090184_INSPECTIONS_20171231

of visit: V compliance inspection V operation Review V structure Evaluation V i ectinicat Assistance
in for Visit: G-16utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of visit: I(p Arrival Time: / O _D_5 Departure Time: I I / : ZFD7 County: �J Region: F7_WT5
Farm Name: 2f_ to r ti. Owner Email:
Owner Name: _ TT ! Le-± 13 7-a41/ Phone:
Mailing Address:
Physical Address:
Facility Contact: / Z--Q y Title: &W ►1 .r' Phone:
Onsite Representative: Integrator: �Rp
Certified Operator: r,'.�.-« Certification Number:
v
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design y Pop. Current
Swine Capacit
Wean to Finish
Wean to Feeder K a
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dai Cow
Non -La er
Da' Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Design Current
D , P,oul Ca a_cit P,o
Layers
Da Heifer
D Cow
Non -Dairy
Farrow to Finish
Gilts
Boars
Beef Stocker
Non -La ers
Beef Feeder
Pullets
L
Beef Brood Cow
Other
-
Turkeys
Turkey Poults
Other
Other
Discharges and Stream ]Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[3 Yes [3o ❑NA ❑NE
❑ Yes ❑ No
[—]Yes [:]No
[:]Yes [::]No
❑ Yes 940
❑ Yes ErKo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

l
Lacility Number:_ �� - /ey jDate of Inspection:
1f Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes o ❑ NA ❑ NE
/ a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /2:^
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �Io ❑ 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 FJ-T�o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4fi were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑moo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[n]-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
[]'"go
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[]'11;ro
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes []-N-o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑/Application Outside of Approved Area
12.CropType(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CA W M P? ❑ Yes E]No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [l]Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes D-14o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes [D'No ❑ NA ❑ NE
❑ Yes lD l�o ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[31�o
DNA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[El"No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps [:]Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Ej-�ko
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[E'<o
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
[ "o
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

;f Facility Number: - Date of Inspection: -a /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �To ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3'1 o ❑ NA ❑ NE
' the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 13'1Go ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes F No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [J' o ❑ NA ❑ NE
❑ Yes [TNo ❑ NA ❑ NE
❑ Yes E3- o ❑ NA ❑ NE
❑ Yes [D]No ❑ NA ❑ NE
[:]Yes [y] No
❑ Yes [3" o
❑ Yes F!rNo
❑ NA ❑ NE
DNA ❑NE
❑ NA ❑ NE
Comments (refer,,to gtteshan;#.) Explatn any YES answers and/or any additI6119'reeommendations'or any other comments
Use drawings of facili to_abetteT'e laiin situations use additional $ es as necessa g
to ty ap_ ( P g rY)•
Reviewer/Inspector Name:U�
Reviewer/Inspector Signature:~
Phone: 71W_3V_5__0Kr1
Date: Z' :.2 7 —"-4)1i1
21412015
Page 3 of 3

- _ ivision of Water Resonrces
/ ..
Factlt � Number - � � Divisioa of Soil and Water Conservation �zi . V
®Other Agency
type of Visit: C��ommp�pliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 01outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: '3 Departure Time: ; j County: Region: F�Z Q
Farm Name:j
Owner Name: �6z-44
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: �1 z� ZnLlz� Title: 6VA7 w/-' Phone:
Onsite Representative:
Certified Operator: 4J�
Back-up Operator:
Location of Farm:
Integrator:
Certification Number: / 51""-19
Certification Number:
Latitude: Longitude:
_..
Design Current Design Gnrrent
Design Current
Swine
Capacity Pop. Wet Poultry Capacity Pop.
Cattle
Capacity Pop.
Finish
La er
Dai Cow
YX
Feeder
a
Non -La er
Dai Calf
o Finish
V
Dai Heifer
o Wean
Design Current
D Cow
to Feeder
D , P,outt , Ca aci P,e
Non -Dairy
to Finish
E
La ers
Beef Stocker
Non -La ers
Beef Feeder
Beef Brood Cow
Pullets
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify 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
❑ NA
❑ NE
❑Yes
[—]No
❑NA
❑NE
❑ Yes ❑ No
E j Yes E, No
[] Yes No
❑ NA ❑ NE
[DNA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 1�? No [] NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [DNA ❑ 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 C, 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 0 Yes ®. No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? - ❑ Yes Z No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [3 No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes L� No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 12 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑/ Application Outside of Approved Area
�
12. Crop Type(s): �,caaa/�Dv r/-s,� ��r�r�lc�,�� ,!� / Gl%% T YzSGu��
13. Soil Type(s): ' I Zz Z C Z
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 N No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [KNo ❑ 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 E, No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes El No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes JK 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. S1 Yes [:]No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield iR 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 5a No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes allo
❑ NA ❑ NE
Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

• Facility Number: -Z2M Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
M No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
allo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[a No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ELNo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
allo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
KNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
M-No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
,allo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
C -No ❑ NA ❑ NE
Comments (refer�to question #) Explain any�i answeii and/or any additional recommendatt ns or any other comments' `' �
Use. dirawm sWi'acifi to better explain sitiiaEtons'Weaddihonal pages as necessa �
Reviewer/Inspector Name: S2r61t__ Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412015

