260062_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual
ix)

/,A--/ Af--I g­—
Type of Visit: (?Tompliance Inspection O Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: Dunne O Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: W_2E3f-"Arrival Time: ; V Departure Time: ; DD County: Region: /�lJ
Farm Name: G ,, 11 'w't. Owner Email:
Owner Name: N aw Phone:
Mailing Address:
Physical Address:
Facility Contact: �;6A4 44x,& Title: Phone:
Onsite Representative: -�cY� Integrator: Certified Operator: Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design @urrent
Design
Current
Design Current
Swine Capacity Pop,
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
I lNon-Laycr
I
airy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D_r. P.oultr.
Ga aei
P,o P.
Non -Dairy
Farrow to Finish
Lavers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharaes and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [ 3 No
❑ Yes ❑ No
❑ Yes 2<o
❑ Yes 0_1�0
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continuer!

facili Number: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ErNo ❑ 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): Z_
Observed Freeboard (in): —.Y-j— ,,..3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �No[:] ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes E N ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E3 1 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 2<o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffcrs, setbacks, or compliance alternatives that need ❑ Yes ❑i'i o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ 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): Gp e A-\—.
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ... ❑ Yes [r] No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [�No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes En No ❑ NA ❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes E No
❑ Yes I E <
❑ NA ❑ NE
❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Lti l l''o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
EKo
❑ 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
[]-118*'
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
NA
[3] �Noo
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:].Yes
NA
❑ NE
Page 2 of 3 21412015 Continued

' Facility Number: - Date of Inspection:
/
N /❑
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
2NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check
e" Ies
❑ No [] NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
on -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: / 7
% 041;z
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
[r] 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 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 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
[r] 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
[]'50-
❑ NA
❑'NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Q No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�o
❑ NA
❑ NE
r� I
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone: 9v -,,7P 3--D fsI
Date: %D�`-s�/�
21412015

I ype ul v ISn: \I a.ompuallcC IIISpectivu \J vpCranuu I%CVICw \V AIru CIurC C,vaeuauull \,J I CCIIIIICifI AmIAla IICC
Reason for Visit: Vr Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: 64110-le-(a Region:��
Farm Name: �c ad Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: �}�1�G�C�y gall Title:
Onsite Representative: f 1(_
Certified Operator:
Back-up Operator:
Location of Farm:
,(
Latitude:
Phone:
Integrator: fly -es �
Certification Number: 1 ,Da 2—
Certification Number:
Longitude:
11111i111�iil i
�Maif1
Design Current
Design
Current
Deslgn
Current
Swine
Capacity Pop.
Wet Poultry
Catpacity
Pop!
Cattle
Cgpa4ty
If'op.
Wean to Finish
La er
pair Cow
Wean to Feeder
I D
a
Non -La er
Dai Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
l) , Poult . ,
Caaci
Po
Non -Dairy
Farrow to Finish
I Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
jPullets
Beef Brood Cow
Turkeys
Othe
urkey Pouets
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
[.] Yes
OTIo
❑ 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
E"IVA
❑ 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
['jNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑'ITo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
L! No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facil ky ]Number: jDatcof Inspection:
Waste Collection & Treatment
4'.� Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E]j-NtS—❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [1 "A ❑ 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? 0 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 E3-1�o
❑ 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 �o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Elo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑r -15
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Q No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes O 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): P U`f m l'S
14. Do the receiving crops differ from those designated in the CAWMP?
[] Yes
[Er'�o
0 NA
E] NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[9 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ErNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
]�o
❑ NA
❑ N E
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
C] Yes
dNo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[,TNo
❑ 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
�lo
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[:�No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facilit Number: - ?i Date of Inspection: k
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 2--No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ED<o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 2--go ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [ allo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑-No ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
❑ Yes ❑-No ❑ NA ❑ NE
❑ Yes ff No
❑ Yes ff No
❑ Yes E� No
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Camments refer to ucstionl#, lEx lain an ,;YlLS'answersIand/or an additianallrecommenMlo' ns or "an 'atti'er commentsll
;4.,r1:{! i(. °i +i" :6II'!fl? . ,.I.III!'d) !II ;i€§ :�? 3 ,E�.,,I,. i.' r !# a. 81..„ ErjcIl�eu
{ I� h� r E ,(a i I ' �i ,�. L , , 6,1 3 €.
Use:;dra'wings,,of;facillty�l,ta better=sex;laln�situationsl(use„additlonah agcs;as;neeessa
Z. K s ��
X-6
CCV 9 �09�-_ 6 9
Reviewer/inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone: % 'm
Date: k
21412015

