260064_INSPECTIONS_20171231

- .fes 1111 s'
—`�G Division of Water Resources
Facility Number ®- 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: a 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 0 Denied Access
Date of Visit: Z 2 Arrival Time: 0 rti Departure Time: County: CWAX121Region: F_/LV
Farm Name: L r`�,1 s pOL�.(jG�0.S__A_+ t)rtnry�,..., Owner Email:
Owner Name: gq5-, Phone:
Mailing Address:
Physical Address:
Facility Contact:^'�RS4✓1 _ Title:
G.41>>
Onsite Representative: , �a�Tr�Clta 50/7
Phone:
Integrator: PIR,057Ac-ir P-4�
Certified Operator: N Certification Number: Z0270
Back-up Operator: Certification Number:
Location of Farm:
Swine
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
$d p Q Non -La er
Wean to Finish
❑ Yes
Wean to Feeder
E0 NA
Feeder to Finish
c. What is the estimated volume that reached waters of the State (gallons)?
Farrow to Wean
Farrow to Feeder
Farrow to Finish
❑ Yes
Gilts
V) NA
Boars
2. Is there evidence of a past discharge from any part of the operation?
Other
Other
Design Current
Dry Dr PoultryCapacity Pop.
Layers
Non -Layers
Pullets
Turkeys
-TurkeyPoults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
Longitude:
Design Current
Cattle Capacity Pop.
DairyCow
Dai Calf
Dai Heifer
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [�j No ❑ NA ❑ NE
E] Yes E] No P NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
E] No
E0 NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
E] No
V) NA
[3 NE
2. Is there evidence of a past discharge from any part of the operation?
E] Yes
[!p No
[3 NA
E] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
W No
E] NA
'[:]NE
of the State other than from a discharge'?
Page I of 3 2/4/2015 Continued

Facility Number: - Date of Inspection: Zq
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Pg No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No P] NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3z-�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes P 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 [P No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes F No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes � No E:] NA E:] 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 �g No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Lg No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [0 No [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?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑Yes
®No
T3
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
F No
❑ NA
❑ NE
❑ Yes
1� No
❑ NA
❑ NE
❑ Yes
[M No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes rM No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily availabie? 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
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste TrTfcrs
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ YesNo
23. Ifselected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑N
Page 2 of 3 2/4/2015 Continued

1760li tuber: JtA - Date of Ins ection: j ' 2q
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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?
[DNA ❑ NE
❑ NA ❑ NE
❑ YesNo ❑ NA ❑ NE
❑ Yes No NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
[:]Yes ® No
❑ Yes ® No
❑NA E] NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA F] NE
❑NA E] NE
E:] NA [3 NE
[DNA ❑ NE
IComments (refer to. que`stion`#):, Explain any. YMan;swers! and/or"any: additional recom..mend tions -ori any other comments) ' '; .
Use drawl as of facility to better exulnin`situations (use''ndditioni�liiss'es.as iiecessarV.]: 1 . µ,¢� � �� 11 ' ,ix.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 10
Date: !/ '7
214t'2015

1� I W & OAS &)
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: GO -Routine 0 Complaint 0 Fallow -up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: % a Owner Email:
67 f
Owner Name: A- re Phone:
Mailing Address:
Physical Address:
Regional
Facility Contact: r— a"#-yL`�'� eax b''1 Title: Phone:
Onsite Representative: { Integrator:
Certified Operator: Certification Number:(' 3? L7
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
❑ NE
Design
current
Design Current
@apaclty Pop.
Wet Poultry
Gapaclty
Pop.
Cattle Capacity Pop.
Finish
rF2der
La er
Dai Cow
Feeder jba
Non -Layer
Dai Calf
o Finish
Dai Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D , P,uultr,
Ca acct
P,o P.
Non-DaiY.
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
p
Turkeys
Other
Turkey Poults
3.
Other
Other
Dischar es 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 2r<7 ❑ NA ❑ NE
[:]Yes ❑No E51VIA ❑ NE
❑ Yes ❑ No�A' ❑ NE
❑ Yes [:]No
[:]Yes ONo
[]Yes ❑ No
�NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page 1 of 3 214/2014 Continued

FacilityNumber: - Date of Inspection: Ot)
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [! <o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? []Yes ❑ No � ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NE
Identifier:
I_J leo
❑ NA
[3 NE
[] Yes
Spillway?:
❑ NA
❑ NE
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[;],Ko
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[{3'17o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
,E�'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑'115
❑ 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
Z No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑/ NNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes /IN'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ 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): co_iLon
13. Soil Type(s):
14. Do the receiving crops differ from those desigWated 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
�No
❑ NA
❑ NE
❑ Yes
I_J leo
❑ NA
[3 NE
[] Yes
No
❑ NA
❑ NE
❑ Yes E <o ❑ NA ❑ NE
❑ Yes io ❑ NA ❑ NE
❑ Yes
2<0
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑WUP ❑Checklists [] Design ❑ Maps E31 -ease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E311o' ❑ NA ❑ NE
❑ Waste Application ❑ Wcekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ONo ❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

