820067_INSPECTIONS_20171231

NUH € H UAHULINA
Department of Environmental dual

7L6
Division of Water Resources
Fog
acility Number E K Division of MIN Water Conservation1 -0
•Q Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: �@, dtc- 1 ,t,/f � � Owner Email:
Owner Name: tV4 h-,�I3•V " Tr'�-�'► s �-02491 Phone:
Mailing Address:
Physical Address:
Facility Contact: Doy 5 N r Q o> Title:
Onsite Representative:
Certified Operator: N
Back-up Operator:
Location of Farm:
Region:
Phone:
Integrator: �I�/
Certification Number: My/
Certification Number:
Latitude: Longitude:
Desiga Current
Design
Current
Design Current
Swine Capacity ° Pop.
Wet Pauttry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder ILNon-La
er
DairyCalf
Feeder to Finish
Da Heifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
I) , PTU,I
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
4--
Boars
Pullets
Beef Brood Cow
Turkeys
Other -
Turkey Poutts
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [R No ❑ NA ❑ NE
❑ Yes
❑ No
® NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
,® NA
❑ NE
❑ Yes
�Ej No
❑ NA
❑ NE
❑ Yes
[9 No
❑ NA
❑ NE
Page I of 3 21412015 Continued

i Facil Number: _ Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ft-d ft-3 Ld 4VI
�No [DNA ONE
No F NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
1P 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
D NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�R No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[� No
❑ NA
❑ NE
maintenance or improvement?
T
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA
❑ 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 A
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from
designated in the CAWMP?
15_ Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes T No
❑ Yes IR No
❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste T sfers ❑ 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 No DNA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Fae' ' Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
[] Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [] Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to property dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
❑ Yes qg No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes 4& No ❑ NA ❑ NE
❑ Yes F
No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
W No
❑ NA
❑ NE
Phone: / 1�9" II
Date:
21412015

i ype of v isir: w uompnance inspection v operation Keview u structure Pvatuation ij i ecnnical Assistance
Reason for Visit: • Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: /�j � County: Sle"^Pswki Region:K'
Farm Name: llr &L/�rvt Owner Email:
1
Owner Name: /l r`, Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: iz
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator: 2?m
Certification Number:
Certification Number:
Longitude:
Swine
Design Cnrrent
Capacity Pop. „
Wet Podm
ultry
Design
Capacity
Gnrrent
Pap.
Design Current
Cattle Capacity Pap.
Wean to Finish
-
� -D
Layer
Non -La er
..P,oul .
I
I
Design
Ga aci
I
Current
P,o
I
Dairy Cow
Wean to Feeder
Dairy Calf
Feeder to Finish 2
Dairy Heifer
Farrow to Wean 2c
Farrow to Feeder
D Cow
Non -Dairy
Farrow to Finish
ZdD
Layers
Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
Boars
< :
-
Beef Brood Cow
Turkeys
Turkey Points
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
0 Yes 1PNo ❑ NA ❑ NE
❑ Yes
[:]No
NA
❑ NE
[] Yes
[—]No
NA
❑ NE
[:]Yes [:]No
[] Yes P No
❑ Yes 0 No
NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

X .,
Facili Number: Date -of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes `f' No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [k] NA ❑ NE
Structure I Structure 2 J Structure 3 Structure 4 Structure 5 Structure 6
Identifier: PCH -03,/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
P No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a
❑ Yes
O 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
W No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
T
9. Does any part of the waste management system other than the waste structures require
❑ Yes
K73 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
T
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes 0 No ❑ NA
D 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
in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ NE
❑ NA ❑ NE
❑NA ❑NE
D NA ❑ NE
❑ NA ❑ NE
❑ 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 KA No ❑ NA ❑ NE
the appropriate box. rj
❑ WUP El Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [::]Yes P3 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
[]NA ❑NE
Page 2 of 3 21412011 Continued

r �
Facili Number: G 771 113ate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
V No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
52 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
R No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
® No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
T
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain. situations (use additional pages as necessary).
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9 ro-{('3360
Date: 7 1 0 607
21412011

r * Div"ision of Wafer Resources
Facility Number � - ® O Division of Soil and Water Conservation
0• Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: S0A Region:
Farm Name: _yY,�-C&lv�i �/J�+ !w Owner Email:
Owner Name: vLC202lgC}d2t.�., cu.,Phone:
Mailing Address:
Physical Address:
Facility Contact: ti6vno Title:
�r
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
t<
Phone:
Integrator: DM
Certification Number:
Certification Number:
Latitude: Longitude:
mp�or
Wean to Finish
eDesign
Wet Poultry
La er
Capacity
CurrentSw.
Pop.
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
1) . P,oult
Layers
Non -Layers
Design
Cs aci
Current
P,o
DairyCalf
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
I 10ther
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Pouets
DischarQes_and Stream Impacts
. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 1�1 No 0 NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
[] Yes
❑ No
❑ Yes
No
[:]Yes
No
NA ❑ NE
�NA ❑NE
91 NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

lFacility Number: - Date of inspection: 7 7 Fj
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: `C
J�gNo ❑NA ❑NE
❑No ®NA ❑NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
SP 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?
TT''
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA-
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[P No
❑ NA
❑ NE
maintenance or improvement?
I I . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA. ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [j Evidence of
Wind Drift ❑ Ap lication Outside of Approve;Ja
12. Crop Type(s): TU l }-r61 ski _ 1'-47T�`-� )1 �V_ t 'Lpo­ r fit^ S -
13. Soil Type(s): V,9- IV-44 .
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
[DNA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[59 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 5P No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [R No [DNA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: Date of Ins ection-
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes No' ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail yrovide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes [ No ❑ NA ❑ NE
�T
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes [� No ❑ NA ❑ NE
1
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 0 No ❑ NA ❑ NE
❑ AppIication Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes to No 0 NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
Comments (refer to question #/): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better explain situations (use additional panes as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9 (Q 33`" 3-360
Date: ciZ1 I o
21412015

r ypc ui v isiL. W 4.umpuance rnspecnan v vperarion rLeview V atrucrure invatuarton V i ecnnicai P►ssisrance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ? /" Arrival Time: iDi0 Departure Time: . ,Q� County: '9'K-A%-'-J Region: /Z;Il7
Farm Name: �p'3/�' Y:Ia / f,7� `t., Owner Email:
Owner Name: ly tj C5 Phone:
Mailing Address:
Physical Address:
Facility Contact: p
Onsite Representative:
n
Certified Operator:
Back-up Operator:
Title:
Phone:
Integrator: 7P/K ff
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Gnrrent
Design Current
Swine
Wean to Finish
Capacity Pop..
Wet Poultry
La er
Capacity
Pop.
Cattle Capacity Pop.
DairyCow
Wean to FeederIL]Non-LUer
DairyCalf
Feeder to Finish
Z
DairyHeifer
Farrow to Wean
_Lcm
Design
Current
Cow
Farrow to Feeder
P.ouI
FR!Non-Layers
Caaei .
1?o
Non-DairyFarrow
to Finish
2.D'D
rs
Beef StockeGilts
Beef Feeder
Boars
Pullets
i
113eef Brood Cow
— Turkeys
r Turke Poults
rther
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes []No
[:]Yes [:]No
[]Yes No
❑Yes �No
�NA ❑NE
NA ❑ NE
I:?" NA
❑NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3
21412014 Continued