Type of visit: COrUompliance Inspection V Operation Review U Structure Evaluation V "Technical Assistance
Reason for Visit: 04Z6`utine Q Complaint O Follow-up 0 Referral O Emergency 0 Other O Denied Access
Date of Visit: I /, 1 Arrival Time: .'aa Departure Time: at7 County: �j� .�. Region:
Farm Name: —A j-4: �a�,,ti � Owner Email:
Owner Name: -41 Phone:
Mailing Address:
Physical Address:
Facility Contact: �et Title: eP-w/? f Phone:
Onsite Representative: Integrator:
Certified Operator:y`u-.� Certification Number: �l
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Design Current
Capacity Pop.
Wet Paintry
Design
Capacity
Current
Pop.
Design Current
C►attle Capacity Pop.
Wean to Finish
p11
'A ,
I ILayer
INon-Layer
D . P,oul
Layers
Non -La ers
Pullets
Turkeys
Turkey Poults
LjOther
I
-----
Ca aci
P,o
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non-Da'ity
Beef Stocker
Beef Feeder
Beef Brood Cow
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Qther
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
allo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
IS_No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

FaciliNumber: - Date of Inspection:
Waste Collection & Treatment
_ 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 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
allo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[E�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
[3,No
❑ NA
❑ NE
$. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E3-No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
®-No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes E3No ❑ 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
/I Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): l�t�l►h�!'���rir�#Yr� / �k r!l, rr.�" /lN•r.��
13. Soil Type(s): Gl1 G'
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 allo ❑ 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
E�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
E� 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 ONo ❑ 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 jSNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes J23-No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

fFacility"Number: - Date of Inspection: — 6
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [2 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [!I -No 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 fast 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)
❑ Yes
EkNo
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
[]Yes
Jallo
[] NA
C] NE
[—]Yes L�]_ No ❑ NA ❑ NE
❑ Yes e,No ❑ NA ❑ NE
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes allo
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ®, No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ®-No
answers and/or any
�.iaaa,w.�au6��v l'_16LW6Jt<<v�veuc�}ca�an��i„siaunuvsaa:�u�e,nu{,�uyu�}�asc�y nls�uetca,a{f/)�,��e' __:.,-_ _ -
mD , �'drs2_ J ��9r�rd /4'�Yr
bj /y
Reviewer/Inspector Name: f
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Phone:
Reviewer/Inspector Signature:— Date:
Page 3 of 3 214120I5

Type of Visit: 'Compliance Inspection U Operation Review O Structure Evaluation U Technical Assistance
Reason for Visit: routine 0 Complaint 0 Follow-up 0 Referral O Emergency 0 Other 0 Denied Access
Date of Visit: j�[ /�— `Arrival Time: .� a Departure Time: County: r:-L
FarmName: if' A1-01, Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address: ff L
Facility Contact: -1 bri'r Title: 6 iyn eri Phone:
Onsite Representative: '� _ Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Region:a
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Ponitry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Da' Cow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
Da' Heifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
P,nul
Ga aci
P,o .
Nan-D '
Farrow to Finish
Layers
Beef Stocker
Gilts
I
Non -Layers
Beef Feeder
El
Boars
I
Pullets
Turke s
Beef Brood Cow
Other
Turkey Pouets
Other
Other
.ram ....
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes JNo ❑ NA ❑ NE
[:]Yes [:]No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [:]Yes [:]No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes gNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes 0,No ❑ NA ❑ NE
of the State other than from a discharge?
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 [3.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): r 9
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes allo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes Z 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 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes IR No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. . ❑ Yes IN -No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload 0 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): ��iYtl(�sL _5 ; rTr r
13. Soil Type(s):LCJT
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes MrNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes KNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes LK 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
4allo
❑ NA
❑ NE
Re aired Records & Documents
1.9. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Callo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�No
[DNA
❑ 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 �j 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: jDate of Inspection:
f 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 Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes CA 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).
Reviewer/Inspector Name: ��[_ &:K—f y Phone:
Reviewer/Inspector Signature: Date: �:j—_ /j =
Page 3 of 3 21412011

9
type of visit. w-,r-s_.ompuance inspection V vperanon mevtew u zo[ructure itLvaivaaon L.J iecnmcai Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: sL G�4 Arrival Time:�Departure Time: :__1Z I County: w
Farm Name: Jf'�L' aly-L. Owner Email:
Owner Name: -7 Phone:
Mailing Address:
Physical Address:
Facility Contact: �f�' i/ Eey Title: BlUi7el/ Phone:
Onsite Representative:
Certified Operator
Back-up Operator:
Location of Farm:
Integrator: �
107
Certification Number:
Certification Number:
Latitude: Longitude:
Region:
Design Current
Design
Current
Design Mrent
Swine Capacity Pop:
Wet Poulp.
Wean to Finish
Dat Cow
Layer
Wean to Feeder O
Non -La er
Da Calf
Da Heifer
Feeder to Finish"'f`
Farrow to Wean
D , P,onl
Design
Ca aci
Curren# .-
Pa
D Cow
Non-Dai
Farrow to Feeder
Farrow to Finish
Layers
Non -Layers
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Turkeys
Beef Brood Cow
Other
Turkey Poults
Other
F-TO—ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes Fa'No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[:]Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�o
El NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[B-No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

r IFacility Number: g - /g* I Date of Insoection: ,5-- ]--/
Waste Collection & Treatment
F` 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes ZLNo ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
�No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
[:]Yes
0 11No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
23,No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
M'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
NTo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Callo ❑ NA .❑ NE
❑ Excessive Ponding D 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): ✓� �� C -
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 allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes WNo ❑ 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 51No ❑ NA ❑ NE
[] Yes 2g No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes MNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes D� No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ®, No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection: ! 7—
} 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [3 No NA NE
r
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes E3, No ❑ NA ❑ NE
the appropriate box(es) below.
Failure to complete annual sludge survey Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or 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
E@ No
❑ NA
❑ NE
❑ Yes
[0 No
[] NA
NE
❑ Yes
®,No
❑ NA
❑ NE
❑ Yes M. No 0 NA NE
[-].Yes [�jj No 0 NA [] NE
Yes 2. No ❑ NA ❑ NE
[:]Yes S No
El Yes [R No
Yes ®.No
NA NE
NA NE
NA NE
Continents (refer to question,oz Explain any YES answers and/or any additional recommendations or anyother comments: :..,
Use drawings of facility to better explain situations (use additional pap -es as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ,P 33 —_3M<7
Date: 7 ' /Y
21412011

