770006_INSPECTIONS_20171231

Type of Visit Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit XRoutine O Complaint. O Follow up O Emergency Notification O Other p Denied Access
Facility Number Dale of Visit: " � Time: r a
Q Nat O erational Q Below Threshold
*ermitted © Certified, 3 Colnditionally Certified 0 Registered Date Last Operated or /Above Threshold: .........................
Farm Name: ... .� ...... !�11,r�(..�........��i,r r!1 .. County: ..... i�(CI M.07va/............ .......................
. ...... .........
Owner Name: . ........................
.....��Y.�!4:e.,�.....�..tct;..l..lA..�............................................. Phone No: ..��d :.1......�.7...�ZS'�_
FacilityContact: ................ ....,...................................... Title:................................................................ one No:.......,........,...................................
MailingAddress: .............................. ......... . ........................................................................... ....................................ram ........ ..,.................
OnsiteRepresentative:.......................................................................... .......................... Integrator:........?` rwi.r:..............,........,................................
CertifiedOperator:......... e.5............. ........W..... CS,r l............. ,............. Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude N ` " Longitude • 4 66
C� aici �.Pa ulatian.,�Poultr3'._.�....�Cae$�ginurrent-
. a
gn Current ,
I % 1 f✓attle 1 x
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Farrow to Finish
❑ Gilts
❑ Boars
Maier vDairy
❑ Non -Layer 1 10 Non-Dairy
F::::::F
vi�
❑ Other 1
�Totai `Design Capacity, '' � d'�?
Y
TOtA SSL'W
Nnmber of Lagolfnh Z ❑ Subsurface Drains PresenEll❑Lagoon Area ❑ Spray Field Areas
Holdin Poach / Solid Traps ; , ❑ No Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes o
c. If discharge is observed, what is the estimated flow in gallrnin?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes JtNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes Jff No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure
Identifier: .......................................................................................................................................................................................................................
Freeboard (inches):
5/00 �/e 1/-0 Continued on back

r,
Facility Number: 77 — o6 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?.
❑ Yes
No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
� No
'
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
1
elevation markings?
❑ Yes
,(No
_Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
�No
11. Is there evidence of over applicatio ? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
XNo
12. Crop type4G�
13. Do the receiving crops differ with those desiglatedd in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
o
14, a) Does the facility lack adequate acreage for land application?
❑ Yes
o
b) Does the facility need a wettable acre determination?
❑ Yes
-,ONo
c) This facility is pended for a wettable acre determination?
❑ Yes
o
15. Does the receiving crop need improvement?
❑ Yes
o
16. Is there a lack of adequate waste application equipment?
❑ Yes
o
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
❑ Yes
Q3,No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
kNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
XNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
.,Wf No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
(ie/ discharge, freeboard problems, over application)
�No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24. Does facility require a follow-up visit by same agency?
❑ Yes
ro
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
�o
1Q Yt91 � s'pir 000cje)a0k$ -*re P0fjed• 0009 NsMsit;. Y00 wiii-book #a 6tth$r
.. • corresooridence: about: this 'visit: • ................... • ................ .
Com�oin`ents'(firer, to questioin #) Explain any'`YI S answers and/or any''r'ecatiu€iunenEdatinns'nr'ariy'otl eir coniments.`S@`
Use drawings of facility to better'eicplairi sittations. (use addliional'pages as rsecessaryj.' a �€ i ; €r ; ' ,;'.!�';` " V� �.' � n', !
AL
/ A Ad a�slysue"
e- %lr, ��� 1'A4^1ejiu& fj4.f"�e Oiewo(VIter-5.
W tll �to�.2 7 ! r`tS d /ice ex_hou�-r-
:�.
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 767 5/00

Facility Number: Date of Inspection lL�J
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below k
es ❑ 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
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes T
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 TO
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 100
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yesio
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? es ❑ No
Additional Comments an or Drawings:
5/00

Type of Visit: ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: 10 Routine_0 Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: I ) Arrival Time: Departure Time: p County: A-X6# cr" Region: )*RQ
Farm Name: �JeQ�,r iL'enJ, /r-et! ,, Owner Email:
Owner Name: /�� /�Q> y- p /�' q" r✓94 _- Phone:
Mailing Address:
Physical Address:
Facility Contact: � / ' �ti'P Title: Phone:
Onsite Representative: integrator: P&
u
Certified Operator: Certification Number: -
Back-up Operator: Certification Number:
Location of Farm: Latitude:
Longitude:
Design
Current
Design
Current
Design Current
Swine Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity op.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish Z,
DairyHeifer
'Farrow
to Wean
Design
Current
D Cow
Farrow to Feeder
1) , P,oultt,
Ca acl
Pto
Non -Dairy
to Finish
La ers
Beef Stocker
HFarrow
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes rG No ❑ NA ❑ NE
❑ Yes
❑ No
NA
[D NE
[:]Yes
[] No
NA
❑ NE
❑ Yes ❑ No
❑ Yes No
[:]Yes No
�NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

