430032_INSPECTIONS_20171231

�.�,"1ki�;�'eI,T, n�l�f rk,, .;�kDi'Vlsion of'Water Resources ' I .
Faet6ty�Number;I 3 2 I Dlvisibn of Sail'an^d'Water Conservation
tmlPi�rY,i .
rl � N c fv I
1 it l U1 �'al,�� r r iidl I I I ,- , t
", f r l y
i d�ulf "tlY€;I."I. J I�I,14:: „�.I . LIk�... I I I Uther Agenc
,.I
Type of Visit: (R Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: O Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: �— Arrival Time: rte, Departure Time: (> i County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: 10a ws 1.0." Title:
Onsite Representative:
U
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Integrator: Ptv&w
Certification Number: IML
Certification Number:
Latitude: Longitude:
Ir
11 i �'.1 I Il hr ;;a DesI`In��' C_grreotl.1
I r. hlYlil Ik ail I I 1
IIriM
k'' �I `r '` 1h� , ,1, i'
I
.1 Design
g
7'
Currcnt�..-Desi
gn' Current
7,ik�lrl�lltf
iltrc
�s lil�rf^ "?.YnIF' a� 11.4 1- ­.,
i a ; :.
rrliSwinen 1,,,, Capacity, bn •Pop. r i r I .Wet PoulIII ,
��i��
„ Opacity
Pop ,: l,r
Cattle, , Capacity Pop.
a. Was the conveyance man-made?
I�rF,ii;=III! ��� 'l I �3fl E, crf . l..a�11�
:i>,�.. tlll�l� m�, "Irl ,, , 91
t I� i , r ,
�3 i�� I . i.$,^b ,3 ,I#',H M
I
I 1: , I
� �^� �I 's' ^
,. _
' �'� � I , '' i I
❑ Yes
Wean to Finish
Layer
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
Dairy Cow
I�
�k1
Wean to Feeder
Nan La er
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
EJ�k
Dairy Calf
� NA
Feeder Finish
l
[–]Yes
No
.
Farrow toWean
"'' I,
Design
Current
❑ NA
1to
Farrow to Feeder,D
'Poultl
II'1 Ca ac3t ,
Yr+t
Farrow to Finish
tf' Layers
I�IIl;
Gilts
Non -Layers
`I11
.aa
Boars
k}: Pullets
{
Turkeys
Turke Poults
Other
Other
. ,.,. , ,��•
Discharges and Stream ImD8Ct5
Dai Heifer
D Cow
Non -Dai
Beef Stocker
Beef Feeder
Beef Brood Caw
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
E:] NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
[—]No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
(] Yes
❑ No
� NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[–]Yes
No
[:]NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ YesSDNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2015 Continued

Facility, umber: 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
�Identifier:
S pi 1 lway?:
Designed Freeboard (in):
Structure 2 Structure 3 Structure 4 Structure 5
Observed Freeboard (in): ' L
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
�9No E] NA ❑NE
❑ No �9NA ❑ NE
Structure 6
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
T®
❑ NE
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ NA
❑ NA
❑ NE
❑ Yes
No
❑ Yes
[] No
❑ NA
❑ NE
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
T®
❑ 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)
❑ Yes
i
❑ NA
❑ NE
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
� No
❑ NA
❑ NE
Waste Application
❑ Yes
® No
❑ NA
❑ NE
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
[,BNo
❑ NA
❑ NE
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 WindowEvidence of ' d Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Ccwi� I � a �s5 ) t roe e' .50"• otl- .
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
� No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[,BNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
P No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements F-1 Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [B No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Q�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 2/4/2015 Continued

jFacili '. Number: Z71 - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. [] Yes No [] NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
No
[DNA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes M No ❑ NA ❑ NE
[:]Yes M No ❑ NA ❑ NE
❑ Yes [�6No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/]nspector 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
Comiriettits, refer to ue'stloti"# Ez'"'lainon' n"'IkYES'ani�wers�'atid/o'r,°'an '; additionalltecommeridations or an other caii>iEments
NU Ilett � tE`v In l��9b ..I. `J•I 1
Use1'dra'win°gsi�othellit°v`tob6tterei`ivlain'`sltuatlonlsi(uselfidditlonal�:pa3 es`ash°n°c�ces`sary)l€' `i �l;.a�" �;°� M,,.
Reviewerdnspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Q '-M
Date:
2/4/2015