Facili Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. if yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: PeN - Perk ;3
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
0 No ❑ NA ❑ NE
❑ No ® NA ❑ NE
Structure 6
❑ Yes S 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 DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes `W No [3 NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes W No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes P1 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes T No ❑ NA ❑ NE
maintenance or improvement? T
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window J❑ Evidence ot7Wind Driftl ❑ Application fOutside ofApproved Area
12. Crop TYpe(s)= COa,S-fo l • A S [ � / r �1'rtt , w� ` �,
13. Soil Type(s): { Q
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[� No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes tP No ❑ 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 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ® No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Ot
Facility Number: Date of Inspection: Z e7 L
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[:)Yes r"qNo ❑ 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 1)3 No ❑ NA ❑ NE
27, Did the facility fail to secure a phosphorus toss assessments (PLAT) certification?
❑ Yes [] No [DNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
T
30, Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes [ No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes ® No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
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?
to question #):
scility to better
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
any YES answers and/or any adds
situations fuse additional naees as
❑ Yes P No ❑ NA ❑ NE
❑ Yes E�j No ❑ NA ❑ NE
❑ Yes []a No ❑ NA ❑ NE
ons or any other comments.
Phone:
Date: -7 hw
114120114

I Jilt vi V 1311: O %_U1Lt/114UCV JU&PCC11U11 `J 11l7CFUUUl1 JMr V1CW LJ atFU MUC CVHJU1U1Ull %,J 1 VVUHICa1 iil3lSlaillUV
Reason for Visit: ® Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: / S Arrival Time: Departure Time: ; 00 v. County: SAk--('Son% Region: P42-0
Farm Name: Wee-k- Cita_".�7 Y • z( Wj• • Owner Email:
1 r _ ,
Owner Name: A q 6 s t' '1 Phone:
Mailing Address:
Physical Address:
Facility Contact: k e ALTitle:
d
Onsite Representative:
Phone:
Integrator: TDr%A
Certified Operator. Certification Number: I ff y-111
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
�Desrgn� Current Design Current
a
Swore Capacity Pop:'
-
Wet Poultry�CapacityPop Cattle Capacity Pop.
Wean to Finish
La er DairyCow
Non -La er Da' Calf
E "' D Heifer
Wean to Feeder
Feeder to Finish
Z
Farrow to Wean
i_oD'b
00
�D nCarrent D Cow
., g
Farrow to Feeder
D . P.oultryCa ct"Po ... Non -Dairy
La ers Beef Stocker
IC Farrow to Finish
2W
Gilts
Non -La ers
Beef Feeder
Boars
Pullets 113eef Brood Cow
Turkeys
_�
Other .��
Turkey Points
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 �hNo ❑ NA ❑ NE
❑ Yes
❑ No
qNA
❑ NE
[:]Yes
[:]No
qNA
❑ NE
❑ Yes
❑ No
[RNA
❑ NE
❑ Yes
ERNo
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
Page I of 3 21412011 Continued

Faciliq Number: % Date of Inspection —7S
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 S� NA [a NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: pc —( P CO - 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 414 36 u
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes MNo ❑ 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 M No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 1p 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): Cvac'V <�Y
13. Soil Type(s): N l K-LW/T , WiY?-- L✓�c�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP []Checklists [:]Design [:]Maps 0 Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes (P No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes P No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [-]Yes PNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 21412011 Continued

EaciU Number: Date of Inspection: - S
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below. T
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes P No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29, At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e_, discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ® No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes y No ❑ NA ❑ NE
❑ Yes rp No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [:]Yes q 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 T[fl No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any otber 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: 110`131 3FOD
Date: 7 ��lq
21412011

OR
(Type of Visit: Q Compliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: 0 Routine O Complaint 0 Follow-up O Referral 0 Emergency 0 Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: ` p Hill Owner Email:
Owner Name: /v .vfOrJ G,ler_re- V:/LrInrl 4 T"one:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title:
Integrator:
Phone:
Certified Operator: Certification Number: l S
Back-up Operator:
Location of Farm:
3S.19l13913( N
Latitude:
r? 35 $G q 3 LAc)
Certification Number:
Longitude:
i
DesignCa rent
Design Current "
Design Current
Swine
CapacityPop',�
Wet Pottltry
CapacetyPop
Cattle
Capaeity Pop.
q
La er
DairyCow
Non -Layer
DairyCalf
{
DairyHeifer
:...
Design �Ct�rent
D Cow
Ourr �D . Pauli ,
Ca ace ''
-Dairy
La ers
-
Beef Stocker
Beef Feeder
Non -La ers p'` y
Pullets
Beef Brood Caw
-
Turke s,.
Other
TurkeyPoults
=
Other
Other
CIUf�I 1
Inh,
Feeder to
EBoars
Discharges and Stream Impacts pEr1li11prp
1. Is any discharge observed from any part of the operation? Q11) V fA
Discharge originated at: ❑ Structure ❑ Application Fl/ 0 QMher:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the Statct� EF N
c. What is the estimated volume that reached waters of the State (gallon�OFFICE
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.Jp - ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ o
❑ Yes No
❑ Yes j(No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412011 Condnrzed

Facili Number: - Date of Inspection:
%'aste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes i�o [DNA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
S 1 Structure 2 Structur Structure 4 Structure 5 Structure 6
Identifier: I L K
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 17'
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes hTo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) /�
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ;?No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ?No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes J?TNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L?'fNo ❑ NA ❑ NE
maintenance or improvement?
1 1. Is there evidence of incorrect land 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 Approved Area
12. Crop Type(s):C
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes _�24o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes✓2-Ko
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes j2T-14o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes EfrNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes EfNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes eNo
❑ 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 O'No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes eNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes PrNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - O Date of Insuection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No
❑ NA ❑ NE
25. Is the facility out of compliance with permit copditions related to sludge? If yes, check
❑ YesPEJ�No
❑ NA ❑ NE
the appropriate box(es) below. _Q!) Lk^-�X aZ OV-1
❑ 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,,EfrNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes No
❑ NA ❑ NE
Other Issues
2& Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes or
❑ 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 P<o
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
TT
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes 4No
❑ 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 �o
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes E<N4o
❑ NA ❑ NE
33, Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes Zo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes :�>No
❑ NA ❑ NE
Comments (refer to gnestion 9): Explain any YES answers and/or any additional recommendations or: any -,other comments:
zz
Use drawings of f:iC H:y.ta better explain situations (use additional pages as;ece nssary). T'
_. _ .. ,.iC*rriirm.V
Baca 10-1-13
�)�P t-ro-+3
7g6�1 713
6aa� ��-a-13
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
o1ra PCNI
611 PC N
j•LI PCMI
61 .sk Pc 03
®,15 PC 03
0" 5 Pd b-3
0,610 ?c wt i , 1.91 PC.0.3
_ Mo ( -C
�a m �7
T
Phone: 7 /F
Date: Q
h /A
2/4/2 1

Type of Visit: 0 Compliance Inspection 0 Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral p Emergency O Other O Denied Access
Date of Visit: I L Arrival Time: r Departure Time: County: Region: 41211D
Farm Name: P� {-� i Gl Frv\ Owner Email:
f
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: VO t,1 ems,. Title:
Onsite Representative:
Certified Operator: u
Back-up Operator:
Phone:
Integrator: —rp/A ►i­✓'"I
Certification Number: O q /1
Certification Number:
Location of Farm: Latitude: Longitude:
Design
Current
Design
Current
Design Current
SwineJJIICapacity
Pap. WetPoultry.
Capacity
Pop.
Fettle Capacity Pop.
Wean to Finish
I 11-ayer
I
airy Cow
Wean to Feeder
Non -La er
I
airy Calf
Feeder to Finish
?Z
ZCXYO �'
Dairy Heifer
.
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
i D . Poul
@a aci
Po
Non -Da'
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify D WQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes W No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes [] No
[—]Yes [:]No
❑ Yes No
❑ Yes No
[P NA ❑ NE
1P NA ❑ NE
® NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Conrinued