0
RE
Facih Number O D'visron
ty ®. ® vision of Soil and Water Conservation Wit.
® other Agency
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 01fo-utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Q' t Departure Time: / : D a County: Region:
Farm Name: p:a / n,� Owner Email:
Owner Name: �`'„4 Phone:
Mailing Address:
Physical Address:
Facility Contact: _ A"� — Title: QL <<r_, H ��` Phone:
Onsite Representative: Integrator:
Certified Operator: .for -•cam Certification Number: O
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Cnrrent��Des�gn
Current Design Current
Swine Capacity Pop.
Wet PoultryCap ity Pop. Cat#le Capacity Pop.
Wean to Finish
La er jDairy Cow
Wean to Feeder
30 Q
5D20
Layer
Dairy Calf
Feeder to Finish
�
Da' Heifer
Farrow to Wean
'� �, f
_ '
�Desiga Current Dry Cow
Farrow to Feeder
R 'I
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Non -La ers
Boars
Pullets
e se
Poults
41k
Other
Other
Discharges and Stream Impacts
L Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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 [2fNo ❑ NA ❑ NE
❑ Yes
❑ No
[] NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes [:]No
❑ Yes ® No
[:]Yes � No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
®No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in): g
Observed Freeboard (in): 33
5. Are there any immediate threats to the integrity of any of the structures observed?
[]Yes
Zj No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[S No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ 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
tj 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 N 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): _� yr e 1 f J7rr-lt lU: r-✓}}rrv�GC �IeYS e ilpe
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 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
E No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall O Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Eg No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes El No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ONE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

f
Facili Number: - I 0--T7 Ds ection:
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Cq�No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes O-No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [n No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E[ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
g No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
C&No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[A No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
(LNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Stomge Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
33, Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ®.No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [Z No ❑ NA ❑ NE
Comments{refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. F -
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Phone: p — o
Reviewer/Inspector Signature:
Page 3 of 3
Date: _! Ei
21417011

I
Facility Nnm ®_ ® .�
�v�sjon of Water Quality - "' e-
ber / ®Division of Soil and Water Conservation
Other Agency
type of visit: QkMmpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: QrVoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: / Arrival Time: : Da Departure Time:G� . v,— J County: Region: FF D
Farm Name: /CF t+^ 'rry,lill.- Owner Email:
Owner Name: Ij Phone:
Mailing Address:
Physical Address:
Facility Contact: �/¢r� &=4215k Title: law n-r` Phone:
Onsite Representative: _ Integrator: _AjF_tr..
JIF
Certified Operator: _` -- Certification Number: / 9 9/ 0
�v
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet PoWtry
Capacity
Pop:
Cattle Capaclty Pop.
Wean to Finish
airy Cow
Wean to Feeder
airy Calf
Feeder to Finish
airy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , P.aultr
Ca aci
PEo
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
O#her
Turkey Poults
Other
Other
Discharges and Stream Imoacts
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 ❑ NA ❑ NE
D Yes ❑ No ❑ NA ❑ NE
[—]Yes [:)No
[—]Yes ® No
0 Yes [jg No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: - Date of Inspection:
' Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
r] Yes
4g 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
LN 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
E 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
[N No
❑ NA
❑ NE
maintenance or improvement?
Waste ADnlication
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
❑ Outsidee of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approwd AreaAftr � Viscp
12. Crop Type(s):
607
13. Soil Type(s): jo-K/f le, g
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? IN 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
[g 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 C4 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes N N
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes gLN
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
o ❑NA ❑NE
o ❑NA ❑NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection: —3—
�--
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[Z No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
X No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
H No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
!g No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
MNo
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
D NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
M No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
JA No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Yes
R7 No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
M,,No
❑ NA ❑ NE
Comments (refer to question f: 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).
1Y. doe�t is (AG)
I
Gar )w
1A40d ier % 01TO Ce vrr 17 ;.3 .
qRVaY w w f 6,4a.s L6601-/5A
AV
Cw-&e Wa p i •a 77A L 'P0-PWesQ ?-40-v e-,
Sc�r� NOV
0 Sec w ll-b of o n.c..
/ %Sl.+t %S WCsr IlC r4- �oc�,zt �CSrre+r� yT
Reviewer/Inspector Name: Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3 214112011