1
Facili Number: Date of Inspection: 1 s'
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
❑ NA ❑ NE
8]NA ❑NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Z
Spillway?:
Designed Freeboard (in): p
Observed Freeboard (in): Z l q y
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 4 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan? /
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste_ Application
l0. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes F
No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 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 0 Application Outside of Approved Area
12. Crop Type(s): "
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
l6. 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
T No
U NA
U NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes 01 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps [] Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes T No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [:] Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes r No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes PU N
o
❑NA ONE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Fac€Illy Number: Dateof inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
i 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.
17—
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
25. Did the facility fail 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
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
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
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone:
Date:
Page 3 of 3 21412015

Type of visit: 0 Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Routine O Complaint Q Follow-up Q Referral Q Emergency Q Other O Denied Access
Date of Visit: Arrival Time: 0; Departure Time: County: a ti+ Region: C�
Farm Name: QQX J� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:rTA
/j/J
Facility Contact: Moo l dd Title: Phone:
u
Onsite Representative:
Certified Operator:
Integrator: /EG LGL_ ✓12
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Current110esign
Current
Design Current
Swine
Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
I)r P.auItr.
Ca aclt
P,o .,
Non -Dairy
Farrow to Finish
I
11-ayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I 113eef Brood Cow
Turkeys
Other
tu'rkey 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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[]Yes E�j No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
[—]Yes No
[:]Yes ® No
®,NA ❑ NE
NA ❑ NE
P NA
❑ NE
❑NA
❑NE
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Fac,�li 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 1P NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): &T
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.) T
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 171
No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes M 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 EP 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 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of'Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
a.
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes "C No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes rF' No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑Yes [ No ❑NA ❑NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes M No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [� No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 1� No
DNA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Facili Number: 42 IDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for'sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT") certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑NA FINE
❑ Yes J� No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes 01 No ❑ NA ❑ NE
❑ Yes W No ❑ 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/Inspector fail to discuss review/inspection with an on -site representative?
[:]Yes
®T No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
Yes
[ No
❑ NA
❑ NE
Coments,(reNe tp quetion;#),Explain anyXES;upswers and/oeanyadditlonal recn)n.;m'+e`ndatlons or nny athei�comments', �t x
nweeralslutios("" dditioal'aUdrtoacppRes as necessary
... ..
,�<
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: U0-Y33- 7360
Date: 1
21412015

IType of visit: qr t�ompuance tnspecuon u uperatton xevtew U Ntructure tvaivation U I ecnnicat Assistance I
Reason for Visit: fO Routine O Complaint -O Follow-up 0Referral O Emergency 0 Other Q Den led Access
Date of Visit: Arrival Time: ���^— Departure Time: L_tCounty: / / Region:, �7
Farm Name: eQ,t� olk
e Owner Email:
Owner Name: 1 "� P�.��,(ts Phone:
Mailing Address:
Physical Address:
Facility Contact: 10
Onsite Representative:
Certified Operator: q
Back-up Operator:
Location of Farm:'
Title: Phone:
Latitude:
Integrator: N& Pj,,,_U 411
Certification Number: 1764
Certification Number:
Longitude:
Swine
Design Current
Capacity Pop.
Design Current Design
Wet Poultry Capacity Pop. Cattle C•apaelty
Current
on.
Wean to Finish
I ILayer I
t Cow
Wean to Feeder
Non -La er Iry
Calf
Feeder to Finish
iry Heifer
Farrow to Wean
I Dry Cow
D,r. l;oultr. Ca acl P■o Non -Dairy
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes Qfl No ❑ NA ❑ NE
❑ Yes [] No Qg NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[R 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
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
P No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
NA
❑ NE
Struct re 1 Structurg 2 Structure 3 Structure 4
Identifier:
Structure 5
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
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[� No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
[] Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[� No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes In No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop
� Window ❑ Evide�%'
f Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): LJ:.I.�s'�ll ` rD�^ A �1-Tc�� )�, ©v-e-."�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records_ & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
Q,No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes [! No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 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 21412014 Continued