•
2fNo
❑ NA
❑ NE
Facility Number: - Date of Ins ection:
eNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[E1 o
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
Z[Jb o
❑ NA ❑ NE
the appropriate box(es) below.
1.
❑ 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
[?g Ko
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[3<o
❑ 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 tilt 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? ❑ Yes [f No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes dNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 0"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).,
❑ Yes
2fNo
❑ NA
❑ NE
❑ Yes
eNo
❑ NA
❑ NE
❑ Yes
El"No
❑ NA
❑ NE
❑ Yes
6No
❑ NA
❑ NE
r- I
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
p. ?,- p P,-. -y, o
Phone: J
Date: t,5
214/1014

SmS
2- /11 l 1S 9..S .
Type of Visit: �ErC Hance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up Q Referral 0 Emergency p Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: aktl
Farm Name: %r! -G �!� rQ�d[�C �� (� �'J"t� Owner Email:
Owner Name: �, at r: VV 6aJ I -A Phone:
Mailing Address:
Physical Address:
Region( /
Facility Contact: & 4 V1.i j a Title: Phone:
Onsite Representative: integrator: Pv' U ;'i
Certified Operator:�OA Certification Number: Wj_,�j
Sack -up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
�] Yes
Design
Current
Design Current
Swine Capacity Pvp.
Wet Poultry
Capacity
Pvp.
Cattle Capacity Pop.
Wean to Finish
Layer
❑ No
[ A
Dairy Cow
Wean to Feeder -p
I INon-Layer
I
[]<A
Dairy Calf
Feeder to Finish
Dairy Heifer
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
Farrow to Wean
❑ No
Design
C►utrent
Dry Cow
❑ Yes
Farrow to Feeder
Dr, P■oul
acl
P■o
Won -Dairy
[3'INo
Farrow to Finish
Layers
of the State other than from a discharge?
Beef Stocker
Gilts
Non -Layers
2/4/2014 Continued
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharees and Stream Impacts
I. Is any discharge observed from any part of the operation?
�] Yes
,__,�
[loo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[]Yes
❑ No
[ A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[]<A
❑ 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
[R1<A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
j'N o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[3'INo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3
2/4/2014 Continued

Facility Number: Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E5-5o_�❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No QOGA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
F]"No
❑ NA
Spillway?:
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Q'1\fo
❑ NA
Designed Freeboard (in):
acres determination?
Observed Freeboard (in):
17. Does the facility lack adequate acreage for land apph tion?
❑ Yes
E3"No
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
D - N-5
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
Required Records & Documents
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
U4140
❑ NA
❑ NE
waste management or closure plan?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E31<o
❑ NA
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
t[ o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[�,Xo
❑ 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
[�o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes M4,0 ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus . ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C,FY p
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
es
1[a<'o
❑ NA
[3 NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
F]"No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Q'1\fo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land apph tion?
❑ Yes
E3"No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
hio
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�l�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E31<o
❑ 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 EZ14 o
❑ Waste.Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E],I�o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes J2'No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 2/4/2014 Continued

Facili Number: jDate of Inspection:
;24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check RI—es 10 ❑ 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 ❑ NA I—]NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �rNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes EIo ❑ 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 Igo ❑ 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
�o
❑ 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
B<O
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[J,XT
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[],�I°
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[ I, 4o
❑ NA
❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawinss of facility to better explain situations (use additional pages as necessary).
1�-- (Y-17
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 3l`333
Date: 1I &" 6
2/4/2014

, vc h1w q la- l n
- Di'vi-sion of Water Quality
Facility Number ®- © 0 Division of Soil and Water Conservation
OQ Other Agency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: }Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other.., 0 Denied Access
Date of Visit: L'3"j ij:::l Arrival Time: $ Departure Time: County: Region:
Farm Name: Latt%4, %tr1c 1 I Wary Owner Email:
Owner Name: Litrg EQSQ, Phone:
Mailing Address: 46s-&_ Wnnle_ iL+L 4 i Made Alr� _ ..._
Physical Address: 57NO pfty .% ck fit,- QA_ _ 6,64 i Ne
Facility Contact: Larrf,_Title: Phone:
Onsite Representative:
L 1- nr
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator: fl��J`I-aae-
Certification Number:o2Q-370
Certification Number:
Longitude:
Design Current
❑ Yes
Design
Current
Design Current
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Swine Capacity Pop.Wet
Poultry
CapacityCattle
Capacity Pop.
❑ Yes
Wean to Finish
La er
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
airy Cow
❑ No
Wean to Feeder
Non -La er
c. What is the estimated volume that reached waters of the State (gallons)?
airy Calf
Feeder to Finish
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
airy Heifer
❑ NE
Farrow to Wean
❑ Yes
Design
Current
Dry Cow
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Farrow to Feeder
Dr. P,oultr.
Caaci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
13oars
Pullets
Beef Brood Cow
Turkeys
QtMUM
urkey 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
❑ 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
En No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
® No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3
2/412011 Continued
r_

