820039_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

'vi'sion of Water Resources
Facility Number - 0 Division of Soil and Water Conservation
Mille' 111QQ Other Ageacy
Type of Visit:��ommp�pliancc Inspection Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: &ioutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: r Arrival Time: Departure Time: A E r 5 County: Region:
Farm Name: [�� f �� {�- W a�� �G +vt Owner Email:
Owner Name: &J'I �� �1�'t r �a tj e -A Phone:
Mailing Address:
Physical Address:
Facility Contact: ,f r5 a r W t Title: Phone:
t
Onsite Representative: Integrator:
Certified Operator: tk) () tvve_-i, Certification Number: 17 c(lk7
Back-up Operator: f� , s U Lqy e--., Certification Number: t Z Ct 2 -
Location of Farm:
Latitude:
Longitude:
- Design Current
0 Yes
Design
Current
Design Current
Swtne Ca aci Po
,.... P t5' P
Wet Poult .
ry
Capacity
Pop.
Cattle Capacity Pop.
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
Weant o Finish
❑ No
La er
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
Dai Cow
[a -No
❑ NA
Wean to Feeder
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Non -Layer
['11b
❑ NA
Dairy Calf
of the State other than from a discharge?
Feeder to Finish cl O ' b
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . Poul
Ca aci
l;o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Otherµ
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes O_Nt�- ❑ NA ❑ NE
❑ Yes [-]No �A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
0 Yes
❑ No
[D -17A
❑ 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
[R'1GA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[a -No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
['11b
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2015 Continued

Facility Number: } - 3 Date of Inspection: ASA --ti
Waste Collection & Treatment
❑ Yes
El"No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Cg -N6-_[_] NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
E3 -NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: 3 LO
21 _ Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑.lei
Spillway?:
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
Designed Freeboard (in):
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
Observed Freeboard (in): 3 Z 2 f
[D"No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑Ko❑
NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
03r 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 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
[ 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
[0-4o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EfNo
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? if yes, check the appropriate box below. [—]Yes dNo ❑ 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): -(� -e,1"0k d -k S 6 0 �g sf is t✓
13. Soil Type(s): _,til p W t'L
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [D 1V O ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [E' T�o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Q' Ilio ❑ 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 E31�o ❑ NA ❑ NE
[:]Yes EEI—No ❑ NA ❑ NE
Required Records & Documents
19_ Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
El"No
❑ NA
❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑-o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21 _ Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑.lei
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[D"No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[3"<o
❑ NA
❑ NE
Page 2 of 3 2/412011 Continued

Facility dumber: - Date of Inspection: 9 S d�{
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Lr 1io
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3 -'K -o
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 ❑'l -o
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [] Yes ED-lgo
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?
❑NA ONE
❑ NA ❑ NE
M NA ❑ NE
❑ NA ❑ NE
❑ Yes [31 o ❑ NA D NE
[] Yes �o ❑ NA ❑ NE
❑ Yes [3] No ❑ NA ❑ NE
❑ Yes � ❑ NA ❑ NE
❑ Yes El -No
❑ Yes 0To
❑ Yes [a'%
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situ—ations (use additional pages as necessary).
Ca
C.e.l( aao'.3a�- 6�ss�
Reviewer/Inspector Name: 1 1 U " _ 0 - Phone:116—q3 3—
Reviewer/Inspector Signature: Date: S ✓�
Page 3 of 3 2/4/2015

ype of visit: Ly.compuance inspection V uperanon icevtew v 3rructure tvatuanon V t ecnntcat Assistance
Reason for Visit: "outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: s4t'V' Region:
Farm Name: &)a4 "A •c/ Owner Email:
Owner Name: U (�t J✓ G t'l Phone:
Mailing Address:
Physical Address:
Facility Contact: � ctisFi 5 _ QtA(.. JL `i( Title: Phone:
Onsite Representative: f 1 Integrator: j 16
Certified Operator: tor.0 Certification [Number:
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
.'
splesign Current
Swine Capacity Pop.
Wet Poultry
Capacity
Papa
Cattle ":
x C paci�ty Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Dairy Heifer
-
Feeder to Finish
Farrow to Wean
Design
Current
Dry Cow
=
Farrow to Feeder
La ers
Non -La ers
Pullets
Ca aci
P
Non -Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
Farrow to Finish
Gilts
Boars
Turkeys
Other
Turkey Poults
A`
- �T
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes [Er�o ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [] Yes ❑ No E�rNA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR) ❑ Yes [:]No E!j"'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 E5NA ❑ NE
2. is there evidence of a past discharge from any part of the operation'? ❑ Yes Fj No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters 0 Yes E2�No ❑ NA ❑ NE
of the State other than from a discharge?
Page l of 3 2/4/2015 Continued

