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 'UNo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes SNo
Air Quality representative immediately.
^- Y x' rr � t"a i _ &�k auz ��it� �mwr»u-.r.::� terse rs �.rr�Krsr srKr n � r e w�,•t 3 r' xG,1 ( 1 ''
Comment (refet tv gtaes on'#) EicpIa�n' qy YFS!aaawer$?aad/or aay ar, r o is � t� f
}�=,eta ��u=nssrdr �K��na �,�:; a rN �ji ,i
USC G�% toliLtt!0. ,: ?� dlraw + ty �e�plainsibuatians. (use:ad3itiona! Pam �,nr]')? -Field COPY ❑Final Notes ,�,��.
AL
ReviewerfInspector Name F 3 a � _ .`� M NA ONO=
Reviewer/Inspector Signature: Date:
IV12103 G Continued

Facility, Number: Date of Inspection 2 D
.J
Re- uired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Applicati*t' ❑ Freeboards] Waste Analyst/❑ Soil Sampling/
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ,
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Fong Crop Yield Form ❑ RainfalY❑ inspection After V Raid
❑ 120 Minute I:nspection✓6 Annual Certification Form.-'
❑ Yes XNo
❑ Yes EkNo
❑ Yes ®.No
❑ Yes KNo
❑ Yes Ef No
❑ Yes 9 No
❑ Yes 19 No
❑ Yes J4 No
❑ Yes 0 No
KYes ❑ No
❑ Yes Wo
❑ Yes [KNo
❑ Yes 2LNo
❑ Yes ZkNo
B Yes ❑ No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
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12112103

Facility• lumber Date of Visit: / a O Time:
Not O erational 0 Below Threshold
® Permitted ® Certified ©Conditionaliv Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: NOI'ri S I- #oZ County: �LGIrt 1= 2,)
Owner Name: N S Phone No:D
Mailing Address: 9 1. R e l dO i n 1 0kn:lrl'1 L, LLUL sC.t 6 �&, Lg n Ls Al.-C, -LK
Facility Contact: C,x Morn'S' iitje: Phone No:
Onsite Representative: ixja rr,5 LctQ- Integrator: 13r0 w-L
Certified Operator: Jr JA tJ rr'LS I Operator Certification Dumber: C' 63 23
Location of Farm:
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • �J4 0" Longitude • �� «
Design Current
Swine ranarity Pnni lation
❑ Wean to Feeder
® Feeder to Finish
S 80
❑ Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle . Capacity Population
❑ Laver ❑ Dairy
❑Nan -Laver ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑Subsurface Drains Present ❑ La oon Area ❑ S rav'Field Area
Holding Ponds I Solid Traps ❑ No Liquid Waste Mana ement System
..:
Discharges 8 Stream IMRacti
1. Is any discharge observed from any part of the operation? ❑ Yes 11-1 No
Discharge originated at: ❑ Lasoon ❑ 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 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 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (incbesl: AR
05103101 Continued

Facility Number: ej — = Date of Inspection 1
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion,
❑ Yes
F No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
El Yes
[2 No
Immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
[2 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
® No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes]
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
® No
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Reaulred Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oc/ WUP, checklists, design, maps, etc.)
❑ Yes
O No
19, Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
51No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
P No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24. Does facility require a follow-up visit by same agency?
❑ Yes
No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
—�
v3iv3iv1 i.onnnueu

Facility Number: 4 — Date of Inspection
QSiU Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours7
28. 1s there any evidence of wind drift during land application? (Le, residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
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.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes 0 No
❑ Yes [�a No
❑ Yes ❑ No
❑ Yes ®.No
❑ Yes ® No
❑ Yes ® No
❑ Yes ❑ No
05103101
e

