820002_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Quai

Type of Visit: ( Compliance Inspection V Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: w O County: ,j�c,jd'z Region:
1001
Farm Name: _ }� may, �"dr Owner Email:
Owner Name: p rLrr� _ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: QC-Uh x-✓ Phone:
Oosite Representative: `S +�� Integrator:;)--
Certified Operator: "— Certification Number: / 11 1--, d 6
Back-up Operator: Certification Number:
Location of Farm: Latitude:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design Current
Capacity Pop.
Design C►anent
@attle Capacity Pap.
DairyCow
Wean to Feeder
LNon-La
er
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
7 D
ll , soul
Ca ae` P,o
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Finish
La ers
Gilts
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Beef Feeder
Beef Brood Cow
Boars
Other
OtherI
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes Qq-No ❑ NA ❑ NE
❑ Yes []No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [—]No
❑ Yes [RNo
❑ Yes 04-No
❑ NA ❑ NE
❑ NA ❑ NE
[]NA ❑NE
Page I of 3 21412015 Continued

[Facility Number: -22� DateofInspection;
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes B 1VO ❑ 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): j
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [3'Na ❑ 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
�o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
Q o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E3-N-o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Oho
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
E No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E]-- o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window/ ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop TYpe(s)
13. Soil Type(s): /�1�I7 �I k . H 5 /LSD/� 14'
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Eio ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [E[-I o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [a -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?
Reouired Records & Documents
❑ Yes D-No ❑ NA ❑ NE
❑ Yes ❑-No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0-No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Quo
❑ 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.
L9 r cs
[:]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
["Flo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[] Yes
B-N-o
❑ NA
❑ NE
Page 2 of 21412015 Continued

i IFacilitv Number: f,)9-- I I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[3--go
❑ NA ❑ NE
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[�o
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
[:]Yes
�o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[J-90
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33, Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ["o ❑ NA ❑ NE
❑ Yes [�islo ❑ NA ❑ NE
❑ Yes E]-N-o ❑ NA ❑ NE
❑ Yes [I -No ❑ NA ❑ NE
❑ Yes [] No
❑ Yes [ o
❑ Yes D—No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Cgmments (refer to,questton € ): Explain any, Y}FS Answers:and/or anfey,14dditional recommendations or"any other comments.
e drawings ofif$ciTzty:to,better explaua sitiistrons (use additional page as necessary) ;.3 ��} g , ,, 4; ; ,par
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone:
Date:
21412015

G- q ► 7
ivi"sion of Water Resources
Facility Number ® Division of Sail and Water Conservation
a Other AgeEnncy
Type of Visit: ompltiia ce Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: oune 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: J1 62,2h— Owner Email:
Owner Name: o+ Phone:
Mailing Address:
Physical Address:
Facility Contact: (�!Z at��•C Title: Q C.4-1 h r• I Phone:
Onsite Representative: Integrator:
s
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish •
La er
er
Da Cow
Dai Calf
Wean to FeederF LNon-La
EIFeeder
to Finish fa
Farrow to Wean
Farrow to Feeder
Farrow to Finish
MWRign Current
11T P,oult , Ca aci_ P,o
La ers
Non -Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Turke s
Turke Poults
Other
Beef Brood Cow
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes [&No ❑ NA ONE
[:]Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ No ❑ 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 P!�No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

j Facili Number: - Q Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Eallo
❑ 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
[RNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q, 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
[RNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window /❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): �p�'�1 %•., 5 %9n ��5� 0
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[7No
❑ 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
JM'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 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 [2,No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes KNo
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

lr Facili Number: jDate of Inspection: j- /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes BNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 2,No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes O-No [] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [allo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
L.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
15kNo
❑ 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
MNo
[DNA
❑ 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
allo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
C;ZNo
❑ NA
❑ NE
33. Did the Reviewerlinspector fail to discuss review/inspection with an on -site representative?
❑ Yes
RNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[3-No
❑ NA
❑ NE
Comments (refer_to�<question #) Explain; ny YES answers. andlor any additional recommendations or any other comments.
Use d`rawings,af facilit�_to:bxAlaiwsituations (use additional pages as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signatut
Page 3 of 3
Phone: //y'30-� 0%-3-7
Date:
21412015

