090216_INSPECTIONS_20171231

sem__ :� ���i•�
Ivisidii of Watcr Resources x ,�, Yijjf ``{E' lir{.'!'i ,t'
s 9 i r .' �. ! , f,,! i s` kf1 AFI! 1 Ifl 1 Eji ! fll I Y +1 p�l Y'j�11i
ty I I '" ' iL',flA�rl�' if Ily I Y I l l �l'j �f
Division of S Y „ ! YIN..
�.
Facility Nu oil and Water Conservation
Number
t�'Other Agency, '.. , , y , ,:,,.P,,; ..
Fype of Visit: ompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit; ArrivalTime: Departure Time;County: ,-r` Region:
Farm Name: Owner Email:
Owner Name: Picone:
Mailing Address:
Physical Address: /
Facility Contact: /YJ3 ��..r�! ���ii/��a�. Title: /I Phone:
Onsite Representative: Integrator:
Certified Operator: -; m� Certification Number:
Back-up Operator:
Location of Farm:
• pDesign, 'C
3
Swine Cupucity
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Latitude:
3 U f„;� ,
rent 31 , S hl 1 A' "I
Wet F
n I aver
Certification Number:
INon-Layer I I L
Design Current
Dry Poultry ,+ ,> Capuclty.I
Non-U
Pullets
Turkeys
Other 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)?
Longitude:
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dain
Beef Stocker
Beef Feeder
�•' Beef Brood Cow
�'< u�ll V� �I•lil, t, �i " ,, r��'•rl���
1�
❑ Yes V2 -Ado [] 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 Pg -No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes �No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2015 Continued

Facili Number: 113ate of Inspection:
Waste Collection & Treatment
'• 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ;R.No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): A Z7
Observed Freeboard (in): i Z;2__
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Structure 5 Structure 6
❑ Yes 0 No ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes [3.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 E[ No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [&No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes F;:�No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes jR,,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): 3f/—jL
& _e '_J2 ?rY
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes C, No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes RNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [ 5�-No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑.No ❑ NA ONE
❑ Yes allo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes allo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 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 J�jj 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 [�S No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes KNo
❑NA []NE
❑ Weather Code
❑ Sludge Survey
❑NA E] NE
❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continuer!

Facifi Number: - Date of lns ectian: r !
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes � No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ®.No ❑ NA ❑ NI,
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes MNo E]NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes Z[ No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes E[ 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
JE 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
allo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E�,No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
„Eg_No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
jigbo
[] NA
❑ NE
Ctimmegts (rerer toque§tion'#):,'Explain any YES answcrsai,nd/oc a'ny additional-recomtnendatinns orI-any other,,'cpmittents
„ .;
[Jse drawin of facili ' W bietter'ex -lain`�situations (u§e'adi.ditionul' ii es, as accessary)
Reviewer/Inspector Name-
Reviewer/Inspector Signatut
Page 3 of 3
Phone: r(7—D/,s`�
Date:-if/�'afl/fes
2/4/20!5

.'1'`(_ - ^ /l L- —;2
�► C"ivision of Water Resources
Facility Number ®- ` j 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit:ompli ce Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ;pp Departure Time: ' a County:;C.11-rr z-•-� Region:
Farm Name: :1—j— n1t rniY Owner Email:
Owner Name: 114r ja � 5_Z,-_'naPhone:
Mailing Address:
Physical Address:
Facility Contact: 114) a4- ?/j{d--- Title: ��wsp %�� Phone:
Onsite Representative: Integrator:
Certified Operator: S<21-1�� Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feede
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -Layer
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
jTurkey 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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dai Weiler
Dry Cow
Non-Dair
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes MNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes No
❑ Yes�No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Fincili Number: -4 Date of Inspection:
C�_No
❑ NA
❑ NE
❑ Yes
Waste Collection & Treatment
❑ NA
❑ NE
❑ Yes
CgNo
4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
0 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): /2
Observed Freeboard (in): Lq D
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2[ No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
FZ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
�No
0 NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit'?
❑ Yes
MNo
❑ 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
fallo
[] NA
❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E�LNo
❑ NA
❑ NE
maintenance or improvement'?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 5 NNo ❑ 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): rFn.�s�►o� �Qv j-��x—„�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
C�_No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
CgNo
❑ NA
❑ NE
❑ Yes ®,No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes [gNo ❑ NA ❑ NE
❑ Yes Ea No ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements [:1 Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
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?
❑ Yes [7No
❑ Yes r% -No
❑NA 0 N
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued
0

Facili Number: - Ds ection:
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 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 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 the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E;; No
❑ NA
❑ NE
❑ Yes
®-No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
[:]NE
❑ Yes Q_No ❑ NA ❑ NE
❑ Yes �LNo ❑ NA ❑ NE
❑ Yes f jNo 0 NA ❑ NE
❑ Yes C=No
❑ Yes allo
❑ Yes �AIo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments{refer to question£#) Expliiin any, YES answers and/or any°additional recommendation's or any other comments.
Use'tlrawtn�s,5of,facillty,;to'faetter explain situations (use uilditlonal pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone: 914—jay/, 3 7
Date:
2/4/2015