A
Type of Visit (2P ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: `Oa Departure Time: %D :chi County: _ Region: 1==Ra
Farm Name: Ark- ►y�- _ Owner Email:
Owner Name: A,L���"� c Phone:
Mailing Address: 6'
Physical Address:
Facility Contact: ZZ
,a- II ` C Title: Phone No:
Onsite Representative: S G_ Integrator: 2E2
Certified Operator: S Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [= O = i = u Longitude: = ° =1 = "
Design Cur-ent
Design
Gurrent
Design Current
Swine
Capacity PopWation
Wet Poultry Capacity
Population
.....
CattleMC-0-acity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
® Feeder to Finish
p qC>
Dairy Heifer
❑ Farrow to Wean
Dry -on
El❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ Turke Pouets
❑ Other
Number of Structures:
-
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[allo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Jallo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
KNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):�!
Observed Freeboard (in): 31
❑ Yes 9LNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes J,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 allo ❑ 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
0 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
U.No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[&No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑LApplication Outside of Area
12. Crop type(s) ,[3rrrrwrrf'r A""-X Yr� L(/`�r-�/� tT s ,�.�, .�/ =Z s.
13. Soil type(s) y.9
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
[9No
❑ 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
SNo
❑ 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
50 No
❑ NA ❑ NE
omments re er to nesaon. g lam an YES answers an or an recommendations or an
' gs of facility tabette ezpl4ani s�fuiatroas�(nse additional pages as necessary}�"k= y ptber comments.
Use drawm ...
/`v - /�r�L'u[ i.5 G[Jra/�� �Vt'+•�/`-r,Srr�`'y � /��..i�iti�i.Cf�� f1u'�bt `t"��C2I�'
�
11:J e u) 1U u P h v� eeh a("„e_ 77l S 1.1 Voovr reeo•w6.
� ./ Ilf r
Reviewer/Inspector Name Phone: W,9 l -Z33DO
Reviewer/Inspector Signature: Date: 4-12 %/ _=�//
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes F21 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. QWUP ❑ Checklists ❑ Design ❑ maps
p El other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes t@ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes &No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 5&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
[NNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ZNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PgNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
allo
❑ 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
ONo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
jKNo
❑ NA
❑ NE
dditiona! Comments and/or Drawings:
-7, Ok— r Qyrs N�
H,
Page 3 of 3 12128104

t
Type of Visit I§<o—mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: :(J D Departure Time: vr7 County: Region:
Farm Name: 2td2L a ei" Owner Email:
Owner Name:�� �- �� Phone:
Mailing Address:
Physical Address:
Facility Contact: n`f Title: f_� Phone No:
Onsite Representative: �4.�+-�• Integrator:re����
Certified Operator: 4__.'__ Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: 00 0 ` [�" Longitude: =o = a u
Design Current
Design
Curren t Design Cnrrent
Swine Cacopulation
apityP
Wet Ptry oulCac apity
Population Cattle Capacity Populafion
❑ Wean to Finish
❑ Layer
I
El Dairy Cow
❑ Dairy Calf
Wean to Feeder
1❑ Non -Layer
I
❑ Feeder to Finish
Dry Poultry
❑ La ers
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑Non -La Non -Layer
El Beef Feeder
El Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
❑ Turkey Poults
Other
❑ Other
ID Other
Number of Structures:
Discharees & 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 (3No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
MNo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: Date of Inspection— o
t Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P�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): 3 7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes UNo ❑ NA ❑ NE
Oe/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ElYes JR1 No ElNA ElNE
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 B No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? [:]Yes 3 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [.No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2.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 l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area /
12. Crop type(s) _ z'rH / rX . Jr-- A / 5 Li-t rr+t 77 /jn 'j C v — I O--
13. Soil type(s)
{
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
r�'�
�-lr0
[I NA
[I NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
(0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
( q ) y y 1
IU
omments refer to ueshon # Ez lain an YES answers and/or art recommendahnns or any other comments.
sedrawtn s of facili to better ex lain sttuandns. use addional a es asg y tY p ( R.IS_ _ sue)
neces _
Reviewer/Ins ector Name
P S .�✓L
" D.,
Phone:
/D—y33— 33 00
Reviewer/Inspector Signature:
Date:
(a —4-;' ` / O
Page 2 of 3 11611601vk LUIlL�Il�[C(I

Facility Number: — Date of Inspection
i Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑.No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Ca -No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [ANo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soi] Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ MonthIy and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ®.No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes XNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
®,No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
allo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
9jNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
®No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
&[No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo
❑ NA
❑ NE
Additional Comments and/or'Drawtngs �'' 4,WAl-
Page 3 of 3 12128104

I<3-TP_"'5 /o -o q - Z. o9
G115-i'sion of Water Quality
Facility Number O Division of Soil and Water Conservation
Q Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 7 Z 9 _ Arrival Time: •�Z D Departure Time: County: 49Ad'._1a
Farm Name: _ 1 N ��'.-tjE x;-AA 5: %y5 Owner Email:
Owner Name: 1S5dr S;Afgle.-1--Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: -1 SSA :gNA l Title: 119011eA_ Phone No:
Onsite Representative: Ssa" S�S�� `"7 Integrator: A4<0lf�r 6r�717.�
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = ' =16 Longitude: 0 ° = I 0
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 Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
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?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
Cattle
Design Current.
Capacity. ".Population _ ,
❑ Dai Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: '
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ' vo ❑ NA ❑ NE
❑ Yes
❑ No
LTivA
❑ NE
❑ Yes
❑ No
0'<A-
❑ NE
❑ Yes
❑ No
B A
❑ NE
❑ Yes
31q-o
❑ NA
❑ NE
❑ Yes
e<o
❑ NA
❑ NE
12128104
Continued