Y %
Facility Number: IDate 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):
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
C '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
NNo
❑ 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 Awlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[3 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes CR 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. CropType(s): C0&If4j betmuda, day Smarl 6f,21 Oy#jP4 _,..
13. Soil Type(s): W
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes R No ❑ NA ❑ NE
❑ Yes C' No ❑ NA ❑ NE
Required Records & Documents
l9. Did the facility fail to have the Certificate of Coverage & Permit readily available? Yes ❑ No ❑ NA ❑ NE
Mu -
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. 0 Yes ❑ No
❑ Waste Application K 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 2/412011 Continued

Facility Number: -
Date of Inspection: 4 JUI 3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C@ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA [R 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 [KNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No PR NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
R 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
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
® 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
C�-No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or.any additional recommendations ot;any other comments.,
Use drawings of facility to better explain situations (use additional panes as necessary).
I q,►, Ma, re c olds wer2 siD It, aba -hre.`tr'Ye of cltay eef o pm,�-1 �r� I lay 1)3,
4frjioqm�(%
3'0 co C Ca a� �rmli` �
ani Il mai I o� erftca Cagy I
i��
G�ur�n las r*01, �% [mss �c� ma�`i �i la lf3 Nolen 4�, le JVs
)
aILa 4 Pea have, n9� beyh -fake,, Nfekl , Plea,e IMI r" ,�c
S serfs as a n6 t'e O�eude�iC , ���p-aDl3-ac-olsS, oe (err'? (M)
91ex, m b�-Qi� co 1Ve s fn book v�uey
e- cu�� lsQ ! at
/ '�
r�, Wyo� [of cAal, y o wf need a- new rva,�e�lra�.1, ria arrarbr�
Q4, Ole form ob'ia�& dart inya#6. Noffed-Vol
9h , r
0lyn'rr `rook o�iv *01'n -hI'syear aid— have.�bfi do"i c- 10 �M ' ihiglcla'
Reviewer/Inspector Name:pj,� h n-QI er _
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 3104M—MMf04
Date:V e. ////
2/412011

Facility No''. Farm Name 9� Dat� a�
Permit COC OIC _ NPDES (Rainbreaker PLAT
FR Droos
Annual Cert Daily Pipe)
Lagoon Name; S forspillway - 1 2. 3 4 5 6 7
Design Freeboard / Last Recorded in
Observed freeboard:" -j1,,,'1
Sludge Survey Date
Sludge De th' ft
Li uid Trt. Zone" ft
Ratio Sludge to Treatment':VolUme ifs 0.45
Date out of compliance/ POA?,
HEAT 102
Soil Test Date ! i° i " Crop Yield Transfer Sheets
pH Fields ; ' Wettable Acres RAIN GAUGE
Lime Needed; . ! i !'1 WUP ✓ Dead box or incinerator
Lime Applied I Weekly Freeboard m%!AMortality Records c�
Cu -I ✓ Zn -I ✓ 1 in Inspections ./ Check Lists
Needs S (S-1<25) I ;l I. 120 min Insp. Storm Water
Noone P I I I I I `, E "i i I. WaathPr rnrlac
w,kTF-MPz1F1�R"511=[R MO.
1 • I
®..7
w5j; pia
F IM
1 • I
Verify PHONE, NUMBERS,a d affiliations Rik P
Date last WUP FRO; 't'1��FRO or Farm Records
Date last WUP at farms !' > Lagoon #
ap Hardwar "�}:�' !'�; I ' i", Top Dike' 416"
�,�'S,4`�pp;° i Stop Pump 'fry
1I i;1 Start Pump
Conversion -,Cu -1;3000=
10 115/6c; Zn -1 3000= 213 Iblac
tt1 I
1II jIjj li I .
®..7
w5j; pia
F IM
Verify PHONE, NUMBERS,a d affiliations Rik P
Date last WUP FRO; 't'1��FRO or Farm Records
Date last WUP at farms !' > Lagoon #
ap Hardwar "�}:�' !'�; I ' i", Top Dike' 416"
�,�'S,4`�pp;° i Stop Pump 'fry
1I i;1 Start Pump
Conversion -,Cu -1;3000=
10 115/6c; Zn -1 3000= 213 Iblac
tt1 I
1II jIjj li I .

