260071_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

r' vi"lion of Water Resources
Faciiity Number '-d'�=--�' - © � Division of Soll and Water Canservatlon
Type of Visit: GTompliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: outine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: — / Arrival Time: Departure Time: County:
Farm Name:
p�'�- Owner Email:
7 /
Owner Name: ��Y_ 7¢` &Up '6 t=' Phone:
Mailing Address:
Physical Address:
4/Region: 0,10
Facility Contact: Title: (y�GIJ/! �d'J Phone:
Onsite Representative: �5- - Integrator: c5rn t'/cj
Certified Operator: C_:510r_f� Certification Number: _Z% I-
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
besign Current
Swine @apaelty Pop.
Wean to Finish
beslgn Current
Wet Poultapacity
ry C Pop.
La er
Design Current
C city Pop.
attle CapaO
Dairy Cow
Wean to Feeder
D
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design C►arrant
D. , P�oultr, C•apaci P.o
La ers
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Beef Brood Cow
Boars
Other
Pullets
Turke s
Turke Poults
Other
Other
Discharp,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 Q'No ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes ❑ No
❑ NA ❑ NE
❑NA ❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
010
❑ NA
❑ NE
❑ Yes
[ No
❑ NA
❑ NE '
Page I of 3 21412015 Continued

Facili Number: - Date of Inspection: r117 " !
Waste Collection & Treatment
w 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 I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?: _
Designed Freeboard (in):
Observed Freeboard (in):_ S! _
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
No ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 6
❑ Yes e"'!q�o ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
Q o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
"o'_
QN
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
l!J "'o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
l_J o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
t_7 '' o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [3-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): 2 e C/Gtrl7er
13. Soil Type(s): }
14. Do the receiving crops differ from those designate in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[TNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Q o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�o
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
[] No
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[]-No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[rf'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
Q�lo
[] NA
❑ NE
❑ Waste Application , ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[EJ-'No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facility Number: - 21 Date of Inspection: r
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑</o ❑ NA
❑ NE
+ 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
D-50 ❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
[3'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
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ' ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes D o ❑ NA ❑ NE
❑ Yes 9-IQo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes I— 110 ❑ NA ❑ NE
❑ Yes
Q-16
❑ NA
❑ NE
❑ Yes
0-N
❑ NA
❑ NE
❑ Yes
L7 <o
❑ NA
❑ NE
Comments (refer to question:#) iExpiuin any.'YES';auswcrs. and/or any additional recommendations or any othewcothntents;
A
Use drawings: of:facili ` "to better ex Iain,s... tuitions (use additiongl ages asrriecessar )..
x
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone:f>
Date:
21412015

u
5Bivision of Water Resources
Facility Number ©- © 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Compli nee Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Z-oe% r ,legion: PIR;' C)
Farm Name:Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: _j cam— A .A s_ Title: -_02C017 e—or Phone:
Onsite Representative: Integrator,�� _
Certified Operator: �'o��� Certification Number: / y
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle
Wean to Finish
09 Wean to Feeder $�0
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
La er
Non -Layer
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Ll Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 5No ❑ NA [] NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
❑NA
❑NE
Yes
JS No
❑ NA
❑ NE
❑ Yes
[3No
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facili Number: - Date of Ins ection: —
b --/
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
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):_
Observed Freeboard (in): 3 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[!�No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[allo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
®,No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit`?
❑ Yes
[&No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
P5,No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
&No
❑ NA
0 NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [�§ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): zzm6zcmi - / Ou' y"ne' j-�
13. Soil Type(s): f tpA-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
C!FN-o
❑ 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
[j�o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
,Z No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[] Yes
E, No
❑ NA
❑ NE
20. Does the facilityfail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Callo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis []Soil Analysis [] Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge'? ❑ Yes 2 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [] Yes C2�No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Ins ection: --
` 24. Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes E3 No
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes J21 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? ❑ Yes SNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [E No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes [8 No [] NA ❑ NE
❑ Yes [Z No ❑ NA ❑ NE
❑ Yes ;-No ❑ NA ❑ NE
[] Yes 2].No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
[:]Yes C2-No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: _Z S A%S 1
Date: — /6 _* '/y
21412015

3pf~lT `3-1 q — I to
or —
Type of visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: JEHO—utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: �o Arrival Time: ! f7 Departure Time: [ County,
Farm Name: ,���ye�/��r�.,-` /Up✓�,���' ,�"� Owner Email:
Owner Name: Phone:
Mailing Address;
Physical Address:
Region:
Facility Contact: GrrS�Title: Phone:
Onsite Representative: Integrator: AP7!i
Certified Operator: > �.{ J Certification Number:
Back-up Operator; Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Design Current
Wet PoultryMo Wo —ac I t 7v Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Design Current
loultr. C:a acl P.o ,
DairyHeifer
Farrow to Wean
Farrow to Feeder
D Cow
Non -Dairy
Farrow to Finish
rfN
Layers
Beef Stocker
Beef FeederBoars
Gilts
La ers
ts
Beef Brood Cow
©.they
Turke s
Turkey Poults
Other
Other
Discharges and StreamImpacts
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 qNo ❑ NA ❑ NE
[—]Yes ❑ No
❑ Yes ❑ No
[—]Yes [—]No
❑ Yes 0 No
❑ Yes RLNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
0 NA ❑ NE
Page 1 of 3 21412014 Continued