..+ r ' -• ! �`Division}of Water, Quality ILM !t °�i �alr! >E°!'>;
PWater+I{Cbnse.`ryetinn�iF�jr'''f kA{s'!F_
,' 1 -. , v �}. ; v3�,, 17 ' yt r r i �# ° t 0, k+{ tp i . ..
.T ' d j� 76 A.�:' [ y k! y- 4 Ik k .1 ! .4 . Y�G�� �L, S �' rt✓7"�'.I ;p.t dr. C ..
.aA ..,0, :t,i.°
Type of Visit 'Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit $ Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Numberja
Date of Visit; E Time: o�y
Nnt O erational O Below Threshold
( Permitted Ce�rt]ified 0 Conditionally Certified © Registered Date .Last Operated oar Above Threshold: .........................
FarmName: ..........JIOQ.,M� 5.............�.a�....................................................... County:..................................<......P,�.s.........,
OwnerName: .............. AIl ................................ 1' 5........................,................... Phone No:.......................................................................................
Mailingram, a�� c >?� N a
ailing Address: win � ............................ .. ......
Facility Contact: Ili ....c?.c .s..............'Citle:................................................................ Phone No:...................................................
Onsite Representative: ........... srl:11�........A!P, t-'.5................................................. Integrator: .........�f�'cvn............................,......................
....
—� j 1 � .
Certified Operator: ,,,.•,.,..., r GIL.............•................ �`I + ... Operator Certification Number:..... l �3d3�
Location of Farm:
I -- - IT
EySwino ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude " �� ��G
Design Current
awille Unpacity ro ulation
❑ Wean to Feeder
Feeder to Finish
ff Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity population Cattle Capacity. Population
❑ Layer .� , ❑ Dairy
❑ Non -Layer I I[] Non -Dairy
❑ Other I I
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System
Discharees && Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of_the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure S
identifier: .....................................................................................................................
Freeboard (inches):
05103101
❑ Yes [j No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes j No
❑ Yes No
Structure G
Continued

Facility Number: 17 — IDS
Date of Inspection it'�cJ
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste _Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type tA_)Ke47 , 6eekn5
❑ Yes 0 No
❑ Yes %No
❑ Yes ( No
❑ Yes IANo
❑ Yes IV No
❑ Yes ( No
❑ Yes No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 0No
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
VNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
N No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
W No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, aste analysis & soil sample reports)
0-yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
WNo
'LA
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
O No
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
I� No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
t�No
24. Does facility require a follow-up visit by same agency?
❑ Yes
VNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
� No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
- - it a jrtE i._ - 4e •i h - f Y 'Y M h.r• Fx Fy.� :.i. 1 r to �Mk
Coinmenis (refer to:questioti #) ;Explain;any AI answers and/or any recommendations ortany other comments ;
Use drawings of facility to better explain'situatiiiris (use additionalJpage's as necessary) t y Copy []Final Notes
❑ Field C
. A� it
eollec.� c�x���e c� y_C" 'W" Iao ys' A `rn
'n.,, b C Ct (J,-. S�e _Sevmp/e,
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: ,26
O5103101 Continued

Facility Number: — ��+5 pate of Inspection �S a.2
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 [XNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [gNo
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 M 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 0 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
AdditionalCorurnents an OC" rawings.?,;
.A
O5103101

Type of Visit J: t— ompllance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: I Arrival Time: ' J O Departure Time: County:
Farm Name: IV O rd1 &.-da _,,,,,, ,,-, ,- Owner Email:
Owner Name: (I A//d'PT. /Vie),/'" S Phone!
Mailing Address:
Physical Address:
Facility Contact: 14Zf P_ zi do v'r# .3 Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
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
Back-up Certification Number:
Region: tfk()
Latitude: ❑ c ❑ 1 ❑ 11 Longitude: = o = ' E]
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La er
Other
❑ Other I I
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?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: al
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 CRNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
NNo
❑ NA
❑ NE
❑ Yes
&No
❑ NA
❑ NE
12128104 Continued

Facility Number: — (p Date of Inspection I J_ -a
iWaste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �Z 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): 141
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 19No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes J-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 ZNo ❑ 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 JNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes f gNo ❑ NA ❑ NI
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P[No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop, Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s)
13. Soil type(s) A),12A-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
adNo
❑ 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
9 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
K 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):
A) Y- &tr- area- &-L ")de
aA_T-7rra pwm6
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: 1 z
rage Z vJ I wnunaea