Facility Number: p -- /g3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes oNA ❑ NE
a. If yes, is waste level into the structural freeboard? El Yes;0//0[Ej NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ZA'r I
Spillway?: WO
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ NA ❑ NE
❑ Yes No
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 9<�E] 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 B o ❑ NA ❑ NE
&. 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 ElYes Dlro ❑ 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 EJNo ❑ NA ❑ NE
❑ Excessive Ponding [I Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑DEvidence of Wind Drift El Application
/Outside of Area
12. Crop type(s) 00VA1 Gtl t ~� O «..rS 1 F�-s'Cze I.—
13_ Soil type(s) / 41AIS
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
um-, NA
❑ NE
oOE NA
❑NE
L1'No LI NA
❑ NE
NA
❑ NE
V[ED3NA
El 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):
R.,Qw�4s ad*f 9/0.308, 685/
Reviewer/Inspector Name Phone: 4j�• �33. 33 3
Reviewer/Inspector Signature: Date: 7-2'r Zd2q
it1Z&U4 Conunuea

Facility Number: Qq- Date of Inspection 7-zy-09
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 appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes 2 o ❑ NA ❑ NE
❑ Yes LSNo ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste
Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain
Inspections ❑ Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain minbreakers on irrigation equipment?
❑ Yes
ff"No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes
B No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
E�J<
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
LTN
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
L''J 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
El, o
❑ 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
L'1"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
ElYes
a<0
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El�,
Yes
�
[ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
x ri7a"'JF" G # F 'k°".�y-,:F a� is ':.+�'+, 4�
Addrhonal CommenPand/orDrawmgs ;g
I Z128104

d,
❑ Wean to Finish
Wean to Feeder 13 0 y
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other _ - ----
)ivision of Water Quality
Facility Number `} 0 Division of Soil and Water Conservation s/ '
3 Q Other Agency 1 _.3 t -0')-7
Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ";utine 0 Compllaint O Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: `- Departure Time: j County: C+� Region: �Z
Farm Name: ,/� 14- A Fa� - _ Owner Email:
OwnerName: �/ lid/" Phone:
Mailing Address:
Physical Address:
Facility Contact: O Title: Phone No:
Onsite Representative: el Integrator: 1�r�3i""1�
Certified Operator: �S�x.+'-.� _ Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: [_-1 o = = Longitude: 0 o =
Design Current . Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ 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
—
El Beef Stockez
❑ Beef Feeder
❑ Beef Brood Cowl
-
Number of Structures: F
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
No
❑ NA
❑ NE
❑ Yes
10 No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes R,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): r -
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes QNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes N No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ayes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes BNo ❑ 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 J?jNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ®,NO ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application'? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window l❑ Evidence of Wind Drift ❑ Application Outside of Area /f
12. Crop type(s) n `.5�� /��/m%dC f _�iu�/S�'d_ ! �/�rr/�`S!</!7/!'��5.
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
0 Yes
W-4 o
�❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ESNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
.0 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
8No
❑ 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):
f
�/-AVs,J, 0���0�gam/- j J/
1
T!
Reviewer/Inspector Name S Phone:
Reviewer/Inspector Signature: Date: �3- .3v -,--7yo
V ® 12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ENo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No. ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. A'Yes! O.No ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
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
�R No
❑ NA
❑ NE
❑ Yes
5d No
❑ NA
❑ NE
El Yes
®No
El NA
El NE
❑ Yes
JO No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes FZ No ❑ NA ❑ NE
❑ Yes ESNo ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes EUNo ❑ NA ❑ NE
❑ Yes
R No
❑ NA
❑ NE
❑ Yes
X,No
❑ NA
❑ NE
Page 3 of 3 12128104

ivision.of Water Quality
f 3 � �4
Facility Number 0 Division of Soil and Water Conservation
OOther Agency i - "
Type of Visit erCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: J D ` Arrival Time: 0,, t7 Departure Time: ,� �/ County: lmR _ — egionE
Farm Name: i'` (f' ZrrY,.- Owner Email:
Owner Name: 1q_i� b �;r� G dz=2 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: 1_5zzl�_ Integrator:�r
Certified Operator: -tea '`-L- Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [_—]' =' = Longitude: = e = I =
11
.,
Design CurrenE
DestgnT :..Current
Design* r' Cur ent
-_Swine T'
Capaci#} :Population
V� et Poultr? Capacity Population
a
Cattle Capacih Po� pulatton
r.
❑ Wean to Finish
0
El Feeder to Finish
El Farrow to Wean
❑ Farrow to Finish
❑ Boars
Discharges & Stream Impacts
❑ La ers
El
❑ Pullets
❑ -furke s
❑ Turkey Poutts
❑ Other
1. is any discharge observed from any part of the operation�. `? ❑Yes No ❑ ElNA NE
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made`? Yes ❑ No El NA [I NE
b. Did the discharge reach waters of the State? ([f yes, notify DWQ) ❑Yes ❑ No ❑ NA El NE
c. What is the estimated volume that reached waters of the State {gallons)?
d. Does discharge bypass the waste management system? (lf yes, notify DWQ) ❑Yes ❑ No ❑ NA ❑ NE
?. Is there evidence of past discharge from any pan of the operation'? El Yes �No El NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes �Vo ❑ NA ❑ NE
other than from a discharge`?
Page I of 3 12/28/04 Continued
Discharges & Stream Impacts
❑ La ers
El
❑ Pullets
❑ -furke s
❑ Turkey Poutts
❑ Other
1. is any discharge observed from any part of the operation�. `? ❑Yes No ❑ ElNA NE
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made`? Yes ❑ No El NA [I NE
b. Did the discharge reach waters of the State? ([f yes, notify DWQ) ❑Yes ❑ No ❑ NA El NE
c. What is the estimated volume that reached waters of the State {gallons)?
d. Does discharge bypass the waste management system? (lf yes, notify DWQ) ❑Yes ❑ No ❑ NA ❑ NE
?. Is there evidence of past discharge from any pan of the operation'? El Yes �No El NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes �Vo ❑ NA ❑ NE
other than from a discharge`?
Page I of 3 12/28/04 Continued
1. is any discharge observed from any part of the operation�. `? ❑Yes No ❑ ElNA NE
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made`? Yes ❑ No El NA [I NE
b. Did the discharge reach waters of the State? ([f yes, notify DWQ) ❑Yes ❑ No ❑ NA El NE
c. What is the estimated volume that reached waters of the State {gallons)?
d. Does discharge bypass the waste management system? (lf yes, notify DWQ) ❑Yes ❑ No ❑ NA ❑ NE
?. Is there evidence of past discharge from any pan of the operation'? El Yes �No El NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes �Vo ❑ NA ❑ NE
other than from a discharge`?
Page I of 3 12/28/04 Continued

