820089_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qua!

//,--Z.. -/ S�
IType of Visit: O Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: 0 --routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: I Departure Time: County:, Region:
Farm Name: GJ(JC�.r�s �. Owner Email:
OwnerName: �i,^;.5 ��i,-.� l/�vt /��y�p/~� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: X50" -rI Integrator:
Certified Operator: 1_ r'i /� f7 , ice Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
SvviiEe
Wean to Finish
Wean to Feeder
Design Current
Capacity Fop.
Wet Poultry
Layer
11 Ina:.LaLer
Design
Capacity
I
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Feeder to Finish
D . Poul
Design
Ca aci
Current
P,o
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
her
'• iMa'�e+ih:.""Y,rwhaSa�A±^
.. �—.-:-:�.s��.i�i�iY10 11Y:ii-'�... iiissG:«T.�'¢ie.YG.'bewf
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 ED No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
[:]Yes ❑No ❑ NA ❑ NE
[-]Yes ❑N/o
❑ Yes Gr(.)
❑ Yes �No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 2/412015 Continued

_1
Facili Number: - Date of Inspection: G `-
[:]Yes
[] No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
EDINo
❑ NA
❑ NE
. 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[:]Yes
io
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: 1;12
Spillway?:
Designed Freeboard (in): / g
Observed Freeboard (in): 3 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Q-IQo
❑ 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
Q No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
F_ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
rj­No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [] No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): tm-99mia
13. Soil Type(s): /Y/1
14. Do the receivingcrdiffer from those designated in the CAWMP? ❑ Yes 0' -No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Q No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [D 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
EDINo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[j NNoo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
0 Yes
[J`No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Ej No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ErNo ❑ NA [] NE
Page 2 of 3 2/4/2015 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [3 o ❑ NA ❑ NE
` 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E] --Ko ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[]'{o
❑ NA
❑ NE
❑ Yes
Q-T�o
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes [TNo ❑ NA ❑ NE
❑ Yes !o ❑ NA ❑ NE
❑ Yes �lo ❑ NA ❑ NE
❑ Yes [3-<o
❑ Yes Q o
❑ Yes [I] No
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature: Date: —G sa
Page 3 of 3 2/4/2015

(Type of Visit: Q'Com ' nee Inspection V Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: &Routine O Complaint Q Follow-up O Referral O Emereenev O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: �Ci --f>---Region:
Farm Name: Owner Email: —✓]�
Owner Name: D ---Phone:
Mailing Address:
Physical Address:
Facility Contact: ��!`/'©/'�� Title: �sG, _ Phone:
Onsite Representative: —_� _ -- - Integrator:
v
Certified Operator: *j(�' or ./' Certification Number: t'f3L�>
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
- -
---
Design Furrent
❑ NA
Design
Carrent
Design Current
Swine
Capacity P.
Wet Poul�ry
Capacity
Pop.
Cattle Capacity Pop.
can to Finish
La er
Dairy Cow
can to Feeder
Non -La er
Dairy Calf
Feeder to Finish
"''`
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , P,ottl
Ca ac'
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Soars
Pullets
Beef Brood Cow
F
Turken
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a- Was the conveyance man-made?
b- Did the discharge reach waters ofthe State? (If yes, notify DWR)
c- What is the estimated volume that reached waters of the State (gallons)?
❑ Yes JR No ❑ NA ❑ NF
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
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
[:]Yes allo
❑ Yes El -No
E]NA ❑ NE
❑ NA ❑ NE
❑ NA [] NE
Page I of 3 21412015 Continued

. Facili Number: jDate of Inspection:
❑ Yes
KLNo -
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
E5 -No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E4 -No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier: �^
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Jallo
❑ NA
Spillway?:
Required Records & Documents
Designed Freeboard (in):� 0 -
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
0 No
❑ NA
Observed Freeboard (in):
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
)ZLNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
❑ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
J�J--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
f�3_No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
RLNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN 0 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): Z&VZ,moi✓
13. Soil Type(s): / --
14. Do the receiving crops differ from those designated in the CAMP?
❑ Yes
KLNo -
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E5 -No
❑ NA
❑ NE
16. Did the facility fail to secure andlor operate per the irrigation design or wettable
❑ Yes
JZ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
25 -No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Jallo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
0 No
❑ NA
0 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 XNo ❑ 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 Wo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes M No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes -0 No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes §allo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
J&No
and report mortality rates that were higher than normal?
29. At the time ofthe inspection did the facility pose an odor or air quality concern?
❑ Yes
];�No
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
2�No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
ONo
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32: Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E0,No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
F%7 -No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
f i+10
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone:�'3C�7�7��
Date:�
21417015