Facili ' Number: Date of Ins ection:
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 Eg NA 0 NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �L �CI� 3 FQ
Spillway?:
Designed Freeboard (in): Observed Freeboard (in): 3S cf 35- u g cI! b _r
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 4] No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
Fg No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
10 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
n No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
ce of Wind Drift ❑ Application Outside of Approved Area
❑ Outside of Acceptable Crop Window ❑ EZvac
12. Crop Type(s): a"�
"S
13. Soil Type(s):,��,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
M No
LP
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Q3 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
T
17. Does the facility lack adequate acreage for land application?
❑ Yes
[13 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�q No
❑ NA
❑ NE
Reuuired 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
M 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 �3 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [—]Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes No
❑NA ONE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 . 21412011 Continued

FaciliO Number: - Date of Ins ection: Z$ ►L
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:
25. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Lrtj No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[;g No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
KM 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
5 No
❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[,T No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
V3No
❑ 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 napes as uecessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
V AO
le
Phone: 110- L133-33-CO
Date: 6 L7-95/17-
21;12011

r' Divtston of Water Quality
�`acility Number IE 89�M vision of Soil and Water Conservation
DQ Other Agency
Type of Visit: 0 Compliance Inspection Z5 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: (D Departure Time:
� County: f Region: -y
Farm Name:V-dA-tl Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: ,� N�o� Title:
N
Onsite Representative:
k
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: f SJ
Certification Number:
Longitude:
�:t"' I
eigsig
Cpacity Pop.
Wet Poultry Capacity Pop. C««attleIII Capacity
Pop.
Wean to Finish
Layer Da' Cow
Wean to FeederHiNon-Layer
airy Calf
Feeder to Finish
,3I
Dairy Heifer
rrow to Wean
2Gt�
Z�,p
Design Current D Cow
rrow to Feeder
Dr. P,oultr . '
Ca aei Po Non -Dairy
rrow to Finish
La ers
Beef Stocker
L
lts
Non -Layers
Beef Feeder
ars
Pullets
Beef Brood Cow
Turkeys
ber MAR
TurkeyPoults
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 convevance 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 P No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes � No
❑ Yes 6a No
NA ❑ NE
NA ❑ NE
Ej NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

1''acilih �llumber: - Date of Inspection: �( u
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavv rainfall) less than adequate? ❑ Yes E�jNo ❑ 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: 3-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): )II E B t
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ YesNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) T
6_ Are there structures on -site which are not properly addressed and/or managed through a ❑Yes CIA No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement'? Pa
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 [;I
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 AceiSs_w
le Crop QQW��indow /❑' EvidrtASj,-e),
ofWind Drift ❑ Application
jOutside of Approved Area
12. Crop Type(s): -- IlX�lL �5S a,-Y� , y
13. Soil Type(s):
14. Do the receiving crops differ from those designated inihe CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
[�NNo
❑ NA
❑ NE
❑ Yes
® No
[DNA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑Yes
[5gNo
❑NA
❑NE
❑ Yes
P No
❑ NA
❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
2 1. 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 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility ;'umber: - T jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the. r riit. ❑ Yes ®No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance.
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes M No DNA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes 8 No ❑ NA D NE
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP? ❑ YesrNo
o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yeso ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ 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 paizes as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: i 1r
21412011

t'mS $ - H - z o l 0
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine O Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 7-28-/D Arrival Time. :40 Departure Time: 774. UO p,. County: �"�1,gA . Region: �ieb
Farm Name:/10i9/,/C- �/ 1t!l>/ N'�. / Owner Email:
Owner Name: A4, -1I`z, l ,,z"-e Phone:
Mailing Address:
Physical Address: ,,I
Facility Contact: hd-ual we C:bl- Title: �^111• �fY • Phone No:
Onsite Representative: _ (�o °+ 4 /,f��/Gi04 o` Integrator:
Certified Operator: bD-M r — 1 �!-Y
A �' Operator Certification Number:/ 5el,`7
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =o =]' =µ Longitude: [__]o =
Design Current Design
Swine Capacity Population Wet P1oultry Capacity
Current Design Current
Population Cai#!e Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dai Cow
❑ Wean to Feeder
10Non-Layer
❑ Daja Calf
❑ Daja Heifer
❑ D Cow
ElNon-Dairy
El Beef Stocker
El Beef Co
Number a# Structures:
Feeder to Finish
3 Z
©
Dry Poultry
❑ Layers
❑ Non -Layers
POBrood
❑ Pullets
❑ Turkeys
Other El Turkey Pouets
❑ Other ❑Other
Farrow to Wean
Zna�
�
El Farrow to Feeder
® Farrow to Finish
200
Gilts
J�
Discharges &Stream Impacts
1, Is any discharge observed from any part of the operation?
El Yes
No
❑ NA
❑ NE
Discharge originated at: El Structure ❑Application Field El Other
a. Was the conveyance man-made?
El Yes
ElL.� No
�,,Np►�
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
❑ No
D<
❑ 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
��
[J wA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
11✓0
❑ NA
❑ NE
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State
[I Yes
,❑'
CENo
❑ NA
❑ NE
other than from a discharge?
11/28/04
Continued

Date of Inspection
Facility Number: Sz — (0`7
Waste Collection & Treatment
,�,
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
ElYes
'IV
Lyo❑ NA
[INE
a. If yes, is waste level into the structural freeboard?
ElYes
D-Ko' ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: f' Or
.� G
Spillway?:
Designed Freeboard (in):
��a�� •L
Observed Freeboard (in): �! !�(,/
!1 Z z�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
D< ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
El Yes
,�
0<0 ❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental) threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
ElYes
R o ❑ 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
El Yes
,��
LTNo ❑ NA
❑ NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below.
ElYes
0<0 LE] NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12. Crop type(s)
a
13.
Soil type(s) 102AisisZ .
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Ed< ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
3'TV�a El NA
El NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
2 N'o ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
3<. (❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment'?
❑ Yes
BNo ❑ NA
❑ NE
Comments (refer, to question 9): Explain any YES answer ,a% -.A or.any recommendations or any,0ther comments
J' N
Use drawings of facility to better explain situations (use addrhoaal pages as necessary}
Y
Reviewer/Inspector Name ice% i .ue:Cs"� Phone 9/2
Reviewer/Inspector Signature: e"� Date: - 29 r 20/Q
I2128104 Continued

Facility Number: 7 Date of Inspection
Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 21 o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Eo ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
U o
❑ 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 Inspectionss El Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
a o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ YesB<o
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
NN
[I NA
El NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[E,
L�fi, <o
❑ 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
3 o
[:1 NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
LTNo ❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
C] 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
2 o ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
�
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E No ❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
10 ❑ NA
❑ NE
Additional Commenis.andlor Drawin
r A�
I Z28104