' 1) 1 yk5 ° 5 ' R 0 G IL �3D
IT: i'sian of Water Resources
Facility Number ®- ® 0 Division of Soi1 and Water Conservation
Q Other Agency
Type of Visit: Compliance Inspection Z3 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: IrRoutine Q Complaint O Follow-up C) Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: 3D Departure Time: '/ 1 County:
c
Farm Name: [ c� Faym Owner Email:
Owner Name: i( Phone:
Mailing Address:
Physical Address:
Facility Contact: 1`t Title: Phone:
Onsite Representative: _ t c
Certified Operator: it
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Region:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Pou11 ltry
Capacity
Pop.
Cattle apacity Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
p c7
]Non -Layer
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D , P■oultr,
Ce�aci
P.o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turke Poults
Other
Other
Discharues and Stream Imnacts
1. is any discharge observed from any part of the operation?
[]Yes
[? Ro
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
E'NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[01 A
0 NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
❑ No
NA
[] NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑Tio
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
ZTN o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

FPaelli Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes � ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No []-WA ❑ 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 [ o ❑ 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 [B�o ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes [!j"No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes [lNo ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes [pooNo ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ❑'No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes C2 o [DNA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[3'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
[2,�Ko
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[5**'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
dNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ 0No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[2No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [ZrNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes f No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ga-No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ! No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes Duo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �o [] NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [�] N ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[�o
❑ 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
IVo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
i
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
[] Yes
[;�<o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP7
❑Yes
[No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Yes
[2 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[5No
❑ NA
❑ NE
Reviewer/inspector Signature: Date:
Page 3 of 3 2/4 1 S

C
US
Type of visit: t mom nance inspection v uperation tteview V btructure Evamation V rectinical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Arrival Time: S
Departure Time:
County: hl .r�'Region:
Farm Name: ���
���'"1
Owner Email:
Owner Name: (
Phone:
Mailing Address:
Physical Address:
Facility Contact: &f-� Title:
Onsite Representative: 1
Certified Operator: �L
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: {
Certification Number: �
Certification Number:
Longitude:
Design Current Design
Swine Capacity Pop. Wet Pouitry Capacity
Wean to Finish Layer
Current
Pop.
Design
Cattle Capacity
Dairy Cow
Current
Pop.
Wean to Feeder
0ILJNon-L2yer
Dai Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design
I Dry EYE Itt: Ca aci
JLayers
Current
l;o
Dairy Heifer
Dry Cow
Non -Dairy
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? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No CIrNA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR) ❑ Yes ❑ No [3 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)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [:]No
❑ Yes 950
❑ Yeso
DiA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Eacilit Number: - Date of Inspection: Q u-111C
Waste` Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
CI 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
C&<o
❑ 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
03No
[] 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
[2Io
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[r'No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
l0. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
I. Is there evidence of incorrect land 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 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): C LU
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 [5'No ❑ NA ❑ NE
❑ Yes <( ❑ NA ❑ NE
❑ Yes [?(No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes [3'-No ❑ NA ❑ NE
[]Yes [3No ❑ NA ❑ NE
❑ Yes []] No ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes C2'I To
❑ 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 [D"No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [!] No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

Facility Number: 4 6- Date of Ins ectlon: 'i Aw-',
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes gj o ❑ 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 C �No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 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 Q 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 I 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 ❑ No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes WNo
o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ 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 eages,as necessary). .
1,41 4L
6j 4L,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �S
Date: < ��
21412014

Z
f t ype or visit: to uompuance inspection v uperanon xeview v btructure Lvatuanon tj i ecnnicai Assistance I
(Reason for Visit: �utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: jr ,Arrival
AATimed 7 , ©t� Departure Time: ' O c3 County :C Region:
Farm Name: j�; G 1"y ITa.C� fa fn"� Owner Email:
Owner Name: /� ; UI�f 1J I ► a_6t Phone:
Mailing Address:
Physical Address: %
Facility Contact: /� G/�y �� Title: (,�J`l r✓ Phone:
Onsite Representative: S%e_. _ _ Integrator:
Certified Operator: o- Certification Number: IX-6
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design
Current
Swine Capacity Pop,
Wet Poultry
Capacity
1'op.
Cattle
Capacity
Pop.
Wean to Finish
Layer
Dai Cow
74
Wean to Feeder
I INon-Layer
I
airy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
I Dry Cow
Farrow to Feeder
Dr, P,oultr
Ca aci
PoP.
INon-Dairy
Farrow to Finish
I Lavers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
©-ther
Turkey Poults
Other
Other
Discharees and Stream Imuacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes gNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ® No
❑ Yes allo
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

lk Facili Number: Date of Ins ection:
Waste Collection & Treatment
+. 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [allo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [3 No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):� �}
Observed Freeboard (in): 3 131)
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes � No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes MNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes S—No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Z. No ❑ NA E] NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus [] Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence
//of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes � No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes n 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 ❑NE
❑ Yes ® No ❑ NA ❑ NE
Renuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA [] NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. []Yes a No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [3 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 allo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

_% lFacility Number: - Date of Ins ection: D/:.,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C�J_No [DNA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check] Yes P�No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32, Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/[nspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
0,No
❑ NA
❑ NE
❑ Yes
Ea No
❑ NA
❑ NE
❑ Yes EqNo ❑ NA ❑ NE
[:]Yes E�.No ❑ NA ❑ NE
❑ Yes ® No ❑ NA [3 NE
❑ Yes E] No
❑ Yes �No
❑ Yes [ 0 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other. comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9%O :]K2 3_T0 V
Date: fir'
21412011

ivision of Water Quality
Facility Number ® - 0 Division of Soil and Water Conservation
0 Other Agency
hype of Visit: Comppliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Cl Koutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
aDate of Visit: 6�77 70L Arrival/Time: p p Departure Time: ! Q County: Region:
Farm Name: e, ce•GC �'i'+'+Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: i G� Title: �[��j/j s•✓ Phone:
_.._
Onsite Representative: Integrator:
Certified Operator: �'6c�y 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
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
L
ayer
Design Current
Dry Poultry Capacity Pop.
Lavers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharses 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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beet' Brood Cow
❑ Yes � No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes C3,Vo
❑ Yes [& No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: (o - (,• I Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes 0 No [DNA ❑ 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
r
Identifier:
Spillway?:
Designed Freeboard (in): _9
Observed Freeboard (in): �S
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes f, No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes ® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes �4 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes g No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes r'm No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes � No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes ' CKNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
�+
12. Crop Type(s): _CD et-r lGyhr /SB'16 �rz•��.
13. Soil Type(s): W-0— tre3.
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 [ o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reuuired Records & Documents
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 2. No ❑ NA ❑ NE
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
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 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EL No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facili Number: C2 6 - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes C,No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [a No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [ No
wtil
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[DNA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes (g No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
[] Yes [a No ❑ NA ❑ NE
[:]Yes No
[] Yes ® No
❑ Yes gLNo
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations: or any other.:comments.
Use drawings of facility to better ex lain: situations (use additional pages as necessary).71
J� J C.• �j r't.0 yl V ul /l �p C'r' ► " `� �r ��r� f1 s+ -'C Cam-/ rwK C.[r }D ^- �7'� i
T4-2 w u n4vC. G l bl' ro^•
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: f/8'�L%3�-3t?
Date: — /7—d-a 13;
21412011

M
Type of Visit: D<ompliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: (5-Mo—utine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: ® Arrival Time: i t7D Departure Time: / ; County: Region: x%
Farm Name: ; Gky 1� �ry�� Owner Email:
Owner Name: /� ; G r`Cy Jai {��t� Phone:
Mailing Address:
Physical Address:
Facility Contact: / Ick A}z Title: �Phone:
Onsite Representative: �, Integrator:
Certified Operator: Certification Number:
Sack -up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design
Current
'Design
C>urrent
Design Current
Swine Capacity
Pap.
Wet Poultry
Capacity
Pop.
Cattle
Capacity
Pap.
Wean to Finish
La er
Dai Cow
Wean to Feeder
, p f�17
�j
Nan -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D�, P,oultr,
C•a aci
P.o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
TurkeyPoults
Other TOther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ®, No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes 1E No
[:]Yes E�[ No
[3 NA ❑NE
[DNA ❑NE
❑NA ❑NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection: /�-
Waste Collection & Treatment
` 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2!�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): / 9-
Observed Freeboard (in):--
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ® No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an Immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [NNo ❑ 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 [KNo ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes ❑, No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes rNo ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): GO_r-rL - A-LgWX 7
13. Soil Type(s): ZjX77-e-3
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes tZ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Jc No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes R 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 [E[No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Callo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design [] Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. [:]Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facili Number: - Ds ection: ~ /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [M No ❑ NA ❑ NE
r
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)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
[:]Yes
No
❑ NA
❑ NE
❑ Yes ® No ❑ NA [] NE
[:]Yes Z.No []NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes ® No
[:]Yes ® No
❑ Yes [5No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any;other comments::;
Use drawings of facility to better explain situations (use add(tional pages as necessary). s . ,
Reviewer/Inspector Name:
Phone: -9y'9 -'f3_T3F00
f /
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412011