Facility Number: Date of Inspection
— I
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 2�No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ZYes ❑ No ❑ NA ❑ NE
XWaste 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
K No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
J2 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
$No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ONo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ANo
❑ 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
Z No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
;4 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
AL
r
Page 3 of 3 12128,104

ivision of Water Resources
4 Facility Number - © 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: ompli nce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ;�-�-171 Arrival Time: ! ' 7 1 Departure Time: County: Region: fl
Farm Name: /"�� �c�rn-�� Owner Email:
Owner Name: AlIt-1jo r/IS Phone:
Mailing Address:
Physical Address:
Facility Contact: /4 /�U!'Ci_� . Title: Phone:
Onsite Representative: Integrator:
Certified Operator: S�
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
Boars
Other
Other
Certification Number:
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
L
ayer
ury routtry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
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)?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes MNo ❑ NA ❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (Ifyes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. is there evidence of a past discharge from any part of the operation? ❑ Yes E No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes CANo [] NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

' Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
2-No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 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
J�3 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
;a 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
LR�No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
QV 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 Apmlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
J] No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes 5LNo
❑ 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/Drib ❑ Application Outside of Approved Area
��❑
12. Crop Type(s): /i /14 7I��1o� / Oy�•'�'r�-s/
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes [Z-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ;R—No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes JDLNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ZLNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q j_No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the 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
2]-No
❑ NA
❑ NE
the appropriate box.
❑WUP [-]Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
,Z-No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall D 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
Wo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Wo
T
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

' Facility Number: - ld Date of Ins ectlon:
} 24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32, Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33, Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
r No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes ZLNo ❑ NA ❑ NE
❑ Yes �Q No
❑ Yes JF&LNo
❑ Yes W No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ONE
Comments (refer tolquestftr&#)!Explain any,WES answers and/df any3additionalire-com'mendatlons or,any;.other, comments:
- ?,�r.�'� •:f; t:.i. .,'�..� i�., - =a� ,,o,!yw., ,o-..?.�'i;�€,.s4s.;i.,,z..:".'$iXa::;Q
U`se druwingsaf;Facility,tobetterexplain'situstions (use..additionall ages;as,,necess.a : ,).�,.,, <r_;
rV 01 't- i - % as
Reviewer/Inspector Name:
Phone: 1y fin( 1-57�
Reviewer/Inspector Signature:
Page 3 of 3
Date: 3 7j� j -?
21412015

1 _i_vi"s_i_on oflWnt_�r Rc_saurces
411 � � Other Agency
Type of Visit: CoZutine
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: Arrival Time: D ' w Departure Time: County: [ro•G%r�- Region:
Farm Name: ! " 'e 4 ij rat' rrn1, � Owner Email:
Owner Name: �.,4-1I�0-- NO //-.3 Phone:
Mailing Address:
Physical Address:
Facility Contact: '4&-', Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design
Current
Design
Current
Design Current
Swine Capacity
Pop.
Wet Poultry
Capacity
Pap.
Cattle
Capacity Pop.
Wean to Finish
I
ILayer
I
ow
-
Wean to Feeder
Non -La er
I
alf
Feeder to Finish
S�
airy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr, P�oultr,
C•.a acit
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Qthe
ITurkey Poults
Other
10ther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �q No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
MNo
0 NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
Page 1 of 3
21412014 Continued

Facility 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 E[ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):�
Observed Freeboard (in): /fry
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes MNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [3-No (DNA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes �No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ® 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 [3-No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 11nd 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 AcceptableCropWindow [] Evidence of Wind Drift [] Application Outside of Approved Area
12. Crop Type(s):IGorn-
13. Soil Type(s): A Z -JSA Do the receiving crops differ from those designated in the CAWMP? ❑ Yes � No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[-]Yes
21 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
®-No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
allo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design []Maps ❑ Lease Agreements ❑Othcr:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [RNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: Date of Inspection: Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
j 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.c., 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
®No
❑NA
ONE
❑ Yes
[g No
❑ NA
❑ NE
❑Yes [ZNo ❑NA ❑NE
❑ Yes P5No ❑ NA ❑ NE
❑ Yes —® No ❑ NA ❑ NE
[:]Yes ® No
❑ Yes [ No
[:]Yes ® No
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Comments (refer to' questionk#) Explain anyt.°YES answerstandlor;any hddltionel recom"mendations or.°uny other,coniments
s
Usedravin sof.facilityto:betterexpmn-situatians�[useedilitionalipages�esj.necessary) e' x.* �¢ �i�ro „Q _.;};_� ;
T �-� cX7Gs �y 1
LtI aj f�0 w�- --
C
Reviewer/Inspector Name:
Phone: 2L&—,zi331- -�;3-00
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412014