r
_ I . 11'., r'n it
lype of Vlstt: Compliance inspection V Vperation Review t.] structure Evaluation U Tecnnical Assistance
Reason for Visit: Routine O Complaint 9 Follow-up 0 Referral O Emergency _ 0 Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region: FPO _
Farm Name: I C 'S Pj a �JVls P/ V Owner Email:
Owner Name: La rr i Phone:
Mailing Address:
Physical Address:
Facility Contact: L drry Cofon Title: Nrro- Phone:
Onsite Representative: E0901 Integrator:
Certified Operator: la rig s Certification Number: x03'70
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
101 Design Current
Swine Capacity Pop.
Wet I M
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
airy Cow
Wean to Feeder
Non -La er
airy Calf
Feeder to Finish H
ai Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
I)t, P.oultr,
Ca aci
P,o P.
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
13ecf Brood Cow
Turke s
Other
�Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes R No ❑ NA ❑ NE
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 F No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

l
Facill 'Number: 4M - Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? 5R Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ® No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes '® No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes "'g No
❑ NA
❑ NE
waste management or closure plan?
❑ No
❑ NA
aNE
❑ Yes
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 improvcment7
❑ Yes
❑ No
❑ NA
Cj�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
rp NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA
fj;�NE
maintenance or improvement?
11. 1s there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 5�,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 Wiinnd.,,o-w ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
l2. Crop Typc(s):
13. Soil Type(s):
l4. 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. 1s 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
No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
aNE
❑ Yes
©,'No
❑ NA
❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ED NE
❑ Yes ❑ No ❑ NA 2 NE
[:]Yes ❑ No ❑ NA C@'NE
❑Wl1P ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements C] Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes R No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ®, 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
rwf
NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Mf
4*"acill Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA E] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check []Yes ❑No ❑ NA 52 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 21 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No [-NA ❑ NE
Other lssues
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?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes CR No ❑ NA ❑ NE
❑ Yes 8 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA [Q NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
tR 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. I
Use drawings of facility to better explain situations (use additional pages as necessary).
4, Peo& evaILdo,) `4r st ,64 h�4 -ereebm& , Pam rs st II in df7,0,
,� hi h
Fay reca�ds shoal 16, o3 t'rain for ane a . aa�Y "Fain l --
eQchdo� Wths had c, T" rQl"-atl ori a,� day. era �Ir7
�e Is u4iye-
bol x r-e"fed_ it be rr06,ed_ `��Io, -fioen nearhY firms, vvIie pr-mfho9ejr
O goa.16w a) bot raise 1 � a beve rwNevej s'o l� fe ('s n o -rPlaih
porwk- ~b -W if ow
Spray iv hdow Dn Cod) rani vvt � y I '�a �e� ae cly9zli mn C ro f
Thr'e- are.. W Ot& CrO�
AAa, Wr j fin1.0c
"o�� fo.► o of 1��rr� f a ale df V0 y err �'
�fiecro I w# ! wa 4 u � f
y J c 1 r a cro� �s�o, r�hc� h� har e-
a^eQ � e e4 lwhleh car beady �-'
Iso r a�. �.
2� 9av1✓ LOW v#bul Vavh6sfo Vk4v1� a ah kv
` Add0itj ndi!� ' l ,,Ap-
e,
ilor-o� 0%�' CD��yy. pr � 'file
VoIrMin),�4rn' o �� 1NI�ICS 00V wird 1�1rIA� T'�r�, � Q'�'L►Inr �co�d - �D11R9' �7 tnChPf �'D� 4t 8 i�3,]
Reviewer/Inspector Name: Sch jykie t• 44 i
Reviewer/Inspector Signature: 1JPOA A Uk LO�
Page 3 of 3
Phone: gragD-_7*d0Tbe)
Date:
2/4/1011

(PIDivision of Water Quality
Facility Number - ® O Division of Soil and Water Conservation
0 Other Agency
Type of Visit: CYCompliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: VRoutine 0 Complaint O Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: qA1 Departure Time: County:C,,fnhtk p Region:
Farm Name: C . re N !,(ZgQ ��f Owner Email:
Owner Name:qgp (1 Phone:
Mailing Address:
Physical Address:
Facility Contact: �TC1r�AtZ4� 'E�AS� N Title: CO Wtrtt' - Phone:
Onsite Representative: ? \"Mai 'E,Acp�(l Integrator: P it
Certified Operator: n 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.
HLa er
p
Non-LayerI I
Non -L
Pullets
Other
Poults
Design Current
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Becf Feeder
Beef Brood Cow
❑ Yes 1p No ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
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
[:]Yes K No
[]Yes Q No
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/412011 Continued