Facili 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):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
M No
❑ NA
D NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
®. No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus . ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): An�=41'e ©�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [ 5No
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ®..No
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ZNo
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes R, No
18. Is there a lack of properly operating waste application equipment? ❑ Yes � No
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [SNo
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes .j-No
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
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes allo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes allo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[DNA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

. Facility Number: - Date of inspection: 42
24. Did the facility -fail to calibrate waste application equipment as required by the permit?
❑ Yes
[Z No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
U] 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
bMv y No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[,No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
MNo
❑ 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
[allo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
CE�No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
CC .No
❑ NA
❑ NE
Comments (refer to question?ft Explain4anyYES answeisyiindlorkany adi#itlanal'r"recommendations"aranyothe;rw comments.'`'
Use,drawmgs;of facili =to,netter,ex laiti'situatinns, use additional. ages asrriecessa )z�x F f � # �, `� ?,`
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412014

vision of Water Quality / JP_ q
Facility Number - ?J O Division of Soil and Water Conservation
Q Other Agency
Type of Visit: ompliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: .'p(] Departure Timer County: G�Reglon: rA?D
Farm Name: ��t/c{a�-�- ►r,1 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: L yt• �ps,�; f► y Title: z3yzl Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
La er
Non -La er
ury routtry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Discharaes and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [—]No
[:]Yes ® No
❑ Yes Eg No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: -ZZ jDate of Inspection: r/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ® No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):_
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Q No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a []Yes ® No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes & No ❑ NA ❑ NE
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 IRLNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes JR No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below, ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 2—f/' f©w.
13. Soil Type(s): / el/ ID4'
14. Do the receiving crops differ from those designaterrin the CAWMP?
❑ Yes
p-_g" No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
5jNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
§allo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[allo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
g!�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
MNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
)�No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: d& - Date of Inspection: —j RE=
`1 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® 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
Z No
❑ NA
C] 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
C] 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
[Z No
C] 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.
C] Yes
[g 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
ZLNo
❑ NA
❑ NE
Comments (refer to question #)::Explain any YES answers and/or any additional "recommendations or any other comments J
Use drawings of facility. to better explain"situations (use additional panes as necessary)• ",
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: Dr '.'S� �a
Date:
214.12011

.A I-
Ii ype of visit: tycompnance inspection v uperatton tcevtew V structure tvatuation u iecnntcat Assistance I
Reason for Visit: utine O Complaint 0 Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: ; ,� Departure Time: County: a ,✓
Farm Name:y,..r��,-ram Nip/S/"J �,�' Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
ih�
Facility Contact: L r-e ff92shr ny Title: doh r� Phone:
Ar !r'
Onsite Representative: f ^-+-.- —
Certified Operator: f�A-�--
Back-up Operator:
M
Region:
Integrator: %%%U✓f'y �'j��Wv4
Certification Number: / 9"4 7; 1
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
LLer
Dai Cow
Wean to Feeder
!)
0
Ner
I
El
Dairy Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean
Dt, P■ u-It ,
ffWe7sign
Ca aci
Current
P,o .
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
I
cker
Gilts
Non -Layers
der
Boars
PulletsL
LBeefod Cow
Turkeys
Other
Turkey Poults
Other I I
Other
Discharees and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify 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 FLNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA' ❑ NE
❑Yes No ❑NA ❑NE
❑ Yes ❑ No
❑ Yes ® No
❑ Yes [� No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412014 Continued

Facilik Number: Date of Inspection:
t Waste Collection& Treatment
t 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): — / 2
Observed Freeboard (in): 31
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E] No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): fel'moe�i �,7a�✓�r•r�
13. Soil Type(s):AlvA �/ w�3
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes EZ 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 ® No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box.
❑WUP []Checklists [:]Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ 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 [3 NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

'[Facility Number: - Date of Inspection: --t
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes O No []NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes f@ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
®No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
[:]Yes Z No ❑ NA [] NE
❑ Yes 5? No ❑ NA ❑ NE
❑ Yes [!� No ❑ NA ❑ NE
[:]Yes [Z No
❑ Yes 5 No
[:]Yes C. No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or: any other comments:
Use drawings of facility to better explain situations, (use addi
tional itlanal pages as: necessary)
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9`%D —i�33— 331l�7
Date:
21412014