w
. 4
Type of Visit: ®'Compliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: &<Outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ,� l3' Arrival Time: O; OTC Departure Time: p D County: Region: YOKC?
Farm Name: / i j c7/rY[ Owner Email:
Owner Name: //L�ji A162 rra, Phone:
Mailing Address:
Physical Address:
Facility Contact: '411Yn —Title: Phone:
Onsite Representative:
Certified Operator: ,S4rk
Back-up Operator:
Location of Farm:
Latitude:
Integrator: , /yctri.
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pap.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
ceder to Finish
Dai Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dt, P.oultr
Ca adt
P.o
Non-Dal
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
,NJ Other
TurkeyPoults
Other I IrOther
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes [&No ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes [:]No
Q Yes ..❑ No
❑ Yes E, No
[:]Yes ®-No
DNA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page 1 of 3 21412014 Continued

Facility Number: - G Date of Inspection:
4 Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Sri
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 allo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 CropWindow ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
�
13. Soil Type(s): ,5X '+ �A/ I7 7r1
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? C-Yes�eo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reuuired Records & Documents
❑ Yes fZ No ❑ NA ❑ NE
❑ Yes Z No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® 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
[3 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facility Number: 91 - G Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ,No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes M 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?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss reviewlinspection 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 [g No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes ®-No ❑ NA ❑ NE
❑ Yes S No
❑ Yes [& No
❑ Yes S No
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Use drawings of facil' �tn better explain situations use9ad`dition r,�:any additional recommendations or any other comments Comments refer to question # ::Ex la n an answers° an
g ty � al' pages
�
ty.r C✓'1T� Gc�s �vr� , /�v ,r-t i�5 Lark; �.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: DO
Date:
2/4/2014

__FC_ —moo
Type of Visit: (-Compliance Inspection O Operation Review I0 Structure Q Technical Assistance I
Reason for Visit: (&<outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: .'O O Departure Time: County: Region:
Farm Name: J001-rIs Fao-O L. Owner Email:
Owner Name: I— A//,rK %l10/-%Ij Phone:
Maiiing Address:
Physical Address:
Facility Contact: //�� j�pr�,�j Title: &2Wt7 tr N
Onsite Representative: SamIntegrator:
v
Phone:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Deslgn Current
Design
Currcnt
Design Current
Swine
Capacity Pnp.
Wet Ppultry
Capacity
Ppp.
Cattle Capacity
Pop.
Wean to Finish
11
Layer
Dairy Cow
Wean to Feeder
JNon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
©, P.oult .
Ca aei
P,o
Non-Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
� No
❑ NA
❑ NE
❑ Yes
(2 No
❑ NA
❑ NE
Page I of 3 21412011 Continuer)

Faciiit Number: y - Date of Inspection: IX — 6 — /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes MNo ❑ 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 [g 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 rM 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 IQ No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload [] Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ID 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): `(1/1r_�Se �►6,.,...s
If
13. Soil Type(s): 05YL.Alok ._
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ®, No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes RNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E�No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [2 No ❑ NA ❑ NE
❑ Yes pR 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 R5 No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ® Yes []No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard 'aste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [allo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo 0 NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [—]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-complianee of the permit or CAWMP7
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
No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes 52 No ❑ NA ❑ NE
❑ Yes (2 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes ® No
❑ Yes No
❑ NA [] NE
❑NA ❑NE
❑NA ❑NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
oT rs��s ry
Reviewer/Inspector Name: Phone:
Reviewer/Inspector Signature: owl Date:
Page 3 of 3 21412011

y
ivision of Water Quality
Facility Number .` ®- / 0 Division of Soil and Water Conservation
0 Other, Agency
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Qleo'utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: p ; O Departure Time: a County: `7� Region: fz-wfl
Farm Name: yr r l S rail Owner Email:
Owner Name: T ,-1 f Wit % $j Vt h S Phone:
Mailing Address:
Physical Address:
Facility Contact: Ziben 1J o rr ; 5 Title: c9al 7Y,,-' Phone:
Onsite Representative: `S' �r.��_ integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
HNI�on-Layer
a er
Non-L
Pullets
Other
Poults
Design Current
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?
Design Current
Cattle Capacity Pop.
Dairy Cow
--
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[]Yes allo ❑ 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: - Ds ection:
3
Waste Collection & Treatment
=• 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 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
S No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
� 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
CR No
❑ NA
❑ NE
S. 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
a No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[& No
0 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): !��
v
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
ON
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
5?],,No
❑ 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 ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes &LNo
❑ 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 MNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