Cor-L t••s j N&4 SZ-f$�
5riw-f if 2 S--c9
3
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �� Z�-Q9 Arrival Time: 9%r�/t-� Departure Time: Z 30 County: �� "`>D� Region: �o
Farm Name: Po rlC C� H- (r Owner Email:
Owner Name: Ale "I /_6 N Cr" e.. Z r41 "► c ' c1 Feed Phone:
Mailing Address:
Physical Address:
Facility Contact: D-045 INI a +'-Lr-C -Title: 0i"' �;i � ' Phone No:
On site Representative: �Bu eC11 /it Integrator: - � Y&'~S
Certified Operator: � Alt,- `&0 At Operator Certification Number: % 8 40 7
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = I ="
Longitude: = o =
Des gn
Current
Design Current
Design
Current
Swine
Capacity Population
Wet Poultry Capacity Population
Cattle Capacity
Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
® Feeder to Finish
3 S
t�
❑ DairyHeifer
® Farrow to Wean
❑ Farrow to Feeder
® Farrow to Finish
❑ Gilts
❑ Boars
2 000
Zoo
�20 Q
D
Dry Poultry
El Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ D Cow
❑ Non -Dairy
El Beef Stocker
El Beef Feeder
❑ Beef Brood Co
Other
❑ Other
❑Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ 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
❑ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: 82 — 6
Date of Inspection 72—q__D9
Waste Collection & Treatment ��,,/�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes 1 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ETNo ❑ NA ❑ NE
Structure Structure 2 Structured Structure 4 Structure 5 Structured
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z Jr $
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 El Yes L'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 ONo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes CTNo ❑ 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 El Yes B No ❑ NA ❑ NE
maintenance or improvement?
Waste Annlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes l TNo ❑ NA ❑ NE
maintenance/improvement? �
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Bl ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 Ibs ❑ 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) dot. 6E, ) . sl-� 1 r�C rJ 5&1 6 c.&.J - w i. - C. —.s
13. Soil type(s) i-Iq_,g . Vfl A
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. is there a lack of properly operating waste application equipment? ❑ Yes
ET'No
❑ NA
❑ NE
N/o
El NA
El NE
,�
No❑
NA
El NE
ETNo
❑ NA
❑ NE
[?go'
El NA
❑NE
Comments (refer to question #): Explain any YES answers andlor any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
w
Reviewer/inspector Name �i.�. R eV s Phone 9I0 • y33.33 04
Reviewer/Inspector Signature: Date:
I ZIM04 Continued

Facility Number: 82 — 67— Date of inspection
ReQuired Records & Documents ,.,�
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes I1No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [15 o ❑ NA ❑ NE
the appropriate box. [ 3 WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
3<
❑ 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
ET -No
ElNA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
E 'No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ErNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
B<o
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
01No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
3 o
❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ffNo
❑ 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
��
C! 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
[go
❑ 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
['to
❑ NA ❑ NE
12178104

t%
1-06-01 iut_
Type of Visit Otompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit (3-6-utine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 112 -I%'j% D Arrival Time: /0 3(o q„� Departure Time: /O," County: �psoN Region: �r�
Farm Name: rOrk_CkaP1�%^i�'r�iti�� Owner Email:
Owner Name:Phone:
Mailing Address:
Physical Address: //
Facility Contact: �4uq /,,�ieMoN d Title: �Ny4� Phone No:
Onsite Representative: ! Ae-A4QNC1 Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = 1 = ,1 Longitude: = o = I 0 "
Design. Current MYER
esigm�Ciirrent Design C►urrent
Swine Capacity Popul x °nr Wet PoultpanWei pu 1� hon� C ale Capacity Population
❑ Wean to Finish ❑ Layer
❑Dai Cow
k`
❑ Wean to Feeder ❑ Non -Layer r ❑ DairyCalf
Feeder to Finish 3Q6C7 a l r .+�. Dairy Heifer
M ! Y it.
❑ Farrow to Wean;IJPoultr � ❑ D Cow
❑ Farrow to Feeder y =r
❑ Non -Dairy
❑ Farrow to Finish ❑ Beef Stocker
❑ Gilts Am
VI ❑ Beef Feeder
>G.
❑ Boars ❑ Beef Brood Co
a
-.
Other �+ �.
❑ Other^ Number of Structures:
❑ Layers
❑ Non -La -Layers
❑ Pullets
❑ Turkeys
❑ Turke Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[ to
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
DINA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
B1A
❑ 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
[J-9A-
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
LTNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[I-IN-6—
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

1 4.
Facility Number: $Z— 6 % J Date of Inspection
Waste Collection & Treatment ��
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ElE Yes ,NNoo El NA ❑ NE
a. If yes, is waste level into the structural freeboard? El Yes l_=l ivo ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: /—aA &_
Spillway?: NO
Designed freeboard (in): 117
Observed Freeboard (in): 7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [3 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) ,/
6. Are there structures on -site which are not properly addressed and/or managed El Yes Ej o ❑ 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? El Yes ISNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
Cli ❑ 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
ElYes
0 NA
e00
❑ NE
maintenance/improvement?
�
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
El Yes
2 o ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) ';RerM (may %Irate S�' Z' (;�ra e',d ('O, S,
13.
Soil type(s) 1116 A lac{ S
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
EKo
❑ NA
❑ NE
I&
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[J o
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
01 o
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
❑-Ko
❑ NA
❑ NE
Reviewer/Inspector Name °�r`c,k. ����(� Phone: 9/0, f 33,3330
Reviewer/Inspector Signature: Date: 12- - 1 9 —2,00 8
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ETNo ❑ 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. E] WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes B o ❑ 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
2'No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ETNo
El NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
&5No❑
NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
B<o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E NNoo
El NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
0 o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
B ko
El NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
2 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?
ElYes
0<
❑ 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
ElLc
,�—,�
>'tvo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
,�.,,��
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
I_5., oo
❑ NA
0 NE
33.
Does facility require a follow-up visit by same agency?
El Yes
9<o
❑ NA
❑ NE
Comments and/or
12128104

L�
j3_riuS_ i 210G 12667
0 Division of Water Quality
Facility Number $z �0 0 Division of Soil and Water Conservation
- - 0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1 %0 -0-0 ] Arrival Time: Departure Time: County: Region:
Farm Name: P—hC" gill6kL-y_&)A/q Owner Email:
Owner Name: 6`,��7'%N_ Phone: _
Mailing Address:
Physical Address:
Facility Contact: Aid Title:y. e�it�9l/ • Phone No:
Onsite Representative: Togi AlI e"./►WWI Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [� o [� g [� Longitude: [= ° = t =
Ld
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ La er
❑ Non -Laver
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
I❑ Turkey Poults
D Other
Dischar es & Stream hnpacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes I No ❑ NA ❑ NE
❑ Yes
[� No
❑ NA
❑ NE
❑ Yes
11 No
❑ NA
[IN E
❑ Yes
F No
❑ NA
❑ NE
❑ Yes
1�No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
72128104 Continued

4
Facility Number: fZ — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
W No
❑ NA ❑ NE
a_ If yes, is waste level into the structural freeboard?
❑ Yes
15a No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[yNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
EXNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[� No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
1
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�PNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
No
ElNA [INE
maintenance/improvement?
11. Is there evidence of incorrect application'? If yes, check the appropriate box below.
❑ Yes
[$No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn,
etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop ❑ Evidence of Wind Drift ❑ Application Outside of Area
(jWindow
12. Crop type(s)—Vulul.L�x-, J Gi to J SL'�-(� �d1
L S
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
V1 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
ICi No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
VNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
IComments (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 K i -L K R e v e lS Phone: C? I0 , :�33, 33 o o
Reviewer/Inspector Signature: Date: Zoo 7
12128104 Continued