ivi`sion of Water Resources
Facility Number - ® O Division of Soil and Water Conservation
Q Other Agency i
Type of Visit G-Co—mpliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: E outine 0 Complaint 0 Follow-up O Referral 0 Emergency 0 Other Q Denied Access
Date of Visit: Arrival Time: /D.'�p Departure Time: 02 ;3 _D County: fa Region: V
Farm Name: 42: � t�a Ir -14 �,� _ Owner Email:
Owner Name: art Phone:
Mailing Address:
Physical Address:
Facility Contact: ��rYYrf /?%vim Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
,,�
Integrator:
Certification Number: 5 '? 133
Certification Number:
Longitude:
Design Or en
in
Milli,Design
i
❑ NA
Current
Design Current
Swine Capacaty Pop.
Wet Poultry
Capacity
Pop.
Castle Capacity Pop.
Wean to Finish
er
Dai Cow
Wean to Feeder
ELa
Non -La er
Dai Calf
Feeder to Finish eta
Design
Current
Dai Heifer
D Cow
Farrow to Wean
Farrow to Feeder
D . P,oult ..
Ca acs
Po
Non -Da'
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Tarke s
Other 1262'
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)?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
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
❑ Yes 2, No
❑ Yes 54 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

FacaiNumber: - Date of Inspection: .1-30 —/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [DNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[2.No
❑ NA
Spillway?:
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Pn No
❑ NA
Designed Freeboard (in): Gr j
acres determination?
Observed Freeboard (in): .3 J/
17. Does the facility lack adequate acreage for land application?
❑ Yes
V1 No
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
Required Records & Documents
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
jallo
❑ NA
❑ NE
waste management or closure plan?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
®-No
❑ NA
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
[aNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
RNo
❑ 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
CaNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
NINo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ®-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �e'/J►t 0 v �
13. Soil Type(s): I,Ut rrt✓� / /f'lctr
14. Do the receiving cropYdiffer from those designated in the CAWMP?
❑ Yes
� No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[2.No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Pn No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
V1 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EE�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
j. 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 R] 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 SO No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes n No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 2/4/2014 Continued

Facili Number: - - Date of Ins ection: ) /6
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 2jNo ❑ NA ❑ NE
1
" 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes
No
[] NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
13,No
❑ NA
❑ NE
❑ Yes Jallo ❑ NA ❑ NE
[:]Yes Jallo ❑ NA ❑ NE
❑ Yes [gNo ❑ NA ❑ NE
❑ Yes JgNo
❑ Yes ENo
❑ Yes _, No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone:
Date: y-- 3.1) '2d/g
2/4/2014

W
i
!f 19 -/s -
Type of Visit: EMozoutine
nee Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:%�� �+� Arrival Time: r Departure Time: 3 D County: Region:
cY
Farm Name: ly,, G Al61,s ,rrt [ Owner Email:
nnf�l
Owner Name: C �e kle— r te- �� /8� Phone:
Mailing Address:
Physical Address:
Facility Contact: [}/ rYr / j eYTitle: f G,
Onsite Representative: �� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
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?
[D Yes MNo ❑ NA E] NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[] Yes ❑ No
[] Yes No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 214/2014 Continued
Design Current
t Design
Current
Design Current
Swine)
Capacity Pop.
Wet Poulit, y'Cap
city
Pop.
tattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
eeder to Finish
Dairy Heifer
Farrow to Wean
` . Design£
CurrentDry
Cow
Farrow to Feeder
Dry P,oWtr -
;,Ca aei
Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
a
Pullets
Beef Brood Cow
� ;t','
Turkeys
er
P=p
a- , .Turke
Poults
r
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?
[D Yes MNo ❑ NA E] NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[] Yes ❑ No
[] Yes No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 214/2014 Continued

a
Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes D3 -No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): L -
Observed Freeboard (in): 3�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �o ❑ 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?
❑ Yes
LS.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
EkNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[S No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
9. Does any part of the waste management system other than the waste structures require
[:]Yes
CANo
❑ NA
❑ NE
maintenance or improvement?
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'?
[:]Yes
Waste Application
❑ NA
❑ NE
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® 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): 21-r " ! - A U r _ser ' j — -
13. Soil Type(s): /11, ' r #fu•�U��c
14. Do the receiving crops direr from those designated in the CAWMP?
❑Yes
�,No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
LS.No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[allo
❑ NA
❑ NE
acres determination?
❑Other:
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
0 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
MNo
E] 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
�ZNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'?
[:]Yes
CE�.No
❑ NA
❑ NE
Page 2 of 3
214/2014 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0 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:
25. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes (a. No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fait 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 3of3
❑ Yes E No ❑ NA ❑ NE
❑ Yes Ma No 0 NA ❑ NE
[:]Yes 03 -No ❑ NA ❑ NE
❑ Yes LE�No ❑ NA ❑ NE
❑ Yes [KNo
❑ Yes C• No
❑ Yes [23 -No
❑ NA ❑ NE
❑NA E] NE
❑ NA ❑ NE
Phone: 91, 9 3:3 ;0
Date:
214/2014