�rLv
Division of Water Resources
Facility Number - ® 0 Division of Soil and Water Conservation
Other Agency
Type of Visit: O`Compli ce Inspection V Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: "'tine O Complaint O Follow_ -up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: O : OO Departure Time: /r County: Region: %
Farm Name: f �-' /i�J � lrn6 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: _ �jpr Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number: f K3g:z
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er I I --d
b" I(I INon-Layer
ury rounry
Layers
Non -Layers
Pullets
Turks
Turkey Poults
Other
Design Current.
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Daig Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes CB No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
6g -No
[] NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
RNo
❑ NA
[] NE
of the State other than from a discharge?
Page 1 of 3 2/4/2014 Continued

Facility Number: C111 - / 1 Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E[No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [DNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes IM No E] NA E] NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
Q No
❑ NA
[] NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an Immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
M[No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Callo
❑ 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
RNo
C] NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Eg No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload [] Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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):/ fTJN�iz v r'/ �y f
13. Soil Type(s): C=Z % "M PX
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E�,No [DNA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 2 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Callo ❑ 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 Z, No ❑ NA ❑ NE
❑ Yes 21No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [] Yes 2[No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes R[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 JS� 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 2/4/2014 Continued

_
Facili Number: - Date of Ins ection:6
24. Did the facility fail to calibrate waste application equipment as required by the permit?
aYes
rm-fo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
®..No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
25. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus toss assessments (PLAT) certification?
❑ Yes
M -No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ 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
allo ❑ 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
[ 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
® No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
allo ❑ NA ❑ NE
Comments (refer to question #,): Explain -an' YES answers.'ancilar any additional:"recommendations or any other comments �;g � '_'
Use drawings of facilitZ to better ex lain; situations--`(usaditionalas ;isecessar
__/ cl`%6
el
C ✓
Q/rte �Ag ow.
�o
r'c ,� "�_���
�m- was��r •� ��rm t
uL�0 s
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:�b
Date: /S— /.6
2/4/2014

�9016,oco9,7 Nva —,-zo/G--FC lye.
PLAN OF ACTION (PoA) FOR HIGH FREEBOARD AT ANIMAL FACILITIES
Facility Number: - County: 31Ad c W1
Facility Name:_
Certified Operator Name: �'� kpe ri, K Operator # / S' 3 S 9
1. Current liquid level(s) in inches as measured from the current liquid level in the lagoon to the
lowest point on the top of the dam for lagoons without spillways; and from the current liquid level
in the lagoon to the bottom of the spillway for lagoons with spillways.
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Lagoon Name/Identifier (ID): /
Spillway (Yes or No): ND
Level (inches): 26
2. Check all applicable items
Liquid level is within the designed structural freeboard elevations of one or more structures. Five
and 30 day Plans of Action are attached. Hydraulic and agronomic balances are within
acceptable ranges.
Liquid level is within the 25 year 24 hour storm elevations for one or more structures. A 30 day
Plan of Action is attached. Agronomic balance is within acceptable range.
Waste is to be pumped and hauled to off site locations. Volume and PAN content of waste to
pumped and hauled is reflected in section III tables. Included within this plan is a list of the
proposed sites with related facility number(s), number acres and receiving crop information.
Contact and secure approval from the Division of Water Resources Prior_ to transfer of
waste to a site not covered In the facility's certified animal waste management plan.
Operation will be partially or fully depopulated.
- attach a complete schedule with corresponding animal units and dates for depopulation
- if animals are to be moved to another permitted facility, provide facility number, lagoon
freeboard levels and herd population for the receiving facility
3. Earliest possible date to begin land application of waste: +eL IYO Zol&
hereby certify that I have reviewed the Information listed above and Included within the attached Plan
of Action, and to the best of my knowledge and ability, the information is accurate and correct.
I'ic.AaC G Ln^ah Phone: q1L�- '4$�!'i"
Facility Owner/Manager (print)
Facility Owner/Manager (signature)
Dnd f`na•nraor.n �r�irnn
Date:

PLAN OF ACTION (PoA) FOR HIGH FREEBOARD AT ANIMAL FACILITIES
THIRTY (30) DAY DRAW DOWN PERIOD
I. TOTAL PAN TO BE LAND APPLIED PER WASTE STRUCTURE
1. Structure Name/Identifier (ID): Laq owl
2. Current liquid volume in 25 yr./24 hr. storm storage & structural freeboard
a. current liquid level according to marker
b. designed 25 yr./24 hr. storm & structural freeboard
c. line b - line a (inches in red zone) =
d. top of dike surface area according to design
(area at below structural freeboard elevation)
e. line c x line d x 7.48alq Ions -
12 ft3
IQ& inches
,9 7 inches
inches
J01 071 ft2
3KI40 gallons
3. Projected volume of waste liquid produced during draw down period
f. temporary storage period according to structural design TO days
g. volume of waste produced according to structural design g68'8g ft3
h. actual waste produced = current herd # x line g ft3
certified herd #
6yoo
volume of wash water according to structural design 309`7 ft3
excess rainfall over evaporation according to design 396 SS ft3
k. (lines h + i +i) x 7.48 x 30_ days = gallons
line f
4. Total PAN to be land applied during draw down period
I. current waste analysis dated 2 al �_ 69 Ib/1000 gal.
m. (lines e + k) x line I = I97, Ib PAN
1000
REPEAT SECTION 1 FOR EACH WASTE STRUCTURE ON SITE
II. TOTAL POUNDS OF PAN STORED WITHIN STRUCTURAL FREEBOARD AND/OR 25 YRJ24
HR. STORM STORAGE ELEVATIONS IN ALL WASTE STRUCTURES FOR FACILITY
Po%A ren na„i iminn
I

J
1.
structure ID:
line m = X91,2- Ib PAN
2.
structure ID:
line m = Ib PAN
3.
structure ID:
line m = Ib PAN
4.
structure ID:
line m = Ib PAN
5.
structure ID:
line m = Ib PAN
6.
structure ID:
line rn = Ib PAN
n.
lines 1 +2+3+4+5+6 =
1g9, Z Ib PAN
III. TOTAL PAN BALANCE REMAINING FOR AVAILABLE CROPS DURING 30 DAYDRAW DOWN
PERIOD.
DO NOT LIST FIELDS TO WHICH PAN CAN
NOT BE APPLIES DURING THIS 30 DAY PERIOD.
o. tract #
p. field # q. crop
r. acres
s. remaining
IRR -2 PAN
balance
(lb/acre)
t. TOTAL PAN
BALANCE
FOR FIELD
(lbs.)
column r x s
u.
application
window'
13
3,S
SO -f
2�5, 83
11
3
y,3
5-q, 75
Z ;5
'State current crop ending application date or next crop application beginning date for available receiving
crops during 30 day drawn down period
v. Total PAN available for all fields (sum of column Q _ ��� $ • 3O Ib. PAN
IV. FACILITY'S PoA OVERALL PAN BALANCE
pnA fon n4mv1 9194tnn 7

I:)
w. Total PAN to be land applied (line n from section 11) = 197,-) Ib. PAN
x. Crop's remaining PAN balance (line v from section 111) = 5—IM 3 O Ib. PAN
y. Overall PAN balance (w - x) = — S51 '10 Ib. PAN
Line y must show as a deficit. If line y does not show as a deficit, list course of action here
Including pump and haul, depopulation, herd reduction, etc. For pump & haul and herd
reduction options, recalculate new PAN based on new Information. if new fields are to be
Included as an option for lowering lagoon level, add these fields to the PAN balance table and
recalculate the overall PAN balance. If animal waste is to be hauled to another permitted
facility provide Information regarding the herd population and lagoon freeboard levels at the
receiving facility.
NARRATIVE:
1R, A --1D 4 C [ e-, AA,�6 it jo 14,,w , 4,"J 4. S a ,
o., a van ns,.i 2j m inn
q

Type of Visit: eTompliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance I
Reason for Visit: Qrttoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: -- Arrival Time: D -;3Z Departure Time: i 3 u County: JI.7>1 IV/,-, Region:
Farm Name: �— �V1L �a✓�_ _ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Phone:
Onsite Representative: Integrator:
Certified Operator: /i i [�il3 Y I rj-j�-�- - Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
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 ELNo ❑ NA ❑ NE
❑ Yes [:]No
[:]Yes ❑No
[:]Yes ❑No
❑ Yes [a No
❑ Yes 12 -No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Page I of 3 2/4/2014 Continued
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capaclty Pop.
Wean to Finish
Layer
airy Cow
Wean to Feeder
Non -La er
I
ai Calf
Feeder to Finish
airy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
IIrF P,oultr.,
@a acl
P.o P.
Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[]Yes ELNo ❑ NA ❑ NE
❑ Yes [:]No
[:]Yes ❑No
[:]Yes ❑No
❑ Yes [a No
❑ Yes 12 -No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Page I of 3 2/4/2014 Continued

4
Facili Number: -JL jDate of Inspection: '3--
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [,FNo ❑ 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): p�7
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? Yes C4 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes ® No [:]NA CD NE
waste management or closure plan? `4
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 4 No ❑ NA ❑ NE
maintenance or improvement?
Waste Auplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes '2�No [DNA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes I 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): zl e' 1 rrf 4-r.r� le'-Olek
i
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
K�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
& No
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Jallo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
J4 No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists []Design ❑ Maps ❑ Lease Agreements []Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes _&�No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections []Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes allo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 5a No ❑ NA ❑ NE
Page 2 of 3 2/412011 Continued