` Facility Number: - 41 Date of lns ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Revicwer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ®.No ❑ NA ❑ NE
❑ Yes SNo ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
®-No
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments.
Ilse.drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature: _
Page 3 of 3
Phone: �7`%Q-`l.�f�'33bC>
Date: 3
21412011

Division of Water Quality
Futility Number ® - F 7 _&7T 0 Division of Sell and Water Conservation
0 Other Agency
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 tiontine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: — Arrival Time: Departure Time: O p County: Region: rRy
Farm Name: 102'ae'1, .. M�' Owner Email:
Owner Name: 7-'jU/ram Mo i`r,_5 Phone:
Mailing Address:
Physical Address:
Facility Contact: A 1 rvk 1J p / r1s Title: �i7 i! r r � Phone:
Onsite Representative: ,S' _ _ _ Integrator: ,077ur4�
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Soars
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
ury routtry
Layers
Non -Layers._
Pullets
Turkeys
Turkey Poults
Other
Design Current
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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes (�j No ❑ NA ❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
[D Yes
E] No
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes (� No
[-]Yes a No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: jDate of Inspection:
/
lWaste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
®,No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[ 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?
f-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
[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 Approved Area
12. Crop Type(s):
13. Soil Type(s): Z
7,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ENo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[Z 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
[E-No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
54,No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
allo
❑ NA
❑ NE
the appropriate box.
❑ WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® 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 CE;.No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �.No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:901
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [&No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes RNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes E, 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 reviewtinspection 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 Q5-No ❑ NA ❑ NE
❑ Yes 1A No ❑ NA ❑ NE
❑Yes ®No ❑NA ❑NE
❑ Yes M7 No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
® No
❑ NA]
NE
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any add I ti6n a Frecom me udation sor.any.othercomments."
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: /-2-
2/4/2011

CFIDivlslon of Water Quality
.Facility Number G S 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
,�C..,,ommpliance
& outine 0 Complaint
0 Fallow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: �' Arrival Time: Da Departure Time: '; AA County:'"14^ Region:
Farm Name: O Fjaim �;? Owner Email:
Owner Name: T r4 l lr -%- 1�11'nrr i -5 Phone:
Mailing Address:
Physical Address:
Facility Contact: If-11wrl- W rr7S 'Title: Phone No:
Onsite Representative: Integrator: _M P'Y& ^
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = =61 Longitude: 0 ° = d 0
11
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Points
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
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 Mlo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
El NE
El Yes
[:]No
❑ Yes
®No
❑ NA
❑ NE
❑ Yes
&No
❑ NA
❑ NE
Page I of 3 - 12128104 Continued

Facility Number: 7 — Date of Inspection
' Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes XNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ®No
❑ NA
❑ NE
(ie/ iarge trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes 21 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 L)!f-No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes RNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance altematives that need ❑ Yes KNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes U�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.
v
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
19 No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[) Yes
JZ No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
®-No
❑ NA
❑ NE
Reviewer/inspector Name �. � is ��x_,$�; : Phone: V—J6�?--,33C7D
Reviewer/inspector Signature: Date: Off`` / 4 /1
Page 2 of 3 12128104 Continued

Facility Number: — fp Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes KNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ( f�No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes SNo ❑ 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
SNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
N No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit`?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus toss assessment (PLAT) certification?
❑ Yes
Callo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
9 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
P-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
ZNo
❑ 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
O No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
O No
❑ NA
❑ NE
Additional Co`inmen'ts and/or Drawings
3 � -Dr ; 17 L. Y X
Page 3 of 3 12128104