Type of Visit: ® Compliance Inspection U operation Review U structure Evaluation U t'echnical Assistance
Reason for Visit: ® Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: . C"Region:
I
Farm Name: 13L Vei�(LW SXi-L4 Owner Email:
Owner Name: D �/1 Phone:
Mailing Address:
Physical Address:
Facility Contact: of , OS i Title: Phone:
Onsite Representative: t j Integrator:
Certified Operator: ` f Certification Number: f 2 �04
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
j
Design
Current
Design
Current
Design Current
Swine
Capaty
, Pop:
Wet Poultry
Capacity
Pop.
CatNe
Capac€ty Pop.
Wean to Finish
I Layer
Dairy Cow
Wean to Feeder
Non -Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
C►urrent
Dry Cow
Farrow to Feeder
1)a P,oult .
@a aeit
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharees and Stream Imaacts
1. Is any discharge observed from any part of the operation?
❑ Yes
MNo
[DNA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
TT``
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
r
❑ 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
M 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
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: 2b - Date of inspection: L
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: Z
No ❑ NA ❑ NE
❑No joNA ❑NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): r 3-3
•�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes )n 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 DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 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
WMP?
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?
❑ Yes No
❑ Yes ® No
❑ Yes ® No
❑ NA
❑ NA
❑ NA
❑ NE
❑ NE
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[R No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
rC(] No
T�
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[P 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

f
Facility Number: Z - 7 1 jDate of Inspection
1.
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
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
gNo
❑ 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
M 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
C6 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
Og No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
50 No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
US 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 anyAdditional'reebmmendations or any other caminents >; §�;
Use drawings of facility to better ex lain''situatians.(use;a[iditianal pages a"s,necessary)., _`"`; ;
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Cjt0 _Lj33--3.=
Date: I J'1 Z
21412011

Type of Visit: 0 Compliance Inspection 0 Operation Review ()Structure Evaluation Q Technical Assistance
Reason for Visit: * Routine O Complaint 0 Follow-up O Referral 0 Emergency Q Other O Denied Access
Date of Visit: Arrival Time: D r, Departure Time: County..Q6W_L egion:
Farm Name: �dQp�j Owner Email:
Owner Name: l f-f- i^t , �'IB:S ,ty�c Phone:
Mailing Address:
Physical Address:
Facility Contact: L� !`i'i TJdSi�n�j Title:
Onsite Representative:
�r
Certified Operator:
Back-up Operator:
U
Phone:
Integrator: N
Certification Number: lab?y
Certification Number:
Location of Farm: Latitude: Longitude:
Design Curren
Design t►urrent
Design Current
Swine
Capacity op.
Wet Poultry
Capacity Pop.
Cattle
Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
$;xL7j
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
lDrvCow
Farrow to Feeder
Dr, P,oultr,
C•_a aei. P,o
Non -Dairy
Beef Stocker
Farrow to Finish
La ers
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
©,ther
"Turkey Poults
Other
I 10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes F 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
PL'�Mo No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No No
❑ NA
❑ NE
of the State other than from a discharge?
`P
Page 1 of 3 21412011 Continued

F4c!litY Number: -17 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: /i
No ❑ NA ❑ NE
No NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): l_
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.) r
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes j'j No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ,{TT 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?
T
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 tj No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload [] Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
j
❑ 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
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.
❑ NE
❑ Yes
[15No
❑ NA
❑ NE
❑Yes
�No
❑NA
❑NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[ No
❑ NA
❑ NE
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 18 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes N
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

F cilit Number: Date of Ins eetion:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes rg] 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(cs) below.
T
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes �a 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? I f yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[:]Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[]Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations -or any other comments­'y
Use drawings of facility to better explain situations (use additional pages as necessary).`
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 16-21 3
Date: .2-4 %(
21412011

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: Arrival Time: Departure Time: County: CUMB1=RLAPJo Region: FRO
Farm Name: &Gi\)t' 4tYh NLvw'I 1 s -Z- Owner Email:
Owner Name:Lt.-P_ X. Oosk-,ha Phone:
Mailing Address:
Physical Address:
n �
Facility Contact: te_ OS�n�i Title: Phone No:
lvl Wu-�I+OW h Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
MAN
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 ❑ 4 = i1 Longitude: = o = d = 1I
Design Current
n Current
Design Current
Swine C►opacity Population
Wet Poult'VIMapacity Population
Cattle C►opacity Population
❑ Wean to Finish
❑ Layer
❑ Non -Layer
❑ DairyCow
❑ DairyCalf
❑ DairyHeifer
IS Wean to Feeder T7_00 C
❑ Feeder to Finish
❑ Farrow to Wean
pry Poultry
❑ D Cow
❑ Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Layers
❑Non -La ers
❑ Pullets
❑ Turkeys
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Cow
❑ Gilts
❑ Boars
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�RLNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
M NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
O NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
P9 NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
SNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
MNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — Date of Inspection aO f0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes $� No ❑ NA FINE
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: f--
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 36.11 3 f
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �M No ElNA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes �] No [I NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes, ] No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ElNE
maintenance/improvement? 1P
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable+ Crop Window] ❑ Evidence of Wind Drift ❑ Apppll'ii�cation Outside, of Area
12. Crop type(s) Cmasit,t� perm" � SSLASL)i -�4, (1'►z4 aL�/3ae,.
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
"Psi No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
"'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
09 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
IF No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
QNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other.comm'ents
Use drawings of facility to better explain situations. (use additional pages asnecessary):
Reviewer/Inspector Name I r j,r1 o� I Phone: /a 300
Reviewer/Inspector Signature: mg, im Date: / ao O
Yage 2 ojJ 12128104 Continued

Facility Number: — t 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 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes FNo ❑ 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
tjlNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
X No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�1No
❑ 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
0 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
t8 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
R No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
C9 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
�9 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
V No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ClkNo
❑ NA
❑ NE
Additional Comments and/or Drawings:.
Page 3 of 3 12128104