(Type of Visit: EMolice Inspection U Operation Review O Structure Evaluation 0 Technical Assistance I
Reason for Visit: outme 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I[..�1J Arrival Time: ,0-' DO 1 Departure Time: : 3 D County:
Farm Name: �AGr d'-�crl/'�'1. Owner Email:
Owner Name: �h� y "t', Phone:
Mailing Address:
Physical Address:
Region: f5z b
Facility Contact: h., t2te , '/'T // Title: Phone:
Onsite Representative: lj`�re��� Integrator:
Certified Operator: J`'-��_ Certification Number: L %
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Current
Design Current Design Current
Capaci
Finish
rgFeeder
La er Dai Cow
Feeder
Non -La er
Dai Calf
o Finish
3G
3 ✓�
DairyHeifer
Farrow to Wean
Design Current D Cow
Farrow to Feeder
D . P.oal , -a aci P,o Non -Dairy
Farrow to Finish
Layers Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other.
I
JTurke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[-]Yes [a No ❑ NA ONE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
[2,No
❑ NA
❑ NE
Page I of 3 21412014 Continued

rIkSte
Number: $� - /'� Date of Ins ection:
Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes E�No
a. If yes, is waste level into the structural freeboard? [:]Yes [:]No
Identifier:
❑ NA ❑ NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 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 [2No ❑ 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 [3 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [RNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes [,3 No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
allo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
allo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
O No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
allo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[�No
❑ NA
❑ NE
Reuuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
allo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
RNo
❑ NA ❑ NE
the appropriate box.
❑WI P ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
M No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[&No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Callo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

LFacili Number: KL - Q 7 — Date of Inspection: L
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [RNo ❑ NA ❑ NE
• 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes ( o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of fast survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [allo ❑ 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 P' 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 L&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 [a 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 QE�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 E2 . No ❑ NA ❑ NE
Comments (refer to question # ): Explain any YES answers and/or any'additional recommendations or any other com merits.
Use drawings°of facility to better:explain situations:(nse additional:pagesas
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: y-T3—
Date:
21412014

Division of Water Resources
Facility Nu[nber lJ - O %— Division of Soil and Water Conservation
© Other Agency
Type of Visit: ompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:. —1 Arrival Time: / Q: / j' Departure Time: / ,' 30 County: Region: /�C7
Farm Name01a f I d L5 lr^-s t-Q
Owner Name: TO ririn P 1 At
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: o ,,! y► �Tyn 014t Title: 6a-C.cJh 7'r Phone:
Onsite Representative: Integrator: L1/ ►��u�rt
Certified Operator: rj"� Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop. Wet Poultry
Wean to Finish Layer
Design Current
Capacity Pop.
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
Farrow to Wean
D�. P■oul_
Layers
Ca aci P,o
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Otherm jTurkeyPoults
Other
Turkeys
Other
Pi
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
®,No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Q� No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
10 No
❑ NA
❑ NE
of the State other than from a discharge?
Page .1 of 3 21412014 Continued

[Facility Number: - jDate of Inspection:
— S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[3No
❑ 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): _ C'
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[2 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑' No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[&No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[3No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ®No ❑ NA [:]NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): earn .140 I, -A;;( ��6�7_�J`rm^�-s f /r'�ih .��v�� "--,
13. Soil Type(s): �d i��f{ / � r n3 1 0IGrSZD/'D
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes [RNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes MA No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [Z 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 UNo ❑ 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 [Z No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

wacility Number: jDate of Inspection: / �O/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[S No
❑ NA
❑ NE
❑ Yes
2 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes LgNo ❑ NA ❑ NE
❑ Yes [0 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
[—]Yes ® No
❑ Yes ® No
❑ Yes �, No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments:--
We.drawings of facility to better explain situations (use additional pages as, necessary).
-Z
�°l6 W K e
Reviewer/Inspector Name:
Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9fo-�/ 33an
Date: 3 /S
21412011

3-vS bim 1�11&11�R
- Division of Wale' r Q� �i2Jpw�y
Facility Number ®- aaa, 1 OO Division of Soil and Water Ganservation
QQ Other Agency
Type of Visit: O Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: O Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: lZIFJ Arrival Time: Departure Time: County:Region: F ,O
FarmName. 5cy}s l`M Owner Email:
Owner Name: UhnnrTW)7d fl Phone:
Mailing Address:
Physical Address:
Facility Contact: U-0 �
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title: Avoi, Phone:
Latitude:
Integrator: H_-9
Certification Number: 16-72 d
Certification Number:
Longitude:
Design C►urrent
Swine Capacity Pap.
Wean to Finish
Design
Wet Poultry Capacity
ILayer
Current
Pop.
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design
D . P,oul Ga a
Layers
Current
P,o ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey 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?
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)?
❑ Yes JR No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
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 tS No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [-]Yes CE�rNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3
21412011 Continued
l