Facility Number: $2 — "r Date of Inspection 10 3f^ D7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes W No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E� No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Q9 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Ep No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[P No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑Yes
[4 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[�No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[P No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[ No
❑ NA
❑ NE
if yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
1� No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Revicwerlinspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0 No
❑ NA
❑ NE
12128104

Type of Visit ® Compliance inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: /O: Departure Time: County: ate/ Region: FA0
Farm Name: l' "L �'/ % �� F.'I✓/SLI�r� _ Owner Email:
sr.
Owner Name: AvAt V; 4X41,.A�:., T_ /�ti'!'iwisy _ Phone:/ 910 S'9</ , D Z/ 9
Mailing Address: _Ra 23.-Y 3T2> N*� f7`�+✓ G �✓i �83�
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator: _
Location of Farm:
Title:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o Longitude: 0 0 W
Design Current Design Current Design C*urreut
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
Feeder to Finish
;3-- ot)a
I
❑ Dairy Heifer
El DEY Cow
Dry Poultry: � . �
�'' ' ° ��'"''
❑ La ers El Non -Dairy
El Beef Stocker
El Non-Laers
El Beef Feeder
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
El Pullets
❑ Beef Brood Co
❑ Boars
❑ Turkeys
❑ Turkey Poults
�. •.
Numiier of Structures:
_
w . _._..„.
Other
❑ Other
-tea•-_- ]
❑Other
,.e.m��:';�i.";as.�a_
Discharges & Stream Impacts•
1. Is any discharge observed from any part of the operation?
❑ Yes
[XNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
[MNo
❑ NA
❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
❑ Yes
[3 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
[9No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[M No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
R No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: SZ _ %p 7
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E�dNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes E!PNo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 97 r
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes V No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes P9 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 V?No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
M No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
5?No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
FM No
El NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[gNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) � n�ual�w a� $�r».K �c� Gr�,s �<!/ Ct �• %^'/
13. Soil type(s) j, . A/PA
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Wo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[27No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
0 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
PNo
❑ 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 gecessa`
E.
Reviewer/Inspector Name ,� �� Phone: qua 3300
Reviewer/Inspector Signature: Date: 4P
Page 2 of 3 - 12128104 Continued

Facility Number: $Z — (� Date of Inspection $-Zz-oG
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes eWNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E'No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [?No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [�No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [$No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes PNo ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes [ rNo ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes P No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
;R No
❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
®No
❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
qNo
❑ 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
[ANo
❑ 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
[�j 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
�Nl No
❑ NA ❑ NE
Additional Comments and/or Drawings: �'•'' '
f�
Page 3 of 3 12128104

e
Date of Visit: R-I1-03 Arrival Time: ! I a e e rr4 Departure Time: County: -Sar.P t,rr� Region: )~ ie t)
Farm Name: _ �a *� C � o n . F, vt 1 .c _ Owner Email:
Owner Name: J7 [ rri ..L s Phone: Q I O q O 3 JQ
Mailing Address: 'eO _k99 -1 0 0 Ne,- f -. C rov e A/to iQ E3 j
Physical Address:
Facility Contact: 7) wkk V, Ad6 X.- a -._eC Title:
OnsiteRepresentative: DOL
Certified Operator: ( r it alb
..
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
a Feeder to Finish
8 oo o
o
❑ Farrow to Wean
❑ Farrow to Feeder
© Farrow to Finish
a e o
❑ Gilts
❑ Boars
Other
❑ Other -
Phone No: 110 -6~`ty-'fie /AFL
integrator: �7L PK -
Operator Certification Number: /o
Back-up Certification Number:
Latitude: =e =' = Longitude. =o =' =
Design Current
.Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poulis
❑ Other
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design . Currents
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
t f St Number of - Ell
j
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the %waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ®.No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[9 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
1.2128104 Continued

Facility Number: -- R Date of Inspection I .2-4—
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: !
Spillway?: Ala
Designed Freeboard (in):
Observed Freeboard (in): 3 r
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes allo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[allo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of/Wind Drift ❑ Application Outside
of Area
12. Crop type(s) 1�11►001.u->t4L �t ti Gr.....�e.� ✓�,2r �ir_+. L�
ram �` �.
13. Soil type(s)
t4. 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 acre determination`0 Yes
® No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ONo
❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
[A -No
❑ NA ❑ NE
Comments (refer to question ft Explain -any YES answers and/or anyrecommendationsor,"y other^cnmmenfs.
Use drawings of facility to better explain situations. (use additional pages as necessary):
J� 7rr,eI /Lr t p/ �FQ-r�Ot �Rdst�ti CCiw[��i %�✓ faG*iv /`�L�C� 1' �.bi�Ir�i��
Reviewer/inspector Name �. 3 r_ kj�,�q j,, Phone: Q/i
Reviewer/inspector Signature: Date: '2—��Df
12128104 Continued

i
Facility Number:(pq Date of Inspection - -ot
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAW MP readily available? If yes, check ❑Yes 2 No ❑ NA ❑ NE
the appropirate box. s
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21, Does record keeping need improvement? If yes, check the appropriate bo below. ❑ Yes ® No ❑ NA ❑ NE
El 1d'asiL.9pp�i�- ❑ s ❑ Waste Analysis I ❑ sis ❑ ❑ A
❑ Raiu€a+- ❑ inf. ❑ 9� FQp_Y=—P4- ❑ 1 �n�� n„f t �n s� ❑ s ❑ Weather-C-ode
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit'?
26. Did the tacility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29, Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal`?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector tail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
R No
❑ NA
❑ NE
Yes
[N No
❑ NA
❑ NE
❑ Yes Q.No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑Y"es ®No El NA ❑NE
❑ Yes
[20 No
❑ NA
❑ NE
❑ Yes
L& No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit B Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit e(Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number L Date of Visit: '=0 Time:
NNot erational O Below Threshold
Gfermitted Q Certified 13 Conditionally Certified D Registered Date Last Operated or Above Threshold: ..�.... ---•
Farm Name: or1L C�fl �1i �tA i...� County:
Owner Name:---.....I_....._,7.-.-..�.....rW ;-1I.f..a..w._.e...........A.+.._.._...Phone No: o a
� �0�� NCMailing Address:Gcw4m- Zr,,u' fie.... } ...._.._...W . W
Facility Contact: ........W Title: ---�` R Phone No:
Onsite Representative: Dow N 1 Integrator: -rD m
..- -- - -- - ................................... _ ........ .... ... ___ .
Certified Operator:.._., .Jlv , 1� i ; - , ,•, Operator Certification Number:
Location of Farm:
Utwine ❑ Poultry ❑ Cattle ❑ Norse Latitude • 4 it Longitude • ' it
Disci g Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes [.31No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/rnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes Oko
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Gf4o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I
Identifier: ... ._... ._.... _.
Structure 2 Structure 3
Structure 4 Structure 5
❑ Yes []"No
Structure 6
Freeboard (inches): 3$
12112103 Continued

I
Facility Number: — (, Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑,No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or [,J Yes B No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes [RWo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes �o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes URNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes 2NO
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes f311�o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop hype L oa u 01+4A:1
13. Do the receiving crops differ with those designated in a Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes 131Ro
❑ Yes QNo
❑ Yes dNo
❑ Yes ErNo
❑ Yes ErNo
❑ Yes [�No
❑ Yes ErNo
❑ Yes eNo
❑ Yes Q No
❑ Yes []fio
Cour t (re[gf�to ei. on,f) *Ezpla ai y YF5 aaswers and/nr an_yrecsfmmeadatt_ons or any otlsercommas =_ =
:Use drawn�gs of fat ty to better explain sitaati ( e'aeidttzonal pages as ne aryj [, ,eld COPY [I Final Notes -
-16 n j]5
1
J rr I
4rt �i � rf�lat�
Reviewer/Inspector Name -
Reviewer/Inspector Signature: Date: 6