IType of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denim Access
Date of Visit: - ---- Arrival Time: .{�Q Departure Time: a=County: CaMEF-01"p Region: 420
Farm Name: 13egve-e-do aAj `V -? Owner Email:
Owner Name: k-ct` It
Mailing Address:
Physical Address:
Facility Contact: ���-,at Title:
it
Onsite Representative:
Certified Operator:
Sack -up Operator:
Location of Farm:
Pr
Phone:
Phone No:
Integrator:._ -0 --6 t4
Operator Certification Number:
Back-up Certification Number:
Latitude: = o =' = Longitude: = ° = I =
Design
Current Design Current Design
Current
Swine Capacity
Pop 1l3tfvn Wct Poultry C►►opacity Popuiatlon Gattic Capacity
Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
Wean to Feeder
Non -Layer
❑ Dairy Calf
LI Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean Dry Poultry ❑ Da Cow
❑ Farrow to Feeder ❑ Non -Dal
El Farrow to Finish ❑ La ers ❑ Beef Stocker
❑ Gilts ❑ Non -Layers
❑Beef Feeder
El Pullets
❑ Boars ❑ Beef Brood Cow
❑ Turkeys
Other ❑ Turkey Poults
❑ Other ❑ Other Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
R NA
❑ NE
❑ Yes
❑ No
[§ NA
❑ NE
NA
❑ NE
❑ Yes
❑ No
❑ Yes
[9 No
❑ NA
❑ NE
❑ Yes
[n No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
$4 No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[j NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: ` PIZ
Spillway?:
Designed Freeboard (in):
fW
Observed Freeboard (in): 2-9.
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
P 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
J@ No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
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
FRNo
❑ NA ❑ NE
maintenance/improvement?
]I. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidf Wind Drift ❑ Application Outside
enc
of Area
12. Crop type(s) C006 S
13. Soil type(s) lU�l`'
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
F No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[9No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination
? ❑ Yes
No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA ❑ NE
18, Is there a lack of properly operating waste application equipment?
❑ Yes
[9 No
❑ NA ❑ NE
€''�ry�" ■"e..ryy: 7; au' veil
COmnients (refer t� question#) Explain any VES answers and/or any r ' omme.ndations,orany other�comments.
Use drawings of facility tn,better explain situationss{usefaddtiobal pages 'Qas necessary) ®
bR:sti;.,�`:�`2!! i
1W
Reviewer/Ins ector Name x �` �' 9
Phone:
p
Reviewer/Inspector Signature: Date: a 7
0
12128104 Continued

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

L
f Visit • Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
n for Visitt O ,R,ouutine O Complaint O Follow up 0 Referral O Emergency /01 Otherr❑ Denied Access
Date of Visit: (i �j D� OJ�i Arrival Time: QH.• Departure Time: �,� County: `—um 6e Region:
Farm Name: �erda,M lYI. C1___� S�Z, Owner Email:
fee '
Owner Name: 0 Phone:
Mailing Address:
Physical Address:
Facility Contact: - La_ L H 05k- vA Title:
Onsite Representative:
4l
Certified Operator:
Back-up Operator:
Phone No:
ll
Integrator we w „I1y tfwms
Operator Certification Number: fQio4 7
Back-up Certification Number:
Location of Farm: Latitude: = o = 1 0 Longitude: = o = 1 =
Current
Design Current Design C*urrent
Capacity
tl. Clekfl'Y.
Population
Sl OPEC tI
Wet Poultry Capacity Population Cattle Capacity Population
1�
❑ La er ❑Dai Cow
❑ Non -La er ❑ Dai Calf
rDesign
to Finish
IR to Feeder
5"o^=
Qr to Finish
❑ Dai Heifer
Dry Poultry ❑ Dry Cow
w to Wean
❑ Farrow to Feeder
❑Non-Dai
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gifts
❑Non -La ers
❑ Pullets ❑ Beef Feeder
❑ Beef Brood Cow
❑ Turkeys
❑ Boars
:,
Other
❑ Turkex Poults
ME] Other
❑Other Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes VNo ❑ NA ❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes ❑ No
NA
❑ NE
NA
❑ NE
❑ Yes ❑ No
❑ Yes CpNo
❑ NA
❑ NE
❑ Yes 0 No
❑ NA
❑ NE
12128104 Continued

Date of Inspection
' Facility Number: —
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
1P No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
ffn NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: a
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): d �,
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
$jNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
1p No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
CiNo
❑ 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
O No
❑ NA ❑ NE
maintenance/improvement?
1 l . Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
(9 No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
13. Soil type(s)
v
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
IMNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
WNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
`F" No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
gjNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
I No
❑ NA
❑ NE
1
Commen#s {refer to question, #, : E:xp€nin any YES answers and/or any recommendations or any other comments.
Use drawings ,of facility tob�ctter explAin situations.{use additional pages as necessary
C,d r�+�
ReviewerlInspectar Name Phone: 3 300
Reviewer/Inspector Signature: Date: 8 p�
Page 2 of 3 I2/28/04 Continued

f Facility Number: — U1 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes fBNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 1P No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? I f yes, check the appropriate box below. ❑ Yes [P No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes P No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 13 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
? [ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[gNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
P No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Jig No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[] No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
®No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[�.No
❑ NA
❑ NE
Page 3 of 3 12128104