Facili Number: - j Date of Inspection: jL,j
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): q
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E!�No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
g3 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?
0 Yes
Ca"N'o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit'?
❑ Yes
[2'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
fNo
❑ 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):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CA W MP? ❑ Yes �No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [!n—No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes ®'No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [. ]'No ❑ NA ❑ NE
❑ Yes �o ❑ 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? 1 f yes, check the appropriate box below. ❑ Yes EZ'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard []Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 6 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes dNo ❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facili Number: - Date of Inspection:
4 Mo
µ
24."Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
R] No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
Cygo
❑ 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
ERNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[(No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [;KNo ❑ NA ❑ NE
[]Yes FB No ❑ NA ❑ NE
❑ Yes [;?S4o ❑ NA ❑ NE
❑ Yes [2 -No ❑ NA ❑ NE
❑ Yes []'No
[:]Yes ff No
[:]Yes E?rNo
NA NF,
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
�`'v-'` 3 -P( - l
b.o q6s
C4 Ito- - kLj
Reviewer/lnspector Name: U j
Reviewer/Inspector Signature:
Page 3 of 3
Phone:t - u33 3 3N
Date: 'r l 11
21Y615

type of visit: (y ommpliance Inspection V operation Review U structure Evaluation U Teclinical Assistance
Reason for Visit: "utine 0 Complaint 0 Follow-up O Referral O Emergency O Other Q Denied Access _j
Date of Visit: Arrival Time: Departure Time: County:
FarmName: r P (q ("�`P Owner Email:
Owner Name: `i tl LJafi+c^, Phone:
Mailing Address:
Physical Address:
Facility Contact: r<.] 1
Onsite Representative:
Certified Operator:
q
Region:
F 0—
Phone-
Integrator:
hone:
Ilntegrator:l ( e• rt 5 -C
Certification Number: 11 [ A 7
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
111111 jli�! 11 1 11 11,
- Design Current
❑ Yes
Design
Current
Design Current
Swine "" "Capacity Pap.
Wet Poultry
Gapacity
Pap.
Cattle Capacity Pop.
2. Is there evidence of a past discharge from any part of the operation?
Wean to Finish
Layer
❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Da' Cow
21 No
Wean to Feeder
Non -La er
Da Calf
Feeder to Finish
Da Heifer
Farrow to Wean
.Design
Current
D Cow
Farrow to Feeder
D P.onitr.
Ca acit
Po
Non -Dairy
Farrow to Finish
Lavers
Beef Stocker
Gilts Non -Lavers
Beef Feeder
Boars Pullets
Beef Brood Caw
Qther 4 _
Other
Turkeys
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?
[-]Yes io [) NA ❑ NE
❑ Yes [:]No 8 ❑ 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
217No
❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
21 No
❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 214/2015 Continued

FacilityNumber: - Date of Ins ection:MXV
Waste Collettion & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? D Yes [ 'l�~❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? D Yes ❑ No g-AFA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ZNo
❑ NA
Spillway?:
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[?f No
❑ NA
Designed Freeboard (in):
acres determination?
Observed Freeboard (in): �: Y
17. Does the facility lack adequate acreage for land application?
❑ Yes
jNo
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
JEno
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
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?
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
ore vironmental
threat, notify DVM
7. Do any of the structures need maintenance or improvement?
Yes
dNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑Yes
[Z"'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
ZNo o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [,Tko ❑ 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): B f` AV'L SG t/
13. Soil Type(s): X/0 W.
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ZNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[?f No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
jNo
❑ NA
0 NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[� No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[—]Yes
ONo
❑ 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
dNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
FJ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
dNo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

V 01
[Farility Number: a L IDate of Ins ection:
24. Did the falility fail to calibrate waste application equipment as required by the permit? ❑ Yes [E} No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes C;�No ❑ NA 0 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? D Yes ONo ❑ 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 [yNo ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes [ o ❑ NA ❑ NE
❑ Yes g No ❑ NA ❑ NE
[:]Yes 0 No
❑ Yes 21 No
❑ Yes [Z No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
Date: 1200 i�
21412015

i ype of visit.. %.-.�r%_ompuance inspection V operation Keview V nrrucrure nvaivanon V i ecnmcat Assistance
Reason for Visit: QKoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: lJ I Arrival Time: r O a Departure Time: ; 3a County Regio
Farm Name: C- llJQrrerti FLL/_#% - Owner Email:
Owner Name: W ; /I i a'P'_ z� W-0- 0, w r.*,- Phone:
Mailing Address:
Physical Address:
Facility Contact: B; It Lo a t'r r-.,- Title: 6W 11 T- Phone:
Onsite Representative:
Certified Operator: J`•c�
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:/ 729 7
Certification Number:
Longitude:
5w�ne
Wean to Finish
Design
'
Capacity
Current
Pop.
Wet Poultry
Layer
Desfgn*"'C e`
- iirrent
CapacEty P.op.
Design Current
Cattle CapacityM P.
Da' Cow
Wean to Feeder
,`
I
alf
Feeder to Finish
O
jam'
b. Did the discharge reach waters of the State? (If yes, notify DWR)
."
Dai Heifer
°`.
Farrow to WeanDIgq,Cyrren_t
Cow
Farrow to Feeder
D . Po_ul
Ca ciPo
Non -Dairy
Farrow to Finish
❑ No
❑ NA
Layers
2. Is there evidence of a past discharge from any part of the operation?
Beef Stocker
Gilts
❑ NA
❑ NE
Non -Layers
❑ Yes
Beef Feeder
Boars
❑ NE
of the State other than from a discharge?
Pullets
Beef Brood Cow
Turkeys
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
S 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
(2 No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
R No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2014 Continued