1`
hacili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes P No ❑ NA
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes VNo ❑ NA
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)
❑ Yes No
❑ Yes No
❑ NE
❑ NE
❑ NA ❑ NE
[DNA ONE
❑ Yes 9 No ❑ NA ❑ NE
❑ Yes LV No ❑ NA ❑ NE
❑ Yes V No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[:]Yes
No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA
❑ NE
Comments;(refer to question #) Expl.iiln any YES answers: andlor anyadditionalt �ecomniendations�or
any
athe'r comments
`_.� ; ".
Use,drawings_;offacilityto-better=.ezpEsin''situatians4:(use;addltionalpagesashe cessary)�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412014

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Iteason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: d County: MO�lD
Farm Name: V l:a' Vt P'/ rh Owner Email:
Owner Name: [vs -A mft.Q A':)�'Ut Phone:
Mailing Address:
Physical Address:
Facility Contact: Qom. —� D8 Title: Phone:
Onsite Representative: Integrator: NG Pay
Certified Operator:
Back-up Operator:
Location of Farm:
Ll
Latitude:
Certification Number:
Certification Number:
Longitude:
Region: FTZO _
DesigNU
Swine Capacivp.
to Finish
rrent Design Current Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pop.
..-, La er- DairyCow
to Feeder
Non -La er
DairyCalf
er to Finish
DairyHeifer
Design Current D Cow
Dr. P�oultr. Ca acl l;o Non -Doi
w to Wean
w to Feeder
[Farrow
to Finish
La ers
Beef Stocker
Non -La ers
NPullets
Beef Feeder
s
Beef Brood Cow
KL_jOther
Turke s
Other Turkey Poults
jLOther
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)?
❑ Yes [A No ❑ NA ❑ NE
[]Yes [:]No
[:)Yes [:]No
[�a NA ❑ NE
[�)NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No NA ❑ NE
2. is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3
21412014 Continued

Facility umber: —71 - Date of Inspection: Z.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 N NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?. -
Designed Freeboard (in):
Observed Freeboard 2,� V
(in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[ No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
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
YW
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11, Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [] Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): L SS H4, 14i9»G._w
13. Soil Type(s): ro
14. Do the receiving crops dif er 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
T
❑ 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 ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑(Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Fhcifi umber: % - Date of Inspection: Z "?
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [V No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �a 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?
Reviewer/Inspector Name:
Reviewer/Inspector Signature: 3Q4
Page 3 of 3
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
[:]Yes � No
❑ Yes No
❑ Yes ® No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[P No
❑ NA
❑ NE
Phone:
Date: TV
21412014

f'ype of Visit: 0 Compliance inspection U Uperation Review U structure Evaluation U recnnical Assistance
Reason for Visit: • Routine l) Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: v Arrival Time: L Departure Time: County: 'f�rrlo>~1A Region: ��
Farm Name: 1�� `��f'�"� Owner Email:
Owner Name: t- Phone:
Mailing Address:
Physical Address: -�
Facility Contact: F3� /" 4y -� Title: Phone:
u
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
i
Latitude:
Integrator: 0 & Pa.- V"" s
Certification Number: zl,
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pap.
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
123
3 Z_
Dai Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dr, P�oult a
Ca aci
P,o P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turke Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
P No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[] Yes
❑ No
`'t'' 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)?
TT
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[] No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
KP No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3
21412011 Continued

Facility Number: - „�] Date of Inspection-
Waste Collection &'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[P 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: 2-
Spillway?:
Designed Freeboard (in):_
Observed Freeboard Z
(in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
4111 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
n9l 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
�2 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �3 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptablee Crop
y�Window
� ® [3Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Typc(s): CKi7�ri[ /d er,`�f4 6�aSj (112J. _5Z• 6; �
13. Soil T e s
( )
YP : -A
14. Do the receiving crops Jiff from those designated in the CAWMP?
❑ Yes
MI 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
O No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�1 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 Iq No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
Page 2 of 3
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
21412011 Continued

Facili Number: 17 1- Date of Inspection: YMT
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[�FNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check
❑ Yes
No
[DNA ❑ 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
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-appheation)
T
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑. Yes No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or anylother comments:::
Use drawines of facilitv to better explain situations (use additional pages as necessary)..
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: `TY3~'33�
Date:
21412011