Type of Visit: ,EI -Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: ro tcoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: jj� Arrival Time: 't;:50 1 Departure Time: County: Region:
Farm Name: C!v ds G Owner Email: �=
Owner Name: l_k`; 1 3t"- Phone:
Mailing Address:
Physical Address:
Facility Contact: (5 le -i -e mh" z Title:
Onsite Representative:
Certified Operator: p �r
Back-up Operator:
Phone:
Integrator:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [&No ❑ NA ❑ NE
❑ Yes
y;DesignCurrent�
Swine
Capacity Pop.
..:
Wet Poultry
Desig�Cuirrent
Capacity Pop:
Design Current
Cattle Capacity Pop.
❑ NA
Wean to Finish
La er,
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
r: , ....
Dai Heifer
Cow
Non -Dairy
Farrow to Wean Design Current
Farrow to Feeder D . P.oult , C aci Pa
Farrow to Finish
La ers
Beef Stocker
Beef Feeder
Gilts
Non -La ers
Boars
Pullets
Beef Brood Cow
_ Turkeys
Turkey Poults
Other
10ther
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [&No ❑ NA ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[-]Yes ❑ No
[:]Yes. No
[:]Yes No
[DNA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 2/4/2011 Continued

- Facility Number: - Ds ection:
/
RLNo
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
CR No
❑ NA
❑ NE
'. 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
R No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[]No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
Spillway?:
Required Records & Documents
Designed Freeboard (in):
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q No
❑ NA
Observed Freeboard (in):_
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[Z No
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
� No
❑ NA
E] 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
[S No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[Z-No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
CZ No
❑ NA
❑ NE
maintenance or improvement`?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload p Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): l wmm; /e.� eor
13. Soil Type(s): f{f�,,'An,
14. Do the receiving crops d&er from those designated in the CAWMP?
❑ Yes
RLNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
CR No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
R] No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
jK 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
Q No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[Z No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [�j No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes ® No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: - I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C4No ❑ NA ❑ NE
t
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check C] Yes [Z No D NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes [jq No ❑ NA [j NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes � No E:] 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?
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)
3 L 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 reviewlinspection 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 Ea No ❑NA ❑NE
❑ Yes Z No ❑ NA ❑ NE
❑ Yes UL No ❑ NA ❑ NE
❑ Yes �5 No
❑ Yes 54 No
[—]Yes O_No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: gyp :g33.3ac'
Date: t7waL)' 7~( -
2/4/2011

t
Type of Visit: O'Compliance Inspection U Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: routine O Complaint O Follow-up O Referral O Emergency Q Other Q Denied Access
Date of Visit: Arrival Time:Q ;o D Departure Time: County- Region:
Farm Name: fLf 6ys ,. c , Owner Email:
Owner Name: l�!] Y ; {T��t,—� „� %V a-yLD/" Phone:
Mailing Address:
Physical Address:
Facility Contact: rter rr-/ /%%z)d f � Title: Phone:
Onsite Representative: S��`
Certified Operator: t"!.51 ;e 1'j
Bach -up Operator:
Location of Farm:
Latitude:
Integrator: '71°e1_S7�
10,
Certification Number:
Certification Number:
Longitude:
j=r,ro
Swine
Wean to Finish
Desi gn�Current
teapac� Pomp ,.
p DestgnCurrent' x Design Current
Wet Poultry CaP �ty�Pop. Fettle Capacity Pap.
La er Da' Cow
Wean to Feeder
Non -Layer
Da' Calf
Feeder to Finish
9
k ..
Da' Heifer
Farrow to Wean
esign Current __
FD
D Cow
Farrow to Feeder
Dr. P,ouIt .
a aci , _ P,o ..
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other`
f
Turkey Poults
Other
Lj2ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes &No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ONE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [-]Yes ❑No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes Qq No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [—]Yes [ o ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

FaciliNumber: - Ds ection:
❑ Yes
[g No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
f3 No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[]Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
E] NA
Identifier:
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[3 No
❑ NA
Spillway?:
Required Records _& Documents
Designed Freeboard (in): �� f 9 -
19. Did the facility fail to have the Certificate of Coverage & Permit readily available`?
❑ Yes
RA No
E] NA
Observed Freeboard (in): __30
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
RZNo
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Cg 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
M 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
PS No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[E,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
Eg No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[gNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes L4No ❑ 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): Zff r/n A L
13. Soil Type(s): l,(,j,R,�r�,._� /jJ1�,- !i
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[g No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
f3 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
0 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
� No
E] NA
[:]NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[3 No
❑ NA
❑ NE
Required Records _& Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available`?
❑ Yes
RA No
E] NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
RZNo
❑ 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 N 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 q 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
E] NA ❑NE
Page 2 of 3 2/4/2011 Condnued