0
I
Type of Visit (ZA01npliance Inspection O Operation Review Q Structure Evaluation Q technical Assistance
Reason for Visit tine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Dale of Vivit: tl�L L=J :Irri►a1 Time: r7� Deparlure "Time: ® County: Le••n~ Region:
Form Name: !Tif i .ti �Gir►r►ti_ �_ __ Owner Email:
Owner Name: V / I d /1V- 1L ij O re-i i Phone:
Maiting Address:
Physical Address:
Facility Contact: Title: Ahonc No:
Onsite Representari►e: -:C gy-g-►e-- lnlegrator:
Certified Operator: 5�-�— � Operator Certiftealion Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Gilts
Other
❑ Other
=O =1 `=N
Latitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
�� , ❑ Layer
❑ Non -Layer
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?
Back-up Certification Number:
❑o❑�
Longitude.
In
Design Current
Cattle Capacity Population
❑ DairY Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: IT]
I
b. Did the discharge reach waters of the State? (Ifyes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters Of the State
other than from a discharge?
❑ Yes M-No ❑ NA ❑ NE
❑Yes
❑No
El NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
2kNo
❑ NA
❑ NE'
❑ Yes
[K No
❑ NA
❑ NE
12128104 Continued

i Facility Number: — Date of Inspection /Q
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes X No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Stmeture 2 Structure 3 Structure .1 Structure 5 Strticturc 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 KNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes RNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes (R No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes YNo ❑ 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 Drifl ❑ Application Outside of Area
12. Crop type(s) h
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
K No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
t4 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determinations❑ Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
21 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
9 No
❑ NA
❑ NE
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
[Ise drawings of facility to better explain situations. (use additional pages as necessary):
111J� S�u�� Su r-✓r p� y,�.aC; y0
lif/%i �o�i? 4.S �I)�73 r�r1 Lea-r�+�er ��S •�/^rr e , (�C! �`�W tPI �,r�;
6r
LReviewer/Inspector Name d Phone:wer/Inspector Signature: Date:

Facility Number: — / Date of Inspection, ,,[ D
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design
g ❑ Maps ❑Other
❑ Yes ® No ❑ NA ❑ NE
❑ Yes MNo ❑ NA ❑ NE
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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
4No
❑ NA
❑ NE
❑ Yes
4 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
RjNo
❑ NA
❑ NE
❑ Yes
Wo
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
5kNo
❑ NA
❑ NE
❑ Yes
�No
❑ NA
El NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[0 No
❑ NA
❑ NE
❑ Yes
]91 No
❑ NA
❑ NE
12128104

01)'ivision of Water Quality s
Facility Number Q Division of Soil and Water Conservation
O Other Agency v�
(Type of Visit &f,,ornpliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit E7 outine O Complaint O Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: ® Arrival Time: r, Departure Time: i County:
Farm Name: (�(`�5 Now-L r Owner Email:
Owner Name: _/` 6. r2 „_ � J�:2 e) -,r rr ,5 I Phone:
Mailing Address:
Physical Address: !!
Facility Contact: A � I Yy-v Y � O Title:
Onsite Representative: L._A
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Region: ) R C-L
Phone No: lv l�—dby� Ivy
integrator: xvry 1
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 =1 = Longitude: = ° = d = ft
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ Layer
❑ Non -La et
U4-Feeder to Finish r
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ DEL Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
CgNo
❑ NA
❑ NE
12128104 Continued

Facility Number: C1— (A Date of Inspection
} Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes C Mo ❑ 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): /`T
Observed Freeboard (in): cc! S--
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ZNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ®,No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ®,No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ®,No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 91 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ZNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [XNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s) 15- x A 1 Ix-1
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
R] No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
BNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
A No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
JSNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
P�LNo
❑ NA
❑ NE
Reviewer/inspector Name!/ Phone: qJ0— y,3 cam
Reviewer/Inspector Signature: Date: 9
Yage L of J ■�/coiv+r a vrnueucu

4 Facility Number: — Date of Inspection
f
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes allo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes CffNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo ❑ 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 C-No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [jNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
M No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
EgNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
C.No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[K No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
18 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
[S 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
[3 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
SNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