Facility Number: — Date of inspection 1
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes [•B'No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes O No
23. Does record keeping need improv!.9ent? If yes, check the appropriate box below. ❑ Yes [-To
❑ 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
BNO
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
Q No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
Uallo
(ie/ discharge, freeboard problems, over application)
❑
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[gf4o
28. Does facility require a follow-up visit by same agency?
❑ Yes
014o
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
B No
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
Bf4o
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Q"No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
214o
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
[E'No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
ENo
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit ® Compliance Inspection O Operation Review t) Lagoon Evaluation
Reason for Visit ®Routine Q Complaint O Follow up 0 Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: %7 aZ- 'rime:
Not O erational 0 Below Threshold
® Permitted E Certified 0 Condition/ally Certified [3Registered Date Last Operated or Above Threshold:
Farm Name: �� t/1Y1// — County:
Owner Name: /�� G.�U�s_f9_l.�i.� f�,f �.�G. Phone No:
Mailing Address: i lV4ea,.✓
f
Facility Contact: iHo Title: Phone No:
Onsite Representative: Integrator: l ./
Certified Operator: �- %G i/�,. _ Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ' " Longitude 0 `
L
Swine
Design Current
rnnnrihv Pnnnlatinn
We
❑ an to Feeder
® Feeder to Finish 64Q
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons
ding Ponds I Solid Traps
Design Current Design
Poultry CapacitV Population Cattle Ca acit
❑ Layer ❑ Dairy
❑ Non -La er I 1 10 Non -Dairy
❑ Other
Total Design Capacity C
Total SSLW
rface Drain
No Liquid Waste Management
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State? (If yes, notify DW[�
c. If discharge is observed, what is the estimated flow in gatimin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2_ Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
irav Field Area
❑ Yes 9No
❑ Yes ) No
❑ Yes )Z No
❑ Yes )R No
❑ Yes N'No
❑ Yes eKNo
❑ Yes /[ No
Structure 6
Continued
Number of Lagoons
ding Ponds I Solid Traps
Design Current Design
Poultry CapacitV Population Cattle Ca acit
❑ Layer ❑ Dairy
❑ Non -La er I 1 10 Non -Dairy
❑ Other
Total Design Capacity C
Total SSLW
rface Drain
No Liquid Waste Management
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State? (If yes, notify DW[�
c. If discharge is observed, what is the estimated flow in gatimin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2_ Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
irav Field Area
❑ Yes 9No
❑ Yes ) No
❑ Yes )Z No
❑ Yes )R No
❑ Yes N'No
❑ Yes eKNo
❑ Yes /[ No
Structure 6
Continued

Facility Number: Z— ," ;7 Date of Inspection 0
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Annlication
❑ Yes PdNo
❑ Yes M No
❑ Yes KNo
❑ Yes N No
❑ Yes M No
10. Are there any buffers that need maintenance/improvement? ❑ Yes �"'j No
11. Is there evidence of over application? El Excessive Ponding ElPAN ElHydraulic Overload ❑ Yes ® No
��
12. Crop type 4"r— -fir _X /f J
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes O No
b) Does the facility need a wettable acre determination? ❑ Yes ® No
c) This facility is pended for a wettable acre determination? ❑ Yes No
15.
Does the receiving crop need improvement?
❑ Yes
® No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
,® No
Reauired
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
.® No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
®No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
'You No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
CKNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
RNo
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24. Does facility require a follow-up visit by same agency?
❑ Yes
No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
EYNo
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
Commen {refer to question #): Esplaf m any YES answers and/or any recommendations or any other eomments.
Use drawings of faeiIity to better explain ssiitua�tions. (usee additions! p/ages as necessary): ❑Field Cov�v7 �❑ Final Not%es f py
���%�� �/j`/I/s� n.✓ �A�%r' !-✓ /��irl�f�f�` �y�•J ./��1�/��. %��%iselir� G�I�
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 2 7 �•Z
05103101 Continued

t
Facility Number: —�; Date of Inspection MZ4GZ
Odor Is. _sues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the Flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes f O No
❑ Yes No
❑ Yes No
❑ Yes 5No
❑ Yes ® No
❑ Yes .l No
E9 Yes ❑ No
05103101

Type of Visit •40 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number Z Date of Visit: Z O Time: l=
0 Not Operational 0 Below Threshold
Permitted d Certified 13Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ...
Farm Name: ......!� a .... ��.. ........./............................................. County: ...... ...
Owner Name: ..•evr.L?e'r��! Phone No:.. rT......aZ/. ..........� ._.�
Facility Contact: ....s ........_...... Title: ................................ . ..r/ .. .. .. Phone No:
Mailing Address:.._. i.. .. of;....lill. k !''.. �,Y �,c....,�Y...�r.......ffj�..................... ...W.. .
Onsite Representative: ....,a'......Nrfdlend.....................-...................... Integrator: _1._. ......_� .�.... __ _ -
Certified Operator � (,,t ►,,j .. Operator Certification Number
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ° 49 Longitude • 4
Design ' Current, :-
wrne- Capacity Pnnnl2,6611i
El Wean to Feeder
ff Feeder to Finish
jgpe
Toe)
El Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
20*
-$r
Gilts
Boars
Design Current Desrgrii_ Carr+
Poultry. Cipadty, Population, ° Cattle Ca id .. _Po ... l
❑ Layer1 10 Dairy
❑ Nan -Layer ❑Non -Dairy
❑ Other - - -
TotaT D bl& Capacity
. Tota1�SSLW
Number;oiLagoons 1 ❑ Subsurface Drains Present Lagoon Area 10 Spray Field Area
.
Holduig Ponds /Solid Traps No Liquid Waste Management System x
r-
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes P No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes JR-No
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) ❑ Yes A No
c. if discharge is observed. what is the estimated flow in gaUmin?
d. Dees discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes JUNo
2_ Is there evidence of past discharge from any part of the operation? ❑ Yes AtNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Wo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes �RNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
jg-Identifier-.y..............................................................................................................................
Freeboard (inches):
5/00 Contenaed on back

• Facility Number: -- g5_7 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (i trees evere erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancermprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type As_ zlltll�rc%,9
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checkli is, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20, Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0. •Yi0;a(i0tis;er dgtjcjenc{es -!ire ngte(%dltr* gth'sMslt;- Yoo %idj-treeeiye 00 tiutthOe ;
corresil)66dence: abouti this AMC :::::.:...........:::.......... .
VYes ghl-
❑ Yes f%No
oYes �No
❑ Yes rPTNo
—
❑ Yes J9 No
❑ Yes Z§No
❑ Yes S No
I
❑ Yes 'No
❑ Yes KNo.
❑ Yes t9 No
❑ Yes RNo
❑ Yes XNo
❑ Yes ANo
J
❑ Yes JqNo
❑ Yes Eff No
❑ Yes allo
❑ Yes jkNo
❑ Yes PNo
❑ Yes IN No
❑ Yes ANo
❑ Yes ANo
❑ Yes MNo
Reviewer/Inspector Name
ReviewerAnspector Signature: Date: /ZfQ1 _ _ 5100