Facili Number: - Date of Inspection: 3
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 r�jNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
.® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
® No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32, Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[R 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 necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 111-3-- j3 ai!
Date: /
2/4/2011

- ivisian of Wat r Quality
Facility Number ®- ® O Divisionof Soil and Water Conservation
0 Other Agency
111111111 —
type of Visit: ompliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit:outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: '7 -- Arrival Time: = d0 Departure Time: /'j v County: _ fir-_
Farm Name: Lwfi Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: ��fr-y/ �j%�(Jp/� Title: `j Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Region: &�
Integrator:/t`,5a- fz
Certification Number: ? 9-/ �
Certification Number:
Longitude:
•�
'71r#
Design Current
SMV" ik �m'xf'3i
'x`
gn Current
:. Design Current = DesiHe
Swiney _.
Capacity< Pap.
Wet Poultry
Capacity Pop.
Cattle Capacity Pap.
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
Wean to Finish
b. Did the discharge reach waters of the State? (If yes,.notify DWQ)
Layer
I
Dairy Cow
Wean to FeederNon-La
c. What is the estimated volume that reached waters of the State (gallons)?
er
I
Dairy Calf
Feeder to Finish
[xsj
`"='
❑ No
Dairy Heifer
Farrow to Wean
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Design Current
Dry Cow
Farrow to Feeder
3. Were there any observable adverse impacts or potential adverse impacts to the waters
D ' jP�ault '
Ca aci. I!o P.
Non -Dairy
Farrow to Finish
of the State other than from a discharge?
Layers
Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
Boars
Beef Brood Cow
Turkeys
Other
Turkey Poults
11 Other
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
®.No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes,.notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[] Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[KNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
CK No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

Facili Number: E1_77_Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure�2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: �JyjaXJC
Spillway?:
Designed Freeboard (in): g ��
Observed Freeboard (in): q_3 q, j
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not property addressed and/or managed through a
❑ Yes
[gNo
❑ 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
[S 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 [a No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): gev x �6J PI,cryr.r-off
13. Soil Type(s): Gud1/� �►^- /yl�r�dyit
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes S. No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [� No ❑ NA [:]NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of property operating waste application equipment?
[:]Yes ® No ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes � No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements E] Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [Z No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes allo
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? []Yes �allo
[DNA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/412011 Continued

Facili Number: 8' - Date of Ins ection. %
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E—A
No
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ZNo
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 '123 No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes � No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
C] NA E] NE
❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ELNo ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
r No
❑ Yes
071 No
❑ Yes
[!I No
❑ NA ❑ NE
❑NA E] NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other commeats.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2011

Type of Visit: gKompance inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: OrRoutine O Complaint 0 Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: �/ Arrival Time: Departure Time: ' ,' p County5� Region:
Farm Name: Owner Email:
Owner Name: �P / /� �.�— Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:Phone:
Onsite Representative: �� y/�z�rz_ Integrator: a4d._ s/ _
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
De
#� sign Current'
,Design
Current :-^
Design Current
Cut-kE
.•,Capacity Pop.
y.
Wet Poultry aCapacity
i.
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Layer
Dai Calf
eeder to Finish —
Dai Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D . Poul ,E :,Galati
Po _._
Non -Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other _ _
Turkey Poults
,
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge'?
❑ Yes &No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
[:]Yes j. No
❑ Yes ®No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 2/4/2011 Continued

Facili Number: - Date of Inspection:
J� No
❑ NA
❑ NE
❑ Yes
Waste Collection & Treatment
[DNA
❑ NE
❑ Yes
P No
t 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
,® No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 7�
5. Are there any immediate threats totheintegrity of any of the structures observed?
❑ Yes
[a 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
[34 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
❑ Yes7❑
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
O -No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [ANo ❑ 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): -br—
13. Soil Type(s):
14. Do the receiving crops i ffer from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
J� No
❑ NA
❑ NE
❑ Yes
0 No
[DNA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes 54 No ❑ NA ❑ NE
❑ Yes CR No [DNA ❑ NE
❑ Yes Mn No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑WUP ❑Checklists [—]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E(No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes El No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA []NE
Page 2 of 3 1./4/2011 Continued

Faciti Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes � No ❑ NA ❑ NE
1 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [-]Yes a No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [:]Yes 0 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 p Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
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 q No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes [� No ❑ NA ❑ NE
❑ Yes ,Q No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes No
[:]Yes No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Phone:
Date:
2/4/2011