Division of Water..Quality
Facility Number .Q Division of Soil and Water Conservation
O Other Agency
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 1 N Arrival Time: WS04M I Departure Time: f ayh County:
Farm Name: I S ;�'" Owner Email:
1
Owner Name: I q e A, r� Phone:
Mailing Address:
Physical Address:
i
Facility Contact: L-0-C dOS 'nq Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: i + Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
0
Latitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
S 3 ❑ Non -Layer
❑ Wean to Finish
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ 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?.
Region: T yZO
Longitude. ❑ o =' =
Design Current
Cattle Capacity Population
❑
Dairy Cow,
❑
Dairy Calf
❑
Dairy Hcifej
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 1% No ❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes ❑ No `J�j NA ❑ NE
❑ Yes M No ElNA ElNE
❑ Yes [11 No ❑ NA ❑ NE
12128104 Continuer!

Facility Number: D.p_ Date of Inspection I f b
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No �INA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: BL D
Spillway`?:
Designed Freeboard (in):
M
Observed Freeboard (in): q ' 33
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�No El NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan'?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
ElYes
ifxNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
tp 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
rM
[I NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EP No ❑ NA ElNE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
r*No ❑ NA El 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) CCO&W &(IVKUQ&� (004,4 . ), SSmaL &ra�.
13. Soil type(s) pfQ% 91 �AIVW-j .C412// I'll A6 —
v
14. Do the receiving crops differ from those designated in the CAWMP?
Cl Yes
Lpp No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
`p No
[I NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
IX No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[P No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: 43 3' 300
Reviewer/Inspector Signature: Date: [all
12128104 Continued

Facility Number: w — Date of Inspection J t
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes $ No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design [I Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes to No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes M No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ERNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
EDNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
05 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
5No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
TV No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
10 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
I.No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
&No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
'�;[No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[.No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit l�mpiiance 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: Arrival Time: Departure Time: r3 D County: e n Region:
Farm Name: /_d_'�, Owner Email:
or
Owner Name: _ .L e e .. � ` �%DS �i H� / Phone:
Mailing Address:-`�rz�3 ��-rrd�u—�- Lu��� �d. R143
Physical Address:
Facility Contact: i-e—mm A = , "-< Title: Phone No:
Onsite Representative: �` Integrator:
Certified Operator: _____ 14-0-� Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: = o ❑ 1 Longitude: = ° = 1 ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
j ❑ Layer
i.
!9,;O D 13 V) D 1� JEJNon-Layer I Ii
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
❑ Daia Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non-Daity
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
�I
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 C� No ❑ NA ❑ NE
❑ Yes WNo ❑ NA ❑ NE
12128104 Continued

Facility Number
Date of Inspection
IIf Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0,No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[KNo
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / 9" 19,
Observed Freeboard (in): 3 4P
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
,ZNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
[]Yes
XNo
❑ 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
19 No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
ZNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
R No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
0No
❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop/Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) �r►lmw�iL� b �ll�r r� QyY�j z��d
' 13. Soil type(s) �69.4 Z S 7
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
allo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
&Yes
❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination;❑ Yes
EKNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
EKNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
NNo
❑ NA ❑ NE
I,S- /<z-r.� lc�r� f c tr. `�i � L �t` ��Y �'r Lel zli ��vr�s a''� (/ �-14v�
Reviewer/Inspector Name %d."'�'%„4 �.',»� Phone: /J�� /_ Al
Reviewer/Inspector Signature: Date: 3 �p
01 12128104 Continued

Facility Number: Z,71 Date of Inspection ��_ ko
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 14No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box bclow. ❑ Yes ZNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
C3�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[9LNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
/tNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the pen -nit?
❑ Yes
[Z No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Z.No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
KNA
❑ NE
Other Issues
28.
Were any additional probiems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
,(kNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
(MNo
❑ 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
A No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
(o No
\
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Adiiitionul Comments:tsndlor Drawings:
12128104

�IJ
u.: x '.. ;.q ..,:.��. n i.�r.:., ... x� �rw�....,..��.�1 r ti T._ ..., ,2., 41TF ._.,,4' .., . ':... _... ... .
(Type of Visit • Compliance Inspection O Operation Review O Lagoon Evaluation
for Visit ® Routine p Complaint O Follow up p Emergency Notification Q Other ❑ Denied Access
Facility Number
Date of Visit: ® Time:
�— Q �
OJIcs"5 O Not O erational O Below Threshold
O Permitted 0 Certified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold: ..............
FarmName:........deRveK.......... ....pP...11...................... ................................................... County:.....................................................................................
OwnerName: ................................................... ........................................................................ Phone No:.......................................................................................
MailingAddress: .............................................. .................. .................................................. ...............................................................................................................
FacilityContact: .............................................................................. Tide:................................................................ Phone No:...................................................
OnsiteRepresentative:............................................................./................................................ Integrator:......................................................................................
Certified Operator: .............G.ff ,.............................._XKin,....................................... Operator Certification Number:..........................................
Location of Farm:
IkSwine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 At Longitude • ' 94
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes G-No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes Ewo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑Wo
c. If discharge is observed, what is the estimated flow in gaUrnin? f
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes QW0
2. Is there evidence of past discharge from any part of the operation? ❑ Yes Dl o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [3-go
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes D-No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:...................................................................................................................................................................................................................
Frechoard (inches):
12112103 Continued