1
Division of Water Quality
Facility Number ©- ® 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 4D 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 0 Denied Access
Date of Visit: Arrival Time: ?O w Departure Time: County: Erse Region: Plu
Farm Name:_ 1 '� _ Owner Email:
Owner Name:—^Pres4q T �"►' iY}S . Phone:
Mailing Address:
Physical Address: ,, .- f
Facility Contact: _a MeS J ��,b Title: Phone:
Onsite Representative: 14
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Integrator: PresLm e
tol
Certification Number: nc60
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop,
Layer
Non -La er
Non -La
Pullets
Other
Poults
Design Current
Dischari=.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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes P No ❑ NA ❑ NE
[:]Yes ❑No
[:]Yes ❑No
❑ Yes ❑ No
❑ Yes r9* No
❑ Yes �] No
NA ❑ NE
�NA ❑NE
[2�JNA ❑ NE
E] NA [3 NE
❑ NA ❑ NE
Page 1 of 3 2/412011 Continued

Facili Number: Lt,3- Date of Inspection: 7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): q
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 73 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 P No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes91 No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) T
9. Does any part of the waste management system other than the waste structures require ❑ Yes � No ❑ NA ❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ YesNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes EPNo ❑ 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%rWind Drift('��❑ Application Ouutside'of.Approved Area
12. Crop Type(s); � i�u► Mel q l�'v�i [ ff� ) I f� kV
n
❑ Yes
No
❑ NA
❑ NE
1 3. Soil Type(s);
❑ Yes
No
❑ NA
❑ NE
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
EP 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?
[:]Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
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.
[3 Yes
E�No
E]NA
[3NE
[3Waste Application [3Weekly Freeboard [3Waste Analysis E]Soil Analysis
[:]Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[P No
T!
❑ NA
C] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
2/4/2011 Continued

jFacilky'Number: Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ YesNo ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No [ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No [DNA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
(Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any.other comments:.° I
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q 1 Q -Y33 -.335D
Date: 0_707
2/4/2011

Z_ 4,,..1IK[/j6
!. W Division of Water Resources
Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency
Type of visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 40 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: . 3 County: Region:
Farm Name: —6/`1 Owner Email:
Owner Name: / s Phone:
Mailing Address:
Physical Address:
Facility Contact:
S
Onsite Representative:
Certified Operator: �< P"
Title:
Phone:
Integrator: Prys4lo.-
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
ury rounry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes M No ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
[3 No
]t NA
❑ NE
❑ Yes
-W No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
Page l of 3 2/4/2014 Continued

Facili Number: Date of -inspection: Y(
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ YesNo [:]NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No 10 NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Ir
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.) 0
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ YesNo ❑ 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 W 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) r
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No C] NA ❑ NE
maintenance or improvement? 77��
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [;a No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes A 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 Acce table Crop Window IP Evidence of Wind Drift ❑A plication Outside of Approved Area
t2. Crop Type(s): ( RGr� Hi r
13. Soil Type(s): /7y1_1 1 1/0
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
F No
❑ NA
❑ NE
❑ Yes
$2 No
❑ NA
❑ NE
❑ Yes
P] No
❑ NA
❑ NE
❑ Yes �g No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Yes ® No ❑ NA ❑ NE
❑ Yes Q] No ❑ NA ❑ NE
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agrecments ❑ 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 I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes 3 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 01 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
E] NA ❑NE
E] NA ❑NE
Page 2 of 3 2/4/2014 Continued

' Facili y Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ®No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 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 [A No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
rM No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
IR 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 ft Explain any YES answers and/or any additional recommendations or.any other comments
-."
Use drawings of faeilityto better explain 'situations (use additional pages as necessary)
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2014