.J ~
Facility Number; Ig Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: At -I�
Spillway?:
Designed Freeboard (in): %
Observed Freeboard (in): Q l
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
®No [DNA C]NE
❑No 4 N ❑NE
Structure 6
❑ Yes 14] No ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
DfNo
❑ NA
❑ NE
waste management or closure plan?
(N No
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design [] Maps ❑ Lease Agreements
❑Other:
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NA ❑ NE
9. Does any part of the waste management system other than the waste structures require
[] Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes { No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. CropType(s): 1�F.[Lr+r�uOt� ��lA—fG. 7ncxVIDA C"RA-L
13. Soil Type(s): d
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes M No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [4 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes M No ❑ NA E] NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reaulred Records & Documents
❑ Yes [ No ❑ NA ❑ NE
❑ Yes 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
(N 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
M 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
(4 No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes � No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

r�
Facifi Number: JDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
fjQ 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
No
"[��
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA ❑ NE
Other Issues
2$. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
($] No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[1] No
❑ NA ❑ NE
Reviewer/Inspector Signature: Date: \Z1
Page 3 of 3 2/412011

ivision of Water Quality
Facility Number ®- 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: eO 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 0 Denied Access
Date of Visit: Arrival Time ! o a Departure Time: O County: L/�_-.14Aegion:
Farm Name: L Cz 5W—' -'LT- Owner Email:
Owner Name: ,��--� Phone:
Mailing Address: ,
Physical Address:
Facility Contact: m T�� Title: Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder QED
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Integrator: -
Certification Number:
Certification Number:
Latitude:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
on -
Other
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Daia Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[:]Yes [&No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑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 CE No ❑ NA E] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes allo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

Facility Number; Date of -Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [3 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 1'
Observed Freeboard (in): r
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes allo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[Q No
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
1� 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
RNo
❑ 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)
[:]NE
the appropriate box.
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes M No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable CropWindow❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): iAj D
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes (25.No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes gNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes CR No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E4 No
[DNA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
1� No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[4 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ YesNo
[:]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 qNo
❑ 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 0 No
23. If selected, did the facility fail to install and maintain rainbreakcrs on irrigation equipment? ❑ Yes E�_No
Page 2 of 3
s
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
[DNA ❑ NE
❑ NA ❑ NE
2/4/2011 Continued

Facility Number: Date of Inspection:
—
No
❑ NA
t 24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
O No
List structure(s) and date of first survey indicating non-compliance:
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
25. 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
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 concem?]
Yes
RNo
❑ 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
O 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
RNo
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
Ell No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
J�g_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/ 330-c�
Date: J�1t( 410 %/
2/4/2011

ivision of Water Quality 43716'/v
Facility Number t -f 0 Division of Soil and Water Conservation .3
Other Agency
Type of Visit 0�bmpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0.1outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: " % O ;Arrival Time: d D Departure Time: County: G Region:
Farm Name:�� 'C AA, e - e,- y Owner Email:
Owner Name: i GfT ao"O� i t' F—�cz_40--
Phone:
Mailing Address:
Physical Address:
Facility Contact: I 140d, dtfTitle: Phone
No:
Onsite Representative: „�----7 ________— _ - _ _ ___ Integrator:%✓ t"�/� ��
Certified Operator: ��,f4X /� a� sOperator Certification Number: 42-77D
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Soars
Back-up Certification Number:
Latitude: =0 =1 Longitude: =0=1
°=1 =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ La er l
L['�11D !_ 3frrI ❑ Non -La er
Other
❑ Other I
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑
Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: --D
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 I -No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
C1 NA
[:1 NE
El Yes
[:1 No
❑ Yes A No
❑ Yes INo
Page 1 of 3 12128104
❑ NA ❑ NE
❑NA Ll NE
Continued