Facili Number: - ME jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[No
❑ NA
[:]NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: Lu,F W
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ 30
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
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
0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that necd
❑ Yes
ZC No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes jo 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): c,.dL 1,9 vz-rSrnr-�
13. Soil Type(s): %�%p, Z !i zz
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 0 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 El No ❑ NA ❑ NE
❑ Yes ?[ l- No [:]NA [:]NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Ea No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes allo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement'? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ®.No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ANo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 2/4/2014 Continued

F
Facility Number: -2: 1Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes }]C No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface 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?
❑NA ❑NE
❑NA [3 NE
F] NA ❑NE
❑ NA ❑ NE
❑ Yes fo No ❑ NA ❑ NE
❑ Yes g No ❑ NA ❑ NE
❑ Yes 52 No ❑ NA ❑ NE
❑ Yes U No ❑ NA ❑ NE
❑ Yes ® No
[:]Yes ® No
❑ Yes 01 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question tt): 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:3-TO(D
Date:
2/4/2014

e--li--I,--IZ-7 j 44'
ivlslon of Water Resources
Facility Number ®- 3 0 Division of Soil and Water Conservation
- Q Other Ag�ney
Type of Visit: GYINmpliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: (>16utine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: f
Arrival Time: 'Ua
Departure Time:1 149! DO 1
County:
Region:
Farm Name: ai~
Alt rn {C [AJ���}-,1 ro"*- Owner Email:
Non -La er
1
Owner Name: UJJt l ; "L-"'- 7Y1 wa//>-, Phone:
Mailing Address:
Physical Address:
Facility Contact: —1--11 Title: Phone:
Onsite Representative: Integrator:
IF
Certified Operator: Certification Number: l zw
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine : Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
IDairy
Current
Pap.
Des'ga Carrent
Cattle Capacity Pop.
Cow
❑No
Wean to Feeder
Non -La er
1
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
D . I;oul
Design
Ca aci
°` " -
Current
Pa
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other -
Turke s
T ey Poults
......
Other Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes [ANo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[-]Yes
❑No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page Y of 3
[-]Yes ❑No
❑ Yes ® No
❑ Yes [ No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
2/4/2014 Continued

Facili Number: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
(2k.No
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: 4U W LJ
Spillway?:
Designed Freeboard (in): I g 1
Observed Freeboard (in): q 3_3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not property addressed and/or managed through a
[:]Yes
[54,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?
5res
Q No
[:]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
®No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2g No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes Q 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): 43..r -f rX u s10- C-5 fi0 2w, 112V r rs r 2 -al
13. Soil Type(s): )U i24-1 W 0-H _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [R No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? 0 Yes 0 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ®.No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes [ANo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? 1f yes, check ❑Yes � No [:]NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements [—]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes M No
❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 ° Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [-]Yes ❑C,No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes (ANo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Facili Number: - 3 Date of Inspection: — 7-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Co No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes EL No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes El No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours andlor 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 representatiNe 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 pennit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [0 No ❑ NA ❑ NE
❑ Yes [0 No ❑ NA ❑ NE
❑ Yes R 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.
Use drawings of facility to better explain situations fuse additional oat=_es as necessary).
Ci v rnwr GUSrk' B+2 �c"''-✓ I- ..r �r�„�c jars a lro-
Reviewer/Inspector Name: CTZ�
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �%/G�- �;3� MC='
Date:
2/4/2014

I�U
Type of Visit: @'Compliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance I
Reason for Visit: 01routine 0 Complaint 0 Follow-up 0 Referral 0 EmerQencv 0 Other 0 Denied Access
Date of Visit: Arrival Time: ' Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: AV %%i anti %H L�/str17R� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Discharizes 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 JKNo [:]NA ❑NE
❑ Yes [:)No
❑ Yes ❑ No
[:]Yes ❑No
[:]Yes No
❑ Yes No
❑NA ❑NE
❑ NA C] NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 2/4/2011 Continued
Design Current
� �.,
Design
Current:..::
-:r: ° _ Design
Current
Swine
Capacity Pop.
WetPoultry
Capacity
Pop ..
Cattle .:. Capacity
Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
on -Layer
Dai Calf
Feeder to Finish
Q p
'�
Dai Heifer
Farrow to Wean
_=L
Design
Current'
Cow
Farrow to Feeder
D .:-<P.oul
Ca aei
P,_o'
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
_
Other
TurkeyPoults
-
Other
Other
Discharizes 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 JKNo [:]NA ❑NE
❑ Yes [:)No
❑ Yes ❑ No
[:]Yes ❑No
[:]Yes No
❑ Yes No
❑NA ❑NE
❑ NA C] NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 2/4/2011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [3 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �CJCc✓/�L(�y�
Spillway?:
Designed Freeboard (in): /9 l
Observed Freeboard (in): _ 'Z_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Eg 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
[5.No
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
S 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
®. No
❑ NA
❑ NE
8. Da�atty of the structures lack adequate markers as required by the permit?❑
Yes
� No
❑ NA
❑ NE
(not -applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
the appropriate box.
9. Does any part of the waste management system other than the waste structures require
❑ Yes
M1 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
10 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes JZ 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): " /Oy C2311
13. Soil Type(s): 622A Z_&az
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 j] No ❑ NA ❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes B No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
S No
❑ NA
❑ NE
Ree uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[::]Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists p Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes R No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield [:)120 Minute Inspections ❑ Monthly and l" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