f
•' Facility Number: 7 — 01
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 0-No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes Eallo
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑'No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes [-No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes 9Nb
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [TTo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑-90
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [3•No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
[3'No
b) Does the facility need a wettable acre determination?
❑ Yes
M No
c) This facility is pended for a wettable acre determination?
❑ Yes
G'Ko
15.
Does the receiving crop need improvement?
❑ Yes
ONo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
[}No
Odor Issues
17.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
❑ Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
18.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
0-No
19.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
[-No
roads, building structure, and/or public property)
20.
At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
[ No
Air Quality representative immediately.
;,,Cammeats (refer�ta`uestton;#)z, Explatm �y�YES�answers!and/or�a�ny;recomrilendatiaas or�any other catnrrients �� _'�
se
5f�ed«'d' v�rlawt€€ias;a�3€t:� n9.i#t;il:Ht`¢t!3�"a�'"��4-�:`i?.ntdt[.tP;#i.,€'.;,t"-.,kP;&tt€ff�..?.;EiSidltii j'1.ii��:'�"•c��;:.��,..,,�u�aE3¢�d€iP«t,3s!1,�sia91i9a;9%,siISR�_s6+3aiI's1�! c�?K F,!G'�p:is� m.;E,rii�te.jPE�:�Pi'l�6urS33'�tu�fc€.�Lal.ti€dN:dt¢�, i�€;s�r,i�t-}� at�.: alti;:;a.xfi.��.W.�.°...,✓e.�.ut"9,"s'<�w,.:,�i.i«owt.e71�sU(useadditro€neaf a )•s}gs as necessa eld Copy �Final N
.Z
Inv
Reviewer/Inspector Name " .:� 1 ;r,d lii €; € €� e y� °1 C l ,tu �Ea
d� !.a trap �r ��t ;,4,€��:
Reviewer/Inspector Signature: - Date: $ "
12112103 Continued

Facility Number
Date of Visit: I Timc: � G
10 Not Operational Q Below'Threshold
® Permitted M Certified O Conditionalli• Certified © Registered Date Last Operated or Above Threshold:
Farm Name: SeX"Lff CG�r.�.�i�.f`Srre.. # 1 d- County: _ Cu.wl(a CA, G.n
Owner Name: Phone No: 4 i O 1
Mailing Address: 4132 — �i .Krr�.�w. [L...,r4-. g,� _��L2 f Q Kt1:1
Facility Contact:,r. C 6�-aS{c i n e/ Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification number: 1 Q to 4
Location of Farm:
0 Swine ❑ Pouitry ❑ Cattle ❑ Horse Latitude ' 4 k Longitude • �• ��
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
Wean to Feeder 4 J❑ Laver ❑ Dairy
❑ Feeder to Finish JEJ Non -Laver I I 1E1 Non -Dairy
❑ Farrow to Wean
Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons Subsurface Drains Present
'Holding Ponds / Solid Traps ❑ No Liquid Waste Managen
Discharges S Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Laeoon ❑ 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 Collejetiap & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: L�_� .� RA) 2-
Freeboard (inches): Q
05103101
❑ Yes 5No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
J4 No
❑ Yes
No
❑ Yes
No
Structure 5
Continued

Facility Number: —
Date of Inspection a
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes K] No
❑ Yes N No
❑ Yes (�,No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
[6 No
Wash App3ication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
lvo
11, Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
g] No
12. Crop type Ur'4' __ IL, o ,. .
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
SNo
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
'Z No
Regu
red Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
G�No
18.
floes the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
ONo
(ie/ WUP, checklists, design, maps, etc.)
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
M 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?
❑ Yes
[gLNo
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
(� No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question #) Expiain!any,YES answers'and/or,any recommendations 4r snyo er1coinments A '
Use sirawings of facilltyltn better explain situations. (tile additeona[:pages as necessary) i , , , —
"❑ Field Cory ❑ Final Notes >
dig..
/�
W 0. �'-i �uG•1
Reviewer/Inspector Name [ + •. i--
Reviewer/Inspector Signature: 6<4Date:
05103101 1 Continued