IFacility Number: -21 Date of Inspection: -_7.7
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes rANo ❑ 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
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
CaYo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
E&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
�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
[a No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
MNo
[:]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 YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:!f✓" $3" -' _D
Date: 3 ": ev
214/2011

vlsion of Water Quality �-
Facility Number - 0 Division of Sol] and Water Conservation a s;Z6
0 Other Agency
Type of Visit: pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
[lesson for Visit: 0 -routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: D Departure Time: , a County: Region:"-✓ —1)
Farm Name: /\ i1'1 F:fa,1a44s _ Owner Email:
Owner Name: j77 ; r1a�a l f� :]V- YtWdM4A Phone:
Mailing Address:
Physical Address:
Facility Contact: Q f
Title: eg�e� p, r ✓ Phone:
s�
Onsite Representative:
Certified Operator: %j? fJ,y,%
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Integrator:�,�
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
I E] U Layer
Non -La er
ury routtry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
D Cow
Non -Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes Wo ❑ NA ❑ NE
[:]Yes ❑No
[-]Yes ❑No
❑ Yes ❑ No
❑ Yes E. No
❑ Yes Co No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 2/412011 Continued

Facili Number: Date of Inspection:
Waste Collection & Treatment
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): 42 Z _
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.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
�,No ❑ NA ❑ NE
0 N 0 N ❑NE
Structure 6
❑ Yes ®. No ❑ NA ❑ NE
❑ Yes r No ❑ NA [:]NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [KNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes rM 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 RLNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes Z No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): e
[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 MNo E]NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [RNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ER No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[R No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
allo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [] Design [:]Maps ❑Lease Agreements
❑Other:
21, Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ER No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
R No
❑ NA
[] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
allo
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facill Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 5Q 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:
❑ Yes
[&No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑Yes
� No
❑ NA
❑ NE
❑ Yes MNo [:]NA ❑ NE
❑ Yes j"nj No ❑ NA ❑ NE
❑ Yes a No ❑ NA ❑ NE
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 ELNo
❑ NA ❑ NE
[] NA ❑ NE
❑ NA [] N E
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better explain situations (use additional Daees as necessarv).
pfry` z �B- 1��•�*y--ByL i$- ff0;�, J��r1
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:7'-��/
2/4/2011

Division of Water Quality
I Facility Number � - p'l� 0 Division of Soil and Water Conservation
0 Other Agency
Z
:for
Visit: Compliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Visit: 0 outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: „ L_.ZaArrival Time: Departure Time: , ` " !7 County: Region:
Farm Name: 4—/J'l J err',+cf Owner Email:
Owner Name: J0% Phone:
Mailing Address:
Physical Address:
Facility Contact: fff 1~ N.z� _554,o1f.—Title: / Phone:
Onsite Representative:
Certified Operator: J0..,
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Integrator:�J
Certification Number:
Certification Number;
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
le Of Da Non -Layer
Non -L.
Pullets
Other
Poults
Design Current
ro
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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 5K -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
r'M No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/412011 Continued

Facili Number: - I Date of Inspection: /5
t 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?:
❑ Yes
[V No
Designed Freeboard (in): Z2
❑ NE
18. Is there a lack of properly operating waste application equipment?
Observed Freeboard (in):�
[S -No
DNA
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes W No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a El Yes No
❑ NA
❑ NE
waste management or closure plan?
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
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 J� No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ®,No
[] NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes a No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes [Z No
❑ NA
❑ NE
❑ Excessive Ponding [] hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus • ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop/Window ❑ Evidence of Wind Drift [] Application Outside of Approved Area
12. Crop Type(s): Ay /L' D /r,- / S �s'y�« ••-1
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �_61 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 PQ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[V No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[S -No
DNA
❑ NE
Re4uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[2 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
allo
❑ NA
❑ NE
the appropriate box.
❑ WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes [2�No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes N
❑NA E] NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
No
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facili Number: - 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 ® 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)
3 L 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?
E] Yes
®No
❑NA
❑NE
[:]Yes
No
❑ NA
[] NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes [S No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes Eg No
❑ Yes ® No
❑ Yes ® No
❑ NA ❑ NE
❑NA ❑NE
[DNA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use.drawings of facility -16 better explain situations (use additional pages as necessary)..
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ',)jQ -!QTZ---W DD
Date: /
2/4/2011