4
Facili Number: jDatcof Inspection: — 3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes CRNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes C�LNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge`? ❑ Yes � No [:]NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes MA No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes j5it No ❑ NA ❑ NE
❑ Yes CRNo ❑ NA ❑ NE
❑ Yes [M No ❑ NA ❑ NE
❑ Yes [. No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
® No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
&No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers andlor any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name- Phone: �/'"3�' 337 0
Reviewer/Inspector Signature: Date: %/
Page 3 of 3 2/412011

Type of Visit: ECompliance Inspection Q Operation Review O Structure Evaluation C) Technical Assistance I
Reason for Visit: ®'Routine O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: ;s rrival Time: Departure Time: a as County:. 5was–d— Region: t t7
10,
Farm Name:
LVZrr(z!ykt
t} Uj ex e iG1I
_ ��rys.
Design Gnrrent
Owner Name:
Capacity
Pop
rrr-'t,.
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Z; 11. waer e"_ Title: Phone:
Onsite Representative: Integrator: ! nroswa_
Certified Operator: Certification Number: 7
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
- Design Current
DM. esign
Current"
Design Gnrrent
Swine ` Capacity Pop.�WePoiltry
Capacity
Pop
Cattle Gapacity Pop.
o
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -Layer
Dai Calf
Feeder to Finish
_
Dai Heifer
Farrow to Wean
5'
Design
Current
Cow
Farrow to Feeder
D . Point
Ca acity
Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars I
1pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
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 [Z No ❑ NA ❑ NE
❑ Yes [] No
❑ Yes [] No
❑ Yes ❑ No
❑ Yes [Z No
[:)Yes JSL No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
[DNA ❑ NE
Page I of 3 2/4/2011 Continued

Facilit Number: - Date of Inspection:
Waste Collection & Treatment
. 4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[:]Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[] No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: bJ d -UJ
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
g[ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
10 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
JANo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [Z.No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, 7_n, 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 L]Application Outside of Approved Area
12. Crop Type(s): YWM L44,1- f O t r— yell --
13. Soil Type(s): & D >4 Z u) a z
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes P, No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes ®.No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes 0 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes MNo E] NA [:]NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes rNo E] NA E] NE
the appropriate box.
❑ WUP ❑Checklists ❑ Desigm ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes S No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility tail to install and maintain a rain gauge? ❑ Yes allo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes [&No
E] NA E] NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
[]NA ❑NE
Page 2 of 3 2/4/2011 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �No
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes XNo
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 to No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [3,No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the R evi ewer/] nspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
E-] NA ONE
E-] NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes CZ No ❑ NA ❑ NE
❑ Yes EkNo ❑ NA ❑ NE
❑ Yes [RNo [DNA ❑ NE
❑ Yes j No ❑ NA ❑ NE
❑ Yes
C, No
❑ NA
❑ NE
❑ Yes
D4 No
0 NA
❑ NE
❑ Yes
tZ No
❑ NA
❑ NE
Comments (refer to question #1): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better explain situations (use additional vaees as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/412011

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ® Arrival Time: Q ; S Departure Time: J&3a County: Region: �y
Farm Name: GUGeIj'erL �' b(Ja YrCn Fo �'�
Owner Name:
Mailing Address:
Owner Email:
Phone:
Physical Address:
Facility Contact: �%i��- /�/���.-� _Title: Phone:
Onsite Representative:�� �� Integrator:
'
Certified Operator:Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
` Design Current
Design Current
Design Current
Swine _- Capacity P
Wet Poul#ry
Capacity 1'0
Cattle;{ Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish(�
_
airyHeifer
Farrow to Wean
Design C int
Dry Cow
Farrow to Feeder
Dry Poultry
Ca acsEo
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
-Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
..
Other
Turkey Poults
Other Other
Discharp_es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 ®No ❑NA E] NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [] No
❑ Yes CK No
❑ Yes ® No
❑ NA ❑ NE
❑ NA [] NE
❑ NA ❑ NE
Page I of 3 2/4/2011 Continued