Facility Number: — Date of Inspection —l7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
EB�Vo
❑ 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
LgNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
WNo
❑ 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
t4 No
❑ 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
I.No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks. or compliance alternatives that need
❑ Yes
El No
❑ NA
❑ NE
maintenance/improvement?
1 I . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes R No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift El Application Outside of Area
12. Crop type(s)!
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWM P? ❑ Yes .!.No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
RNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
KNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
9[No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
J�lNo
❑ NA
❑ NE
IComments (refer to question # ): Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name S�r�� Phone: `Y%/O -- 330 O
Reviewer/Inspector Signature: Date: - /i?' I�a�a�
1 �/lit/fl.f l�nnliH lfOl�

l
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes W—No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Ug No ❑ NA ❑ NE
the appropirate box. ❑ W UP ❑ Checklists ❑ Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 29 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes fE�No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RLNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
JRNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
KNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
B-No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Wo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
RNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
19LNo
❑ 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
jo No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
f4 No
❑ NA
❑ NE
Additional Comments and/or Drawinns:
12128104

Type of Visit Com
��pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 6utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access JI
Date of Visit: �Arrival Time: T Departure Time: County:
Farm Name: G II_A. FQ'l�- _ Owner Email:
Owner Name: A �D zY� C O Phone: _
Mailing Address:
Physical Address:
Facility Contact: r� ✓/ Title: Phone No:
Onsite Representative: Vie— Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Region: LPL
Latitude: 0 c = ' = u Longitude: [::] o =
Design Current
Design
,Current
Design Current
Swine
Capacity Population
Wet Poultry
Capac ty
Population
Gartle Capacity Population
❑ DairyCow
❑ Dairy Calf
❑ Wean to Finish
Layer
Wean to Feeder
D
LEE] Non -Layer
❑ Feeder to Finish
Dr Poultry
3_
i L
❑ Dairy Heifer
El Dry Cow
❑ Farrow to Wean
El Farrow to Feeder
❑ La ers
ElNon-Dairy
❑ Beef Stocker
❑ Farrow to Finish
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Beef Brood Cowl
El Boars Boars
❑ Pullets
❑ Turke s
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures: /r
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Q? No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
P&No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
J&No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: Date of Inspection
i
Waste Collection & Treatment
1 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): JD
5. Are there any immediate threats to the integrity of any of the structures observed? El NA ❑ NE
❑ Yes No
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes XLNo ❑ 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 N No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. 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 EN No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes JS 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) ,Z /'I;PWJt 1,e '2_ 4 _e-
13. Soil type(s)
1
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
to No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
M No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑
Yes
IM No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ONo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
1KNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to bette,- explain situations. (use additional pages as necessary):
Reviewer/InspectorName -. Phone: �3D
Reviewer/Inspector Signature: Date: a
1 Z1Z51U4 uonanuea

Facility Number: — Date of Inspection "D
t
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ff No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes PlNO ❑ NA ❑ NE
the appropirate box. ❑ wuP ❑ Checklists ❑ Desig
n ❑ Maps
p ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JS No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes JZ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain minbreakers on irrigation equipment? ❑ Yes J4 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EffNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
XNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[a No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
®, No
❑ NA
❑ NE
Otherlssues
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
E9 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
0 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
JZ 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
EINo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
JR No
❑ NA
❑ NE
Comments and/or Drawings:
12/291W

sion of Water Quality
Faeility Number O Division of Soil and Water Conservation
Other Agency
Type of Visit �mpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 09r1routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Q Arrival Time: ; D Departure Time: ' i7i7 County: Region: LPL
Farm Name: d ol- A Owner Email:
Owner Name: tfLAelt- c- i73� r Phone:
Mailing Address:
Physical Address:
Facility Contact: 23 Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Current
❑ Wean to Finish
Wean to Feeder
o Yo
13799
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
- ❑ Other ---- - v
0
Latitude:
Phone No:
Integrator: >�lt'5���
Operator Certification Number:
Back-up Certification Number:
= u Longitude: 0 ° 0 1 = "
Design Current
Wet Poultry ?C " Po`�.alation
P .:,�' p .
❑ La er
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream tm acts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry 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?
Page I of 3
❑ Yes Q No ❑ NA ❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
[RNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
allo
❑ Yes
ANo
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
12128104 Continued

r Facility Number: Date of Inspection r/ B
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWW readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ RainfaIl ❑ 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
CR No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
5.No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
K$ o
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
C9 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[3 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
CgNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P.No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
RNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
R No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
j$No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
5Q No
❑ NA
❑ NE
Ad6fldnal'Comments an'dVor Drawings:
a
Page 3 of 3 12128104