,lFacU4 Number: - Date of Ins ecti
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?:
t
Designed Freeboard (in): i
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
10 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[5j 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
5§7No
❑ NA
❑ NE
maintenance or improvement?
Waste Ai3plication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
R No
❑ NA
❑ NE
maintenance or improvement?
1 I. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes MNo ❑ 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 _ _0 nEv_ideen_cIe of Wind Driift� J ❑ Application Outside of Approved Area
12. Crop TYpe(s): �In : V✓hf _t , cS_0 1,�f_'_ S I C0?&[t � I l 6V 5 rn4 11 10/0'; (n
v
-
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[-]Yes
U No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
CRNo
❑ 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
CR 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
N No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design 0 Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
R-Yes
❑ No
0 NA
❑ NE
❑ Waste Application 0 Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking Q 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
tR No
[DNA
❑ NE
23. If selected, did the facility fail to install and maintain rainbrcakers on irrigation equipment?
❑ Yes
❑ No
D? NA
❑ NE
Page 2 oj3
21412011iContinued

Facih ' Number: -
©ate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? 0 Yes R No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes t-Kr No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes Jallo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ❑ No [5�-NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes N No ❑ NA ❑ NE
❑ Yes !a No ❑ NA ❑ NE
❑ Yes ER No ❑ NA ❑ NE
❑ Yes [8;No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes D3� No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes CR No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes E2'No ❑ NA 0 NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments -' �
Use drawings of facility to better explain situations (use additional pages as necessary). M
Q1 I ?061 1~ i U Ch kk w-i`4� 12VA-r .G4/ ca I h- o-, , 14 1v QS rn Ss q b,*
� �N � back YetI6i
Upm w111 rnaI 1 awbrAA 2 I
Id.jS'&jed
'�9 L ar is
D4 i�t9F Q o , �' e. aea-
J,
Reviewer/Inspector Name: v o,23 SC_h it lPi -Pl
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Q (¢-yam-3 200&ffi(?)
Date: I)E'C y Q
2/4 011

c ty Tndafl(-�� 14113
Fac�li No. Farm Name_ Date
Of (
Permit �.� COC ✓ OIC_
NPDES (Rainbreaker PLAT Annual Cert Daily Pipe)
-Lagoon Name, S forspillway
1
2
3
4
5
6
7
Design Freeboard 1 Last Recorded in
Observed freeboard
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume if> 0.45
D& out of com Iiancel POA?
txtWhI aaiq
Design Flow (gpm)
Design Diam. MY
Actual Diam.
Soil Test Date
pH Fields
Lime Needed
Lime Applied
Cu-I Zn-I
Needs S (S-1<25)
Needs P
Crop Yield
Wettable Acres
WUP
Weekly Freeboard
1 in Inspections
120 min Insp.
Weather Codes
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
Mortality Records
Check Lists
Storm Water .
..
..
y �►i7�fl�
1i a d /
t
�E
ii
41
ll�•i'
,
a
.ONE,�.
Verify PHONE NUMBERS and affiliations
Date last WUP FRO �ZP--06
FRO or Farm Records
Date last WUP at farm Jl4I( P
Lagoon # �
App. Hardware
Top Dike 5 k Q
Stop Pump ua
Start Pump'k 0 1
-�4
I,-*�?
Conversion- Cu-I 3000= 108 Iblac; Zn-I 3000= 213 lb/ac
046 Q
D bMo Pre�1At t(D
Corn lao,f2b Is--oL�9
yv)k+ jq4 4--Ayr
4�t
m(I M4r
100 SI`

Type of Visit: 40 Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 40 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: [ ! Arrival Time: C ".< Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: &I �, ,,f L- , /.7/l�^ G�� Phone:
� O
Mailing Address:
Physical Address:
Facility Contact: '` � It n y L .%rr Title:
Onsite Representative:
Certified Operator: N
Back-up Operator:
Phone:
Integrator:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pnp.
Da' Cow
Wean to Feeder
Feeder to Finish Q
Non -La er
Da' Calf
Dai Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , $o_ult .
Layers
Design
Ca sei_
Current
P,o
Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
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 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 W No ❑ NA ❑ NE
❑ Yes
❑ No
P NA
❑ NE
❑ Yes
❑ No
1p NA
❑ NE
[—]Yes [:]No NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: 2,- Date of Inspection:
2
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
V3 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
Pq NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
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
[�hNo
❑ 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 [] pplication Outside of Approved
Area
12. Crop Type(s): Ss
p
,,,, rrtri�{Cf ►►
13. Soil Type(s): ,�V�� -- c�l� �71 -
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
T
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
_Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes "'-In 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 CqNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection: y Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes No ❑ NA ❑ NE
�] Yes 51
No ❑ NA ❑ NE
❑ Yes �l No ❑ NA ❑ NE
❑ Yes Qg No ❑ NA ❑ NE
❑ Yes §� 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
F%No
T�
❑ 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
5j No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional=recommendations or:any. other comments
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ID
Date: Z % Z
2/4M11