Facili Number: - 3 Date of Inspection:
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
Waste Collection & Treatment
V!�No
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑
Failure to Incorporate Manure/Sludge into Bare Soil
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
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
Identifier:
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Spillway?:
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Z[ No
❑ NA
Designed Freeboard (in): 1� —
acres determination?
2/412011 Continued
Observed Freeboard (in): ,.3e-7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
JR] 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
K1 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
-R] No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
K 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
0No
❑ 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 a No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ Yes
V!�No
❑ 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
❑WUP ❑Checklists E] Design ❑ Maps ❑ Lease Agreements
12. Crop Type(s):,�/nluela.
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑Yes
�No
❑ NA ❑ NE
13. Soil Type(s): /UO ZfZVQ
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
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 Z[ No
❑ NA
❑ NE
acres determination?
2/412011 Continued
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
V!�No
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists E] Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑Yes
�No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
'Q No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�,No
❑ NA ❑ NE
Page 2 of 3
2/412011 Continued

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

Type of Visit (i -Compliance Inspection U Operation Review U Structure Evaluation O Technical Assistance
Reason for Visit QAoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:may �l/D Arrival Time: :J� C� Departure Time: �.�D County: Region: ! _
Farm Name: -& - I,tct d FQr&I _ Owner Email:
Owner Name: �cr4 ,�' a i �X� Z k /Z ✓� Phone:
Mailing Address:
Physical Address:
Facility Contact: K, G 12ard &I / la ed��?? Title: f��r'/ Phone No:
Onsite Representative: % � �� tr laCrr_ ; 1;1001`G Integrator: (�
id✓�_ f/
Certified Operator: Operator Certification Number: 1
Back-up
_.
Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0 =6 =is Longitude: = ° =
Design Current
Swine Capacity Population
Destgn
Wet P ultrypac�ty
Current Design Current
Poputatton' Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
Feeder to Finish
-
Dai Heifer
❑ Farrow to Wean❑
Dry P oultry -"
D Cow
❑ Farrow to Feeder
❑ Yes
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
Brood Co
❑ No
❑❑Beef
Turke s
❑ NE
ewr *
M
El Turkey Poults
10 No
El Other
ElOther
Number of Structures:
❑ Yes
�RNo
❑ NA
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
❑ Yes
[ No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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
10 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
�RNo
❑ NA
❑ NE
other than from a discharge?
Page I 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 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in): y�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes (e 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 RNo ❑ 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 [Z 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 RPgo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes fRNo ❑ NA EINE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [8 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)
'e -37— rfC�CS'G .
Reviewer/ins ector Name oc�
p r✓`t• . t*. ._ Phone: 910 –y3 -
Reviewer/Inspector Signature: Date: /,;7-- 93/�
Page 2 of 3 12/28104 Continued
13. Soil type(s) l`3r. .[SD0er,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
allo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
®No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[--] Yes
® 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
EZ No
❑ NA
❑ NE
'e -37— rfC�CS'G .
Reviewer/ins ector Name oc�
p r✓`t• . t*. ._ Phone: 910 –y3 -
Reviewer/Inspector Signature: Date: /,;7-- 93/�
Page 2 of 3 12/28104 Continued

Facility Number: (, —3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 51 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes B 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 P9 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
CgNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[2 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 tZ No ❑ NA ❑ NE
Other Issues
28_ Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E9 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Z[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
10 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
10 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
B.No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Page 3 of 3 12128/04

Division of Water Quality 6/ f
iFacilily Numberm�—
rim
Q Division of Soli and Wther Agency
Type of Visit
ompliance Inspection
0 Operation Review O Structure Evaluation
0 Technical Assistance
Reason for Visit
tine 0 complaint
O Follow up O Referral O Emergency
0 Other ❑ Denied Access
Date of Visit: 17-1-!A
EA Arrival Time: O
Departure Time:
County: O`__ Region:
Farm Name: %
l�xr YtP_4L d- �Y-'�-'
_
Owner Email:
Dairy Cow
Owner Name: %(1
. ! Q",,s-
❑ Dai Calf
Phone:
Mailing Address:
Physical Address: ! J
Facility Contact:�TJ�11 btl'4rryr .'L__ Title: &L -A. _ Phone No:
Onsite Representative: integrator: I-r4ZLZ= _
Certified Operator: _ ���"� _ Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = =i =" Longitude: = o ='
Swine
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)
?. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes Wo ❑ NA ❑ NE
El Yes
[I No
❑NA
1Ui—esiggnj0LG-ur,
apacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er I
Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dai Calf
El NE
Feeder to Finish D q
El No
❑ Dai Heifer
❑ Farrow to Wean
Dry pointry
❑ Dry Cow
❑ Farrow to Feeder
[&No
ElNon-Dairy
El Farrow to Finish
❑ Layers
ElNon-Layers
❑ Beef Stocker
El Beef Feeder
Gilts
PE013oars
El Pullets
ElBeef Brood Cowl
❑ Turkeys
Otj
10 Turkev Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
?. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes Wo ❑ NA ❑ NE
El Yes
[I No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
El NE
❑ Yes
El No
[71 Yes
�To
❑ NA
❑ NE
❑ Yes
[&No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: Date of Inspection
a
Waste Collection & Treatment
Reviewer/Inspector Signature: Date: a
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[SNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
10 No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): f `
Observed Freeboard (in): � _'a
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
BNo
❑ NA
EINE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
CKNo
❑ 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
I&No
❑ NA
❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[9 No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
F714 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [K No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) VV
13. Soil type(s) lv
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes C.No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
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
t8. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA ❑ NE
tKNo❑ NA El NE
No ❑ NA ❑ NE
E§�No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
a
Reviewer/Inspector Name Phone: '*170-43DO
Reviewer/Inspector Signature: Date: a
Page 2 of 3 ` 1 /2/28/04 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ISNo ❑ 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 EI Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes KNo ❑ 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
allo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ESNo
❑ NA
❑ NE
24_
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ESNo
❑ 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
C,No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[a No
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
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
RNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
9No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did ReviewerAnspector fail to discuss review/inspection with an on-site representative?
❑ Yes
Wo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
;E�.No
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12/28/04