�1 Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [9 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ER No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 31 f
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 allo ❑ 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 0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 2 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 'R No ❑ NA ❑ NE
maintenance/improvement?
U . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes N No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu. Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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) v 45�,f r.- ef!&3ffiMX Bd '
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
V9 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
IT 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
CKNo
❑ NA
❑ NE
Comments (refer to question, #):.Explain any YES answers and/or any recommendations or anyotherscomments
Use'drawings of facility, to better explain situations. (use additional page`s asinecessary):
�t8rr 4CT`ern d 144r, [i8u7
Reviewer/Inspector Name I I Phone: M —+
Reviewer/Inspector Signature: Date: B
Yage L of -i I L1-ILNI/4 t.onanuea

Type of Visit 6 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: p Departure Time: ,' County: +o Region: Fla
Farm Name: _ A e_,—— af v Owner Email:
Owner Name: ' 1 r_ �� ecz "t'tlf Phone:/ate 7
Mailing Address: to Df� /� G a I l7 _ yX 9z:5 "7,— _ /xi e e -�
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:.
Back-up Operator:
Title:
Phone No:
Integrator: ,,-rAZ�_ _
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: F—] o = g = Longitude: = o 0. =
is
Design Current
,
Design A„ Current
Design Current
Swine
Capacity Poptlation
Wet Poultr} Capiicity Population
Cattle ,. Capacity Population
Wean to Finish
❑ ❑ La er
D ❑Non -La et
Discharges
&Stream Impacts
1. Is any discharge observed from any part of the operation?
&Stream Impacts
1. Is any discharge observed from any part of the operation?
❑Yes
9 Na
❑ NA
❑ NE
Discharge originated at: El Structure ❑Application Field El Other
a. Was the conveyance man-made?
❑Yes
KNo
❑ NA
❑ NE
h. Did the discharge reach waters of the State? (If yes, notify DWQ)
El 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
KNo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
� No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑Yes
PQ No
❑ NA
❑ NE
other than from a discharge?
11/18/04
Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [d No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
;,No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
ER No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
R NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
to No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
IX No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [9No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
19 No
❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
19 No
❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
P No
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
JZ No
❑ NA ❑ NE
Ad`dttto i.AIZ6 men'ts aizdfor Draw ngs:
12128/04

. .
Facility Number: —
Date of Inspection O" I -`a
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
Identifier:
Structure 2 Structure 3 Structure 4
❑ Yes RNo ❑ NA ❑ NE
❑ Yes VZNo ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): 49
7
Observed Freeboard (in): ,�—
5. Are there any immediate threats to the integrity of any of the structures observed? NA NE
(ie/ large trees, severe erosion, seepage, etc.) El Yes �No El NA
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes f4 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 ZLNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes WNo ❑ 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 El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes nA No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [Z No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)�t/`/�9u�Q
13. Soil type(s) A vZ Cc
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Cayes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination]
Yes
"No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[@ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ZNo
❑ NA
❑ NE
cL� fCrGp Work t PL. 491i's uverol % •�. s�,r �rldf
1.3 lL67' I 1�J71J9W�'` �[ �T G
,S4�y���
T%Yyr ,c
Reviewer/Inspector Namey�� ('.0 x t; < Phone:
Reviewer/Inspector Signature:
Date: /7 -
l2/2aVY4 C.onanueu

rz_
of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
on for Visit • Routine O Complaint O Follow up Q Emergency Notification O Other 0 Denied Access
Facility Nwnber $
Date of Visit: Tune:
rO NotOperational Q Below Threshold
13 Permitted 0 Certified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold: -.
Farm Name: __ _ .� I A :E—a-r►VtS _ County: _._._ 021, �.....
Owner Name:. ----- A.k -- , — — S ei , . 'Phone No: r` ..
Mailing Address: _- <v S NG _ ear lD If"lo . s� Qirf� ll s N �' �iB�Y
Facility Contact: - �ftt----- -i Title: Phone No:
Onsite Representative: Integrator: P
Certified Operator: Operator Certification Number:
Location of Farm:
%Wne © Poultry 0 Cattle ❑ horse Latitude • u Longitude • 4 Uu
Swine
I-Popiffidion,,
19 Wean to Feeder
30 4b
7— S
Layer
Feeder to Finish
Non -Layer
Farrow to Wean
Other
Farrow to Feeder'
Farrow to Finish
TOtBY-�
_ 7
Guts
Boars
P d arees & Stream bnvacis
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?
�, ClII7['!nt
� Catty 30 �( O
OiW'SM_.
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
❑ Yes XtNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
Uio
❑ Yes
J& No
❑ Yes
JKLNo
Structure 6
Freeboard (inches):
12112103 Continued

Facility Number: — Date of Inspection lt1
5_•'Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes IR�INo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ,!gNo
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
B. Does any part of the waste management system other than waste structures require maintenanceJimprovement? ❑ Yes KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes RNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenanoelimprovement? ❑ Yes j$No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes I$ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type Fex,Gtn*. sV•►ti.,vT-a-yw � (.uJ7r��t�a �.mt .�DGrmu�C�-QtztL _ sA..gM1k"
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes J&No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes Wo
b) Does the facility need a wettable acre determination? ❑ Yes JR No
c) This facility is pended for a wettable acre determination? ❑ Yes X[No
15. Does the receiving crop need improvement? ❑ Yes KNo
16. Is there a lack of adequate waste application equipment? ❑ Yes KNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atJor 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 %No
19. Is there any evidence of wind drift during land application? (i.e_ residue on neighboring vegetation, asphalt, ❑ Yes MNo
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 KNo
Air Quality representative immediately.
❑ Final Notes
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Y9/I'1/A?