Type of visit: ® 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 0 Denied Access
Date of Visit: I Z Arrival Time: Departure Time: County:
Farm Name: V1— Cp Owner Email:
Owner Name: '���Q�C�,� �GZ 1t SCiC. Phone:
Mailing Address:
Physical Address:
Facility Contact: ir�_s L&Y1b Title:
Onsite Representative: H
Certified Operator:
Back-up Operator:
Location of Farm:
s.�
Latitude:
Region:
Phone:
Integratorf�e
SG
Certification Number: 2Zo'
Certification Number:
Longitude:
Design Current
Design
Current
juesign Current
SwineCapacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D , P,'oultr
Ca aci
P.o
Non -Dairy
Farrow to Finish
La era
Beef Stocker
Gilts
7Non-La ers
113eef Feeder
Boars
Pullets
jBeef Brood Cow
Turkeys
atliliCiAl
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [A No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
[]Yes ❑No
❑ Yes ® No
❑ Yes No
[ANA ❑ NE
QDNA ❑ NE
NA ❑ NE
❑ NA_ ❑ NE
❑NA ❑NE
Page 1 of 3 2/4/1014 Continued

+' Facility Number: Date of Ins action: j ITT
I
R No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
�K? No
❑ NA
❑ NE
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
YD NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
the appropriate box.
Spillway?:
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
Designed Freeboard (in):
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Pj No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and V Rainfall Inspections ❑ Sludge Survey
Observed Freeboard (in):�
❑ Yes
® No
❑ NA
❑ NE
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.)
2/4/2014 Continued
6. Are there structures on-site which are not properly addressed and/or managed through a
[] Yes
[g No
❑ NA
❑ NE
waste management or closure plan?
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
5g 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
P) 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 F-1Application Outside of Approved Area
12. Crop Type(s): beUJCL�n Cass— � di'r1 ��L(GLI !) lfe�CCL
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes R No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes P No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
R No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�K? No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
�3 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
)2�3 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
Pj No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
CoNo
❑ NA
❑ NE
Page 2 of 3
2/4/2014 Continued

Facili Number: Date of Inspection: I /
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0] No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
.5�1 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 M 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 10 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 2 No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the ReviewerAnspector fail to discuss rcview/inspection with an on-site representative? ❑ Yes [� No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [5] No ❑ NA ❑ NE
Comments (refer to question #1): Explain any YES answers anti/or any additional recommendations or any,other comments.
Use drawings of facility to.better,explain situations (use additional pages as necessary)..;
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: Ifelffa �
Date:
2/4/2014

Division of Water Quality
Facility Number - ® 0 Division of Soil and Water Conservation
Q Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: ® Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: /of Departure Time: / County:
Farm Name: 2— Owner Email:
Owner Name: s 1;k4 Phone:
Mailing Address:
Physical Address:
Facility Contact: �2w,p STitle: Phone:
k
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Region: Ry
Integrator:f`CS�
v
Certification Number: 2 2-069'
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -Layer
ll
Non -L
Pullets
Poults
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑Yes ®No ❑NA ❑NE
[D Yes
❑No
�0NA
❑NE
[:]Yes
❑No
F1 NA
❑ NE
[:]Yes ❑ No
❑ Yes No
�] Yes No
JO NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 214/2011 Continued

VF -i.,
Facility Number: 93 -.3Z 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:
® No ❑ NA ❑ NE
[:)No �NA ❑NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes P No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes l"' 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 [�]p 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 K] 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 ❑f�),
plication Outside of Approved Area
12. Crop Type(s); C r A Cwnss* �fcw- C. mitPm f� u
r
13. Soil Type(s): S-� o
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
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 W] 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 2/4/2011 Continued

W�
Facility Number: �-i' 3 -_ 2 1 Date of Inspection: jr//.:EZ13
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M No
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes FZ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 0 No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 1/ No
Other Issues `�"
❑NA [D NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
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 [7?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., ti.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes Vfl 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 j 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 recommendationso r.any other comments
�7 F`
Use drawings of facility to better explain situations (use additional pages°;as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: t (" Y —3 3 Do
Date: JA//
214/1011

• Division of Water Quality
Facility Number - © O Division of Soil and Water Conservation
O Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: ® Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: / Arrival Time: '. 3C1rtE Departure Time: County:
Farm Name: {O _ Owner Email:
Owner Name: its tic, Phone:
Mailing Address:
Physical Address:
Facility Contact: ,- W4- Title:
Onsite Representative: `� S La,,t
Certified Operator:
Phone:
Integrator: R Azaf.
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feede2
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
HLayer
Non -La er
rou
Pullets
Poults
Design Current
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Region: W
Design Current
Cattle Capacity Pop,
Dairy Cow
Dairy Calf
Dai Heifer
Dry Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes Q?p No ❑ NA ❑ NE
[:]Yes ❑No
❑ Yes ❑ No
[:]Yes ❑ No
❑ Yes [� No
❑ Yes J�q No
NA ❑ NE
InNA ❑NE
�NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 2/4/2011 Continued