Type of Visit UCoompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit e7 Koutine 0 Complaint O Follow up 0 Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: : D O 1 County: 8
Farm Name:n� Owner Email:
nwnPr Nnmr• ('Tz" A td -e_- Phnni-
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
JF
Onsite Representative: /nflnIntegrator:
Certified Operator: /9rlt� Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Region: Jr__�
Location of Farm: Latitude: =0
=1
=11 Longitude: =0=4
°=4 = «
Desigrj G•urreat
Design Current
Design Current
❑ NE
C«opacity Population
FE!
Wet Poultry Capacity Populatio>a
Cattle Capacity Population
❑ NE
an to Finish
❑ La er
❑ NA
❑ NE
❑ Dai Cow
ER No
❑ an to Feeder
❑ Non -Layer
❑ Yes
® No
❑ Dai Calf
&kFeeder to Finish
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
Farrow to Feeder
-
❑ La ers
❑ Non -Dairy
❑ Farrow to Finish
❑ Non -La ers
❑ Beef Stocker
❑ Gilts
❑ Pullets
❑Beef Feeder
❑ Boars
❑ Beef Brood Cow
❑ Turke s
Other
❑ Other
11 Turkex Poultsi
❑ Other
Number of Structures:ECI
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 15No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
ER No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
Page 1 of 3 12/28/04 Continued

Facility Number: — Date of Inspection%
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E@ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 19! / �}
Observed Freeboard (in): 3S 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
QNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ NE
15. Does the receiving crop and/or land application site need improvement?
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
® No
❑ NA ❑ NE
through a waste management or closure plan?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
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
allo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
C,No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ Yes
RNo
9. Does any part of the waste management system other than the waste structures require ❑ Yes
XNo
❑ 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?
H. 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 I O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) X.—t"
13. Soil type(s)
V '
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[gNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ERNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
a No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ 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):
IReviewer/Inspector Name I i Phone: I
Reviewer/Inspector Signature: Date:
Page 2 of 3 12/28/04 Continued

Facility Number: 8 — Date of Inspection
ti Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Eg No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes N No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo ❑ 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 JjNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Lallo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Q?JVo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
WNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
KNo
❑ 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
R No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
j5ZNo
❑ 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
Z 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
allo
❑ 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
L,No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
O No
❑ NA
❑ NE
Adiiitional Comments autllor D�rawtn s•
Page 3 of 3 12128/04
Page 3 of 3 12128/04

Type of Visit Q�mpliance Inspection Q Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: _ 62m= � Q }'L Phone:
Mailing Address:
Physical Address:
Facility Contact: �+✓ r:YL3-e; /.Gr�3s�h Title: Phone No:
a�—
Onsite Representative:Integrator:S�—�
Certified Operator: d�.1 x�- Operator Certification Number: /Zw 9t
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =0 =i =it Longitude: =0=&
o=& ❑
is
Design Curren#
❑ No
Design Current
Design Current
Swine Capacity Population
Wet PouEtry
Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dai Calf
eeder to Finish
❑ No
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ La ers
❑ Non -Dairy
❑ Beef Stocker
❑ Farrow to Finish
❑ Gilts
❑ Non -La ers
❑ Pullets
❑ Beef Feeder
❑ Beef Brood Cowl
❑ Boars
❑ Turke s
Other
❑ Turkey Poults
❑ Other I
Number of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b_ Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes jig -No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes [ LNo
❑ Yes PLNo
12/28/04
❑ NA ❑ NE
❑ NA ❑ NE
Continued

Facility Number: — Date of Inspection
i�SNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination; ❑ Yes
Waste Collection & Treatment
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
ANo
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
N�No
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Stricture l Stnicture 2 Structure 3 Structure 4
Structure
Structure G
Identifier:
Spillway?:
Designed Freeboard (in): LJ-9'
Observed Freeboard (in): -3(o _ n !�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2ZNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
9No
❑ 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
KNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
9No
❑ 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
9No
❑ NA
❑ NE
maintenance or improvement?
Waste Applicalion
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
®.No
❑ NA
❑ NE
maintenancelimprovement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes ®.No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drifl [:]Application Outside of Area
12. Crop type(s) _r-,� yta,..df at / igv�-✓r.-�
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes KNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
i�SNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination; ❑ Yes
,N No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
ANo
❑ 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 Phone: Z%Q�3��`'f�G'G'
Reviewer/Inspector Signature: Date:
12/28/04 Continued

Facility Number: — Date of inspection '�©
+ Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ yes BNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ffNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo ❑ 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
MNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
15No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
SNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
gNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[2�No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
&No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ELNo
[INA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
9 N
❑ 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
Eq 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
EgNo
❑ 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
JRJNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
JgNo
❑ NA
❑ NE
_honal Comments andfor Drawings:
H,
12128/04