f -
Type of Visit ®'Compliance Inspection 0 Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit 2outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ® Arrival Time: Departure Time: ADD County: Region:
Farm Name: Warr -e^ d- war r *^ Fal rm Owner Email:
Owner Name: , W i ! a L _ 1) Gt jC Phone:
Mailing Address:
Physical Address:
Facility Contact: 'i L0040-1– Title: ahu nl -r' Phone No:
Onsite Representative: 5 � _ Integrator: RIZ3
Certified Operator: �'-r Operator Certification Number: 7g^�
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0
=6
= Longitude: = ° [=I
=
gg
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capty Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
❑ NA
Feeder to Finish I to O D
K Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Layers
❑ Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
__
❑ Turkeys
❑ NE
Other
Turke l"aults Other
FO
Number of Structures:
❑ NA
❑ NE
other than from a discharge?
Discharges & 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
K Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
($ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
f 1No
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

Facility Number: — Date of Inspection r -
/
/� C�d'v1 � �'�L W �1 � � ��t �� �'ti- �S i / � e• J f� pt7 / , Q`� [3 r.�
t
f
14. Do the receiving crops differ from those designated in the CAWMP?
Waste Collection & Treatment
2.No
❑ NA
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
54 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑Yes
❑ No ❑ NA ❑ NE
Stricture I Structure 2 Structure 3 Structure 4
Structure
tiEructure 6
Identifier:
❑ NE
17. Does the facility lack adequate acreage for land application?
Spillway?:
[K No
❑ NA
Designed Freeboard (in): Pa
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Observed Freeboard (in): 3 7
❑ NA
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
® 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
0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
4 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
KNo Cl NA ❑ NE
maintenance or improvement?
Waste .Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
RNo El NA El NE
maintenance/impYovement?
11. 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 [IApplication Outside of Area
12. Crop type(s) � rr� J"' /d v rd .�z'r•�
13. Soil type(s) l,(J
/
/� C�d'v1 � �'�L W �1 � � ��t �� �'ti- �S i / � e• J f� pt7 / , Q`� [3 r.�
t
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2.No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ANo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
EX No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[K No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L,No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pagesas necessary):
/
/� C�d'v1 � �'�L W �1 � � ��t �� �'ti- �S i / � e• J f� pt7 / , Q`� [3 r.�
t
Reviewer/Inspector Name B -L Phone: Zlp —V-13 -33CO
Reviewer/Inspector Signature: Date: Al- 1"
12128/04 Continued

4
Facility Number: —3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes L,No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes (a No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes O�No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
X10
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
allo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
DQNo
❑ 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
XNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
XNo
❑ NA
❑ NE
Otiler Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EKNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[XNo
❑ 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
9No
❑ 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
ANo
❑ 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
CR No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
JS No
❑ NA
❑ NE
Comments and/or Drawings:
1212$104

Type of Visit 4a'tompliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit outine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I 7—/570 `0 Arrival Time: 17D Departure Time: ; 3Q County: Region:
Farm Name: Wae-ren ty" Owner Email:
Owner Name: _ Phone:
Mailing Address:
Physical Address:
Facility Contact: ij. I I UJ o 02 Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator: � �r57,_—
Operator Certification Number:_.
Back-up Certification Number:
Location of Farm: Latitude: ❑e ET
=" Longitude: =10 =1' E__1 "
Swine
Design A, Pen PN y
CapacrtyPopulatianet Poultry
Dest_gn Carrent _ Design Current
CapaityP�opulat�ona Cattle CapacityPopulation
❑ Wean to Finish❑
La er
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Laver
❑ Dairy Calf
Feeder to Finish
&D LD2 qZ* �
11sfi El Dairy Heifer
❑ Farrow to Wean
Dr�*Poultry
&�❑ D Cow
I
❑ Farrow to Feeder
❑nLayers
�_e� _ ;�..- -
❑ Non -Dairy
El Farrow to Finish
ElNon-La ers
❑ Beef Stocker
❑ Gilts
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
El Turkeys
Other Q Turkey Poults
❑ NA
❑ Other
mY';
H ❑ Other
Number of Structures:
5? No
❑ NA
❑ NE
Disci & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
91 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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
5? No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
J.No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