Facilit umber: jDate of Inspection: R 242_
Waste Colleetion & 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:
® No
❑ NA
❑ NE
Spillway?:
TT
Designed Freeboard (in);
17. Does the facility lack adequate acreage for land application?
❑ Yes
[P No
�rrr
Observed Freeboard (in): J
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes [� No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
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 (Wiindo-w ❑ Evidence of Wind Drift r❑_'Application Outside of Approved Area /�
12. Crop Type(s): Ccq tv��l f�'lY G—rA.s S Gq")., ersatz S/4l. ` ,7 h ` w4eac
13. Soil Type(s): DP -r I KO
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
NO 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?
TT
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
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 [P No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E] No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes `f§ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/412011 Continued

)F'acili umber: Date of Inspection: q L
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
2$. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes
No
❑ NA
Q NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes M No [3 NA [3 NE
3 I. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes''' F No
E]Application Field E]Lagoon/Storage Pond E]Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No
❑NA E] NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary). +..`
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
/y4rblc
Phone: 110 -E3 -3-33w
Date: 9/24/2
2/412011

.Facility Number
Other
10 Other
Division of Water Quality
O Division of Soil and Water Conservation
O Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 0 n Arrival Time: f� fat. Departure Time: 04E� County:H1W Ear
Farm Name: _`�� Owner Email:
Owner Name: �'1 PS-tQ�_S ��'� C� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Tames
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Phone No:
integrator:
Vrf�-6c
I/
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o =I = Longitude: =0=1 e=1
0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer I _�l
Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑
Turkeys
❑ Turkey
Poults
❑ Other
of the operation?
Discharge originated at: ❑Structure El Application Field El Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: IT -1
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2, Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑Yes � No ❑ NA El NE
Discharges &Stream Imaacts
1. Is any discharge observed from any part
❑ Yes ❑ No [INA El NE
El Yes El No (j� NA ❑ NE
❑ Yes ❑ No (� NA ❑ NE
❑ Yes 0 No' [:INA ❑ NE
❑ Yes Ul No [INA
Division of Water Quality
O Division of Soil and Water Conservation
O Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 0 n Arrival Time: f� fat. Departure Time: 04E� County:H1W Ear
Farm Name: _`�� Owner Email:
Owner Name: �'1 PS-tQ�_S ��'� C� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Tames
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Phone No:
integrator:
Vrf�-6c
I/
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o =I = Longitude: =0=1 e=1
0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer I _�l
Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑
Turkeys
❑ Turkey
Poults
❑ Other
of the operation?
Discharge originated at: ❑Structure El Application Field El Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: IT -1
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2, Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑Yes � No ❑ NA El NE
Discharges &Stream Imaacts
1. Is any discharge observed from any part
❑ Yes ❑ No [INA El NE
El Yes El No (j� NA ❑ NE
❑ Yes ❑ No (� NA ❑ NE
❑ Yes 0 No' [:INA ❑ NE
❑ Yes Ul No [INA
12/28/04 Continued
❑NE
12/28/04 Continued

Facility'Number: �, Date of Inspection t7
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? El Yes `❑ No 1P NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
C�No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
8 No
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
�d No
❑ NA ❑ NE
through a waste management or closure plan?
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
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
tvo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ YesNo
IR
E:1NA E:1NE
(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 ❑ NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) COSW&X LtJA 6-rQ r4(4a,-)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
I No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
8 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
f
No
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ddO
IN_[ No
❑ NA
❑ NE
Comments (refer to question,#)i Explain any, YES -answers and/or any recommendations ole'. -An Mo mentsF
F -'� � „ ✓ � �, -yw t' y �, JAS � f
Use drawings of facility to better explain. situations: (use additional pages wnecessary),
�Qa�gy�S r'2✓fes c1/�`i /O. �
Reviewerllns s
Phone:
ector Name
p .. 3
Reviewer/Inspector Signature: Date: !0 �fe
�I 'If a
12128104 Continued