0
I
Type of Visit (arCompllance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit outine Q Complaint 0 Follow up Q Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: - % Arrival Time: - a C7 Departure Time: fl 1 County: Region: 17-1D!
Farm Name: ��'�► S fGa., rt_ i ► �-- Owner Email:
Owner Name: N o f r IDS -� Phone:
Mailing Address:
Physical Address:
Facility Contact:'I en N o rr i _5 Title:
Onsite Representative: S..c
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = e E:J ' = Longitude: = ° = ' =
rrent
Design 111.1-tion
Swine Capacity Wet Poultry
Uesign
C•""opacity
Current Design C«urreut
Population Cattle Capacity Population
❑Dair Cow
❑Dair Call'
❑Dair Heifer
❑ Dry Cow
ElNon-Dairy
El Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
❑ Wean to Finish
❑ Layer
:Non
❑ Wean to Feeder
❑ -Laver
CR Feeder to Finish
ii
Dry Poultry
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑Gilts
❑ Boars
❑ Layers
Non -Layers ers
❑ Pullets
Other
❑ Other
❑ Turkeys
❑ Turkey POIIIIS
❑ 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'? (Ifycs, 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 ! of 3
El Yes ®No El NA El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
ER No
❑ NA
❑ NE
12128104 Continued

Facility Number: 7— %(v Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? ❑ Yes [Z 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): 19
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 L3,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 r&No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 10 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [`.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?
1 l . Is there evidence of incorrect application'? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil types) t 2(A- I Na X
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
[,No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[N 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
[XNo
❑ NA
❑ NE
Comments;(refer ,to question #) ;Explain®any YES answers and/or any recommendations or'any other comments.:'
Use drawings of facility to. heiter `explain sil:uatioi ns: (use additional pages as. necessary):'
Reviewer/Inspector Name I
T ' Phone: ,gyp-e 300
Reviewer/Inspector Signature:
Date: �2� f ,Oiz�
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection `-
' Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ®.No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes ANo []NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ElMaps ElOther
21. Does record keeping need improvement? If yes, check the appropriate box below. RYes ❑ No ❑ NA ❑ NE
R-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 �K No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
24, Did the facility fail to calibrate waste application equipment as required by the permit?
[]Yes
ErNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[R No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
51No
❑ 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
JR 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
[8 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
Cl Yes
[&No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
CR No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
5.No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

PK Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
MM_= 0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review '* Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency Other ❑ Denied Access
Date of Visit: %3 1 I Arrival Time: Departure Time: © County: Region:
Farm Name: (r �:OSrf _' Z Owner Email:
Owner Name: ^ 1 i S Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title:
`Phone No:
Integrator• 1 ' L ~
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
.'Other
❑ Other
Back-up Certification Number:
Latitude: = o = 1 Longitude: = ° = 1 a
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
1. ❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turke Poults
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: ILI
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters ofthe State (gallons)?
d. Does discharge bypass the waste management 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?
❑ Yes [P No ❑ NA ❑ NE
❑ Yes
❑ No
�a NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ No &NA
❑ NE
❑ Yes
❑ Yes
JA No
❑ NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
12128104 Continued

` `W Division of Water Quality
,aJty Number Q Division of Soil and Water Conservation
__ ___ Q Other Agency
r.
Type of Visit O Compliance Inspection O Operation Review V structure Evaluation Q Technical Assistance
Reason for Visit O Routine O Complaint 0 Fallow up O Referral ()Emergency P Other ❑ Denied Access
Date of Visit: %3 Arrival Time: ' , Departure Time: © County: Region: �"
Farm Name:. S �0,( M - Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
,Pf"hoonne No:
Integrator• 1
' Operator.,Certification,Number:
Back-up Certification Number:
Location of Farm: Latitude: e ❑ ❑ Longitude;, = ° ❑
Swine
Wean to Finish
Wean to Feeder
Eeederto Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
Title:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ Layer
❑_Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �Q No ❑ NA ❑ NE
❑ Yes
❑ No
P NA
❑ NE
❑ Yes
❑ No
P NA
❑ NE
All NA
❑ NE
[:]Yes
El No
❑ Yes
A No
❑ NA
❑ NE
❑ Yes
❑ No
It NA
❑ NE
12128104 Continued