Facility Number: a4-11 Date of Inspection
dor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [&,No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt. ❑ Yes 23 No
roads, building structure, and/or public property)
29, Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes SE No
30. 'Were any major maintenance problems with the ventilation fan(s) noted.? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters. etc.) ❑ Yes RtNo
31. Do the animals feed storage bins fail to have appropriate cover:' ❑ Yes E'No
32. Do the flush tanks lack a submerged fill pipe or a petrnanentltemporary cover? ❑ Yes ❑ No
Additional Comments and/or Drawings:
•
05103101

i?.. `r: 7 F"' N J i' v` s+`•syi�'i; a , r. >wi P-.": isGC i �F..„�,e. i o - ' �,: i+ - r.- a 'F' -
11!:I��g����;�Fr�sF;�jNN���*,"�f}�r����r �'y�.��Itl,9ir+1�-&e+�'g�''(�+kn.4�'_,�,�,��t�eC��e'nCy.F�}�. t.ii��-��f-?i..'.f.-.,.._R:S'�,.+��,�J+yya +Ysn�'-.,n�h!� "{` rJ�'�•'.:..w'tlE'7.- �, '. - r,`:
Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ® Routine ()Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
FacilinNumber Date of Visit: ® Time: 1 1 3d I
not O erational 0 Below Threshold
Permitted ® Certified © Conditionally Certified [3 Registered Hate Last Operated or Above Threshold:
Farm Dame: .24.2 aMacz _ _ County: CU m her If
Owner Name: Phone No: g
Mailing address: LQ. dew Rd Se At.
Facility Contact: T L,, jj�:R'ir Title: Phone No:
Onsite Representative: Jz" L'A- y b�,,,... � Integrator:
Certified Operator: �er4isi&cL__ Operator Certification Number: 2-9 4 A'f
Location of Farm:
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• ���
Design Current Design Current Design Current
Swine Ca acity Population Poultry Ca acfty Po ulatioa Cattle Capacity Population
Wean to Feeder ❑ Laver I 1 1[:] Dairy
❑ Feeder to Finish 10 Non -Laver I I IEJ Non -Dairy
Farrow to Wean '0
❑ Fanow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons Q ''',. ❑ Subsurface Drains Present ❑ Lagoon Area ILI S rov FieldArea
I'Molding Ponds / Solid Traps ;_ ❑ No Liquid Waste Mana ement'Svstem
Discharges 8 5tream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Sprav Field ❑ Other
a, If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure S
Identifier:
Freeboard (inches):
0510,3101
❑ Yes 12 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes MNo
❑ Yes [P No
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
BNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
El Yes
No
(If any of questions 4-6 was answered yes, and the situation poses an
Immediate public bealth 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
P No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
V] No
}Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
®No
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
No
r
12. Crop hype g P r.,. w� r.� (� ; Y ec-6� v.,� 1rrr��� f' lens ��- inc LcC-7-ri-
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
Reguired Rgccrdk & 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? (ic/ 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
VQ1 No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
® No
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
Z] No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
U9 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
Ep No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Conimentsx(r We tojquestioni#}: Explain ariy YES answers,andlorany rec mmendutions nir any other cnraiments �-
.
Use'drawlngs of [acility tawletter explain situations:{use°additional pages as necessary), ❑Field Copy ❑Final Notes x.
wr
Reviewer/Inspector Name
Reviewer/Inspector Signature: A,. Date:
O5103101 Continued

4
Facility Number: (. — Date of Inspection
Odor lfssaes
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?
05103101
❑ Yes P No
❑ Yes ZI No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes MNo
Cl Yes [M No
J

r__ . _.,.r _., w. _.... .._ ... n. ._..,...__..__... ...
❑ DSWC Animal Feedlot Operation Review
DWQ Animal Feedlot Operation Site Inspection
_
® Routine O Complaint O Follow-up of DW ins ection 0 Follow -tip of DSWC review O Other
Facility Number 7/ Date of Inspection
Time of Inspection //: � 24 hr. (hh:mm)
13 Registered ® Certified f© Applied for Permit 0 Permitted © Not Operational Date last Operated: ..........................
Farm Name: ....... �f,Fvf��Xffx-,.................................................. Count .......................
OwnerName:....... .......AV/J. 44......., .., Phone No ...................................................
Facility Contact: ,.. ,1.Orr',r ..,, /g .r!!, ,{�,....... Title: Phone No' ...............
il4ailing Address: .......P`%..........re....��7,(�.............................a's7�.G1......... ..........................
Onsite Rep resentative:..,iP;•.,, Integrator: .......t2�,P..c„�
/ �yCertified(3peratc►r;........,,�....�.1.:�,���.�.....l.�ntr�I.,p�.i�......... �.� Operator Certification Number:....,1.�..............7.........
Locution of Farm:
Latitude • 6 46 longitude 0 4 44
Design Current
Swine Capacity Population
® Wean to Feeder
,S-2p6
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design. Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer JE1 Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
s
Total SSLW
Number of lagoons 1 Holding Ponds) I❑ Subsurface Drains Present JJ❑ Lagoon Area J❑ Spray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
2. Is any discharge observed from any part of the operation'? ❑ Yes 0 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes C3 No
b. Ifdischar-< is observed, did it reach Surface Water`' (Ef yes, notify DWQ) ❑ Yes PSNo
c. If discharge is observed, what is the estimated flow ingal/min?
d. Does discharge bypass a lagr)on system? (If yes, notify DWQ) ❑ Yes RNo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes RNo
4, Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes E9 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes JANo
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design'? ❑ Yes 0 No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes 2LNo
7/25/97 Continued on back