E
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region: r ^ l/
Farm Name: 1-Y,A^Q � -7Lr) Owner Email:
Owner Name: �:° r7 C- �` rL �' Phone:
Mailing Address:
Physical Address:
Facility Contact: e'0' itle: Phone No:
Onsite Representative: �� /'ter!` v�ni-T� _ Integrator: z1=5:
Certified Operator: Operator Certification Number: 1
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o =I
="
Longitude: = o = I = u
Design ,Current
Swine Capacity Population
Design .;Current:
Wet Poultry Cap it}, d ulul hon
- Design Current
Cattle Capacity Population
❑Wean to Finish
❑Layer
❑Dai Cow
❑ Wean to Feeder
❑Non -La er
❑Dai Calf
Feeder to Finish W,,2a7 d
a. Was the conveyance man-made?
Dairy Heifer
❑ Farrow to Wean
Dry Poultry
E]Dry Cow
❑ Farrow to Feeder
❑ Yes
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑Non -La ers
� ❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ No
❑ Turkeys
❑ NE
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
RNo
❑ 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
Do No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
�RNo
❑ NA
❑ NE
other than from a discharge'?
Page l of 3
12/28/04
Continued

Reviewer/Inspector Name j Phone:
Reviewer/Inspector Signature: Date: '?—g2 0� �
Page 2 of 3 12/28/04 Continued
Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�3 No
❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _}
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Oko
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
9No
❑ 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
9No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
J,No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[&No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect 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 > l0% or 10 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) 4__zU�d`�C�� _
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
[--]Yes
PNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
f&No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
® No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[allo
❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
®.No
❑ NA ❑ NE
Reviewer/Inspector Name j Phone:
Reviewer/Inspector Signature: Date: '?—g2 0� �
Page 2 of 3 12/28/04 Continued

Facility Number: Date of Inspection 4 ��
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ANo ❑ NA ❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo ❑ 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
[3No
❑ 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
MNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
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
FS No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[KNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[SNo
❑ 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
19No
❑ NA
❑ NE
General Permit? (ic/ 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
P& No
❑ NA
❑ NE
Ad`dihanalCotn�nents,aod/or DiaYtngs.Ogg
Page 3 of 3 12/28/04
Page 3 of 3 12/28/04

A
ivision of Water Quality —z'/
Facility Number O Division of Soil and Water Conservation s.
O Other Agency
Type of Visit 45tompliance
Inspection
O Operation Review O Structure Evaluation
Q Technical Assistance
Reason for Visit
outine O Complaint
O Follow up O Referral O Emergency
O Other ❑ Denied Access
Date of Visit:rrival Time: ,1 5 Departure Time: ,� / County: Region:�p
Farm Name: ^^ C ►_- T Owner Email:
Owner Name: " Phone:
Mailing Address:
Physical Address:
Facility Contact: r o
Onsite Representative:
Certified Operator: _ Q�1 IDF_VL�
Back-up Operator:
Phone No
Integrator:'�I�`�w
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: n u Longitude: = 0
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
I_ ❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Cts trent
Cattle Capacity P.opulatilo
❑ Dairy Cow
❑ Daia Calf
❑ Dairy Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
■
❑ Yes [I�No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
S No
❑ NA
❑ NE
❑ Yes
�2LNo
❑ NA
❑ NE
12/28/04 Continued

Facility Number: — Date of Inspection
•
❑ Yes
;,No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
R No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
jE�1Vo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Desigmed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
8 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
J.No
❑ NA
EINE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
ANo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
MNo
❑ 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
fgh10
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ANo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 No [:]'NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[--]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifi ❑ Application Outside of Area
12. Crop type(s) S2,0 Zt� Avco � z
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
;,No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
R No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
2jNo
❑ NA
❑ NE
17. Does the Facility lack adequate acreage for land application?
❑ Yes
ANo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
R -No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name �;/�_ 0---�-- Phone:
:3
Reviewer/Inspector Signature: Date: Z—IQ �aa�
12/28/04 Continued

• Facility Number: Date of Inspection
Required Records & Documents '
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes gNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes X No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design g El Maps E] Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes J 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 allo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �JNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EgNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
29 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[ZNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
XNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EN No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
VKNo
❑ NA
❑ NE
and report the mortality rates that were higher than non -nal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
URNo
❑ 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
fRNo
❑ 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
I,No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
fiZ-No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12/28/04

Type of Visit Ij�<Bmpliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit GA outine Q Complaint 0 Follow up 0 Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: ,' 0 0 Departure Time: County: Region:
Farm Name: ciq /` 11 0�'�' Owner Email:
Owner Name: C-rc v rix I Drr >ti Phone:
Mailing Address:
Physical Address:
Facility Contact: &4r. -01'2a C)r177` "__11ritle:
Onsite Representative: r✓-' n?err`7G
Certified Operator:
Back-up Operator:
Phone No:
Integrator: ���•�
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o E__11 ❑ " Longitude: =0=4
o=4 ❑ W
A
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[gNo
❑ NA
Design Current
Design Current
Design Current
Swine C►apacity Population
Wet PouEtry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
10 Layer I
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish
RNo
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -La ers
El Beef Feeder
❑ Boars
El Pullets
Beef Brood Co
❑ NE
❑Turke �s
❑ Yes
Other
❑ Other
❑Turke Poults
❑ Other
Number of Structures:
other than from a discharge?
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[gNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
ANo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
RNo
❑ 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
RNo
❑ 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
WNo
❑ NA
❑ NE
other than from a discharge?
Wage I of 3
12/2$/04
Continued