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
[season for Visit: �utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: / ,',?7) I Departure Timer County:
Farm Name: ;K t-- fn L/iX y Owner Email:
Owner Name: /�,` ZE__-Z;n m^ —_ Phone:
Mailing Address:
Region:
Physical Address:
Facility Contact: 0 ZTitle: ,rte— Phone:
Onsite Representative: h Integrator:
00
Certified Operator: "Vr'Z"t Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current
❑ Yes
Design
C►urrent
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
❑ Yes
❑ No
❑ NA
Dai Caw
can to Feeder o
"INon-Layer
I
❑ NA
Dairy Calf
Feeder to Finish
❑ Yes
2§.No
❑ NA
Dairy Heifer
Farrow to Wean
Design
I Dry Cow
Farrow to Feeder
Dr, P,OUItr,
C•.apari
P.o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Co—
owTurke
Turkeys
s
O-thcr
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes &No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify 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
J&No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
2§.No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

Facility Number: Date of Inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? 0 Yes [g -No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes ®-No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
MNo
❑ NA
[:]NE
waste management or closure plan?
❑ Yes
allo
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
g] 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)
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ZLNo
❑ NA
9. Does any part of the waste management system other than the waste structures require
❑ Yes
ZLNo
❑ NA
❑ NE
maintenance or improvement?
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
M No
❑ NA
Waste Application
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�R No
❑ NA
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
R No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E�No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of A
12. Crop Type(s):
13. Soil Type(s):
❑ NE
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
allo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
RNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Ycs
CaNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ZLNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
M No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�R 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 2ZNo
❑ 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 A�LNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

.]Facility Number: - Date of inspection-
24.
ns ection-24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E -No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Eg Yes ❑ No
the appropriate box(es) below.
0 Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 L 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
❑ Yes
2.No
❑ NA
❑ NE
[]Yes
®.No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes [4 No ❑ NA ❑ NE
C-] Yes ®No F] NA F] NE
[]Yes CE'No
❑ Yes [ No
❑ Yes No
❑ NA ❑ NE
❑NA ❑N
❑NA E] NE
Comments (refer to question ##): Explain any YES answers and/or any additional rec6mmendati_on" or, unybther eomyments: ;
Use drawings of facility to better explain situdtions:(use additional pnges,as neces.'sary).
4;5
oec-,_�d"�-�-r.� w� Neu/
^� J,-1,7— ,frL /1 SO%� se�;V/r.J- 60;/S�/t'tl
ReviewerAnspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �/D—t�3�3300
Date:
21412011

ivision of Water Quality
Facility Number O! O Division of Soil and Water Conservation
O Other Agency
Type of Visit��,,ommp�pliance
Inspection
O Operation Revlew O Structure Evaluation
O Technical Assistance
Reason for Visit
+1coutine Q Complaint
O Follow up O Referral O Emergency
0 Other ❑ Denied Access
Date of Visit: , Arrival Time: Departure Time: D County: 41- Region: f—M9
Farm Name: Owner Email:
Owner Name:f���'�nt'►2��+-_ __ -._ Phone:
Mailing Address:
Physical Address: J -
Facility Contact: ZW i/'A A'e1 15 _-Za M ars. Title: Phone No:
Onsite Representative: Integrator: 1W1Z1W4
Certified Operator: 5�Operator Certif€ca ion Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: =0 =F 0„ Longitude: = o = i =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder / ❑ Non -La er
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑
Turkeys
❑
Turkey Poults
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: IE
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 [RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
[:]Yes
%LNo
❑ NA
❑ NE
[:]Yes
j9[No
[INA
❑ NE
12128/04 Continued

Facility Number: 9" — /4a Date of Inspection L_L�T_.I'/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [&No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 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
KNo
❑ 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?
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
g No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
®,No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
El No
❑ NA
9. Does any part of the waste management system other than the waste structures require ❑ Yes
E�No
❑ NA ❑ NE
maintenance or improvement?
J No
❑ NA
Waste Application
18.
Is there a lack of properly operating waste application equipment?
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
56No
❑ NA ❑ NE
maintenance/improvement?
I. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
9No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 IN ❑ 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) COKeL
13.
i
Soil type(s) �3 ryi� ��1ir4
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
9No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? E] Yes
El No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
J No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
�ZNo
❑ NA
❑ NE
f
Reviewer/inspector Name j Phone -L,.3 33D�
7 i
Reviewer/Inspector Signature: Date:
Page 2 of 3 12/28/04 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
El Yes ®No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes P9 -Vo ❑ NA ❑ NE
the appropirate box. ❑ Wup ❑ Checklists
❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 5.Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard 13Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
r0 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ONo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
5a No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
KNo
❑ 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
Zfo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
allo
❑ 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
E&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
f RNo
❑ 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
ZNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
gNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12/28/04