Facility Number: —
Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 5
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 ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ® 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 ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ZNo ❑ 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) f,C1
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
ONo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
Q No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
Fkj No
❑ NA
❑ NE
Reviewer/InspectorName �a Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12/28/04 Continued

Facility Number: — Date of Inspection 77E->
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? []Yes BNo [INA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes RNo ❑ NA EINE
the appropirate box.
❑ Wi]P ❑ Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. JKYes [:]No ❑NA ❑ NE
10 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
J.No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[Z No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
XNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
!allo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
RNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
jo No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[9 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
ERNo
❑ 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
Q No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
®No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
®No
❑ NA
❑ NE
Page 3 of 3 12/28/04

tvision of Water Quality 1
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
F
of Visit lmpliance Inspection Operation Review Structure Evaluation Technical Assistance
n for Visit outine O Complaint O Follow up 0 Referral O Emergency O Other ❑ Denied Access
Date of Visit: "Ca"Zi Arrival Time. 16 1 DepartureTime: County: Region:
Farm Name: �.L�2t'f ePi't (�" R Q r& lPn Far Owner Email:
l
Owner Name: —1 IL1 r L m /Yl 641 a rr-e n Phone:
Mailing Address:
Physical Address:
Facility Contact: JI) I I l 1)ja re- eA Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: �_ Operator Certification Number: 122
Z^,
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: =0
=6
Longitude: = ° = d
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
n _f_
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current..
Cattle Capacity Populations
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy tt,*]
❑
Di
y Cow
❑ Non-Daity
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:.
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes SNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
;!�No
❑ NA
❑ NE
❑ Yes
[.No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Rj No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): �_ g
Observed Freeboard (in):,�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ,&No ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes JNNo ❑ NA EINE
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? 0 -Yes ❑ No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit.' ❑ Yes 04 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 [K 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 [R 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�jAcceptable Crop Window ❑ Evidence of Wind Drifi ❑%Application Outside of Area
12. Crop type(s) �`O�- LAY `z--� I D r/er-5�edt
13. Soil type(s) A rel a �3
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 [9 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
W No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
® No
ElNA
ElNE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
l
� �0 r� '`- h
qr
Reviewer/Inspector Nameev K--
Phone: `�-I D—�3.3 .300
Reviewer/Inspector Signature:
Date:
12/28/04 Continued

Facility Number: 9Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [9 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 appropirate box. ❑ WUp ❑ Checklists
❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [9No ❑ 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
9 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
INNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
K No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
14 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
WNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[K 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
t4No
❑ 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
ELNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
M,No
❑ NA
❑ NE
Comments and/or
12/28/04

I
DiVision ofiNater Anality
Facility Number l�3 g" O Division of Soil and Water Conservation
O Other Agency
Type of Visit
ompliance inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
outine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: J ate Departure Time: ! County:. S(7``i- Region: I O
Farm Name: Ltl a, I — en idarlveI'l Ff or-pyt- Owner Email:
Owner Name: U 'rr��r r 1 aerL � �Cl_ICl t C WGi 1 rr%�'Y�_ /Phone
Mailing Address: D{�0,�� SntL Garb �Lv� Til?' Ujz-�
Physical Address:
Facility Contact: u% r 1 i wren— UJQ f'f*?? Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator: 7z / 0,
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = [=6
= Longitude: E:10 =' ❑ u
Design
CurrentDesign
Current
Design Current
Swine Capacity
Population Wet Poulfy
Capacity .Population
@attle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Yes
❑ Dairy Cow
❑ Wean to Feeder
❑ NE
b_ Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Non -Layer
®,No
❑ Dairy Calf
Feeder to Finish❑Dairy
c. What is the estimated volume that reached waters of the State (gallons)?
Heifer
❑ Farrow to WeanDry
Pa ltry`
❑ D Cow
❑ Farrow to Feeder
[�No
`"
Ll Non -Dairy
❑ Farrow to Finish
❑ Layers
qkNo
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Yes
❑Beef Feeder
❑ Boars
El Pullets
other than from a discharge?
❑ Beef Brood Cowl
Other
❑ Turkeys
Page 1 of 3
12/28/04
� El Turkey Poults
mber,�of Structures:
❑ Other
El other
� _
�iV
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
LgNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
®,No
❑ NA
❑ NE
b_ Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
®,No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[�No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
qkNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
PLNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

Facility Number: V73q
Waste Collection & Treatment
Date of Inspection 7EM(P
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes jN No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [Z No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: , --,73-LJ
Spillway?: C}
Designed Freeboard (in):
Observed Freeboard (in):�
f
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes r$ 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 ® 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?Ulk
Yes
❑ No
ElNA
ElNE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
1,No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
[9No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
X No
❑ NA
❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes JANo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or I0 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) /L +A-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0,No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes WNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`❑ Yes ANo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes 4 No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes fNo ❑ NA ❑ NE
Comments (refer to question #): -Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):'
Reviewer/Inspector Name r p,1. ' Phone:
Reviewer/inspector Signature: Date:�� /(a
12128/04 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes (jNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes KNo ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists El Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes g No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
KNo
❑ 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
�&No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[KNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
L� No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[K No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
J�j No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[&No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[LNo
❑ 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
ZNo
❑ NA
❑ NE
Additlot,al Comments,and/or Drawings:
12/28/04

Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ® Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
IDateofvisit, -9 11 Time: J O 4 M
Facility Number �
O Not Operational O Below 'Threshold
Mi"ermitted j31Certified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold.
Farm Name: ... Wac fit..._.�sncL County.
W. WW
Ran n ,'e 1 ✓: 1 %.'
Owner Name:..... irdai.G......Cal/....k/:

Facility Number: —
Date of Inspection 1 272=
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?
(H 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 0,N`8'
❑ Yes 0 -No
❑ Yes
S. Does any part of the waste management system other than waste structures require maintenancefimprovement? ❑ Yes �o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes B -No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/irnprovement? ❑ Yes Q NC
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑W6
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12- Crop type 93e raze�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [5] Alo"
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑-96
b) Does the facility need a wettable acre determination? ❑ Yes EIM
c) This facility is pended for a wettable acre determination? ❑ Yes �o
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes B -Ko-
Odor Issues
17. 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?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑-N-0
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes B1C0_
Air Quality representative immediately.
.. L-..n—•..++r 1. '-+_ ..:syL - � !� w -Z"`-5;, ..K.. .'.y_.. �-• .H- -. y.,-
Cormnents (refer to ques4an:1#) � any YES�auswers and/dr any reoommeadaUo� or'a y other comments.
...- -y`.-`. _«� '. w.- was. ---'--•- q�.-Sr
Use drew:ags of facffity to Derr explain s>toatioasx(ust asldrhanal pages as;aeoessary) teId Copy ❑ Final Notes ?F}
F,x "•'„ '"• "- `^'�� .: -ti; s• -•«-f"' _ r---Tre•.�.=irs- -
...��`<`.- ------ _
L
Fa r In 1, S w e ke,,o
�I e COr'd s ire weld lee��
ewer/bspector Namemn
[Revvi
Revieweranspector Signature: /9 Date: Y
12112/03 1/ Continued

Facility Number: —3 cl Date of Inspection
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
O d'6-
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
_ , 1 les welc 5e i ie Q I
SG/)7�0 O T�inau�u7 �payi
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Q'W
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
B-14-6-
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑Wo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
E3 -No
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
0N6
28. Does facility require a follow-up visit by same agency?
❑ Yes
Flo'
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
EINio
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) Yes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ©No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ©-leo
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes D Wo
❑ Stocking Forrn ❑ Crop Yield Frm ❑ Rainfall❑ inspection After I"
❑ 120 Minute Inspection❑ Annual Certification Form`s
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
tiditto mments and/orDrawings - P = y e _ `r. -
sa: ( fesls F-, IOL 7- 1'5 egeocl,'r7
_ , 1 les welc 5e i ie Q I
SG/)7�0 O T�inau�u7 �payi
t
12/12/03

f' Jl{G 1�R;Yli W ,a��si.waww r�.wssray.a. .
Facility No. B =.. u
- 3 9
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIIuIAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: It 112j, 1995
11me• 9:30 a
Farm Name/Owner. B 0 l Wo,,
Mailing Address: 7-95c S• 9 K Eos-' fi r_d . C 1 i n-6vt t3 Z83a S
County: 5 s a vi
Integrator: _ Pre's +orae, Phone: S9 z - 2 H 13
On Site Representative: -1301 Warr Phone:
Physical Address/Location:IKj!i Hal SoWK Ta„ry in fa n Ff & 193 3 — F -a.,+,+
Type of Operation: Swine _2<, -oultry Cattle
Design Capacity: : see. 6-t6w Number of Animals on Site:. Sofia
DEM Certification Number: ACE DEM Certification Number. ACNEW
Latitude: Longitude' •
Circle Yes or No
Does the Animal Waste Lagoon hPFamn(s)?
sufficient freeboard of i Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches)or No Actual Freeboard: sa. t. Inches
Was any seepage observed from the Yes or No Was any erosion ob ed? Yes orIs adequate land available for spray? or No Is the cover crop adequate? C� No
Crop(s) being utilized: Berm ud+� R
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwell' n s? or No
100 Feet from Wells' or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or&
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or® If Yes, Please Explain.
Does the facility maintain adequate waste management re s (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Y or No
AdditionalComments: is regi s+er _ F;w� s�►,'p4 Deo�ron
Ll = le re + % _ o�4D0A 4 - 7,7 51l.oVr2a
Ll ;} S — 6 kovvej
L Z - Z,F y gree bcmi.1
LU tc wv L -n ' O1,
Ej
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

12
13
14 4,
15
iM 1.'
CC
CommerckaAl Advallsing Corp.
PMwM"Hnlete"
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