Facility Number: — Date of Inspection �n
R aired 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?
(ieJ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ waste Applicatiot'❑ Freeboaztvob waste Analysiel❑ 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 reviewimspection 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 AWMP7
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (if no, slip 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?
3C 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 Form ❑ Crop Yield Form ❑ RaintH.l!' ❑ Inspection After 1" Rain
❑ 120 Minute inspections ❑ Annual Certification Form
❑ Yes KNo
❑ Yes JkNo
❑ Yes J&No
❑ Yes JkNo
❑ Yes H No
❑ Yes ELNo
❑ Yes [&No
❑ Yes RNo
❑ Yes RNo
❑ Yes Ed�No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
113 No violations or deficiencies were noted during this visit You will reeve no further correspondence about this visit I
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12112103

b ` ` [ DSWC Animal¢Feedlot OperationMRevlew -
,r � ..�' q �. �� �' �^� C'e', �,. `moo, `*•F 10s�4 e�,�sw'ka°�.`a'a`3
. ®DWQ An>lmal Feedlot Operation Site non « f;
<.'+,n,J`
x ex< „ �, � << t�-!+ a•--.4 •fA a� � ^':��sx��:€fix z t�'�'�`�et xa, �,`�,es
a Routine O Complaint O Follow-up of DW2 inspection Q Follow-up of DSWC review O Other
Facility Number
Date of Inspection
�
Time of Inspection 'dam 24 hr. (bb:mm)
Total Time (in fraction of hours �
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:
Farm Name:.L�/,,
Land Owner Name:._ t... -j:5_.--•. .... ........ .._.......
Facility Conctaet: 1 .... Title:
Mailing Address: __ 9157 141 <f— 11.2f0
County: ------ _ ..._ .... r.
Phone No: %a� L5U-7
.. ». _ Phone Noc. L%--Ss—� y�7y
OIIsite Representative: .-_..... _ Integrator: f.G�.. ._ _....
Certified Operator: 1�I.1 ...... ---- _ .... _ .. » , Operator Certification Number:..
Location of Farm: lell—I 0,"- to
4
Latitude • 4 " Longitude • 6 �u
Type of Operation and Design Capacity
x�, �ss.x� ya+ rcA� : �� •. us =. ♦;�4�x s..w„r.
i � DC5Ign C<lrr_eIIt,� -D CIICrent l7eSlgn �CUiieitt
Swine pn : t
n %z. r ri �aCa aC! ,q PO ulati4n �, Pon �� Ca aCl aPO x latlon � �t e - a� C$ aci Po tllati 6—
Wean to Feeder o 6 r❑ La FE]
Feeder to Finish E Non a er Non -Da
Farrow to Wean
Farrow to Feeder ' > TotalDestgn Capacity z �r k 4
Farrow to Finish n Fi
.. . 'Total 00 A �.
1 ❑ Other �a
esw
Nam6er OVEagoons~f Holding Ponds / ❑ Subsurface Drains Present v
H
t f * La Are Fie Area 3 . goon a ❑Spray !d
� ❑ y�4�
General
I. Are there any buffers that need maintenance/improvement?
❑ Yes XNo
2. Is any discharge observed from any part of the operation?
❑ Yes allo
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes WNo
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 ANo
3. Is there evidence of past discharge from any part of the operation?
❑ Yes l`"� o
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes gNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes No
4/30/97 maintenance/improvement?
Continued on back

r
" l;acility Number.. _
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes KNo
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 �rNo
St tores (Lagogns and/or Ifolding. Pon
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes No
Freeboard (ft): Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
10. Is seepage observed from any of the structures? ❑ Yes <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? AIYes ❑No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes KO
Waste Application
14. Is there physical evidence of over application? ❑ Yes )<No
(If in excess of WMP or runoff enteriwaters of the State, notify DWQ)
15_ Crop type _ ..... ........_ ....__.... ... _ ._ .... _ —._... ....
16. Do *the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes o
IT Does the facility have a lack of adequate acreage for land application? ❑ Yes No
18. Does the receiving crop need improvement? ❑ Yes '5No
19. Is there a lack of available waste application equipment? P'Yes ❑ No
20. Does facility require a follow-up visit by same agency? ❑ Yes No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
For Certified Facilities Qnly
22. Does the facility fail to have a copy of the Animal Waste Management PIan readily available? ❑ Yes 'XNo
23. Were any additional problems noted which cause noncompliance of the Certified AWMP? [I Yes /)KNo
24. Does record keeping need improvement? ❑ Yes No
Coininents {refer ta'queshon ##):" plain any. answers and/or.any recomni endattons or any other cortunents r
[Jse:drawings4affacihi , to better- explain sitiiattons`:(use additional pages'as necessary} f r " "
�.,.. n r : y, d.
Y/ Xl ma.,. ds ('i�n�.0 �o�o�).,..wi//•ter f� Cou.�,� �,�sf ,�v
^'rV
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
cc. Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97