3
Facility Number: Date of Inspection I a 0
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 [:1 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 V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
JP No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
JjJNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
99 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
El No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
F
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
R No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
O�No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EP 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
10 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/]nspector 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:
Page 3 of 3 12/28/04

Division of Water Quality
Facility Number0 Division of Soil and Water Conservation
---- - 0 Other Agency
Type of Visit 0 Compllance 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 [I Denied Access
Date of Visit: a Arrival Time: Departure Time: County: , 7'IgRegion: p
Farm Name: — Owner Email:
Owner Name:G't Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: IT(
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Title: Phone No:
Integrator:T_C�21ew==
Operator Certification Number: C?1 90
Back-up Certification Number:
Latitude: = o= I 0 Longitude: 0°= 1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La er
Other
❑ Other
Dry Poultry
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: MI
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?
J
❑ Yes 1ANo ❑ NA ❑ NE
❑ Yes
❑ No
'S NA
EINE
❑ Yes
❑ No
NA
❑ NE
❑ No `� NA
❑ NE
❑ Yes
❑ Yes
IF No
❑ NA
❑ NE
❑ Yes
11�No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: Date of Inspection
Waste Collection & 'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ( No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No P NA ❑ NE
Struc ure i Stnrcture 2 Structure 3 Structure.; Structure 5 5trrrcturc C
identifier:
Spillway?:
Designed Freehoard (in):
Observed Freeboard kin): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �No [INA [INE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes � No El NA [:1 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
1�No
❑ NA
E3 NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El yes
j f f 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 duplication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenancelimprovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ YesNo ❑ NA EINE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [:]Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ FAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence
oDrif❑ ApplicatiOutside of Area
.5hW.
�i�� �l�12. Crophpe(s)cWC,41 &CCY(C6V_S_..I
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'i ❑ Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
No ❑ NA ❑ NE
�No El NA El NE
�No
0 N
El NE
L4 No
[INA
❑ NE
& No
[INA
❑ 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 I JbPhone: -'"1 .;�,j''0JiULJ
Reviewer/Inspector Signature: Date:1!9 I
12/28/04 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes FNo [:1NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �jNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design El 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 V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
P No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
I? NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
[]Yes
O 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
P9No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ANo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
WNo
❑ 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
W 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 �Commen'ts and/or Drawings,
Paye 3 of 3 12/28/04
Paye 3 of 3 12/28/04

0,Dlvis€on of Water Quality
Facility Number O Division of Soil and Water Conservation
Q Other Agency
Type of Visit *Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason far Visit *Routine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 7-60 Fn Departure Time: .� County: &yT—
Farm Name: P��.,�-._, �- - - - _� Owner Email:
q�Owner Name: 4 �KSa� /] r, Phone:
Mailing Address:
Physical Address:
Facility Contact: f"LU Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Region:
Location of Farm: Latitude: =0 =i =id Longitude: 0 ° = I =
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ on -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑
Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Daia Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ D Cow
❑ Non -Dairy I
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes P No ❑ NA ❑ NE
❑ Yes
❑ No
f NA
❑ NE
❑ Yes
❑ No
eNA
❑ NE
❑ Yes
❑ No
OTIA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ()gNo ❑ NA ❑ NE
Page 1 of 3 12128/04 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No P NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 30
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
PNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes�No
Do the receiving crops differ from those designated in the CAWMP?
[3 NA ❑ NE
through a waste management or closure plan?
❑ NA
EINE
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)
❑ NA
❑ NE
9. Does any part of the waste management system other than the waste structures require ❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
❑ NA
❑ NE
Waste Application
Is there a lack of properly operating waste application equipment?
❑ Yes
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
$ No
❑ NA ❑ NE
maintenance/improvement?
I. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
�d No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
f
12. Crop type(s) RSCAAk CqU )t ��
� "4jn &tKQQ,,> t 7111, C� fS�Q.o't
13.
Soil type(s)ty►p�(Q�t=
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
WN No
❑ NA
EINE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
'M No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
P No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
W No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
5INo
❑ NA
❑ NE
Reviewer/Inspector Name Phone: (jo �33�33�
Reviewer/Inspector Signature: Date:
Pnoe 2 of 3 1MR104 Continued