Facility Number — Date of Inspection
Vi�hstc Collection & Treatment
4. Is storage capacity (structural plus stonn storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
❑ Yes PNo
❑ Yes PNo
❑ NA ❑ NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: !
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
0 No ❑ NA ❑ 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
0
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 4 NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
❑ No ❑ NA I�JNE
(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 NNE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
IK.NE
KNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? El Yes
❑ No
❑ NA
�9 NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
ONE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA "D&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 Phone,.
Reviewer/Inspector Signature: Date:
`-- -%"* 12128104 " a Continued

Facility' Number. -1 Date of Inspection
*hsfe Collectlon & 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 9 No ❑ NA ❑ NE
❑ Yes PNo ❑ NA ❑ NE
Structure 5 Structure 6
Identifier: I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): aZ
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes N No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA NE
8. Do any of the shIctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [--]'No ❑ NA �] NE
maintenance or improvement?
Waste Application '
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ® NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[--]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA XNE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA Z NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[-] Yes
❑ No
❑ NA NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA] NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA] NE
Comments (refer to 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):
�i cou &L
s
Reviewer/Inspector Name
tki TOO Phone:
Reviewer/inspector Signature:
_. Date:
`� �+ I212ar/U4 ' + Continued

Facility. Number: Cj-j Date of Inspection
R_eauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA NE
the appropirate box. ❑ W UP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA gNE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
1%NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
-4NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
ONE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
;&I 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
qNE
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
gNE
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
)gNE
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
gNE
33. Does facility require a follow-up visit by same agency?
ElYes
ElNo
ElNA
6NE
nal Comments and/or Drawings:
12128104

�'acilitaumber: 0,01Date of Inspection
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA 110, NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA Q NE
the appropirate box.
❑ WUP El Checklists ❑Design [I Maps El Other
21,
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA 5�NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
'.
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑ Weather Code `
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA %NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA -4 NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA ONE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA NE
26,
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA W NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA '1A 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 qNE
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 ONE
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 '�fNE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA �ZNE
33,
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA NE
Comments and/or
12128104

ivis""ion of Water Resources
Facility Number - �� d Division of Suil and Water'Conservatian
Q Other Agency
Type of Visit: ampliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: Orlioutine Q Complaint Q Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ; 69 D I Departure Time: ; 0 D County:? __ Region:
Farm Name: �JQf 13 Fa -nry Owner Email:
Owner Name: J_ A 1"'D rP?+� Phone:
Mailing Address:
Physical Address:
Facility Contact: zq No_[1 �_ 5 Title: 4VCU * i Phone: .�/�---
Onsite Representative: Integrator:�1�;7t-��%
Certified Operator: , j l�..cr Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude:
Longitude:
Design Current
Design
it
Current
tRilllfll
Design
j1g1lllll111uqi
Current
Swine Gapaeity Pop.
Wet Paultry
CapBel ty
Plop.
Cattle
apacity
P psi
Wean to Finish
[Layer
Dair Cow
Wean to Feeder
I INon-Layer
I
i Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Desi n
Current
Dg Cow
Farrow to Feeder.
D , P,oult .
Caacl
I'o .
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)? —
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes allo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes ❑ No
❑ Yes t&No
[] Yes ENo
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Fadiit Number: - Date of Inspection: --/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ 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? 0 Yes Callo ❑ 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
EEI-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
S No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[Z No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste ADplication
0. 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 ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [:1 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)� u4/a1- ep r/erSr'
13. Soil Type(s): X 1101-f-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ®-No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [a 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
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ® Yes ❑ No
ff 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

Eacili Number: - Uate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes B No
�25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 5jNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ®, No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes E�,No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes E�jNo
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 S No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ELNo
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or GAWMP? ❑ Yes O No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ®. No
34. Does the facility require a follow-up visit by the same agency? [] Yes allo
❑ NA ❑ NE
❑ NA D NE
❑NA ❑NE
❑ NA ❑ NE
0 NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ONE
❑ NA ❑ NE
[]NA ❑NE
cJ 1',✓/7`� I`J /,)1?40 /v ��5, �/f7Te�� �f�G r �rL*�1�� `j�•r"vJ /1y/ �Z'ttj
r
FD-1- 74,5
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone:
Date:
21412015