.� Facility Number� — 6q I Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 23.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): J `�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes CRNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes ELNo ❑ 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
J2 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
0 No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
allo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
UNo
[INA ❑NE
maintenance/improvement?
I. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
29,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 Window ❑ Evidence of Wind Drift El Application Outside of
Area
/Crop
12. Crop type(s) 4 z-•�i t�f r _ �pu�/�tre/
13. Soil type(s) L✓ D
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[,2 No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
IS 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
O No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
®-No
❑ NA ❑ NE
x g ..;.'.'Yp f � r!.' s 1 ?%s`s3: F � s :f I1, 7j; 1,11,#a :X�r ,.a,
.Comments (referto questtnnP#) Explain any Y3ES answe'rs;and/pr anyEr�ecommendations oryany othef comments: ' `� ,
s tr r 2 f` a a #µ1 a iarw :"
Use dri�wings `of facility to better explain situations. (usc addttto q. pages)as necessary): tr -; '
✓ . - _ - -. i.. . .,� .:-...�.. ...�. 5- a \fin.. z ✓..-.. •l �. _.-�i -i'f .. c:i♦ M3..'K� ..-1._s:}1'-. �.�J:1i. uw.T'_1'
1�D�; l-�a�'+-I,vrr�� �i�r �I t>�� ��co�.� �QU� a�YY/1 ITI %.�.�'.3�'f�J'G��� � ✓I'YL.
W� rkren G✓�i �� �DC r� �,r X Ol� crrlo�� % Vwa
�, / 1 �Tcvc • *-� rt Caen cxr
y9�r"
/:'-,PL�l�lL - 0 7 6-7
Reviewer/Inspector Name � x•'A sT; r, ' '. Phone:
Reviewer/Inspector Signature: Date: /
Page 2 of 3 IL1L4y1U4 t.onnnuea

Facility Number: — Date of Inspection l� /
} Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes En -No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes jRNo ❑ NA ❑ NE
the appropriate box. ❑ WDP ❑ Checklists
❑ Design El Maps ❑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 ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E[No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
RNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
BNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[[No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
0,No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ZLNo
❑ 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
[R[ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
§;�No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
E&No
❑ NA
❑ NE
Additional Comments anillor Drawin s� -
.,a„E
8
r
Page 3 of 3 12128/04

GH13—vision of Water Quality
Facility Number) 0 Division of Soil and Water Conservation
--- 0 Other Agency
Type of Visit Q-6—mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Vislt outlne O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ,� �� Departure Time: tT0 County:
e
Region: LLb
Farm Name: ge, Owner Email:
Owner Name: �Ias Phone: 7 b
Mailing Address:
Physical Address:
Facility Contact: KJOtW( 0,0S Title:
Onsite Representative: Ste
Certified Operator: exrt5T& 1
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feede.
Farrow to Finish
Boars
Other
❑ Other
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [=O
=1 Longitude: =0=6
°=6 = H
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer —�
❑ Non -Layer
Dry Poultry
❑ Layers
❑
Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Poults
❑ Other ---
Discharges & Stream Impacts
1, is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: ZI
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 KNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
%No
❑ NA
❑ NE
12/28/04 Continued

F
Facility Number: — Date of Inspection
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
Waste Collection & Treatment
El NA
El NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
RNo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ip No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
;.No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
SNo
❑ 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
(9 No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes RjNo ❑ 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) L_-✓
13. Soil type(s) we -9
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? f ,Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
M No
El NA
El NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
RNo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment? ❑ Yes
R 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 tw, Phone: 9lD-x/33 33�
Reviewer/[nspector Signature: Date: irPa Q
12/28/04 Continued

Facility Number:,,.A, — 441 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 RNo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes C&No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ®-No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes J@ No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JZ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[A No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
allo
❑ NA
❑ NE
2T
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
C,No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
®,No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
allo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ZNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
0 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
ZNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
g No
❑ NA
❑ NE
Additi nal><Comin qts nd'/aDra Ings
12/28/04
12/28/04

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: C' f Arrival Time: i� •` Q/r Departure Time: [D-: County:"' + Region: FPD
Farm Name: �7 � c 5 i ne A) Owner Email:
Owner Name: Rt cLand &yp'`1 3,01,1Phone: 9ro -1a C3
Mailing Address: cq-to) a�V - bbl ")
Physical Address: !�
Facility Contact: T't'C�afI4 e,,50 15 f ►" tTitle: Phone No:
t' Pre§4ue
Onsite Representative: p r�,, Integrator:
Certified Operator: Bonnt�e �ISOh Operator Certification Number: _42,0.30
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =o =' = Longitude: =° =
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
it. 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? (Ifyes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes q, No ❑ NA ❑ NE
El Yes
Design C*urrent
Desii;n C•"urrent
Design Current
Swine C►apacity Population
Wet Poultry Capacity Population
C►attic Capacity Population
❑ Wean to FinishF-1
La er
[:1 No
qNA
❑Dai Cow
Wean to Feeder 0
Non -La er
Iy
❑ NC
Calf
❑ Feeder to Finish
❑ NA
❑Dairy Heifer
❑ Farrow to Wean
Dry Poultry
El Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
1:1 Turkeys
Other
❑ Turkey Poults
❑ Other
❑ 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
it. 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? (Ifyes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes q, No ❑ NA ❑ NE
El Yes
El No
� NA
❑ NE
❑ Yes
❑ No
[ NA
❑ NE
El Yes
[:1 No
qNA
N
❑ E
❑ Yes
E�No
❑ NA
❑ NC
❑ Yes
V No
❑ NA
❑ NE
Page 1 q-3 12/28/04 Continued