43TAts 8-ij -z d[o
Facility Number
V -Division of Water Quality
Q Division of Soil and Water Conservation
O Other Agency
Type of Visitompliance
Inspection
O Operation Review Q Structure Evaluation
0 Technical Assistance
Reason for Visit
& utine O Complaint
O Follow up O Referral 0 Emergency
O Other ❑ Denied Access
Date of Visit: 7'Og-O Arrival Time: ,d0 Departure Time: [/: QD County: ffj&] 'y
�
Farm Name: ?p �ar�t-s Owner Email:
Owner Name: m Phone:
r
Mailing Address: _T_A1j fee A/
Region:
Physical Address: ��AA
Facility Contact: Title: �WNe-+r Phone No:
Onsite Representative: Integrator:. &et W _
Certified Operator: �►�- -��/� Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: =0 =1 =6 Longitude: =0=1
c=1 =
15
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
'AL1 I ❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑
Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: Ell
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes 3 No ❑ NA ❑ NE
❑ Yes
❑ No
2<A
EINE
❑ Yes
❑ No
iA
❑ NE
❑ Yes
❑ No
B -N. A
❑ NE
❑ YesVo
__1 NA
[:1 NE
❑ Yes
No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: /,7
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):
r
Observed Freeboard (in): 444
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes[INA ❑ NE
;2/0❑ Yes NA ❑ NE
Structure 5 Structure 6
❑ Yes Na ❑ NA ❑ NE
❑ Yes No [INA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental) three , notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes I 'o ❑ NA El 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 Io ❑ 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? /
l l . Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes o ❑ 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 Hare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑/ Application Outside of Area l
12. Crop type(s) ln/s &k*4 _ i_ X, , SM!y��. �l-��:v �O . S • J
13. Soil type(s)
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
[B'NNoo
El NA
El NE
2 o
El NA
ONE
E-9""No
❑ NA
❑ NE
[aN
❑NA
0 N
No
❑ NA
❑ NE
Comments;(refer to question #i):, Explain any YES answers an`dlor any recommendations ti'rany,othcr cmmmicntsa�
use drawings of facility4o o better explain situations: (use additional pages as necessarv)t �
7
Reviewer/inspector Name �`G��v., Phone:/D. J!�Y2. 3304
Reviewer/Inspector Signature: Date:
12/28/04 Continued

l
Facility Number: Date of Inspection F-08- /O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists
❑ Design ❑Maps El Other
❑ Yes
B o
❑ NA
❑ NE
❑ Yes
L7No
❑ NA
❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Lrl< ❑ NA
❑ NE
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ NE
❑ 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
, /[:1
l�1vo ElNA
1:1NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
2 o ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
—Zo
E o ❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Lr}'No ❑ NA
[INE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
1310 Yes
❑ NA
❑ NE
Other issues
A
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Mlo ❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
io ❑ 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
ONo ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-sitc representative?
❑ Yes
10 ❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ETNo ❑ NA
❑ NE
Additional Comments and/or Drawings' ;
A
•
Page 3 of 3 12/28/04

1
ITMS /0—a9- Z009
,3 3
Division of Water Quality
Facility Number Q q0, ' A n of Soil and Water Conservation
,E Other Agency.
Type of Visit 0rompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outlne 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 7- Zl- 011 Arrival Time: Departure Time: �County: Z Q�clv Region:
Farm Name: .—g z /�_ -S _ _ _ Owner Email:
Owner Name: / 1 C.A ct_TA%A A a'-% Phone:
Mailing Address:
Physical Address:
Facility Contact: fu t-
N,14141?
}}Lq Ar.[ XN K&G ni Title: ��� �r Phone No:
Onsite Representative: N, 14141? d I Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ 0 = Longitude: = ° 0 ` 0 "
Design Current Design Current
Swine CanacityPopulation Wet Poultry Capacity Population
❑ Wean to Finish
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
i
❑ Boars
Other
❑ Other
❑ Layer
❑ Non—Layer
Dry Poultry. .
Pullets
Poults
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ l3eef Feeder 1 1.
❑ Beef Brood Cowl i,
Number of Structures:
FLI
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 E o ❑ NA ❑ NE
❑ Yes
❑ No
EJ NA
ElNE
[:1Yes
[INo
2<A
❑ NE
NA
F-1NE
❑ Yes
[D Noo8
Yes
❑o
2
NA
❑ NE
❑ Yes
—❑
L'I'No ❑ NA
❑ NE
12/28/04 Continued

8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes D<o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 9'lqo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Mo ❑ NA ❑ NE
maintenance/improvement?
l l . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes L,_t No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, 2,n, 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. Croptype(s) BGi'mwd.c,-, eH"-f ) ,Si,,aII Coorn:n1_ Cory, SArkie4,J � t.3�e,.ti�
13. Soil type(s) 61 b A , rQ A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes D No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes B<oo ❑ NA
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ [ Yes No ❑ NA
17. Does the facility lack adequate acreage for land application? ❑ Yes:��00[01
NA
18. is there a lack of properly operating waste application equipment? ❑ Yes NA
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):
❑ NE
❑ NE
❑ NE
❑ NE
Reviewer/inspector Name 'R1 -J1--' 1,"d s. , Phone: 910,#33—U3_
Reviewerllnspector Signature: Date: F -,/r- Zt1O `I
12/28/04 Continued
facility Number:0 - 2/(p Date of Inspection 7-27-0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
,,�
El< ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
0<0 ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 2
n
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑Yes
ErNo ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
EDB Yes
,.,/
o ❑ 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
E Flo ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes D<o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 9'lqo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Mo ❑ NA ❑ NE
maintenance/improvement?
l l . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes L,_t No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, 2,n, 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. Croptype(s) BGi'mwd.c,-, eH"-f ) ,Si,,aII Coorn:n1_ Cory, SArkie4,J � t.3�e,.ti�
13. Soil type(s) 61 b A , rQ A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes D No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes B<oo ❑ NA
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ [ Yes No ❑ NA
17. Does the facility lack adequate acreage for land application? ❑ Yes:��00[01
NA
18. is there a lack of properly operating waste application equipment? ❑ Yes NA
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):
❑ NE
❑ NE
❑ NE
❑ NE
Reviewer/inspector Name 'R1 -J1--' 1,"d s. , Phone: 910,#33—U3_
Reviewerllnspector Signature: Date: F -,/r- Zt1O `I
12/28/04 Continued

0 . . y
Facility Number: t09 — Date of Inspection 7-21—D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ONo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ETONo ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design g ❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
20<o
❑ NA
❑ NE
LYJ No ❑ NA
❑ 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
10
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
io
❑ 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
L o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes�r�No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
BNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
L2"1Vo ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LYJ 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
io ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3l. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
0<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?
ElL�Yes
'No ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
2 o ❑❑ NA
❑ NE
Additional Comments and/or Drawings:
AL
T
12/28/04

L
Type of Visit V Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: CL ID Arrival Time: Departure Time: County'- Region: ao
Farm Name: _ 1 r 4, t � 1 �Q-Y IMS _ _ -� Owner Email:
Owner Name: 1 r l 1 L 11� ` V\q��n I Phone:
Mailing Address:
Physical Address:
Facility Contact: d� �V\VX\QA Title: ___ _ � Y _ Phone No:
Onsite Representative: M AQ - M. \ \KM' 'a In Integrator: M-6
Certified Operator: (Y\ ` 1 d)u e_ k ` �\ 4N'\OL--V\ Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ° Q Longitude: °
q
eyr
Design CurrentDesign
Current
Design Current
Swine Capacity Population
Wet Poultry C►aity Population
Cattle Capacity Papuiation
❑ Wean to Finish
❑ Layer
❑ Dairy co
an to Feeder Woo D
❑ Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
KNA
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
JP NA
❑ Farrow to Feeder
c. What is the estimated volume that reached waters of the State (gallons)?�
ElNon-Dairy
El Farrow to Finish
❑ Layers
El Stocker
❑ Yes
&lo
❑ Gilts
❑ Non-Layers
[IBeef Feeder
[I
❑ Yes
PNo
❑ Boars
❑ Pure
El Beef Brood Cow
❑ Yes
[2�No
Tu
❑ Turkeys
❑ NE
Other
❑ Turkey Poults
❑ Other
Number of Structures:
❑ Other I
Page I of 3
12/28/04
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
19 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
KNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
JP 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
&lo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
PNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[2�No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

Facility Number: —71 J> Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ;No [INA ❑ NE
a. If yes, is waste level into the structural freeboard? []Yes �R(No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes
Structure 6
Identifier:
ElNE
15. Does the receiving crop and/or land application site need improvement?
Spillway?:
W No
❑ NA
Designed Freeboard (in): 11 ri
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
R�No
Observed Freeboard (in):
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
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.)
❑ Yes
19 No
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[R No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN> ]0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
iMNo
[INA
ElNE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
W No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
R�No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
19 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):
DU.Snear ev"o 0 � bA 31D Poi I� t . Nod Svc,
4 kr i L 16 VA 04 1+.
0 OW Ct-150 , . o-4 c LA Dfa-r o �P f
Reviewer/Inspector Name K4 STI NC Q -7 N Phone:
Reviewer/Inspector Signature: 12 Date: FA 019 1
12/28/04 Continuer)

Facility Number:(]Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes tRNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes ONo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes '19 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No OLNA ❑ 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
fAiNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
NaNo
❑ NA
Cl 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
Wo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[:]Yes
K,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
P 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
P�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
lF'' No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[;]No
❑ NA
❑ NE
pp
Addition'Al Comments and/or Drq n s
b.
- X2'1 � ..f $gyy
: �; �` 1 '. �_ ` ' f — 4 s K
� � 3 »,6 y, ice, Y';( 3aI xi,ta�:L:. I., k`a,
L m y 6-
Y, Zx�U►nCA b
ye n d r err-,',
AL
N 40 do
Rf_-(zMrrLe'rL1
nV n uc s u 1y�p' y`\ �� -e s�� rna 2. S I k e lk r (& me ,
Nor P kiC; S I L"�4 oy-I E.
;'
Page 3 of 3 12/28/04

` s
Facility No. ��, �! is Time In Time Out Date
•
Farm Name �- {� Integrator rn_1?j _
Owner Site Rep
( 5 =2.
Operator i No.
Back-up No.
COC Circl Gene)I) or NPDES
FREEBOARD: Design o(/ �.�� Sludge Survey
Observed / Calibration/GPM-y� 1
Crop Yield Waste Transfers
Rain Gauge Rain Breaker
Soil Test Wettable Acres '/ PLAT
Weekly Freeboard Daily Rainfall 1 -in Inspections
Spray/Freeboard Drop
Weather Codes 120 min Inspections
Waste Analysis:
Date Nitrog (N)
'C ZO
`6 L?S�
Date Nitrogen (N)
Pull/Field Soil Crop Pan Window
OMIA.V,
,�-
L,.
c%M

til
Facility lity Number r] a
-0 Division of Water Quality '
0 Division of Soil and Water Conservation
O Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (?Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit:a1 U Arrival Time: J0()0&j Departure Time: County:
Farm Name:MM Owner Email:
Region:
Owner Namc r ` ► C. .. n Phone:
Mailing Address: l 0 � `- +'e.�L _ t 01.E ► f�C�� �3��
- Q i
Physical Address: .__lt O� 1 t"t 1y1D.r� 1 0—U, k" t
Facility Contact: M 1 Vi ac� `Y"�0.r% Title: O wyu Phone No:� 1D ) q 3QL5�
Onsite Representati
Certified Operator:
Maal Operator Certification Nu
Back-up Operator: I Back-up Certification Number:
Location of Farm:
Swine
Latitude: [=O =1 =" Longitude: =0=6
°❑6 0
di
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish I ❑ La er
Erveanto Feeder lkx4w 15 ❑ Non -La et
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑
Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current.
Capacity Population
❑ tialry Cow
Cl Dairy Calf
❑ Dairy Heifer
aDry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: M
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 k$o ❑ NA ❑ NE
❑ Yes ❑ No
O NA
EINE
❑ Yes ❑ No _L�NA
❑ NE
_tV4A
❑ NE
❑ Yes []No
❑ Yes Wo
❑ NA
❑ NE
❑ YeA No
❑ NA
❑ NE
12/28/04
Continued

s
t�
Facility Number:Q —
Date of Inspection I" J
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: i
Spillway?:
Designed Freeboard (in): a�
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes kb No ❑ NA ❑ NE
❑ Yes ❑ No IONA EINE
Structure 5 Structure 6
❑ Yes 1No ❑ NA ❑ NE
❑ Yes Jdl No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �tNo ❑ 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 'SNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes -E$.No ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
'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 El Evidence of Wind Drift r]. Application Outside of
Area
12.
Crop type(s) W i<Y Lk& L t 1 � h-', C1 Y Q I WY r) C. Yo.s n
01 ' *At3Z rVS
13.
Soil type(s) Ga fl -04
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ho ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
Wo ❑ 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 orany other: comments.
Use drawings of facility to better.explain situations..(use'additioual pages as necessary):
Reviewer/Inspector Name , �� %V r(D &J I Phone: 'I
Reviewer/Inspector Signature: Date:
Page 2 of 3 AZ48/041 Continued

Facility Numbe—_" -p� Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes'tp-No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Wo [INA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 114.No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes )9 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
PjkA
QNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
INo
El NA
[:1 NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
$—No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
),NA
❑ NE
Other Issues
2$.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
,,To
❑ 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
10 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 I.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
''tT—No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
IkNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
AI No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Q ro ✓ i {nevi Qo.:r` 'b'. [FreeLoo"'j U3� nng I l�(Z Z
N -br
tea( � s ti �. V POA
Page 3 of 3 12/28/04

f
a ``-- fir, • •-_• _ _
Facility No. G 1 iP Time In Time Out _ Date
s
Farm Name �a _ Integrator l
Owner �&4Ag h Site Rept Q
Operator No. + I
Back-up No.
COC Circle: 4. ene or NPDES
Design Current Design Current
can Feeq2 Uy 60 Farrow -Feed
-- HIS Farrow - Finish
Feed Finish Gilts 1 Boars
Farrow - Wean Others
FREEBOARD:ign
Sludge Survey -:3.(9-1
Crop Yield
Rain Gauge's
Soil Test _
Weekly Freeboard
Spray/Freeboard Drop
Weather Codes
Waste Analysis:
PLAT
Daily Rainfall
120 min Inspections
Date Nitrog n (N)
D-'S" z . .
Observed
Calibration/GPM«" o(0 1 O
Waste Transfers
Rain BreaTer -
__—'-'-
1 -in Inspections
r
Date Nitrogen (N)
Will,
�r..r.�����a*
•� E LIZ=w
l