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1 7 Arrival Time: �,� f1n Departure Time: County: -<A'MRegion: F�W
Farm Name: rieco s 7O' n aOwner Email:
OwnerName: a_0kKrn!4 L-, 4r'daq Phone:
Mailing Address:
Physical Address:
Facility Contact: GOLOVtta Title.. Phone No:
Onsite Representative. W Integrator: Ah4^0Ct... r%1dcV;-k4 LLJ(
Certified Operator: `� Operator Certification Number. 1675�
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = , Longitude: = ° = =
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry C►apacity Population Cattle Capacity Population
❑ Wean to Finish ❑ La er ❑ Dai Cow
❑ Wean to Feeder
ID Non -Layer I
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Non -Layers
ElPullets
❑ Turke s
❑ Beef Stocker
❑ Beef Feeder
El Beef Brood Cowl
❑ Gilts
❑ Boars
Other
❑Turke Poults
Number of Structures:
❑ Other ❑Other
Discharges & Stream Imoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes IQ No ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
NA
❑ NE
❑ Yes
❑ No
❑ Yes
NNo
❑ NA
❑ NE
❑ Yes
'P No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 10 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 0 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
M 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
0 No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
EX No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [)9No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ELNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l O 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)
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
[XNo
❑ NA
❑ NE
PNo
El NA
❑NE
EA No
❑ NA
❑ NE
1 No
❑ NA
❑ NE
EJ:No
❑ NA
❑ NE
Comments (refer to, question #); Explain any YES answers and/or any°recommendations or:,any other comments ' rt
Use drawings of facility to better explain situations. (use additional pages asnecessary):
Reviewer/Inspector Name — — ;� Phone:�j ` d0
Reviewer/Inspector Signature: Date:
Page 2 of 3 12/Z8/04 Continued

Facility Number: — Date of Inspection 7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes OqNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [P No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design El Maps ❑Other ��44
21. Does record keeping need improvement? If yes, check the appropriate box below. El6Y Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 1A No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes R No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
, EgNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
qNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
6No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
'KI No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[A No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
14 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
[X 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
14 No
❑ NA
❑ NE
General Permit? (iel 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 u." r L
T
Page 3 of 3 1228104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Lil(1 �� Departure Time: a � s, County: 5+4> SEYti Region: /�-40
��jj rr c
Farm Name: _�vt (Jlt f S �brr S Fax- l Owner Email:
Owner Name: ��Ni1L`� Phone:
Mailing Address:
Physical Address:
Facility Contact: p►1�n1/ �'T�U�l1 Title:
u
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
U
Phone No:
Integrator: {' Wr(J l dj.Z
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 O [__1 I 0 u Longitude: = o 1—_1' 0 a
Design
Current Design ,gr ent
Design Current
Swine Capacity
opulati0n Wet Poultry Capacity Population
Cattle C+apacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
Feeder to Finish
Q
❑ DairyHeifer
El Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ La ers❑
❑ Non -Dairy
Farrow to Finish
❑Non -La ersPullets❑Beef
Beef Stocker
rEl Gilts
Feeder
Boars
❑ Beef Brood Co
❑ Turke s
Other.
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures: C
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �'No ❑ NA ❑ NE
❑ Yes
❑ No
T NA
❑ NE
❑ Yes
❑ No
59 NA
❑ NE
0NA
❑ NE
❑ Yes
❑ No
❑ Yes
ER No
❑ NA
❑ NE
❑ Yes
®.No
❑ NA
❑ NE
12128104 Continued

r
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: f
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 33.
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes [)PNo ❑ NA ❑ NE
❑ Yes ❑ No FNA ❑ NE
Structure 5 Structure 6
❑ Yes Q9 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [51No ❑ 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 C&No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes RNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes PQ),jo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or i 0 ibs ❑ Total Phosphorus []Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Accc�eptta�b_lejCrop Window ❑ Evid�7a
_of W- iinnd Drift El Application Outside of Area j
12. Crop h Pe(s) [ Jna, i f �"'�i &a r
13. Soil type(s) lvw4l k; 1�0 6S 61 D , I[A.t1
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
yrou 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
rp No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
E�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
M No
❑ NA
❑ NE
.Comments (refer to question 6 Explain any_YES answers and/or any'recommendations or any otherr coimiments _V f
Use drawings of facility to better:explain 'situations (useadditional pages as necessary)
Reviewer/Inspector Name FMaXii~ - ] Phone: /D ^Lf3 3.900
Reviewer/Inspector Signature: Date: 09
12128104 Continued

Facility Number: Date of Inspection
Re uired 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 KNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ YesV'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
9No
❑ 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
EgNo
❑ 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
JNo
❑ 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
11� No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
P No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Fmwo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 L Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�No
❑ NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
!E
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
I,No
❑ NA
❑ NE
12128104