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
Zir
Date of Visit: Arrival Time: Departure Time: / County: R/e//^0"'0 Region: lJ
Farm Name:_ LL6ay 11/ ite" I -"' _ Owner Email:
Owner Name: ��'r '^ I &ko A eta Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: y
L
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
i $. �y°'+��y"
�-� 6!&;i4�%3
t
ENNINNIN
USEon
n t
"m
•
0
. .
��
,.,t
1.l,.
Fl1�1
�.
��
�;'
EM
Discharses and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes r1p No ❑ NA ❑ NE
[:]Yes
[:]No
'� NA
❑ NE
[3 Yes
[] No
NA
❑ NE
❑ Yes ❑ No
❑ Yes No
[—]Yes No
(]NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection: Z
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: f
E No ❑ NA ❑ NE
❑No [PNA ❑NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �S 9
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
e] 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
P No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):Q
13. Soil Type(s):
14. Do the receiving crops di er 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
Renuired Records & Documents
N. 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 I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes �No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [M No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes P No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately,
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes [�] No ❑ NA ❑ NE
❑ Yes EP No ❑ NA ❑ NE
❑ Yes [0 No ❑ 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/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better explain situations (use additional naves as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Pl0W? Sm
Date: le/
21412011

Division of Water Quality
iacility Number ®- -� 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: lb Compliance Inspection Z3 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: rrival Time: 5 Departure Time: : / County: Region:
Farm Name: 'ea� Wi yr.v Owner Email:
Owner Name: J� 1' +may--Q�� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: � Integrator:
Certified Operator: r-A Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish 3
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Non-L
Pullets
Other
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)
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
D Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes �No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [] No
MINA ❑ NE
®NA ❑NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No (_ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Nu ber: 4 jDate 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
NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in);
6f
Observed Freeboard
(in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
FZNo
[DNA
❑ 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
tp 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 r" No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes P No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes t 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 Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.))
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Wi dow Evidence of Wind Drift �❑ Application Outside of Approved Area
9
12. Crop Type(s): �M fLJ
13. Soil Type(s):
14. Do the receiving crops differ fr m 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
CJ�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
T
❑ 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 ❑ ].ease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EA No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Tradsfers ❑ 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 L-VNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

lFacility Nu ber: - Date of inspection: &jq�.
24. �id the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes 4DNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes T� No ❑ NA ONE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes tpNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No MNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes 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 No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
T
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[:]Yes
[] No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendgtions.or an
, other;comments
,A
Use drawings of facility to better explain situations (use additional pages as necessary)..
Reviewer/Inspector Name: C VA Q� Phone:
Reviewer/Inspector Signature: _ - Date: iZ
Page 3 of 3 21412011

Division of Water Quality
Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 40 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: Departure Time: i? h. County: lzo
Farm Name: Oe-14) Owner Email:
Owner Name: A/#'Ir4t / ► cy-g &rvt"L, LLC Phone:
Mailing Address:
Physical Address:
Facility Contact:�lop� Title:
u
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
Phone:
Region: A09
Integrator: A) 6— io"'Orl
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
k—kNon_Layer
a erI I -::]
Pul
Other
Design Current
Discharzes and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes P No ❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes
❑ No
P NA
❑ NE
❑ Yes
T No
[DNA
❑ NE
❑ Yes
`{�j No
❑ NA
❑ NE
Page 1 of 3
21412011 Continued

Facility Number: Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2
Identifier:
Structure 3 Structure 4 Structure 5
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
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
R�)No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
g3No
[DNA
❑ 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?
1 I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus [] Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Wi o ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): , J/hEv... U' D��'li
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
l5. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [RNo
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA. ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [] Yes P 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. T
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [j!�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 n No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ' N
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Pracility Number: Q 17 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes [,& No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check []Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. 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? ❑ Yes ® No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative? ❑ Yes ® No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes JE No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or4ny additional recommendations orany uther3comments . ,.. tf ` (.
Use drawings,of facility to better explain situations (use additional pales as necessary).
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Phone: qf�' , `f3o
Date:
21412011

IType of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: !O Arrival Time: Departure Time: County: !ybN Region: 640
Farm Name: ,C�i%�rAl.L. /}1ed✓ M Owner Email:
Owner Name: /yOr� 1 ' laore I ' i ,/j/j u- C Phone:
Mailing Address:
Physical Address:
Facility Contact:Title:
N
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator: 4�6 f Lwal
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = { = Longitude: = o =' =
Design Current
Design C*urrent
Design Current
Swine Capacity Population
Wet Pouitry C►apacity Population
C«attle Capacity Population
❑ Wean to Finish
I0 Layer
I
w
❑ Wean to Feeder
JE1 Non -Layer
I I
Dairy Calf
Feeder to Finish 3 2-3 7
❑ Dairy Heifer
Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
El Beef Stocker
❑ Giits
Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
El Turkeys
Other
❑ Other
❑ Turkey Poults
❑Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes 9No ❑ NA ❑ NE
❑ Yes
❑ No
§aNA
❑ NE
❑ Yes
❑ No
?I NA
❑ NE
❑ Yes
❑ No
I INA
f❑NA
❑ NE
El Yes
[PNo
❑NE
❑ Yes
�p No
❑ NA
❑ NE
12128104 Conlinrred

t ,
Facility Number: Date of Inspection B D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
P No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
PNA
❑ NE
Struct re 1 St eture 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
D
Observed Freeboard (in):a
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
1PNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed
❑ Yes
EpNo
❑ 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 ANo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes TJ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes $9 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ["No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 1PNo ❑ 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 ElApplication Outside of Area
12. Crop type(s) 1ay, VV' --0"a C�q,t'lh
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. is there a lack of properly operating waste application equipment? ❑ Yes
�No El NA [I NE
No ❑ NA ❑ NE
�No❑ NA NE
[�PNo ❑ NA ❑ NE
MNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name �� Phone: 10 3 —3
ReviewerlInspector Signature: Date: Ai�e
Page 2 of 12/28/04 Gonanuee

S
Facility Number: — Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
[]Yes
["No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
n No
❑ NA ❑ NE
the appropriate box. ❑ Wup ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
�PNo
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Q%No
❑ NA
Cl NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[�bNo
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
1P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
§a 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
rMNo
❑ 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
1P No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
CS No
❑ NA
❑ NE
Comments and/or
Page 3 of 3 12128104

7vs 13 f N[ y 131 a
Facility Number
Qi Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 16Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: } Departure Time: " }r p County: A Region: 47K0
Farm Name: (-).:ed'^ V11 & �M Owner Email:
Owner Name: i11� C'I(X!''ts ManujN,�vf �L G Phone:
Mailing Address:
Physical Address:
Facility Contact: JaN4 400e Title:
Onsite Representative: ! r)Mu Moue_
Certified Operator: -rffi V
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Latitude: n 0
Phone No•
Integrator• P!/✓ins' Fdnl17 gag"i L LC
flr�7—
Operator Certification Number: 0 C' `i b
Back-up Certification Number:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
X Feeder to Finish j
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Diseharees & 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?
N ❑ O = i = p
Longitude:
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Fleifei
❑
Dry Cow
❑
Non -Dairy
❑
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 49 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ZRNo
❑ NA
❑ NE
❑ Yes
JZ No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): 1�9 IT
Observed Freeboard (in): 3 9
❑ Yes SNo ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
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
[N No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
1,;� No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
®, No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
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 ofAcceptable Crop Windrow Evidence of Wind Drill (I Application Outside of Area
i❑
12. Crop type(s) way I g I y�U{iAft,�0—i_i►J_G
13. Soil type(s) Allty $ Is
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
12 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
PNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
S No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 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):
w
Reviewer/Inspector Name �yS Q _ E 1 s Q Phone: t]D - 3
Reviewer/Inspector Signature: Date: Meych 31 0 a QO
V 12128104 Continued

Faality Number; — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate ol'Coverage & Permit readily available? ❑ Yes RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [RNo ❑ 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 ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking 15JCrop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[allo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[RNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
® Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
N No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[2 NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
BNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
JZ 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
El 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
ErNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
F?D No
❑ NA
❑ NE
Additional Comments and/or Drawings:
�I, Plebe fu-f Cron retard r �o- ha�r co f
as, aoo8 S kid J nle hot anal e-
Page 3 of 3 12128104

Facility No.••Farm Name
Permit ✓ COC
l�l [I.+" V i' (�✓ Date 3131101
OIC_ �'� eNPDES (Rainbreaker PLAT Annual Cert )
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft & %
Liquid Trt. Zone ft
ETTAIT M.
Soil Test Date 0
pH Fields
Lime Needed p,q.rP�n1-p�
Lime Applied
Cu Zn
Needs P
Crop Yield 6*4" •
Wettable Acres
WUP
Weekly Freeboard v,"
Rainfall >1"
1 in Inspections
120 min Inspections
Weather Codes L/
Transfer Sheets
RAIN GAUGE
Dead box or incinerator /
Pull/Field
Soil
Crop
RYE
PAN
Window
Max Rate
Max A t
CA
Ino
Verify PHONE NUMBERS and affiliations
Date last WUP FRO' Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump Is•i-
App. Hardware
W7hk�,

)%Division of Water Quality `
Facility Number--� O Division of Soil and Water Conservation
O Other Agency
Type of Visit V Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit V Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: D Arrival Time: 3 Departure Time: ®County. Region:
r� _ It r
Farm Name:
Owner Name:
Mailing Address:
I CXA.S a,rf,V _ Owner Email:
Physical Address: j� �,., ,,,
Facility Contact: _ �_QV1 lA I r Lam[ __ _ Title:
Onsite Representative. 1 or) Moo �yy r
Certified Operator: f 10t1r'�
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
Other
❑ Other
Phone No %0 zq'5
PIntegrator: Ui'v!_5
Operator Certification Number:
Back-up Certification Number:
Latitude: = o Longitude: = ° =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
Non -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?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
II
Number of Structures: I
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 [RNo ❑ NA ❑ NE
❑ Yes
❑ No
ER NA
❑ NE
❑ Yes
❑ No
A NA
❑ NE
® NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number:, — O(p Date of Inspection ?� 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �n No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes $3 No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I Z_
Spillway?: q
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
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [M No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes W 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 N No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes WM 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 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drib ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
M No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
gNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
[�Z No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
nQ 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,
AL-
Reviewer/inspector Name Nei5 /Y= C AJ_rD/t% Phone: 0
1
ReviewerfInspector Signature: Date: ita 6KIL
12128104 Continued

Facility Number. Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes %No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes %No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [N No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
IQ No
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
;RNA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�E No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
1� No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
�2 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
,t No
XNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
N 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
P,No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�ZNo
❑ 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:
-- n C.e www un s .
�Q ate, OM 0.C"-,DL4
1 12128104

Facility No. 7� ` d Time In t O D Time Out Date
Farm Name . _U_Integrator Urd
Owner Site ReplIL
Operator -- No, -T (Ogg
Back-up - No,
COC _1Z Circle:. enerai or NPDES
C
Desi n
Current
Design
Current
Wean - Feed
Farrow - Feed
Farrow - Finish
Feed - Fini
Gilts 1 Boars
arrow - Wean
Others
FREEBOARD: Design (q 111
Sludge Survey ytwl
Crop Yield
Rain Gauge
Soil Test Au rwJ4L;- Wettable Acres
Weekly FreeboaDaily Rainfall ~
Spray/Freeboard Drop _ 4u _
Weather Codes
Waste Analysis:
120 min Ins
Observed ' (- r
Calibration/GPM +� G I At �QS
Waste Transfers
Rain Breaker
PLAT �+
1-in Inspections
6C�
Date Nitrogen (N) Date Nitrogen (N)
.2-
Pull/Field Soil Crop Pan Window
4 Y"
�.1
r c - ev
FLL-

t
Type of Visit A Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑Denied Access
Date of Visit: L�1i_LV_�_I Arrival Time: © Departure Time: ®County: 1 Region: ELDL
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
61
Facility ContactTitle: one No:,] lc) a�e r)u
Onsite Representative-� �� Integrator: rV
Certified Operator: d (jr�-� Operator Certification Number: la
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [� o F-T = Longitude: 0
Design C►urrent
Swine Capacity Population
❑ Wean to Finish
Design Current
Wet Poultry C«apacity Population
❑ La er
Design Current
Cattle Capacity Population
❑Dai Cow
❑ Wean to Feeder
❑ Non-Laer
❑ Dairy Calf
nish 3/
❑ DairyHeifer
Dry Poultry
❑ D Cow
El Non -Dairy
❑ Layers
❑ Beef Stocker
EaF,
❑ Non -La ers
El Beef Feeder
❑ Pullets
❑Beef Brood Cow
❑ Turkeys
❑ Turkey Poults
❑Other
Number of Structure
ean
eeder
nish
Discharees &Stream Impacts
1. Is any discharge observed from any part of the operation?
❑Yes
�No
❑ NA
❑ NE
Discharge originated at: El Structure ❑Application Field [I Other
a. Was the conveyance man-made?
[I Yes
[--]No
'WA
❑ NE
b. Did the discharge reach waters of the State? ([f yes, notify DWQ}
El Yes
❑ No
4�:KA
❑ 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
nTNA
❑ NE
2. Is there evidence of past discharge from any part of the operation?
El Yes
o
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28104
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes J*No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? []Yes ❑ No XPNA ❑ NE
Struct re I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes PDNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes �+To
❑ 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 FbNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No
❑ NA [IN E
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes %&�;o
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes X"No
[:3 NA El NE
❑ Excessive Ponding El Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.) �� VV
❑ 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) I!_RA_kn LA.63L t{ A� L r
13. Soil type(s) 0_i&M
14. Do the receiving crops (Qer from those designated in the CAWMP?
❑ Yes
No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No ElNA
ElNE
18. Is there a lack of properly operating waste application equipment?
ElYes
❑ 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):
�
r`
Reviewer/Inspector Name , Phone: % V73 3 tt
Reviewer/Inspector Signature: Date: f Q% % a(��
Page 2 of 3 12128104 Continued

Facility Number. — (p Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Cl Yes No [INA ElNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ZNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes I No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ;9No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
56o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
o
❑ 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
PMNo
❑ 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
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
C9 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
c-,E- fir, it 5 -P r n�,. �,.►�.
jcm,� t-�A.
-
�910
y
Page 3 of 3 12128104

Facility No. 1 100�D Time In � Time Out Date —4-/9'p-7.
Farm Name Integrator
Integrator
Owner ) 0 `� Site Rep t
Operator No.
Back-up No.
COC Circle: General or "\
Design
Current
Design
Current
Wean — Feed
Farrow — Feed
Barr —T
Farrow — Finish
Fee --
Gilts I Boars
Farrow —Wean
Others
FREEBOARD: Design
Sludge Survey
Crop Yield
Observed
Calibration/GPM
Waste Transfers
Rain Gauge / Rain Breaker
Soil Test _ L _ __O_AL PLAT Wettable Acres
Weekly Freeboard _ Daily Rainfall 4-in Inspections 1 %
Spray/Freeboard Drop
Weather Codes
Waste Analysis:
120 min Inspections
Date Nitrogen (N)
Q .qz
- o,k-fE- -
Date Nitrogen (N)
Flo
tQI •
WIN i"I
W IN

Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: CK- I Arrival Time: ' Q Departure Time: 3 O County:
Farm Name: .G__ Owner Email:
Owner Name: /E/ df �My, /'z: WA Lq e..,. L e Phone: _
Mailing Address:
Physical Address:
Facility Contact: ff'2& r— Title:
``+mod Region: ��D
Phone No: v�gu� %L,2_�
Onsite Representative: _:5'_Cv ' Integrator:
Certified Operator: —.0ri `4--______ Operator Certification Number:
Back-up Operator: I Back-up Certification Number:
Location of Farm:
Design Current
Swine Capacity Population
❑_Wean to Finish [ �+
❑ Wean to Feeder
Feederto Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Latitude: = o = A = Longitude: = ° = d 0 u
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Nan-Dai
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
i
j
Number of Structures: ®I
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 jQ No ❑ NA ❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑Yes
QQNo
DNA
ONE
❑ NA
❑ NE
[--]Yes
[4No
❑ Yes
Q No
❑ NA
❑ NE
❑ Yes
[KNo
❑ NA
❑ NE
12128104 Continued

Facllity Number: —
Date of Inspection—f
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[7 No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
® No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: {
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[[No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
X No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
a No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
� No
❑ NA El 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
q No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2Q No
❑ NA ❑ NE
maintenance/improvement?
I. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
,jNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s) -1 Le 4
r�
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
QqNo
❑ NA
❑ NE
15,
Does the receiving crop and/or land application site need improvement?
❑ Yes
[�kNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determinations❑
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
N No
❑ NA
❑ NE
Reviewer/inspector Name""'fiy K.::t?' Phone:
Reviewer/Inspector Signature: Date: —'_�—pw
JZ1Z61U4 (-onnnuea

i
Facility Number: Date of Inspection �(p
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑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 RLCrop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes KNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ANo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
L&No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
(,No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
RkNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
KNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
(KNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
JK No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
RNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
EkNo
❑ 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
X1 No
❑ NA
❑ NE
Adii3ti0naliGornments addlorobrawln s
o2i'cr crotp lirld
12128104

Type of Visit ® Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit g Routine O Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility.Number Date of Visit: Time:
10 Not Operational 0 Below Threshuld
Permitted [3 Certified © ConditionaIly Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: 4Lr-4, kA'3'% s, Wl,. c/ County: t`cc ►,.La�..�Ji 3�
Owner Name: Ci e Y . e.t.) 1=G.!'r+n Phone No: �In jLAkc a,,ss
Mailing Address: 0 ` 27`3�J-
Facility Contact: j4 +fMiA -e Title: Phone No: Slo -I&I ODj
Onsite Representative: e. Integrator: --
Certified Operator: Tb—.1100,!adrf, Operator Certification Number:
Location of Farm:
1�rSwlne ❑ Poultry ❑ Cattle ❑ Horse Latitude 6 0 µ Longitude .6
Design Current Design Current Design Current
Swine Capacity Population Poultry Ca acity Po ulation Cattle Capacity Population
❑ Wean to Feeder I IEI Laver ❑ Dai
El Feeder to Finish ❑ Non -Laver ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
Farrow to Finish 7 Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons r: ❑ Subsurface Drains Present ❑ La non Area S rav Field Area
Holding Ponds / Solid Traps „ : ❑ No Liquid Waste Management System
Discharges d Stream ImjRa is
1. is any discharge observed from any part of the operation? ❑Yes ®No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (if yes, notify D WQ) ❑ Yes ❑ No
c. if discharge is observed. what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Q No
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Q No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 40ac: 1( u-V-1
Freeboard (inches): ?.1
05103101 Continued

Facility Number. — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes (� No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ® No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ["No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 5No
Waste Annlication
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. Crop type Qerr,.l, d c, -4-- cLr./ ",_ 4 d
13. Do the receiving crops differ with those designated in the Certified Animal
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
aste Management Plan (CAWMP)?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes allo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [�O No
❑ Yes ® No
❑ Yes [0 No
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
m No
CC No
(21No
M No
MN,
U No
R No
EgNo
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comim
ts; refer to question #} Explain any YESfi 3jWec3 grid/or:eny rCC4RtlnCnilgtion9�01 Any, other C0117�,nent�'�Notes
`Uittc
seilrawing of facility to /►alter explain situatiurtg�*�use aditional pages as necessary)" ❑Field CD
*J
3 �
r (3L�i ld� �v ! -�! u;ic�vie �aG( � AAC � +� a�- �Qd—
It j
Reviewer/inspector Name i as
Reviewer/Inspector Signature: 4., k kJ Date: 03
- r
05103101 Continued

Facility Number: — Date of inspection
Odor ssu s
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to dischargc at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. N ere any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s). inoperable shutters. etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes [� No
❑ Yes d'No
❑ Yes Q No
❑ Yes 5 No
❑ Yes ® No
❑ Yes 52 No
❑ Yes �] No
Additional Comments and/or Drawings:
A.
7
05103101

I- • A
Type of Visit ® Compliance Inspection O Operation Review ' O Lagoon Evaluation I
Reason for Visit ® Routine O Complaint Q Follow up O Emergency Notification 0 Other ❑ Denied Access
Date of Visit: 3 O - Time:
roFacilin� Number
-Not Operational 9 Below Threshold
® Permitted M Certified 0 Conditionally Certified Q Registered Date last Operated or Above Threshold:
Farm lame: r County:r�
Owner !dame: CLe.6..r l��`.P+_l GGr•" Phone No: O � !�
illailing Address: 25 D4_ Sn� rn 2,d c6z-L (zo 6ty __ C,
Facility Contact: Title:
Onsite Representative: T� I(t nn m
Certified Operator: TL" 1, VA06rr_._ - _
Location of Farm:
Phone No:
integrator: - e s
Operator Certification Number:
®Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ° " Longitude • �• K
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Laver I I JE1 Da'
® Feeder to Finish o 10 Non -Layer I I Non -Dairy
❑ Farrow to Wean
❑Farrow to Feeder Other
Farrow
Total Design Capacity
❑Gilts
❑ Boars Total SSLW
Number of Lagoons I❑ Subsurface Drains Present �I❑ Laeonn Area 1❑ Spray Field Areg
C ..
:Holding Ponds / Solid Traps " ❑ No Liquid Waste Management System
Discharges 8 Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes F4 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) [I Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes `fd No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes U No
Waste Collection 8 Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes $ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): S4' 43
05103101 Continued

Facility Number: — Date of Inspection o�
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes FM 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 M No
(If any of questions 4-6 was answered yes, and the situation poses an yy
Immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes [� No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes LP
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. Crop type Re f' rVX t A. A e. _ -4— .S ix^ Pr rr. r,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
�Q No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
No
16. Is there a lack of adequate waste application equipment?
Required Records &Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fait to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ic/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes [P No
❑ Yes §qNo
❑ Yes F� No
❑ Yes *No
❑ Yes EA No
❑ Yes P No
❑ Yes 'J,No
❑ Yes No
Cl Yes No
❑ Yes �#No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.

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