Facitity Number: L - 7
Date of Inspection Z d
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
❑ Yes
kNo
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
allo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
ANo
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
PNo
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
nNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
[RNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
XYes
❑ No
I-Additional-Comments'aa or ravings:
5100

® Routine 0 Com laint 0FoIlGw-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Z Date of Inspection
Time of Inspection 1 24 hr. (hh:mm)
E Permitted ® Certified 0 Conditionally Certified [] Registered 10 Not Operational Date Last Operated: ..........................
FarmName: ............�.............. .. ..�... ...��- ...........................-.......-.-...................................... County: ......... .r.1 ................... . -.I-.................. .
Owner Name:.....Phone No: 0) zl y
.......................................................... Facility Contact: ......1 ..................Title: ..... Phone No: ...................................................
BailingAddress: ....... r..... .... 0........................ ..................... I ... I .... -.................. ............................................ I...................... ..........................
Onsit.e Representative:. ���w�4'... zT! ?,P!�!~`�' Integrator: .......... .7.....`.................................................
Certified Operator:,,_,.-- ...... Operator Certification Number:,,,,,,,,,,,,,,,,
Location of Farm: /.
Latitude ' 4 4 Longitude =• ° 6;
❑ Wean to Feeder
Feeder to Finish
3Zp
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Desigq Carrent
`Foci try, Ca, paci Po ula6on Cattle
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non-
❑^Other
Total Design .Capa
- - Total SSE
Number of La Dons `' ❑Subsurface Drains Present ❑Lagoon Area ❑ Spray Field Area
Holdin Pondsa. SolEii Trans' �,' F1 No Liquid Waste Manaeement System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min'!
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes 0 No
❑ Yes No
❑ Yes ® No
❑ Yes
Q No
❑ Yes
® No
❑ Yes
P No
❑ Yes (@ No
Structure 6
Identifier: If
Freeboard(inches): ..........F7r .......................................................................................................................................................... .........
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes P No
seepage, etc.)
3/23/99 Continued on back

d
Facility Number: 8�7 — dC7 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes IR No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? Yes ❑ No
$. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes P(No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
_Waste Application `
10. Are there any buffers that need maintenance/improvement? ❑ Yes XNo
11. Is there evidence of over application? / ❑ Excessive Ponding ❑ PAN ❑ Yes JR No
12. Crop type �i•sr ,-- . sr, 41��,�•J
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes KNo
14, a) Does the facility lack adequate acreage for land application? ❑ Yes NNo
b) Does the facility need a wettable acre determination? ❑ Yes KNo
c) This facility is pended for a wettable acre determination? ❑ Yes N No
15. Does the receiving crop need improvement? ❑ Yes [d No
16. Is there a lack of adequate waste application equipment? ❑ Yes XNo
Reuuired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
"KNo
18-
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
No
(ie/ WUP, checklists, design, maps, etc.)
79
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
No
(ic/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
j No
0; NO •viOgtidiis:or deficiencies mere h ed- dix`ing �his:visit: Yoit will reeeiye �o; i~urther
correspondence. about this visit.
omments (refer to question #)m. Explain any YES answers and/or,any recommendations or any outer,comments -
_ r
lse:.dravrings of facility to better explain`situations useadditional pages as�niecessary) f
wr-
A6
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
3/23/99

i
Facility Number: 8Z — ,� 7 Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Ye 4"
liquid level of lagoon or storage pond with no agitation? / 1
27. Are there any dead animals not dispo'sed of properly within 24 hours? ❑ Yes (4No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes PNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes JR�No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i_e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes V No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? W/00
3/23/99

V e /�
'z.^�rnrt� s aFRo
❑ Division of Soil and Water Conservation ❑ Other Agency
9IDivision of Water Quality
Routine O Complaint Q Follow-up of DWQ inspection O Follow-up of DSWC review O Other �
EofInspection
of Inspection r
Facility Dumber
• j7= 24 hr. (hh:mm)
© Registered # ertifed Applied fo V re it APermitted JE3 Not Opera Date Last Operated:
Farm Name: ........ r C� .... /1 I County:.... ...........5��� ...............................
ber t1 r err 'n; 5� D Zl �}
Owner Name:.Al....... c ......Lr... ----i • .............. .......1............. Phone 'vo• 1..........................................
•....................................... .
Q.
y . .. .........[.11.�..... Title: .................................................
Faciht Contact B Phone No: _ �—
ZViailing Address:
�/ �- 7...........
..
Onsite Representative: ....�.v.`.................. Inte};rator:...............1.1..�..�... ..... .......
Certified Operator; .......... .......K............... -.......... Operator Certification Number:.................
Location of Farm:
Latitude �' �� Ors Longitude �• �' 0"
G ;Design
4 Current o Design Current m Design Current
�Capac- Population Poultry F Capacity Population Cattle Capacity ,Populatrorn �.
❑ Wean to Feeder
❑ Layer ❑ Dairy wi
Feeder to Finish
❑Non -Layer fo Non-Dai ry
Farrow to Wean.
{ . k
arrow to Feeder
❑ Other 3" �-
Farrow to Finish
Total Design Capacity. '
i' Gilts
❑Boars
" n . Total SSLW
Nuin6er of Lagoaits / Hald Ponds
❑ Subsurface Drains Present
❑ Lagoon Area ❑ Spray Field Area
❑ No Liquid Waste Management System
.p�
General
1. Are there any buffers that need maintenance/improvement? ❑ Ye ,No
2. Is any discharge observed from any part of the operation? Cl Yes
�AqNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. if discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
No
4. Were there any adverse impacts to the waters of the State other than from a discharge'?
❑ Yes
NNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
)No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
7/25/97

S
Facility Number —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoonsjjolding Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I
Identifier:
Freeboard (ft): ........... ...7..............
Structure 2 Structure 3 Structure 4
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenancelimprovement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
❑ Yes No
❑ Yes AK�No
Structure 5 Structure 6
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering w rs of the State, notify DWQ)
15. Crop type. / .. P
lw?........ ........
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
2I. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
No vialations.or'deficiencies.were;iiated;during this:visi& You:will i-eceive-no'.fdrtlier',
: c6rr6p4nd &e. about: this'. Visit.-
Tb-Z.-Ol
ied-f
a0 D 0` r eC o , , S r SPI'c -7
❑ Yes No
❑ Yes No
❑ Yes gNo
❑ Yes gNo
❑ Yes gNo
❑ Yes No
❑ Yes No
❑ Yes `PIX No
❑ Yes .' \ o
❑ Yes XNo
❑ Yes o
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes XNo
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: 1111'6� r /L Date: z - 3Q