Division of Water Quality �--�
Facility Number - ® O Division of Soil and Water Conservation
O Other Agency
Type of Visit: ompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time:1 Departure Time: Countyce.14 �� Region:
Farm Name: ; G7 �csf.0 �`� min- Owner Email:
Owner Name: E 1-GA y N 1��( Phone:
Mailing Address:
s
Physical Address:
Facility Contact: f�; ! ��% Title: Q_e,(1H r Phone:
Onsite Representative: . 5, �
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
Other
Discharges and Stream Imnacts
Integrator: L �-
Certification Number: /�S-�--
Certification Number:
Latitude:
Design Current
Wet Poultry Capacity Pop.
La er
Non -La er
ury Nouitry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dai Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
I. 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
[&No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
D§_No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: g L - Date of Ins ection:
Waste Collection & Treatment
1 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?: _
Designed Freeboard (in): _� - _
Observed Freeboard (in): �3 )
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
[ZNo ❑NA ❑NE
❑No ❑NA ❑NE
Structure 6
❑ Yes [Z No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? E[ Yes ❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [0 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes allo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s) �7�i? C/�d�16�� i
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes EQ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑, No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a tack of properly operating waste application equipment?
Required Records & Documents
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes CE No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[Z No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 ° Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
D Yes
rV1 No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of ins ection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
i 25. is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes ® No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[:]Yes � No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes E] No ❑ NA ❑ NE
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
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: 9/0 -' -3302
Date: S_ /��159e /1/
21412011

�r
ivislon of Water Quality s� 1/
Facility Number i O Division of Soil and Water Conservation
-- O Other Agency
Type of Visit C<o—mpliance inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival
Time: 0 Departure Time: County: Region: L�
Farm Name: ,1� + %y TI�r•�"� Owner Email:
Owner Name: ,tK. i G/��/ /J r Phone:
Mailing Address:
Physical Address:
Facility Contact: +GiTitle:Phone No:
Onsite Representative: _S'w-. Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Back-up Certification Number:
Latitude: = c = =Ld Longitude: 0 0 = ` 0 "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
ElLayer sl��4 Z1 ❑ Non -Layer
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey PoultsI
❑ Other
-El
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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: Yll
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
Page 1 of 3
12128104 Continued

Facility Number: & — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 9No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ;&No ❑ NA ❑ NE
❑ 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 Jallo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
[]Yes
A 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
i!g.No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[RNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
QNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12, Crop type(s)
13. Soil type(s),7���
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�-No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
JZL No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
allo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
JO No
❑ NA ❑ NE
.Comments-(referz!o.question #) >Explain any YES answers and/nr any, recommendatinnssur�ariy other comments ,er
'Usc`drawings ot,faciiity t6:better explain situations.° (use additional pages;as necessary):`. :x ,f # ' h ; �v a � ' '
t
Reviewer/Inspector Name' �} ':
rs=� rbs'i. Phone:
Reviewer/]nspector Signature:
Date: �?� �D/ D
Page 2 of 3 ' 12128104 Continued

Facility Number: 4,-621 Date of Inspection ` D
` Required Records &_Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑:No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
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
f-No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
Cl Yes
RNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
O No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
®.No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2[No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
B,No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
RNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[SNo
❑ 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
5Z-No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same ageney?
❑ Yes
,®-No
❑ NA
❑ NE
Page 3 of 3 12128104

ti
F
Type of Visit "(5-Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Q1 outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: � Arrival Time: r� � Departure Time: P; County:
J
Farm Name: +Ci Q Q� /Yt Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: _45'4m� _ Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Region:
Location of Farm: Latitude: ❑ e 0 { 0 4i Longitude: = o = 6 0 "
ra q�;r .. %$'... 1. - sx e '"S
Desrgn Cur5,r,ent `'llesigrk Current f�� '°� ��` 1Design 'Current
k� 3 �P. c. 'e a . bYrti's" Y 4 £ k..F . 4�" t,.
Swine Ca acit ,Po ulatton ' , 4 Wet Youltr> Ca ace Yo ulatron Cattle's @a act Po ulation
r*: $•.PsY�,.�� P.��. :� y, .f:s«pft3 pn„��3 .°,�.a��_ ��,... Ya...p
a ❑ Wean to Finish 10 Layer i a: ❑ Dairy Cow
® Wean to Feeder 0 ❑ Non-Layet
' ' El Dairy Calf
❑ Feeder to Finish
., ��. - ❑ Dairy Heifer
❑ ` ❑ Farrow to Wean Day Poultry Dry Cow R „H
El Farrow to Feeder f. ❑ Non -Dairy
❑ Farrow to Finish ❑ Layers
❑ Beef Stocker
❑ Gilts ❑ Non -La ers
❑ Pullets ❑Beef Feeder
❑ Boars ❑ Beef Brood Cow
❑ Turkeys ':; ", -
.VowOther ❑ Turkey Poults
❑ Other s; ❑Other � Num�ber�of�Structures
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[N No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
15� No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
K No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

r
Facility Number: (p — Date of Inspection p-91
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [9 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
a
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ,� No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the 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 [9 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LKNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes rot ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) GOt^►1 / Uvhj-�
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
7�No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
[R No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
C� No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
®-No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
i
Reviewer/Inspector Name �U� Phone:
Reviewer/Inspector Signature: Date: lv �-
� ' 12128104 Continued