Facility Number:,z� — ��
8. Are there lagoons or storage ponds on site which 'need to be properly closed?
Structures fLaeoons.Holdina Ponds, Flush Pits, etc:.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4 Structure 5
r r• r ��,
❑ Yes No
❑ Yes No
Structure 6
Identifier:
.. /....... . .....
Freeboard (ft): ...........7..."F..`'` ............................ .I...... .
10. Is seepage observed from any of the structures? ❑ Yes M No
11. is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes No
12. Do any of the structures need maintenance/improvement? ❑ Yes No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
H'No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
X No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
; No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
t9 No
18. Does the receiving crop need improvement?
Yes
❑ No
19. Is there a lack of available waste application equipment?
OYes
❑ No
20. Does facility require a follow-up visit by same agency?
❑ Yes
Ej No
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
IZNo
22. Does record keeping need improvement?
❑ Yes
(SNo
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
N No
24. Were any additional problems noted ,which cause noncompliance of the Certified AWMP?
❑ Yes
® No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
KNo
® No.violations or. deficiende's.we're-noted during this;visit. ,You.'will receive no•furth:er,
OeO pendetice about this: visit:
f1�''� G"•��7,r���O �i.�.T .�vo✓� t�IG'Gcc�r. C:v� .GHfiir �!"/�ddc.� � P®.c- ��%d_
9 � �
I ,tad %�� ?�/s of :s �✓dr� e ��ac .r�o C.r.���i c �� �� ,s"61'O'i/�r
'"'"7/
„--A-- - �� &-�.t ;wy �✓� C�In/.w1e� /.t.2/..L aJ 25�97
Reviewer/Inspector Name
IReviewer/Inspector Signature:
Date: 8 - 27- F7

s
.....
�[] DSWC Animal Feedlot Operation Review
r►
hn
�® DWQ Animal Feedlot Operation Site Inspection
kY.n�,.'"P
.>
,
Routine O Contnlaint O F()Ilow-up of I)WO inspection O Follow-un of USIVC review
O Other
Date of inspection -.t7 ZI
-
Facility Number Z
Time of Inspection r c¢-d 24 hr. (hh:mm)
■ Registered O Certified l] Applied for Permit E3Permitted 13Not O erational Date Last Operated:
Farm Name: ....... 13?V-Z County:...... k.d+-�E.��9r!1.................................
........................................ ............... ...........
Owner Name:.....,..?,..L.�,%.�`Sttr..........,. Phone No: s ��sZ...........................
�>'o�'
Facility Contact: ........ Title: ................ Phone No: ..................
Mailing Address:.... ���.. °- � P..ca.. / ....,P4<L.. Zr.......................................... ..........................
Onsite Representshive:.....- h! .✓ Q.. .....Ze!.............................. Integrator:......,C1't�,��.
Certified Operator;....., , , �i 1, vft ... Operator Certification Number ...../ql `�7.
Location of Farm:
Latitude Longitude
Design Current
Design Current Design Current
Swine . Capacity Population
Poultry
Capacity Population - Cattle Capacity Population
® Wean to Feeder
10 Layer
I 1 10 Dairy
❑ Feeder to Finish
❑ Non -Layer
10 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Soars
Total SSLW
Number of Lagoons /Holding Ponds' ❑ 5uhsurface Drains Present ❑ Lagoon Area ID Spray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvenent?
❑ Yes
9No
2. Is any discharge observed from any part of the operation?
❑ Yes
IS No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
No
b. I1'dicchargo is observed, diet it reach Surlace Water? (If yes. notify DWQ)
❑ Yes
No
c. If discharge is observed, what is the estimated flow in gal/min?
d, DoQs discharge bypass a lagoon system? (Ifycs, notify DWQ)
❑ Yes
No
3. Is there evidence of past discharge from tiny part of the operation?
❑ Yes
No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
�, No
7/25/97
Continued
on back

Facility Number:2C —
S. Are there lagoons or storage ponds on site which need to be properly closed?
Structures I,a oons floldin Ponds Flush Pits etc.
9. is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes (f No
❑ Yes " No
Structure 5 Structure 6
Identifier:
Freeboard(ft):..........�..........................................I......I.I..,..
...................................
10.
Is seepage observed from any of the structures?
❑ Yes
U No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
M No
12.
Do any of the structures need maintenancelimprove ment?
❑ Yes
IN No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
t No
Waste_
Application
14.. Is there physical evidence of over application?
❑ Yes
OFNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type:6^~{.........................................................................................................................................................................................................
15.
Do the receiving crops differ'with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
E 'No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
J$ No
19.
Does the receiving crop need improvement?
Yes
❑ No
19.
Is there a lack of available waste application equipment?
Yes
❑ No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
.® No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
N'No
22.
Does record keeping need improvement'?
❑ Yes
allo
For Certified or Penn'ttted_Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
A' No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
R1 No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
A No
0 Ndviolationsor. defideneies4eire-n6ted during this:visit.� You,will recei've•no further
coeres'ponde'pce about this'visit::
Comments (life to question #) Explain any YES ansrWv is�and/or any recommendations or any other comments.
Use. dra ngs of factht} .to better .clam situations (use additional pages asyn essary). ,
tt,
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: .2 7- 9