Facility Number: —6 Date of Inspection / 0�
Waste Collection & Treatment �
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E .No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ;�R(NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
§�No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ NA
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
ZNo ❑ NA ❑ NE
through a waste management or closure plan?
1P No
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
D�No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
5UNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ NE
9. Does any part of the waste management system other than the waste structures require ❑ Yes
5 No [:INA ❑ N E
maintenance or improvement?
❑ NA
Waste Annlication
18. Is there a lack of properly operating waste application equipment?
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes�,No
ElNA [__1 NE
maintenance/improvement?
❑ NE
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
$1 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window+ ❑ Eviid/encee of Wind Application Outside of Area
rDrift/�❑
12. Crop typc(s) CC4S4a( �'rn► C,ma VfQe._), _.q. a VrLe , Qve�
.
13. Soil type(g)
00
v
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
NNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
1P No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[B No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[9 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ERNo
❑ NA
❑ NE
Comments (refer to question #j: txplain any YES answers and/or any'recornmendationsVr any.other comments.
Use drawings of facility to better explain situations. (use additional pages'as.necessary):
Reviewer/Inspector Name s ;� Phone:33
-330o
Reviewer/Inspector Signature: Date: S S
Page 2 of 3 12/28/04 Continued

Facility Number: Date of Inspection I d
Renuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 1�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes tPNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists
❑ Design ❑Maps El 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 ❑ Wasie Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge'?
❑ Yes
*No
❑ NA
EINE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
tNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
t9 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
J�j No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge'?
El Yes
AM
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
R3 No
❑ NA
❑ NE
Other Issues
28,
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
E,No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes]
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
P No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency'?
❑ Yes
[ (No
❑ NA
El NE
Additional Comments and/or Drawings:
Pale 3 of 3 12/28/04

Type of Visit (VCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: .� %� County:
Farm Name: LSP Owner Email:
Owner Name: ki CA Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: ftr__ Q
Certified Operator: Sl��
Back-up Operator:
Region: /W
Integrator:i ry
Operator Certification Number;D to
Back-up Certification Number:
Location of Farm: Latitude: =0 ❑ I ❑ Longitude: = ° ❑ I 0 11
Design ' Current
[4 No
Design Current
❑ NE
besiF,ii urreCwm
Swine Capacity Population
Wet Poultry
Capaty Population
Cattle 3
�nt
Capa city Population
❑ Wean to Finish
❑ Layer
❑ Yes
❑ Dairy Cow
❑ NA
❑ Wean to Feeder Oleo D
❑ Non-Layet
ANo
❑ Dairy Calf
❑ NE
❑ Feeder to Finish
❑ Dairy Heifei
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑Non-ts ers
El Beef Feeder
❑ Boars
El Pullets
El Beef Brood Cow
ElTurke s
Other
❑ Other
❑Turke Poults
Number of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State`? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes allo ❑ NA ❑ NE
❑ Yes
[4 No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
f -O No
❑ NA
EINE
❑ Yes
ANo
❑ NA
❑ NE
12/28/04 Continued

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?
Facility Number: lv —
Date of Inspection ®1 Y
[INA ❑NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[]� No
Y Waste Collection & Treatment
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
(-No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
❑ NA ❑ NE
maintenance/improvement?
Spillway?:
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
ZLNo
❑ NA ❑ NE
Designed Freeboard (in): /
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
Observed Freeboard (in):
12. Crop type(s) �-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
R No
❑ NA
❑ NE
(ic/ large trees, severe erosion, seepage, etc,)
❑ Yes
roNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
f4 No
❑ NA
❑ NE
through a waste management or closure plan?
17. Does the facility lack adequate acreage for land application?
❑ Yes
4No
❑ 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
�Z No
[INA ❑NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[]� No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
ZLNo
❑ 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 Drill ❑ Application Outside of Area
12. Crop type(s) �-
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
roNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determinations ❑ Yes
QQ No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
4No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ZNo
❑ NA ❑ NE
na"4 Up �''ajs be •,�3z mala & )%tie
J �D ��is �t-✓ Pk /� j ,r�S w,' / " y n
Reviewer/InspectorName �'" 1' /r`//
-;� .� . Phone: ✓-
Reviewer/Inspector Signature: Date: 3
12/28/04 Continued

Facility Number:— Date of Inspection 3� Y4
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 StNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ® Yes It No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard 54 -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
KNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ERNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[.No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
50 No
❑ NA
❑ NE
26,
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[ZLNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ZNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
allo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
M No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[&No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
RNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[K No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
4No
❑ NA
❑ NE
*ltibnal Coinni