Facility Number: 43 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �jNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes nNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design [I Maps [:1 Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes fPNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
VNo
❑ NA
EINE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
C6 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
'�jNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
JN No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
$3 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
JA 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
N 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
Wo
❑ 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
6 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
JjANo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12/28/04
Page 3 of 3 12/28/04

(Type of Visit 4P Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 10 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �� Dr Arrival Time: -_ Departure Time: County: L� Region:
Farm Name: J
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
a NO #rG&" �hC Phone:
Facility Contacrj�t�i'Z.t => �n Title: hone No:
Onsite RepresentatiCCQbM4 Integ tor: T/Ite_. 17, S�T_
Certified Operator: ��� �veS'44ynpk, Operator Certification Number:
Back-up Operator: �- �� M f)'! Back-up Certification Number:
Location of Farm: latitude: e Longitude: 0 ° 0
Dcsign Current
Swine l. i. Population
❑ Wean to Finish
Design Current
Wet Pouitry Capacity Population
❑ La er I I
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Wean to Feeder
11 1[--]Non-Layer___l❑
Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
arrow to Wean;Woo cXQ
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
NA
[INon-Dairy
❑ Farrow to Finish
El Layers
El Stocker
El Gilts
El Non-Layers
ElBeef Feeder
El
El Bo
El Pullets
❑ Beef Brood Cow
❑ Turkeys
❑ Yes
Qther
❑ Other
❑ Turkey Poults
JE1 Other
Numher of Structures:
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
0 No
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
MNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NF
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
0 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

Facility Number: R— C�3
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural Freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes Wo
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
CRNA ❑ NE
Structure 6
❑ Yes PNo ❑ NA ❑ NE
❑ Yes kNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �o ❑ NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ YesNo ❑ NA [:1NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �'] No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [�] No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) IAV_ f1 -1X rn LjA r ` y :>,n C_"1 V- o is
13. Soil type(s) 5�tt-hp(i. L S �C41�e C_(
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes _J�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
M�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
IV, 3 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
09 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[9 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):
a
Reviewer/inspector Name '� �Q)/I/ � Phone:
Reviewer/Inspector Signature: Date: l'
Page 2 of 3 �— t 12128/04 Continued

FacilityNumber: — Date of Inspection I i G
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ';5�o ❑ 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 C3 maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �ffNo [:INA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
N No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[N,No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
IgNo
❑ 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
No
❑ NA
❑ NE
29,
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[0 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
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:
I ke- dA �'o Wig„`, a 1( 11Z +e. �m s , c S� I�t
a
�t�'t,�l ��J It C.rx �•� ,-- � � �' �.t � Soh .
Page 3 of 3 12/28/04

03
Facility No. Time In Time Out Date
Farm Name f Integrator
Owner rr1 �L jI7 M C' Site Rep
Operator No.
Back-up No.
COC Circle; General or NPDES
Design Current
Design Current
Wean -- Feed
Farrow — Feed
Wean — Finish
Farrow — Finish
Feed — Finish
Gilts 1 Boars
Farrow — Wean
Others
FREEBOARD: Design Observed
Sludge Survey Calibration/GPM 1
Crop Yield Waste Transfers
Rain Gauge Rain Breaker
Soil Test PLAT Wettable Acres
Weekly Freeboard Daily Rainfall 1 -in Inspections
Spray/Freeboard Drop
Weather Codes 120 min Inspections
Waste Analysis:
Date Nitrogen (N) Date Nitrogen (N)
ct r. a 4%0 3

Type of Vlsit &Compliance
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Vislt
0 Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date,of Visit: Arrival Time: �`DU Departure Time: .� 3ti County:
Farm Name: S ~`5 Owner Email:
Owner Name: f fr n -, 'I LAS S T�Jzxo1 f i5rryt' &V=NC= Phone:
Mailing Address:
Physical Address:
Facility Contact: /2sr / c1 zk& � Title:
Phone No:
Region: M—)
d
Onsite Representative: Integrator:
Certified Operator:/1n --� i �Yt m r/'� Operator Certification Number:Z! j l
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Back-up Certification Number:
Latitude: =0
=1
Longitude: = o = I 0 "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
Fa er
on -La er
5012
Other
❑ Other I
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
LaT—lurkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field Cl Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dai Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non-Daity
❑ Beef Stocker
❑ 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 U,No ❑ NA ❑ NE
❑ Yes
[XNo
❑ NA
EINE
❑ Yes
[RNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
21No
❑ Yes
R No
❑ NA
❑ NE
❑ Yes
,® No
❑ NA
❑ NE
12/28/04 Continued