1.
Facility Number: (p — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes ERNo ❑ NA ❑ NE
❑ Yes D�No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ®.No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ic/ discharge, freeboard problems, over application)
32. Did Reviewcr/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
C&No
❑ NA
❑ NE
❑ Yes
[R No
❑ NA
❑ NE
❑ Yes
[, No
❑ NA
❑ NE
❑ Yes
R.No
❑ NA
❑ NE
❑ Yes
CKNo
❑ NA
❑ NE
❑ Yes
R No
❑ NA
❑ NE
❑ Yes C,No ❑ NA ❑ NE
❑ Yes ,QNo ❑ NA ❑ NE
❑ Yes XNo ❑ NA ❑ NE
❑ Yes J&No ❑ NA ❑ NE
[:]Yes
M No
❑ NA
❑ NE
❑ Yes
R No
❑ NA
❑ NE
12178104

iI.
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: w Arri��al'1'ime: B"9Cll2 K Depurture'I'ime: County:
Farm Name: Karl Cam` Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address
Facility Contact: i'd, HQl Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Region: P (20
Phone No:
Integrator:
Operator Certification Number: A8x9;z
Back-up Certification Number:
Location of Farm: Latitude: = o = ' E__1 Longitude: = ° = I& ❑ 1{
Design C•urrcnt Design Current
Swine Capacity I'opulution Wet Poultry C•upucity Population
Cattle
Design Current
Capacity Pupulutiun
❑ Wean to Finish
❑ La er
❑
DairyCow
Wean to Feeder
0
❑ Non -Layer
❑
❑
❑
❑
❑
Dair Calf
Dai Heifer
D Cow
Non -Dairy
Beef Stocker
Beel'Feeder
El Feeder to Finish
Dry Poultry
❑ La ers
❑Non -La ers
❑ Pullets
❑ Turkeys
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑
Beef Brood Cow
Other ❑ Turkey POuIIS
❑ Other ❑ Other
Number of Structures:
Discharp,es & Stream Impacts
1. Is any discharge observed from any part of the operation'?
❑ Yes
'nNo
❑ 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
[r NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation'?
❑ Yes
No
❑ NA
❑ NI?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
DP No
❑ NA
❑ NE
other than from a discharge'?
Pale 1 of 3
12128104
Continued

Facility Number: — Date of Inspection �O
Waste Collection &"Treatment r,
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
M No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
1P 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
�Z 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)
`t
9. Does any part of the waste management system other than the waste structures require rl Yes
%No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
6 No ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑"Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) C&I'1A , WWqQ —S
13. Soil type(s) 15ul-f e!'S —
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
p No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
K 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
N3 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment`?
❑ Yes
nNo
❑ NA
❑ NE
Comments (refer to question #): ;Explain any, YES answers andlor any-recommenduti��ns 6r any other, comments.
Use drawings of facility to better explain situations. (use additionalpages:as necessary):
i
T
Reviewer/Inspector Name f T f- - Phone. f'd
Reviewer/Inspector Signature: - Date:
Page 2 of 3 12128104 Continued

*1 . ',
Facility Number: a — Date of Inspection
Reuuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists / ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes PVNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes JZ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Y No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ljd No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[)-dNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
P No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[,No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
§iNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
J�lNo
❑ 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
V9 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
[5iNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
P No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
$ No
❑ NA
❑ NE
Additional Comments and/or Drawings:;
Page 3 of 3 12128104

Division of Water Quality
Facility Number Q-Division of Soil and Water Conservation
Q ;Other Agency
I Type of Visit *Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
!I Reason for Visit Routine o Complaint t) Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: e20 o1 Arrival Time: Q Departure Time: Qr►l County: Cf��t r Region:
Farm Name: I 11 j. + '�'� M (D M Owner Email: I r,
Owner Name: '`I 4—N N CL a Phone: 9 + 53 + 't �7
Mailing Address: A %"rf? Ni ; 21B qr i) 309-11 aS(el!)
ti
Physical Address: n �j� [ 11 I
Facility Contact: f�1�-t`-"I 1'{C��r Title: Phone No��i�� �i 7,b
Onsite Representative: ti Integrator: Certified Operator: Operator Certification Number: 1 a6S .
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: = o = I =" Longitude: ' = ° = 6
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Puilets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑
Daia Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stockei
❑
Beef Feeder
❑
Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes F7 No ❑ NA ❑ NE
❑ Yes
❑ No
1�3 NA
❑ NE
❑ Yes
❑ No
[�NA
❑ NE
❑ Yes
❑ No
[ KNA
❑ NE
El Yes
�No
El NA
[I NE
❑ Yes
11Fo
❑ NA
El NE
12128104
Continued

{
r
Fai:ility Number: VA — b�
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: I A
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 r 't 33
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 Full
No ❑ NA ❑ NE
❑ Yes ❑ No INA ❑ NE
Structure 5 Structure 6
❑ Yes f- No ❑ NA ❑ NE
❑ Yes 1�a 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 M No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 09 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 t-61 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes $dNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ;.No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable CropWindow❑yEv_idence of Wind Drifl [:]Application Outside of Area
12. Crop type(s) Gr'� ,W. S� CYG x_
13. Soil type(s) & A
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 rld 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
09 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
K No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name VU W—f-It— Phone:
Reviewer/Inspector Signature: _14Date:
12128104 Continued

i
s
Facility Number: 6 — 6ja, Date of Inspection y O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Wo ❑ 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 t� No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [P No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
1�1 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
V No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
PNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
V�No
❑ NA
❑ NE
Otherlssues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
$No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
PNo
❑ 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
�4 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
CKNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
R5No
❑ NA
❑ NE
al Comments and/or Drawings:
12128104

(Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit Routine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access JI
Date of Visit: -0 Arrival Time: .3 / Departure Time: �r County: (0-*"4 Region: PAO
Farm Name: IC� �I- r���{ Owner Email:
Owner Name: R11+4LA Phone: rqtD) s.3 1-Vy ?L
MailingAddress: 49? WIji � � , n r'o ,n}C- a838� — _ , 3,* T7a.s_ 6,0
.�J i� � �� � ,
Physical Address:
Facility Contact: ��G 9 Title:
I I it
Onsite Representative:
Certified Operator: .c
6 �
Back-up Operator:
Location of Farm:
Phone No:
Integrator•'
Operator Certification Number: g a'
Back-up Certification Number:
Latitude: = c 0 I = Longitude: = ° = 6 =
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish I I❑ La erI I ❑ Dairy Cow
Wean to Feeder I
Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry ❑ Dry Cow
❑ Farrow to Feeder
❑ Non-Daity
El Farrow to Finish
❑ Layers
El Beef Stocker
Gilts
❑ Non -La ers❑ PulletsBeef Feeder
❑ Beef Brood Cow
EOBoars
❑ Turke s
Other
❑ Other
❑ Turkey Pouets
❑ Other Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
❑ No
[XNA
❑ NE
❑ Yes
❑ No
M NA
❑ NE
N NA
❑ NE
❑ Yes
❑ No
❑ Yes No
❑ Yes No
12128104
❑ NA ❑ NE
❑ NA ❑ NE
Continued

A.
Facility Number: a/0- Date of Inspection L'!
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes M 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: I A
Spillway?: 33 3 a",
Designed Freeboard (in): Ig
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes In No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes [�f No ❑ NA [I 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 JP No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes 29 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 J� No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes W No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? Ifyes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s)j US
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
q No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
7No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
P No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
M No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
P 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):.' , .;
AL
Reviewer/Inspector Name Phone: 9/0)�
Reviewer/Inspector Signature: Date:
Page 2 of 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 6N No ❑ NA ❑ NE
the appropiiate box.
❑ WUP ❑Checklists ❑Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes P No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ®No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[P No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
91 NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
1P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
P9 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
0 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
IK 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
X No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
IQ No
❑ NA
❑ NE
v.r -. V.
Addltiorial�Comments�audl¢or;,DrAwingssif
12128104