Facility Number: —
Date of Inspection ©a
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2/I Structure 3 Structure 4
Identifier: f+s -L-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3S-
5.
V
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ANo ❑ NA ❑ NE
❑ Yes IgNo ❑ NA ❑ NE
Structure 5 Structure 6
❑Yes 14No El NA 0 N
❑ Yes A No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes A No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes X 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 X No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes J,No ❑ NA ❑ NE
maintenance/improvement?
II. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes J,No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) D _
13. Soil type(s) �,r��r,,.L� ,
OF
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[KNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
M No
❑ NA ❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination' ❑ Yes
W No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
UN No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Dd No
❑ NA ❑ NE
Comments (refer to question #): Eiplain any YES answefs and/or any recommendations or aby other comments.
Use drawings of facility to'better explain situations. (use additional pages as necessary):`
n`
Reviewer/Inspector Name {c/' G1�
Phone:
Reviewer/Inspector Signature:
Date:
42
7- ooh
12/28/04
Continued

t Facility Number:— Date of Inspection p6
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes PINo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes j9No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists
❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
[:]Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soi] Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 9ffNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes ANo [INA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
54 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
J9 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
,M No
❑ NA
❑ NE
Other Issues
28_ Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[A No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
MNo
❑ 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
[Z No
❑ NA
EINE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
14 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
K No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
5d No
❑ NA
❑ NE
Additional: Comments and/or Drawings ;
Page 3 of 3 12/28/04
Page 3 of 3 12/28/04

J
i
Division of Water Quality
Facility Number �2 �q . Division of Soil and Water Conservation
Other Agency
Type of Visit ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
DateofVisit: ��20'�- Arriv�alTime: tom!-fr[ Departure Time: 1 ;/S'� County: ,��
!go-% Region: _
Farm Name: _ 11 e r Jr P l'A
A A,,& .t _ Owner Email:
Owner Name: ���rS{ .v c Phone: 7/O 6 ¢A -
Mailing Address: Afe 213 aCL
Physical Address:
Facility Contact: _Lf Iecr 'Ok, .e Title:
Onsite Representative: e d e rv_
Certified Operator: P ro r 70�AV
�.
Back-up Operator:
p
Phone No: �i
Integrator: / 1 e 1 Tas e
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o =I =" Longitude: = o = t 0 u
Seine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finisb ❑ La er
❑ Wean to Feeder 10 Non -La ei
r�KFeeder to Finish of r) S &e
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ElStructure ElApplication Field ❑ Other
a. Was the conveyance man-made?
Design COrrent
Cattle CapacityPopulation
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: z:
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 01190 [INA ❑NE
❑ Yes
❑ No
❑ NA
EINE
❑ Yes
❑ No
❑ NA
❑ NE
N0 ❑ NA
❑ NE
❑Yes
❑ Yes
EVNo
❑ NA
❑ NE
i
❑ Yes
&o
❑ NA
❑ NE
12/28/04 Continued

L
Facility Number: qkX Date of Inspection 9�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [9r'No LINA ❑ NE
a. If yes, is waste level into the structural freeboard? [--]Yes ❑No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 T
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [9 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes RNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes Gkl,Fo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes allo ❑ 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 WNo ❑ NA ❑ NE
maintenance/improvement?
1. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ErNo ❑ 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) �,R ti.+r. u ryC�l ! T� tR l4 rwi �K-,w �,/ �'e : -►
13. Soil type(s),�L'
14. Do the receiving crops differ from those designated in the CAWM P?
❑ Yes
[TNo
❑ NA
EINE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ffNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination:
❑ Yes
[allo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ff No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[J No
❑ NA
❑ NE
Reviewer/Inspector Name,'a. Phone' 9/0
--flS
.:./ r074Q't
Reviewer/Inspector Signature: Date: tel-• o'€!
12/28/04 Continued

Facility Number: Date of Inspection
Re uired Records & Documents _,,/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes LrJ No ❑ NA ❑ NE
the appropirate box.
❑ WUP [_1 Checklists [:1 Design El Maps E] Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes &'Evo ❑ NA ❑ NE
❑ Waste..Aipp� ❑ Weekly Freeboard ❑ Wwrte 4uaLysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking rop Yield ❑ 120 Minute Inspections ❑ ❑
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [TNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28_ Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29_ Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal'?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
R No
❑ NA
❑ NE
❑ Yes
GJ -No
❑ NA
❑ NE
❑ Yes
[ErNo
❑ NA
❑ NE
❑ Yes
[ErNo
❑ NA
❑ NE
❑ Yes
52� No
[]NA
❑ NE
❑ Yes El"No ❑ NA ❑ NE
❑ Yes [PNo ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes [RNo ❑ NA ❑ NE
❑ Yes
Q'No
❑ NA
❑ NE
❑ Yes
[�No
❑ NA
❑ NE
Addlti _nai C _n _n�aiidJ
nnngs:
P[tA,se- Gw_t `�'��Lvatoy- afeL,w eCv-a&nA[/
r
12/28/04

Type of Visit • Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit *Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number �� B Date of Visit: s �8/O jeune:
O =Not Operational Q Below Threshold
Permitted ($ Certified 13 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: .........................
Farm Name: 5 on County: ar. -S Fe -z,
Owner Name: _.C?co.�s��ra�a....................... . Phone No:4.`f:?11
Mailing Address:c7
....,S -------
�f - S.�?��.�.....�,o= Q..--. _.��!-,f.�.� ,r.L _�.. _ ____ ��32�
mit
Facility Contact.W �o.W o 1� h? �_ . Title:.. . �^!` �:. .. _ ..— - - Phone No: C! 0 0 0 7..
Onsite Representative . .... Sri �...... L r y, son Integrator:
Certified Operator: _ G ate. e, ..,_ .. �+ � n yam_.-........._._ Operator Certification Number:
Location of Farm:
0 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 64 Longitude • 4 cc
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 ❑ 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/min? A) !"j
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes j No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _....... ........ ........ _.... — ....._............................................... ._........ ........ _...
Freeboard (inches): _ 31 3
12112103 mm Continued

9cility'Afumber: a — 8Y
Date of Inspection
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 maintenanceJimprovement?
8. Does any part of the waste management system other than waste structures require maintenancerimprovement?
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 maintenancerimprovement?
❑ Yes 14 No
❑ Yes M No
❑ Yes No
❑ Yes [ No
❑ Yes No
❑ Yes 9 No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes J No
❑ Excessive Ponding ❑ PAN /❑/Hydraulic Overload1 ❑ Frozen Ground [3 Copper and/or Zinc
12. Crop type �� r,. oPo. C /7c r;le J .5 rALZ O Bi o �cQ
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 [P No
b) Does the facility need a wettable acre determination? ❑ Yes 9 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
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ® No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes No
Air Quality representative immediately.
:Commits (refer togteean #}F,xplam any YES aa5weis and/or aay i �ammendations ar aay otte=r commeats. -
Use drawuigs of fadity to better explam s,tttat<ons. (use add,ttonat pages as necessary)_ �F Field Cop ❑Final Nates � �_
:- __. '..: �...-. __—LC�'t'�_. __�a....:.n _ ...-- ..,- ��.���.`....._'-"__ r.a._�_.. '_.�•_T-s..-....._.: JS »..,._���.�"` •. R_s_.,_..�_ •x �.u:.°.x' ..-i:�� _�..
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: S
12/11/03 e�l_ Continued

Facility'Number: ? Eg-T Date of .Inspection s/fig/aY
Required Records &_Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ 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?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
\TPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
ki] Stocking Form ® Crop Yield Form Q Rainfall ® Inspection After 1" Rain
120 Minute Inspections ❑ Annual Certification Form
❑ Yes (] No
❑ Yes No
❑ Yes [ No
❑ Yes No
❑ Yes 1� No
❑ Yes q No
❑ Yes 53 No
❑ Yes ® No
❑ Yes E,No
19 Yes ❑ No
0 Yes 14 No
❑ Yes ® No
❑ Yes 0 No
❑ Yes 0 No
® Yes ❑ No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
dditi6hil Comments':astdlor Diiwings �' T om '
�/►
sb
/.^caf..als 1C�
1
3s� 711-1L,d/ QI/ /Qlnr4iJ CYrG►�t) .""1 L-+ a'C QLLF C"' 1`7 IlC b C2e-LA }
_N c
•1 �r ca tic � S' 1{'Gh- .
7
12/12/03

Site Requires Immediate Attention:
Facility No. S". - 8 9
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
Farm Name/Owner:^;
Mailing Address:
County:�d.+
Integrator:_
On Site Representative:
Physical Address/Locat
DATE: 1995
Time: /Z /
ffQ/
Phone: 91� -
P-,361
Type of Operation: Swine Poultry Cattle
Design Capacity: _3 p_57D Number of Animals on Site: 39.50
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ° Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) 6is or No Actual Freeboard: -4 _.3 Ft. Inches
Was any seepage observed from the lagoon(s)? Yes oras any erosion observed? Yes or to
Is adequate land available for spray? Yes r No Is the cover crop adequate? dir No
Crop(s) being utilized: �T V
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin s? r No
100 Feet from Wells? r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes ordg)
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes kp
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or N�o If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes o�
Additional Comments: T�1�7 r
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.