110
Type of Visit 49 Compliance Inspection Q Operation review Q Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 10 Iq . Arrival Time: Q Departure Time: County: __V� Region:
Farm Name: V� M0 4 5;os (( _ Owner Email:
Owner Name n K � A L Phone:
Mailing Address:
Physical Address:
Facility Contact: rtk �+��+ �� Title:
Onsite Representative:
Certified Operator: u
Phone No:
Integrator: A U_Q OrWC-)
Operator Certification Number: r v�
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [--] o =' =" Longitude: = ° =' = u
Design Current
Design Current
Design
Current
Swine Capacity Population
Wet Poultry iapamM Population
Cattle C**specify
Population
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ Wean to Feeder
n-La yer
❑Dai Calf
Feeder to Finish Paco
❑ Dairy Heifer
Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
Dry Poultry
El Layers
El Non-Layers
El Pullets
El Turkeys
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑Beef Brood Co
Other
Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
PNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
�NA
El NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
ONA
❑ 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
JNNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
PNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
W No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
I2/28/04
Continued

Facility Number: Date of Inspection D 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 5No ❑ 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: 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): sq7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ yes P No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes PNNo ElNA ❑ 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 51No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes PNo ❑ 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 El Yes [�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes IRNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 1�5No ❑ 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
iCrop
"Window ❑ Evidence ofWindDrift( El Application Outside
�off-Area ��
12. Crop type(s) t-.Oadv D� vKjo, &,Lt 6as4u t, t �"^�'� r , beans, I D 14qCCO
13. Soil type(s) �rZpC�yp/V�f�-a f�f )?a4ns
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
TNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
$3 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] yes
JgNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Wo
❑ NA
❑ NE
Comments(refer to quehon#)E�gla n an AYESs a sand/orrany recomruendations or any other commenfs.
,A�.. "S'"�rf�ss3ya, ..� x
Use drawings of facYhty to better explain sit;uationSI(usejadditional pages as necessary):
.� •� = � . _.;,:. � ��r. •sue � ��:�,. ;� � .,; r
f
Reviewer/Inspector Name - — — Phone: io- 33 33co
Reviewer/Inspector Signature: �ImajkoDate: 0 �$
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection I 101 1'1 o$
Renuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 1PNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ES No ❑ NA ❑ NE
the appropiate box.
❑ WUP El Checklists ❑Design ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
D3No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
BNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
10 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�q No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
-0 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
G9 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
P No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
pi No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

® Division of Water Quality
Facility Number Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit & Routine O Complaint O Follow up Q Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Tune: i7 Departure Time: ��OQyN County:
Farm Name: n�t f �✓� 5_ Owner Email-
Owner Name: �B�nV%W 1—+TuYIRLtbt Phone:
Mailing Address:
Physical Address:
i
Facility Contact: Jo�4n 1 yn Title:
Onsite Representative: Ir
N
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator• Mdk
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = c 0 3 = " Longitude: = ° = g = Lf
Design Current Design Current Design Current.
r°Swine ' `"' "' Ca aci Po" ulation" Wet'Poultry Ca aci Po ulation Cattle Ca aci 1Po ol`ati©n
P h p - P ty p p ty . P
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Im acts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Dairy Cow
❑ Dairy Calf -I
1
_
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
C. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes P No ❑ NA ❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes No ❑ NA
❑ NE
❑ Yes V9 No ❑ NA
❑ NE
J
12128104 Continued

facility Number: �3a=
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes P No ❑ NA ❑ NE
❑ Yes ❑ No M NA ❑ NE
Structure 5 Structure 6
❑ Yes 19 No ❑ NA ❑ NE
❑ Yes 19 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes r No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [DNo ❑ 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 El No ❑ NA ❑ NE
maintenance or improvement?
Waste ADDlleation
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ MNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [,;gNo ❑ 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 El Evidence
Evidence of Wind Drill[:]Application Outtssid/e+ of Area
12. Crop type(s) 4,111. ASW C"4e)' "a k-fQS�
13.
Soil type(s) e� 1 Z
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
;9 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
❑ NA
❑ NE
18.
is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question ft 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:
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility'Number: �J
�- Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes MA El NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes W)No ❑ NA ❑ NE
the appropiate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �! No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes EA No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [l No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ES No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
rO No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
10 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes CANo ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
1PNo
❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
PNo
❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
09 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
12128104

-3z H oz
Type of Visit 40 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: Arrival Time: Departure Time: County:.:9U4Stn% Region:
Farm Name: /JAlgu/Z it1S _ f !ir ollm I___ Owner Email: `
Owner Name: J o 1A NrJ_�a__ L., V n! d a Phone: �IO se'7— G, 90s'
Mailing Address: _ ��%li a77-1 (� Z 83j8
Physical Address:
Facility Contact: Z o i�t Aiw � 1•�f Title: %c�ZMc/ z/ Phone No: 69/0 S6 7' 6 70
Onsite Representative: Ub" ajC.-� Integrator: ui �_ �rDkw
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 01 =z Longitude: = a 0 , =
Design Currentry `Design Current Design Current
Swine
Capacity Pdpulation��'�'et Poultry 'Cap�aci Population
❑ Layer _ - _ _
❑ Non -Layer
Cattle Capacity Population
❑ DairyCow
❑ DairyCalf
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
0 _
Dry Poultry ti
❑ Layers
❑ Non -Layers
❑ DairyHeifer
❑ D Cow
[] Non -Dairy
El Beef Stocker
❑Beef Feeder
❑ Narrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Gilts
oars
❑ Pullets
❑ Turkeys
❑ Beef Brood Co
Other
❑ Turkey Poults
❑Other
Number of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes IA No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
tR No
❑ NA
❑ NE
❑ Yes
'KNo
❑ NA
❑ NE
❑ Yes
K No
❑ NA
❑ NE
❑ Yes
IQ No
❑ NA
❑ NE
12128104 Continued

Facility Number: SZ- d Z Date of Inspection -
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes MNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes WNo ❑ NA ❑ NE
Structure I; Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): / Q
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ES 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 (9 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes UU No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Ej No ❑ NA ❑ NE
maintenance/improvement?
H . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes J@ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWW?
❑ Yes
J�j No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
f� No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
❑ Yes
[$No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[%No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[A No
❑ NA
❑ NE
Reviewer/Inspector Name ` , y 5;$ Phone:
Reviewer/Inspector Signature: Date: O — a — ZOd rp
12128104' Continued

• 4�
Facility Number: VZ -d Z Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [9 No ❑ NA ❑ NE
the appropirate box.
❑ W UP El Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes WNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ t20 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[ 9 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
P No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
4 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
0 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[Z No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
IX No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
go 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
19 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
*o
❑ 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
[%kNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
%No
❑ NA
❑ NE
Additi6rial .Comments and/or Drawings:
12128104

Type of Visit Q Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit A Routine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
s Facility Number Date of Visit: �7 r% d Tune: /d: f
Z
...� ' O No# erational O Below Threshold
GWermiitted �rtified 0 Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
Farm Name: ..... __._ , !� � .. -- ... t2`�--_--- County:
Owner Name: j124n 41G _ �g1 _ ... Phone No:
Mailing Address:....., ......... ataaoc _/1�................-...... ✓l��' Facility Contact: __ .!� c :� --- Title:. _ __ _. Phone No:
Onsite Representative:.._.�OfiiL!l�e. -- -T _. _ ._._..w _... Integrator:
Certified Operator:.—,,,,..�aAa�r......-..........-.. 7 f _w , , _` Operator Certification Number:_ �G �z.
Location of Farm:
EtSiwine ❑ Poultry ❑ Cattle ❑ Horse Latitude " Longitude 64
Ek- Currents; Des:gn �4ilii.t- 3 }Y D
tDeSlgn
Sw ne Ca' Pow Wiilat,on. Poultry .Ca .. Cale �'
_,'. P.o ulatioa _ Po ulatlon.. F
Layer Dairy
10 Non -Layer ;a ❑ Non -Dairy
a:.-•c� w
Other
�� TotalDe
_
s
{ Total SSLW
Number. of 14.00a
r.
Wean to Feeder
Discharges
eeder to Finish
3 ti 2
3 G Il7
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
8 Stream IrnRacts .
` 1. Is any discharge observed from any part of the operation?
❑ Yes G-No
' Discharge originated at: ❑Lagoon ❑ Spray Field ❑Other
a. If discharge is observed, was the conveyance man-made? El Yes B- No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑yes BtTo
c. if discharge is observed, what is the estimated flow in gal/min?
:f
. d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑Yes [TNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes B-o-
'� 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑Yes G-No
Waste Collection & Treatment
' 4. Is storage capacity (freeboard plus storm storage) less titan adequate? [I Spillway ❑Yes n-go
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:----�-._____......._ �_—_.......�....................._--- ................... ___...�._..._ .....................-..................................._
Freeboard (inches): 3 3 �!
- I2/I2/03 Continued

Facility Number: g� —
Date of inspections
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6_ Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste application
10. Are there any buffers that need maintenancelimprovement?
11. Is there evidence of over application? If yes, check the appropriate boa below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
440 Grr./ 19t) wo /149
12. Crop type �Prr1 �• a , FtseLc E 5��l-"
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
I6. Is there a lack of adequate waste application equipment?
Odor Issues
17. 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?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes BN�o
❑ Yes B No
❑ Yes BWo
❑ Yes B No
❑ Yes ff No
❑ Yes [vo
❑ Yes [31No
❑ Yes 91go
❑ Yes u go
❑ Yes allo
❑ Yes BVo
❑ Yes ago
❑ Yes ONO
❑ Yes ❑ No
❑ Yes M No
❑ Yes ff No
❑ Yes OW-0
Comatents 44. tr quest<on #} Explain any YF5 answers and/or any ent, -o saran other comments. ~ Y
;Use drawings of fatty to better cxlawn sitna#�o s{use addtt~onal pages as nary) add Cop El Final Notes
_yy
T w o G%a al %i i were 1.1., , M i . ?y n 61ic rrH,ovrd/ �t
�.�,
�q
Reviewer/Inspector Name
Reviewer/Inspector Signature: ,(j Date: -U y
12112103 Continued

i
Facility Number: Date of Inspection Y�'1
Reauired Records & Document;
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? .
jieciclists, d&sW, maps; etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ RMte *PPUsafim ❑*Sebea:+d- ❑ Warte.Aualysis ❑ n
24_ Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which -,:jse noncompliance of the Certified AWMP?
NMES Permitted Facilities
30. Is the facility covered under a NPDES Permit? .(If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes 2-No
❑ Yes EI-No
❑ Yes bid
❑ Yes
B�o
❑ Yes
®No
❑ Yes
2To`
❑ Yes
B'No
❑ Yes
OWo-
❑ Yes
B-90
[--Yes ❑ No
❑ Yes M-No
❑ Yes BNo
❑ Yes Bwo
34. Did the facility fail to calibrate waste application equipment? ❑ Yes Q-Nb
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
06teeYMgForffr ❑ Q[M]ield Form ❑ > eH- ❑ action After 1" Rain
❑ No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
t- V 3
TT 3z �/" Pr
9 s p oe—1 ge *45-0:9" Sfio/y. 3Crrr,ry• Mr, !}nu/a//
tv- N
Y
Tyn�at/
-43 c" Ae— " e rd n ou'..7 s cAer e vtr7
! �► Ave,,
ar^+1
Nil 7 e9�'P"►r^�
6 � �,.s �I/`!d• � G�pp C4 ! f l!h � t/Srst � �ivr� r
Flog,, me-lrr 0,1
M2✓03

® biAsioin of Water Quality
=' _
_ p " Quah -
_ D Division c►f Soil and Water Conservation
- -
O ,C?th er A en s
Type of Visit ® Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit ® Routine Q Complaint Q Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number z Date of Visit: // /p Time: / %�✓ Printed on: 7/2i/2000
Q Not Operational Q Below Threshold
® Permitted M Certified Q Conditionally Certified ❑ Registered Date Last Operated or Above Threshold: ..................
Farm Name:a��.t�� �n.df �i.�� Coup ,tl`. ...............................
..................``............................................... ty:..........,_.......
Owner Name: ...................
.......... �lf'7__...--.��-- //�(/ Phone No: L..@1......!.J CGS~............
Facility Contact: 7v�i--.w�...... 1 ��zC1 1 .. Title:................................................................ Phone No: ...................................................
Mailing Address orYG� � /C
�`+` ......... _............... ..............................................
Onsite Representative: ......... ;,f /> ........... Integrator: u .. �/..................
...
Certified Operator: � ..... .... G��l I/ .....I ................. Operator Certification Number:.....:..... I ..............................
Location "of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 9 66 Longitude �• �6 tt
- -Design Current
('aflac-tv Ponulatinn
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current _ _Deslgtt Ctori ent
Poultry Capacity' Population Cattle _ P bou
❑ Layer I ❑ Dairy
❑ Non -Layer L ❑ Non -Dairy
❑ Other
Total Design Capacity
Tq;w I m ;"
"-' Subsurface Drains Present [.ag—a Area S ra Field Area
Nam' of Lagoons ❑ P y
Hoi Ponds 1 $obit Traps.. No Liquid Waste Management System +�
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ)
c. It'discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes E] No
❑ Yes .@ No
❑ Yes E] No
❑ 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 t No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure l Structure 2 Structure 3 Structure 4
Identifier : ........... ..��. tz....
..........
❑ Yes A�] No
Structure 5 Structure 6
Freeboard (inches):
5100 Continued on Lack

` Facility Number: Z — Z Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes O�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 KNo
(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 maintenancetimprovement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes PNo
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes Zj No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes JVNo
12. Crop type _ [�z¢,,,. '�- ,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes OrNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes `J No
b) Does the facility need a wettable acre determination? ❑ Yes Jj No
c) This facility is pended for a wettable acre determination? ❑ Yes No
15. Does the receiving crop need improvement? Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes XNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes A] No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, map , etc.) ❑ Yes&No
� ✓ ,�
19. Does record keeping nee improvement?irrigati freeboard rite ana ys�s & soil sample reports) IYYes ❑ No
20, Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes JR No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes )X No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) M ❑ Yes ❑ No
23. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative? ❑ Yes UNo
24. Does facility require a follow-up visit by same -agency? ❑ Yes Wo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ® No
yiolatigris'e� dgfciencies mere noted dung �his;visit; Yoir will reeeipe do luithe� ; ;
6 ri4p deft& ahauti this :visiti
Comrents (refer to question #): Explain -any YES answers and/or any recormendations or any other commesrts: "-
Use drawings of facility to better explain situations: (use:a_dditional pages as necessary)- -
Is- e7lall—c
�A`/��A.✓iutr� /S '/J� ��/�i✓'" /!�O �(//�C.L�4/' �1SG!!�G f/9�
/Ay/ 12�...
qV
Reviewer/Inspector Name
Reviewer/Inspector Signature: ,� - - — Date: hlz / . ,-) 5100

a Facility Number: gZ — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atfor below ,® Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes W No
29. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 4K] No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ® No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ® No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes El No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ® Yes ❑ No
J

Routine
- .13 Division of Soil ani
- :D Division of Soil aw
Division of Water
_ Other Agency -OF
Follow-up of
I Facility Number l> Z I
view
pltance Inspection
Follow-uu of DSWC review O Other
n
Date of Inspection IM-Y-7 7
Time of Inspection � 'OV 124 hr. (hh:mm)
0 Permittedof Certified 0 Conditionally Certified Q Registered JE3 Not O erational Date Last Operated:
Farm Name: I
�.sQ.� >`itcr�sf.../`... ... Countl ...... SQ...--
Owner Name:.... s )d (j Hi lfif..!..Phone No:.............................
Facility Contact: .............� /`L-1r.----..._.....................Title:._..---------... Phone No: ...................................................
Iailing.Address: j ..
..7... .......,L - ........... �....x.............................. 7r- .v�146�.. /t/e 2e3j?,
Onsite Representative: p%� k1.2..J .................................................... Integrator: .......... ........... .,11_4, ... rF.....................................
Certified Operator:-.30-4.01A.7....... ........... I/ ..... Operator Certification Number: ..... A7.75.7.2 .......
Location of Farm:
Latitude ' ° •4 Longitude • 4 "
`Design
Current :' _
Design . Current
Design Current
&wine :'T Capacity
Population Poultry
Capaciity Population Cattle- ..
Capacity Po pulahon
❑ Wean to Feeder
❑ Layer
❑ Dairy
Feeder to Finish �p'7
❑Non -Layer
10Non-Dairy
1 1-
Farrow to Wean
❑ Farrow to Feeder
❑ Other
y
❑ Farrow to Finish
"Total Design Capacity
% Z
❑ Gilts
_- z .: . = = -
❑Boars
-, Total SSLW
Number of Lagoons -
u
-e ❑ Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
- Holding Ponds / Solid Traps
❑ No Liquid Waste Management System
n -
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes �NO
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes j'No
b_ If discharge is observed, did it reach Water of the -State? (If yes, notify DWQ) ❑ Yes KNo
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 11 L !Vo
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 ONO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes efNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier: ��(( 0
Freeboard(inches): ....... ......9............. ... ........ ........................ .................................... ..........................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, []Yes O.-lo _
seepage, etc.)
3/23199 Continued on back

Facility Number Z hate of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7_ Do any of the structures need maintenance/improvement?
8_ Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ with those de gnated in the CertiVed AnAal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General 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?
0: �io'*O`a,ftsodiciencies -were h6ted• &aging this:visit: - Yo} wll-reeeye iio furth&r :
correspondence. about this visit. . .
❑ Yes VNo
❑ Yes KNo
❑ Yes fi4 No
❑ Yes KNo
❑ Yes No
❑ Yes No
❑ Yes 9 No
❑ Yes [X No
❑ Yes KNo
❑ Yes RNo
❑ Yes No
❑ Yes j No
❑ Yes f No
❑ Yes P9 No
'Yes ❑ No
❑ Yes No
❑ Yes lJ No
❑ Yes
4 No
❑ Yes
Kf No
❑ Yes
4 No -
❑ Yes
t� No
__._. othComments (refer toquestiou Expan anyYES answers nd/or,an recommendatfonsar aner commens:
Use
r..
drawings of. fac'WO_to:better explain situations. (use additional pages as necessary)
s.
Aie ed -1,> 4mke uxde ya-vuf le s r,.j 141-4 e, 6o dzu1s, ofpPczcNOP%_ AL
�a-yo/PrvX,nru y_ _ every q 1�lo,►ts•�
1jeed5 f�ldWL� U fL 4;ou, I,,s,r a /JAIL fQQ�%^�• 1��}
'deed fo je-� l aloo-•` d es �w -to dederm; e e Sir J f
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 12— P?
3/23/99

[ Facility Number.fZ -Q Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes
2& Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ElYes [ No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes WTo
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 ANO
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes KNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes V4W
Additional Comments an or: raven
a
3/23/99