� � � _` A��rw.' jp h tF}".�tavy'r�C��d'' [i:vt(ga�Lf'�!�{1 }}!��Mji ji T,icT. ��•r �[ . F �'
�
'�' � � �'T G'a'yµ. !Ey i 't`f.�"'4iaSy�V�1�VW��Yi�Yllo��WatYO�� i1 S. � 4` �'n' j�y� ��i �i i 9ii I(i • L {, t �3�� ety 1
;< ,� *�' sY s,. Y `�'� � fir' �•4Pil � � ' a;�It:,s:sip ib.L� � K�,��in�' 1 �� �f k '.i�`��'��'w 1.
to h�nu"S"�f}}, �+ �Dli751o11'pitSoilandWatertConserrat:ou ; � , ",
��y�§�{yyyy ;yy��{��yF !;�: � a�I�yT' , • 1� �(�OKher A en .;"�� �ia.���I{p'�.rL�'k � 'y.'���, f{�yp,N�1x a rl ; F a �' �, � � � : �,.- ,& ��� -� i
�. r� s (�i. S'(iy 'J. S
�'�'�l� � 10•� � .'Ter' k �!ai�l.i�i.'7��Y .t9:L1��L�9�. 1, 3y: 1� }"� 1'el .��3 .{j.°!
'.� �4�1pe i� f e
i1 L+3,�. fg.. � ��.,�I � �
�.:em��i.�
j�(1k���� �'•
��i3.
`bs5r �,_, ^ bt ��f'b'�i f � y }'.n,"ti{ (k�e� �{•`i. .� . Ch
�
&: Y,'[ v�i �: ku .P.'�i'.e're?.�-'�i��3.:Ve.'�"b�^l:.,Ak'�:!��� rp���96�'%,'Y�E`3�n�di.>{�. ^'S�r�<S:I�i3ii��Hli���. iahj:ppM��9 ..9�t'<<;��i�e�f��?�"J w��:t s[�iii;Ela���s7�kl;y�}1r;.:1�x•.+i:. },...Ilk{3C�:ae�!Si���,7r,�"II.���E�f i��'¢�i#�iF.l+S. Cf:?�lii.".
of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
n for Visit O Routine O Complaint O Follow up O Emergency Notification &Other ❑ Denied Access
E
Facility Number Date of Visit: 'i B Time: : /O
0 Not Operational O Below Threshold
(a Permitted © Certified r _0 Conditionally Certified © Registered Date Last Operated or Abo a Threshold: ..»....»..
Farm Name: ...M . »� ivlG V ....mY� _. »., �;'!!� _. »_ » .. » ...». » County:.._. » ... » ..._. _ _.. .._ .. »..........
Owner Name: ... ... ... ___ ......_ ....._.... • Phone No:
Mailing Address:
Facility Contact: .»._._. ....... _ _ ......... »». » ....__ Title:.._...... _._ ........... __».. »....... Phone No:
OnsiteRepresentative:........ »» »» » » ... ... _.» _.w...». _. _ ..__ .._ .. Integrator:.._ .. ... _ ... _ ...... _. » .». »..»».»._..
Certified Operator :............... .._.._ ..__.». »_ ...._.__.»._.......__.»..» ._.................._ Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a Q` " Longitude • 4 it
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): 7 d
12112103 Condnaed

Facility Number: Date of Inspection +0
l
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ❑ No
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ❑ No
elevation markings?
Waste, Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre deternunation? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below f ] Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
I9. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ❑ No
Air Quality representative immediately.
"'�:::aBSR-` "Icr'"'F �. �:!!,^:eE eii �,�,§"9u, 9ttM: ! .., Yi�;¢t,<sy..:�E.t tul��t 4caa¢etna nat�l�:uwstlnu<.... €lea?:' H".s:.a�ntr;;tl;�mn!:iT� �3r!un'r¢°no,I cssr Sf+ra�' t,s::��---.sw<.y,> n€n gtln4a,�i..x r�; 6N¢Y,abe;�a�" r E'S ¢ a1 [[ 1l
S
Commeats (re%rota estiom #) l isin Y YES answers a�dlor arty rccommci"Ons ar any ntiier , !
�Sr a ix - E �¢r9P,t yr r '"•Hayu ^&i', re `!may i "ttk, w' 1}tlIW. ..s�n..e isf.''!S1y.'# � :!H#3�%)ft`i!IZHb7 ita.Ald!?�: t4•r<ylq ...du.:_:e . iL.ss::;�.+. ,,. t8gd
�Use�dr�awiags�af+facility to�better explain situations. (m��additian��pagcs ag�ne�ary��s)'r��` ❑ Fteld COPY ❑Final Notes � ���
Reviewer/inspector Name Er ;#'y `, r� .E ai�".'� , 111�iE�g'ii�s
Reviewerftspector Signature: Date:
i fNi 4/VJ a.whws..�r

f��i-a ` } f.. s s - �y i` a +y,^.}- t vi _•;It s .� 'z ?ry ii:. v�
i�enCyr� a .. a i�. �a�. .e � - �, �.t t4 �i• xa .1,., '"f"r, `h� v k,��y�tj'Is si''rfisf tn? +�
Type of Visit ® Compliance Inspection Operation Review O Lagoon Evaluation
Reason for Visit ®Routine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Date or Visit: Timc:rO d6
Facilih• Number
—Not erationai 9 Below Threshold
Permitted 0 Certified 0 Conditionally Certified 13 Registered hate Last Operated or Above Threshold:
Farm Name: _9,; a4 .r-k, ; Count).: 2ra
Owner Name: R Phone No:
Mailing Address: a0v 1 8 St 28.3 ALL
Facility Contact: CL 14 U 1. f<j _ __ Title: Phone No:
Onsite Representative: _. Q <CIL <a iL U Integrator: _eltr^L4
k 4—
Certified Operator: ,� e�c� t t� Operator Certification Dumber: , . f $ L, L2
Location of Farm: 1
f5 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude e 6 " Longitude ' 1 66
Design
Current
Swine Capacity
Po ulatioi
Wean to Feeder
❑ Feeder to Finish .
❑ Farrow tc Wean
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons
:Holding Ponds / Solid Wraps
Design Current Design Current
Poultry. Capacity Population Cattle Capacity Population
❑ Laver ❑ Dairy
❑ Non -Layer I 1 10 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
r ❑ No Liquid Waste Management System
Discharges b Strgam Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If ves, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4, Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: /
Freeboard (inches): D d
05103101
❑ Yes C,No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes M No
❑ Yes Lyw No
❑ Yes 9 No
Structure 6
Continued

t
4
Facility Number; L — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
Immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste ADnlication
10. Are there any buffers that need maintenance/improvement?
1. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
13. Do the receiving crops differ with those designated in t e Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Reguired Rgcords & Docunignts
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
20, Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22 F '1 t t'f I DW f m r 't t' it d b G I P 't9
❑ Yes l ' No
❑ Yes �9 No
❑ Yes No
❑ Yes ® No
❑ Yes �S No
❑ Yes ® No
❑ Yes No
❑ Yes �N6
❑ Yes ❑ No
El Yes El No
❑ Yes ❑ No
El Yes k] No
❑ Yes Q No
El Yes ® No
❑ Yes No
El Yes No
El Yes No
El Yes �io
ai o no y regtana Q o e e gency st ua tons as rcqu e y enera cant .
(ic/ discharge, freeboard problems, over application) ❑ Yes ® No
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative? ❑ Yes 1 °1 No
24. Does facility require a follow-up visit by same agency? ❑ Yes [BNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP7 ❑ Yes �@ No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
C minents� refer ti uestion5# Ex lain t ri YES anew ra and/or sn recommc dation9 5or auether coinmcn' s
tea( q<x ) p y{�Y . - y: Y
Use drawings of�facility�to Better explain situationsr{useadditional-pages as necessary
❑ Field Copy ❑Final Notes
.�d: 1r".�,f9d '.:� n.Y.�.._..& �trxy
tfQCArclz LG st, W Utu. 2clot
w
Reviewer/Inspector Name
Reviewer/Inspector Signature: ' ' Date:

I
Facility Number: 2(, — Date of Inspection � oC
Naar Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27, Are there any dead animals not disposed of properly within 24 hours? ❑ Yes P-No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [,No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes [ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �;No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Cornments,andlor Drawings:
05103101

Facility Number. -_1 (0 X
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Date: /4 9
Time: ; I
General Information:
Farm Name: Lro,;g-. County: ,_
Owner Name: -- Phone No: '3 i J
On Site Representative: LAA VL C _�'t`o� _ Integrator: r
Mailing Address:_- ��-- „3. 6a- ! ('3 -
''-os t 60 r o . h) G _Z_9 :. . .
Physical
Latitude: j� Lon 'tude: I I
Operatim Descxjption: (based on design characteristics)
Type of Swine No. of Animals. Type of Poultry No. of Animals Type of Cattle No. of Animals
❑ Sow ❑ Layer ❑ Dairy
Cgtusery 30 IFEE ❑ Non Layer' 0 Beef
❑ Feeder
OtherTjpe of Livestock: Number of Animals:
NBmber of Lagoons:�(include in the Drawings and Observations the freeboard of each lagoon)
acility Inspection:
Lagoon
Is lagoon(s) Ereeboard less than 1 foot + 25 year 24 hour storm storage?:
Is seepage observed from the, lAgoon?:
Is erosion observed?:
Is any discharge observed?
❑ Man-made ❑ Not Man-made
Cover Crop
Does the facility need more acreage for spraying?:
Does the cover crop need improvement?:
( list the crops which need improvement)
Crop type: as Acreage:
Setback Criteria '
Is a dwelling located within 200 feet of waste application? ;
Is a well located within 100 feet of waste application?
Is animal waste stockpiled within 100 feet of USGS Blue Line Stream?
Is animal waste land applied or spray irrigated within 25 feet of Blue Line Stream
A01-- January 17,1996 -
Yes ❑
No 0
Yes ❑
No 0
Yes P
No ❑
Yes ❑
No ZO
Yes ❑
No U
Yes ❑
No a
Yes ❑ '.. No � -
Yes ❑
Yes ❑ No M
7 Yes ❑ No &D

Maintenance
Does the facility maintenance need improvement? Yes G No
Is there evidence of past discharge from any part of the operation? Yes ❑ No a
Does record keeping need improvement? Yes ❑ No El
Did the facility fail to have a copy of the Animal Waste Management Plan on site? Yes ❑ No 0
Explain any, Yes answers: Irle , 4b $m_YS �,� toSites.
`J41
Signature:_ Date:.2
cc: Facility Assessment Unit Use Attachments if Needed
Drawings or Observations:
AOI — January 17,1996