S
Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation j
Reason for Visit O Routine O Complaint , O f=ollow up O E=mergency Notification O Other ❑ Denied Access I
r wrr rrrri r. r.. ua ■r -
Facility• lumber Date (of Visit: Time:
Not O erational 0 Below Threshold
® Permitted ® Certified © Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
Farm Name: '�' Countti:
Owner Name: K t [ 61.1-1 �' r -`i Sf4 Phone No: _ �! L d I8 (i — I A13
Mailing Address: _45'RI- 0�[ "P f -6L4 _ Ckl Irl, fall'. i2r�( GUMI W LI �Al.C,
Facility Contact: G{.+�- S 1��G aan Title: Phone No:
Onsite Representative: _ �'i� r` I-� �� e► integrator:
Certified Operator: _ G�`� i S�; ie.saaJ Operator Certification Number: �o3G4
Location of Farm:
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a ° Dµ Longitude ' b OK
Design Current Design Current' Design Current
Swine Capacity Population Poultry Capacity Po ulation Cattle Ca achy Po ulation
® Wean to Feeder e, 090 1 JEI Laver I ❑ Dairy
❑ Feeder to Finish JE1 Non -La 6r I ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder Other
Farrow
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present JJE3 La non Area S rav Field Ares
:Holding Ponds I Solid Traps Qr'
❑ No Liquid Waste Management Svstem
Discharaes g Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: /
Freeboard (inches): o7fa N
05/03/01
❑ Yes [Z No
❑ Yes ❑ No
❑ Yes ❑ No
N/A•
❑ Yes ❑ No
❑ Yes M No
❑ Yes (C No
❑ Yes [ANo
Structure 6
Continued

Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes No
(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 1, No
9. Do'any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes M No
Waste Annlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes 4 No
11, Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes No
12. Crop type Ls e -r m ti j & 4- _� bin . G- , b i �,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes (] No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes [ No
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? ❑ Yes No
15. Does the receiving crop need improvement? ❑ Yes No
16. Is there a lack of adequate waste application equipment? ❑ Yes ® No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ® Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes [ZNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ® No
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑ Yes ® No
24. Does facility require a follow-up visit by same agency? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
Q No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit,
' xk.e zs x `r .tiU ,& y 6 y v
Commments (ref&4twQuestlon,#)
Explain any YES aoswcrs'and/or any recd mmeohdations or, any other+comments y
Use drawings�of facility a d to,better explain situations..(use,tiansl pages as necessary)
.`?� .. r.Field Canv ' El Final Notes ..
19- PiGa6e- r, .iy. ,AIPJ%Acd rc.:, 9&\1 �i,.*oyv.,a.\�opl. pny ear<v%}• ovar 0
r,cy,..e_ cx^ o4 41.4 Wa.A4e— 4. r%% A. sL,s+eK^-
Q5 1 3 be�rq r etY`-ovcc . Oe.r w�� c� } �+�w\� res job ,.R
Reviewer/inspector Name
Reviewerlinspector Signature:
05/03/01
Date:
Continued

w
Facility Number: oZ —L
Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes R] No
❑ Yes N No
❑ Yes 10 No
❑ Yes 2 No
❑ Yes E[ No
❑ Yes ❑ No
05/03/01

Facility Number:2,�2 -. (g 4b
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Date:.)- -/)- (o
Time:) I; 15 -
General Information:
Farm Name: 4y.o.l _Dk,�. - 4-e_ County:
Owner Name: b- - Phone No:o I�2
On Site Representative: d integrator: C test"A_
rA
Mailing Address: N'T f3ax 19;)_
MC ;283W
Physical Address/Location:
Latitude: I Lon 'tude: I I
Qgeration Description: (based on design characteristics)
Type of Swine
❑ Sow
15Wursery
0 Feeder
No. of Animals
Livestock:
Type of Poultry No. of Animals Type of Cattle No. of Animals
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Beef
Number of Animals
Number of Lagoons:_ (include in the Drawings and Observations the freeboard of each lagoon)
Facility Inspection:
Lagoon
Is lagoon(s) freeboard less than 1 -foot + 25 year 24 hour storm storage?: Yes ❑ No's
Is seepage observed from the, lagoon?:
Is erosion observed?:
Is any discharge observed?
Q Man-made Q 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: ,ecaijry Acreage:
Setback Criteria __ ..
Is a dwelling located within 200 feet of waste application?
Is a well located within I' 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?
A0I -- January 17,1996
Yes ❑ No 5
Yes ❑ No a
Yes ❑ No ®'
Yes ❑ No 0
Yes ❑ No a
Yes a
No IM
Yes ❑ _SNo 1i - :_-
Yes ❑
No 0
Yes ❑
No
:__• _. -;: .yrs:,,
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