12. Crop type(s)
13. Soil type(s) -C
Facility Number:113 - Date of Inspection
R
Waste Collection & Treatment
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�KNo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
KNo ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
LKLNo ❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
❑ NA
❑ NE
17.
Spillway?:
❑ Yes
No
❑ NA
Designed Freeboard (in):
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
Observed Freeboard (in): 3
❑ NA
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
'No ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
MINo ❑ 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
RNo ❑ 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
[KNo ❑ NA
❑ NE
maintenance or improvement?
Waste Appliention
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑Yes
®No ❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
�ZNo [INA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) -C
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�KNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
Yes
❑ No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
M No
❑ NA
❑ NE
K" -MOV -r- Lvj Z� qtr+y
C,,, - J - R ,,, J,
Reviewer/inspector Name �gj ° / �-� i� rY , Phone:
Reviewer/Inspector Signature: Date: /'2— &,,;200 �
12/28/04 Continued

Facility Number: Date of Inspection �-
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes .LNo [INA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes "?'No ElNA E3 NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ®&No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? []Yes EgNo [--INA ❑NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes � No El NA El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
(2 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
64 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
RZNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ZNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
M No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ONo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3l.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[S 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
[R(No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
CR_No
❑ NA
❑ NE
"Additionsl�'C'ommentsandlorl)ruwings,
12/28/04
12/28/04

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
005
48
Date of Visit: H Q Arrival Time: Departure Time: Ofd County: H A F -Q >✓YT Region: 'ER -0
Farm Name: 5-5— Owner Email:
Owner Name: PRAM%U hk STA-
tN3 PsJZfl
Phone:
R10 - Sj Z — Z 1 O L.4---
Mailing Address: PD
3 �q
_� �
�8 3 Zq
Physical Address:
Facility Contact: —16 RC,MTitle: Phone No:
9/0 —;Zl g — �o2Y
Onsite Representative: Se VIntegrator.• PS
Certified Operator: Vi +^^ 6fel�G f Lk i a,.Ms Operator Certification Number: ;z Ll ��
Back-up Operator: g ucve>� I M M F_ (4— Back-up Certification Number: Z 1(
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Gilts
Boars
Other
❑ Other
Latitude: Zp 2j ` 0" Longitude: � ° SZ 78
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non-Layet
Dry Poultry
❑ Layers
❑
Non -Layers
❑ Pullets
❑
Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
DDairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: [T)
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes KNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
$4No
❑ NA
❑ NE
❑ Yes
X&
❑ NA
❑ NE
12/28/04 Continued

Facility Dumber: N S— 32 Date of Inspection Z
RR -
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes KNo [INA ❑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?: IVD
Designed Freeboard (in): �q
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
XNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
5-0/S-0
10/1 -
3 i� 1
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
$kNo
❑ 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
(A No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
;9,Yo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
CENo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
U�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 Drifl ❑ Application Outside of Area
12. Crop type(s) 1-��4y t� inAn►/ Swt�li pc-ai &V*'r5e'4 ,
-c—P_ Se.uTi
13. Soil type(s) 5.6 tc - O&M D�t°��-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2!�No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
®.No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination;❑ Yes
59,No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
2;No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
5kNo
❑ NA ❑ NE
BZr►n0)4-
?LS1043
3/t -
10/1S 0-q0 0 iw
ental �-
5-0/S-0
10/1 -
3 i� 1
�e,-,c ,f-,
i'zi)
8/0 -
j3 i
15. Pty w owd4o< -f� -A' Mrd cov;i+�,, +K `K -t rtew �e_scvt; c lose_
777
Reviewer/Inspector Name d - 77-
' AAAA
Phone:
Reviewer/Inspector Signature: Date:
12/28/04 Continued

F pility Number: 14 — � Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available'? ❑ Yes MNo ❑ NA FINE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes IgNo ❑ NA EINE
the appropirate box. ❑ WUP"' ❑ Checklis
i/❑ Desigta-[] Maptr"❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. RYes ElNo [INA [:1NE
ElWaste Appiicati(V❑ Weekly Freeboarfi ❑ Waste Analysis❑ Soil Analysis!// ❑ Waste Transfers[] Annual Certification't-,
❑ Rainfal[ CS -Stocking ❑ Crop Yiel(i✓❑ 120 Minute Inspection Monthly and I" Rain Inspectio*5'❑ Weather Cod(,=`
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit'?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification`?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
O No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
5Q No
❑ NA
❑ NE
❑ Yes
&'No
❑ NA
❑ NE
❑ Yes
[SNo
❑ NA
❑ NE
❑ Yes
Z.No
❑ NA
❑ NE
❑ Yes NNo ❑ NA ❑ NE
❑ Yes EbNo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes PSNo ❑ NA ❑ NE
[]Yes
B No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
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12/28/04

ii";/F�yi'` t"i 1t•"�,a '��`Fh - 'i
%�,
Iowa
Sop and Weter Conservation w k
li, �, r
Othue�r .urs ,� ,,.,
d+'. ngv��'M ONE'.
i�.
Type of Visit ® Compliance Inspection 0 Operation Review (:) Lagoon Evaluation
Reason for Visit ® Routine (_-) Complaint 0 Follow up O Emergency Notification C Other ❑ Denied Access
Date of Visit:� • � Time: i,b • 'O
Facility lumber Z
Not O erational BeloKThreshold
Permitted ® Certified 0 Conditionally Certified ❑ Registered pate Last•Qperated or Above Threshold:
Farm Name: �S— `� County• _�C HCl
Owner Name:-1y�t? �i 1�Y�C � f`Gry�Ct 4R'�a iCG r`,,A Phone No:
Mailing Address: .a Cx .A AS C, I "'n i\ -z Yl C
Facility Contact: JALLInd C, C h Title:
Onsite Representative: lN1.: d'.r1C-
Certified Operator: 1z r„ r►.
Location of Farm:
Phone No.
Integrator: PS F
Operator Certification Number:
&Swine ❑ Poultry ❑ Cattle ❑Horse Latitude ' 6 u Longitude • 1 .4
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder 1 10 Laver I I ❑ Dairy
❑ Feeder to Finish I JEI.Non-Laver I 1 10 Non -Dain'
® Farrow to Wean a400
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons 1 f I
'Holding Ponds 1 Solid Traps
Dilcharges 8 Stream Impacts
I. Is any discharge observed from any part of the operation?
Dischar,e orieinaTed at: ❑ Lagoon ❑ Spray Field ❑ Other
a, if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify D WQ)
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 C
ALM'o & JECatMent
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 S=ture 3 Structure 4 Structure 5
Identifier:
Freeboard (inches)-.
05/03/01
Continued
❑ Yes
SO No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
® No
❑ Yes
C& No
❑ Yes
[5 No
Structure 6
Continued

Facility Number: 3 Date of Inspection - _ 0
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes (� No
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvcment? ❑ Yes ["'No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes MNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes W 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
12. Crap type ECCOM LII A_. �L__ SVI . G3C t' ' 6 ' -S .
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [ANo
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 CS No
RegUired
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[XNo
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
[DNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
[!+No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[g 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?
(ic/ discharge, freeboard problems, over application) Cl Yes 0 No
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑ Yes [jj No
24. Does facility require a follow-up visit by same agency? ❑ Yes tl�No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes [b�No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
a',$:.'_=.,c k,. F �+ -, .:: !< �r.�..,�,rtim -.-,;, -. m-��:::,�.�'��`,-r:��'�` S.� Cn°-4.,:,a:9c$ie.e.w�'��i .�, ..
Comrnents�� referto;question #) Explain3enyYESanswcrsgand/or,eny recommendations or any, other comments ry
�Usesdrings of fac111ty tin;better explain siWtians(use additional p�agsasnecesryl} ❑Field Copv ❑ Final Notes
Reviewer/]nspector Name
Reviewer/Inspector Signature: Date: D
05/03/01 Continued

Facility ]Number: 43 —3a Date of Inspection 3 3 O Q
Odor 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 ® 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 [�2 No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ® No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ® No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
05/03/01