.❑ DSWC Animal Feedlot Operation Review .
x =® DWQ Animal Feedlot Operation Site Inspection z
R
0 Routine O Complaint O Follo►%-up of DIVO inspection O Follow-up of DSWC review O Other
Facility Number 1
13 Registered ® Certified © Applied for Permit © Permitted
Farm Name: ....................t..at:. ...... rtzui1 .kv
Date of Inspection
Time of Inspection L.LZeQO 24 hr. (hh:turn)
0 Not Operational Date Last Operated:
..........................
County:................ �......---..................
.: .............
Oumer Name .-•---------...c�.....M......Favi-As.......................... ......
Facility Contact: ...... .:.G�.......N.l"�!.rrtr!1 ..................... Tiitle:..... ..................
Mailing Address:......��....J�?.,sac.....�.��.....................
Onsite Representative:...-R-1 �...5...... ................ .
Certified Operator.......... tirR....... We ,!!! —VA ......................
Location of Farm:
Phone No: ...... (.!(.- .......
PhoneNo: ....... . ........................................
.� � v. .....�.r .Nw .y.._ .r.................... Z5...3 .x.....
Integrator: ........ -.rfD)141 ..............................................................
Operator Certification 'umber;
a
"o
Latitude • 1 .1 Longitude • �•
Design Current
Swine Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
® Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Laver ❑ Dairy
❑ Non -Layer 10 Non-Dain
❑Other
Total Design Capacity'
Total SSLIV
Number of Lagoons / Holding Ponds L .J ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
❑ No Liquid %N,aste .NIana};cment Svslem
General
1. Are there any buffers that need maintenance/improvement ❑ Yes [in No
2. Is any discharge observed from any part of (lie operation'' ❑ Yes ® No
Discharge 062111att.I at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed. was the conveyance man-made'. ❑ Yes © No
b. If di.schar•,c: is observed, dill it reach Surface Water? ([1 +'cy. notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated flow in -,:t1/n1in?
i1. I7� es cltscharge b�'pass a lag JOn vst�In'? i It �'es. notlly D��'Q)
❑ Yes
0 No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
® No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
5. Does any part of the waste management system (other than lagoons/holding, ponds) require
❑ Yes
91 No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design'
❑ Yes
® No
7. Did the facility fail to have a certified operator in responsible char,,e'!
❑ Yes
ff] No
7/25/97 Continued on back

Facility Number: a
8. Are there lagoons or storage ponds on site which need to be properly closed" ❑ Yes JKNo
Structures (Lagoons Iloldin Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 8 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
. .2
Identifieru. ........................................................................................................................................
v �
Freeboard (ft):.......... ..........................25 .f............
10. Is seepage observed from any of the structures.'
❑ Yes
® No
IL Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
No
T 12. Do any of the structures need maintenance/improvement?
® Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
M No
Waste Application
14. Is there physical evidence of over application?
❑ Yes /N No
(if in excess of WNW, or runoff entering waters of the State, notify DWQ)
13K.t d! uu dA ....r-.. y ..........0 Cc! 4 15. Crop type ....---•-................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWNlP)?
❑ Yes
[& No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
10 No
18. Does the receiving crop need improvement? ❑ Yes N No
19. Is there a lack of available waste application equipment? ❑ Yes &N'o
20. Does facility require a follow-up visit by same agency? ❑ Yes P No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -.site representative? ❑ Yes IN'o
22. Does record keeping need improvement'? ❑ Yes No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes No
24. Were any additional problems noted which cause noncompliance of the Certified AW�1P? ❑ Yes] No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes ❑ No
® No -violations or deficiencies were noted during this visit..You ��°ill receive 'no further
correspondence about this visit: .
Commeiits (refer to question #): Explain any YES answers and/or any reconinlendations or any other.comments.
Use+drawings.of facility to better explain situations. (use additional pages as necessary):
Ac{1 Ic�ks ass�c�� w�' +tx- ��•;s1,U 3�s�R-.,,. �t -c-��. rz ¢.#r�� `
��� o.''t' �(� L a.�orcY• {- � ..e . cz..,•a.�•en -51 u �� �So�a'� , �;`cct,t �.e�.�
7125/97
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:

'-.v-^••i�`__�r'-r,r --:err �R �. .. _ x ...-_ nas�:�+1:!r.�-+yw,+.n�vw7ir•]._!:--�C'S>h�e�tiP•.'''"`4�'`6Y�:.^++`^.yL:•....,...•".�,.,s•?.n... ;��w; :•i _ .-_ ..�
$ w
❑ DSWC Animal Feedlot Operation Review 4 W`'
DWQ Animal Feedlot Operation Site Inspectional m 3w
O Routine O Complaint O Follow-up of D«'O inspection O Follow-up of I)SWC: review O Other
Date of IrLspection '7 3
Facility Number �?� (Q�
47
Time of Inspection I /,q00 124 hr. (hh:tmm)
©Registered ®Certified 13 Applied for Permit 0 Perntitted 113 Not Operational Date Last Operated:
Farm Name: r C t. v I r �n r'. County: 4N aK ............
a...........................�I.....� !..5...... ................ ........:................................„....................
Owner Name: ........ „....1. ....„ r> hl.{.:^........ .................•. ............... Phone No:......�Y"0 ... 9— „......... .......
Facility Contact: 0s.: .5 Ni c�>~ ..... Title: ..••... Phone No: „
Mailing Address: „... :... .............----. E•we �� 2" l.................. „......
Onsite Rep resentatitie:.-_ �.`:.��. c::.�un �r !y .....__
.....).�?....................�---.---•--.._..................._._..---.--....... 1 ntegratrtr:.............................--•-•---•..............._._.._....._.........
Certified Operator;..........A, ...... ..�o++
d......................................................... Operator Certification Number:....... .........
Location of Farm:
0
"o
Latitude • 1 46 Longitude • & 44
Design " Current Design Current Design ;;Current
Swine-'. Capacity Population Poultry Capacity Population. Cattle Capacity .Populatiide":,z.
❑ Wean to Feeder ❑ Layer ❑ Dairy
ff Feeder to Finish JE1 Non -Layer I0 Non -Dairy
❑ Farrow to Wean F-
El Farrow to Feeder t;vo 3 Ze,o ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons / Holding Ponds JE1 Subsurface Drains Present 119 Lagoon Area ❑ Spray Field Area "
❑ No Liquid Waste Management S}'stem
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge orininated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, w&,; the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (if yes. notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
I N there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable Setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7125/67
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes
® No
❑ Yes
[Z) No
❑ Yes
m No
❑ Yes
® No
❑ Yes 91 No
❑ Yes ® No
Continued on back

.. ,4r .--•T_�---..1- .- •t; ,• r,.i�:.-s?!41:.1::Y.ia�h..�i.�ii�rrr''MYf f„ '.a."; , �:w*= . ,. -. .i. "., r-r•ai •� '-=:.J!c : ,. ..
Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes No
Structures (LagoonsHoldingr Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes In No
Structure I Structure ? Structure 3 Structure 4 Structure 5
Structure 6
Identifier: t .......... S .........._.. -•---..............._......_............_.......................... ............. —...... ...........
...................................
Freeboard(ft):.. �........................ ..5. w..... _.... �. — — - ...._.................. ........... _ .... ......
.._ _.. ........-
....
10. Is seepage observed from any of the structures"--
❑ Yes
No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
No
12, Do any of the structures need maintenancelimprovement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
,fixr
1J No
Waste Application
-14. Is there physical evidence of over application?
❑ Yes /IffNo
(If in excess of WMP, or runoff entering waters of the S te, notify DWQ)
((� r�! ctiF.— 4 LDS c• C
15- Crop type ...... _...W� ..--.F........._.. ``' .......... ....._........_...... ..... ...I ...... ...........................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
E�No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
dNo
18. Does the receiving crop need improvement?
❑ Yes
b No
19. Is there a lack of available waste application equipment?
❑ Yes
IffNo
20. Does facility require a follow-up visit by same agency?
❑ Yes
�No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
M No
22. Does record keeping need improvement?
❑ Yes
® No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
EA No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
1A No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
❑ No
[] No .violations' or deficiencies were'n6ted during this visit. You.will receive no ftirther
correspondence about this.visit:
Coil ei its"(refer to question #)::Explain" any, YES answers and/or any recommendat
Use ;drHW,1ngs of facility to better explain situations.'(use.additional pages as necessar;
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7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature:
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Date: