820102_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Quai

(Type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance I
Reason for Visit: 0 Routine Q Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other Q Denied Access 11
Date of Visit: Arrival Time: ` Departure Time: 1 County: c aja Region: C7
Farm Name: ,1f) rylrycy r-s� /�U�i� Owner Email:
Owner Name: Cr„►�Y Phone:
Mailing Address:
Physical Address:
Facility Contact: V1'1-r, /_ /1%Qp Title: me-. Phone: /
Onsite Representative: -- Integrator: �5 '_-6 '
Certified Operator: A-7,w Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Po
c
MGapacity Pop.
Wean to Finish
Wean to Feeder
Layer
Non -La er
Dairy Cow
Dairy Calf
eeder to Finish
31
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Farrow to Finish
Gilts
Dr. P,uu
JLayers
Non -Layers
Ca aci
P,o ,
Non-Dai
Beef Stocker
Beef Feeder
Boars
IPUllets
Beef Brood Cow
Turke s
Other
Turkey Poults
L_jOther
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [AT"O ❑ NA ❑ NE
[:]Yes ❑ No
❑ Yes [:]No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
[3] o
❑ NA
❑ NE
[—]Yes
❑ No
❑ NA
❑ NE
Page 1 of 3
21412015 Continued

Facili Number: - Date of Inspection: 49/
/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
EfNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 19 -
Observed Freeboard (in): q!
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E7—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
[!f%o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
ffo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[2-11o'
❑ 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
[][I�o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[J
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes l_7 110 ❑ 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): Amymoe/-r /pv e-�sYr�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
fo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[]' i�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ffNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[3-'Ko
❑ NA
❑ NE
Reuuired Records & Documents
N
19, Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[3
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWM P readily available? If yes, check
❑ Yes
[ '1 o
❑ NA ONE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
�o
❑ 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
Q No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[o
❑ NA ❑ NE
Page 2 of 3
2/4/2o15 Continued

if '
Facility Number: p Date of Inspection: p-1
/
w 24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E j No
❑ NA ❑ NE
i
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
�o
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26, Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
[3-<oo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[ o
❑ 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
io
❑ 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
�io
❑ 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
[3-<o
❑ NA ❑ NE
33, Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[] Yes
[] No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�o
❑ NA ❑ NE
Ne4r;w��i
mments (refer to question #)-. Explain. any YES answers and/or any additional: recommendations or, any other commerits:
ngs of facility-fo_better explain situations (use additional pages as°necessary}:
�•_,
Reviewer/Inspector Name- Phone:
Reviewer/Inspector Signature: Date.
Page 3 of 3 21412015
�1L
t

fG-- /a 5
ivis"ion of Water Resources
Faeiiliiy Number ®- ® OO Division. ofrSoil and Water Couserva 'on
� Other�Agency �,;,.
type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: /per/S` Departure Time: �2 BPS County:�-5' Region: i 6
Farm Name: _J i-W, 7 ��ij-�. n Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: e mow P-Nl— Title: r S�r� , Phone:
Onsite Representative: Integrator:
Certified Operator: 1,;W-- r.S% Certification Number:
Sack -up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
1,,.
�i Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pap.
Cattle Cap$city Pop.
Wean to Finish
La er
Non -La er
Dai Cow
Dai Calf
DairyHeifer
Wean to Feeder
Feeder to Finish
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D . l;ovlt .
Ca aci
P,o
Non -Dairy
Farrow to Finish
La ers
Non -Layers
Pullets
Turke s
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Boars
Other;.;
TurkeyPoults
Other
TI.i',
Discharges and Stream Impacts
. Is any discharge observed from any part of the operation? ❑ Yes R-No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
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
allo
❑ NA
❑ NE
[—]Yes
®-No
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facility Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage pigs heavy rainfall) less than adequate?
❑ Yes
L3-No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
0 NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 a
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
allo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
®' No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
� No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
jP 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
Ej No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E[No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
P!�No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
12. Crop Type(s):'/.nc4r��
13. Soil Type(s):o
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[2jNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
(M-Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[3,No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
M No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�-No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
®-No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[allo
❑ 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?
0 Yes
allo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[!�No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Faeffity Number: - p 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
DNo
❑ 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
CSNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[] Yes
r5'1 No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
KNo
❑ 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
[KNo
❑ 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
FNo
❑ NA
❑ NE
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
KNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Qc No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
QNo
❑ NA
❑ NE
Comments (refer to questions#) Explaur any•y�ES a ewers, nd/ur any additidnai re d© ihei ttationsror any other comieeents. i;l �,
b` I
se drawm of facih to better explainsrtuatiaus U "gs 'f 'ty ose additional pages as pecessary): _
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412015

_ty�--��
ivisian of Wafer Resources
Facility Number ®- O Division of Soil and Water Conservation
Q Other Agency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
.01
Farm Name: iyi, yH,y i�%7Owner Email:
Owner Name: (rar�s7-� j, Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone: qx
Onsite Representative: Integrator:``
Certified Operator: a.., Certification Numher:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Dgn Cprrent
Swine -_ . Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
@orrent
Pop.
Design Garrent
Cattle Capacity Pop.
Da Cow
Da Calf
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
47
Non -La er
D . P,oul# ,
Design
Ca aci
Current
P,o ,
Da Heifer
D Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
W",-
-
Other
Turke s
TurkeyPoults
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
p. Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
0 Yes [3-No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
[:]No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
(S-No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
TZLNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Faeftity Number: -. Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes V!-No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No D NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): - 9 -
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes allo ❑ 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
allo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[&No
❑ NA
0 NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
la 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 [?!�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ 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): Z /' Mojer
13. Soil Type(s): Q
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
U&No
❑ 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
❑ Yes
J&No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[allo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
Jallo
❑ NA
❑ NE
Reguired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
� No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
&No
❑ NA
❑ NE
the appropriate box.
❑ WUP [—]Checklists ❑ Design [:]Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
�@ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
JqNo
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
_54,.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 ® No
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 5jNo
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 QjKNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Jallo
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
❑ NA ❑ NE
❑NA ❑NE
❑ Yes �,No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
[-]Yes No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes [gNo
❑ Yes �+ No
❑ Yes RjNo
❑NA ❑NE
❑NA ❑NE
DNA ONE
Coutmeatsi(refer to question #): Explain anyt S answers; and/or any additional re 6u mendations or,'any other comments.
Use drawtngs�n[;facility to'better explaln�,s�tuahons_(use additional pages as necessary,) ., w x_
j�4 Gv! 11 h,
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone:
Date:
21412015

■ ype 01 visit: %yc.ozoutine
nce inspection v vperanon xevtew V structure r vaivanon v i ecnmcai Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access _j
Date of Visit: Arrival Time: 1p D Departure Time: 4 County: �� Region:
Farm Name: Owner Email:
Owner Name: .tom Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: ✓�``m�'_5 L� �rS
Back-up Operator:
Location of Farm:
Latitude:
'..—I . Phone:
Integrator: 177 _Z�
Certification Number:
Certification Number:
Longitude:
esign Current Design Current
Swine Cpacity Pop. Wet Poultry Capacity Pap. Cattle Capacity Pop.
IIIlLseisign Current DJ'E
Wean to Finish
Layer
Da' Cow
Wean to Feeder
Non —Layer
Da' Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
7�
3 aOa
Design Current
D . P.oult . Ca aci Po P.
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Layers
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Other
Other
Turkeys
Turkey Poults
her
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)?
-TSYes [&No [] NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ® No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [—]Yes [ZLNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2✓412014 Continued

Facili Number: - Q I Date of Inspection: /
Waste Collection & Treatment
�." 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Wo
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1 Structure 2 Structure 3
M.
Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑NA ❑NE
❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ®,No ❑ NA ❑ NE
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
allo
❑ NA
❑ NE
8. Do any of the structures 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
2 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 or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes jj�jNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence/of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ;3,No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [Na ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
[:]Yes KNo ❑ NA ❑ NE
[:]Yes E&No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
allo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
&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
ENo
❑ 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
ELNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
t No
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

'I Facility Number: - D Date of Inspection: —
`24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
(XNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
C&No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
0 No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
E .Vo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
C3,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
[ONo
❑ 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
KNo
❑ 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
54,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
E!jjNo
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
f;�No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
LNo
❑ NA
❑ NE
Use drawings of facile to.better explain situations use additional a es any other comments._ }_ Comments (refer to' ty tion Explain an YES { swers and/or any.
additional reco mendations or _
� y y'as-necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: .gjf9 --u 3-7 kp
r••
Date: f/ /5-
21412014

9--MI-11 sO-
Type of Visit: ompliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Q Routine Q Complaint 0 Follow-up 0 Referral Q Emergency 0 Other 0 Denied Access
Date of Visit: 11-1 4 1 Arrival Time: Departure Time: / , 3 D County:. a^'
Farm Name: I dvl drys-.. Owner Email: `�—
Owner Name: Lam t 13 Z—� f Phone:
Mailing Address:
Physical Address:
Facility Contact: 1r-'-r-- /rl oar's— Title:
Onsite Representative: 5.
Certified Operator: V ol ej
Back-up Operator:
Location of Farm:
Phone:
Integrator:
Region: L_ ?—_"
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current
Design£~
CurrentDesign
Current
Swine
C p c ty Pop.'We
.. it
Capacity
Pop.
Cattle Capacity Pop.
o Finish
Layer
DairyCow
Non -Layer
DairyCalf
VWW�eano Feeder
to Finish
Dairy Heifer
Farrow to Wean_....
Design
Eurrent
Cow
Farrow to Feeder
aDK.Poul 5
Non -Dairy
Farrow to Finish
Layers
Non -Layers
Beef Stocker
Beef Feeder
Gifts
Boars
Pullets
Turkeys__+
Beef Brood Cow
t
Other
Turke Poults
Other
FTOther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [S No ❑ NA ❑ NE
[:)Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes 0 No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ® No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [&No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Factli Number: jDate of Ins ection: W/
1
Waste Collection & Treatment
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[Z 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
® 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
O No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate puhlic 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
P No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
2] No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Eg 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):+ esiv"S��• _ _
13. Soil Type(s): _-
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes ® No ❑ NA FINE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes (Z No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes 0 No ❑ NA ❑ NE
❑Yes ®No ❑NA ❑NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
®. No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[-]Yes
� No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
�No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste 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
[R No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
GJ_No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: - /D I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No
r
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [A No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �, No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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
❑NA ❑NE
❑NA ❑NE
❑ Yes 5No ❑ NA ❑ NE
❑ Yes (' No ❑ NA ❑ NE
❑ Yes [3 No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes C&No
[:]Yes U?.No
❑ NA ❑ NE
❑ NA ❑ NE
0 NA ❑ NE
Comments (refer to question Explain any YES answers and/or.any additional recommendations or any other comments`:
Use drawings':of facility to better eiplam situations (use additional, pages'as necessary). x
Reviewerllnspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: JJIal3 33�
Date:
21412011

I
Type of Visit: Compli nee Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
-J
Arrival Time:
Departure Time:
County: ��Region:
Farm Name:
% r"
F frrt?�
Owner Email:
Nr'
Owner Name:
rifts
Phone:
Mailing Address:
Physical Address:
Facility Contact: r el.-Ir— Title: �� G. Phone:
Onsite Representative: �s6.z...�. Integrator: _,Jtr.y�tj
Certified Operator: 2�G2 'x,r -%L Certification Number: %Z]
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish La er I
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
X.Fccder
Wean to Feeder
Non -La er
I
to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
DesigQ Current
.
Layers I
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Non -Layers
Boars
Pullets
-
Other
Other
Turke s
Turkex Pouets
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes DR No ❑ NA ❑ NE
0 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
�No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
D4 No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: - p Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): ( g
Observed Freeboard (in): ►'�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
JR 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
JA 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
29 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[Z 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). LO/M iL fin V;'-r<e"
13. Soil Type(s): M aAl
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 Lg No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ®• No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
[—]Yes 5C No ❑ NA ❑ NE
❑ Yes (j 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 2§No DNA ❑ 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 Jallo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility 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 6D No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes R No [DNA ❑ NE
❑ Yes CANo ❑ NA ❑ NE
[:]Yes [Z No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes [Z No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
S1 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
[4 No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
5,No
❑ NA
0 NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments
Use-'drarvinas:of facility to better explain situations (use additional pages as necessary). .
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: <5�1D`�'-"'
Date:S`"/,
21412011
Page 3 of 3

Type of Visit: omplia ce Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: / Arrival Time: p,' c7 Departure Time: Counq_1 Region:
Farm Name: vy� _, / _ Owner Email:
Owner Name: 1 �25 _rs Phone:
Mailing Address:
Physical Address:
Facility Contact: frr/ Title: ZR& Z �61_e _ Phone:
Onsite Representative: r 47'_ Integrator: (
Certified Operator: LKZ s Certification Number: /gX29
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
V 11 Design Cn rent ,w.
Swine ! Capacity Pop.
Wean to Finish
n Design Current +' Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pap.
I ILayer
Daig Cow
Wean to Feeder
ceder to Finish
I INon-La er I I
es
Dign Current
D P,oultry Ca aci P,o .
Dairy Calf
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I Dry Cow
Non -Dairy
Beef Stocker
Layers
I
Gilts
Non -Layers
Beef Feeder
Boars I
Pullets
Beef Brood Cow
jjjq
Other
Other
Turkeys
Turkey Poults 1.
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[] Yes
[0 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
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
�D No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

U
Facifi Number: - Date of Inspection:
Waste Collection & Treatment
• 4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / g
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
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
O No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E0 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 E] No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes KNo [DNA ❑ 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): w
13. Soil Type(s): Vo fr
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 0 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes "No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ®. No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 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. D4 Yes K No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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
.E] 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
0 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
Eg No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E! No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
®.No
❑ NA
❑ NE
Comments (refer to question `#): Explain any YES answers and/or any additional recommendations or anyyotter.,comm is
Use drttwin s of facili to. better explain situations use additional a es as necessary).iL
Reviewer/Inspector Name:
Reviewer/]nspector Signature:
Phone: `�/�T 3 33a0
Date: /
21412011
Page 3 of 3
'4

Type of Visit: Q-Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: QWoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: © Arrival Time: v o Departure Time: �i7 County: Region:
Farm Name: Owner Email:
Owner Name: �.� ,�' Phone:
Mailing Address:
Physical Address:
Facility Contact: .&One- ` Title: � Si re. Phone:
Onsite Representative: Ste_ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Design Current
Des, Current Design Current
Swine
oultry Capacity -Pop. Cattle Capacity Pop.
Wean to Finish
La er Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
_ Dairy Heifer
Farrow to Wean
Design Current Dry Cow
Farrow to Feeder
Dr= P,oultr,
Ca aci P,o , Non -Dairy
Farrow to Finish
Beef Stocker
Layers
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
IBeef Brood Cow
."
`
Turkeys
OtherK_
TurkeyPoults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [Z No ❑ NA ❑ NE
❑ Yes [—]No
[:]Yes [:]No
❑ Yes ❑ No
❑ Yes No
[:]Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page] of 3 21412011 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes R] No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Frceboard (in): 4—
Observed Freeboard (in): `5—;K
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
gNo
❑ 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
[Z 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 5g No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): A/9 /7-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
I & Is there a lack of properly operating waste application equipment?
❑ Yes Eq No ❑ NA ❑ NE
❑ Yes [El 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 j[2 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 [K 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 4 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

I.
Facili Number: - Date of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes � No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of lust survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [:]Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface 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
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes IN No ❑ NA ❑ NE
❑ Yes R] No
❑ Yes R] No
[—]Yes RNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
= Comments (refer to.question.#I): Explain any YES answers and/or any additional recammendations orrany other com>�iei ts.
Use drawrn " `of facility to better ea lain situations;,. use.
gs ty p ( additional pales ,as necessary,)W'�
afe� ��� �us-c �--�-r- c T3�/� 5► �� 0� L-��pr��t
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

Type of Visit (I6, GMpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0-Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival "Time: ! 0 o Departure Time: � p c'7 County: fl — Region:
Farm Name: —�7_11ew mfo zl_ Owner Email:
Owner Name: (/ Gtiur_� +� _ Phone:
Mailing Address:
Physical Address:
Facility Contact: J-1 moon .&-,5 Title:Phone No:
Onsite Representative: �s►"�s�/ %8� Integrator:
Certified Operator: �YS Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: E:�j 0 0 , =,, Longitude: = o = f 0 u
Design Current Design Current Design Current
Swine
Capacity Population Wet Poultry Capacity Populatiop Cattle Capacity Population
❑ an to Finish
ID Layer I
I❑Dai
Cow
❑ an to Feeder
JEI Non -Layer I
Dai Calf
Feeder to Finish
J- it
'_"¢:
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Layers
❑ Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑Non -La ers
❑ Pullets
❑Beef Feeder
❑ Boars
❑ Beef Brood Co
❑ Turke s
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes gNo ❑ NA ❑ NE
El Yes
El No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
5d-No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: et;-- Date of Inspection
Waste Collection & "treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ER No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): j
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
El NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
ELYes
❑ No
❑ NA
❑ NE
S. Do any of the stuctures 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
[,No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
allo
❑ NA
❑ NE
maintenance/improvement?
1 I - Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Qom.No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ]0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes L'gNo ❑ NA ❑ NE
15- Does the receiving crop and/or land application site need improvement?
❑ Yes C,No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes R No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes C,No
❑ Yes ULNo
❑NA ONE
❑ NA ❑ NE
Reviewer/Inspector Name �—y� „ Phone-
O _" 3_-5 33Qo
Reviewer/Inspector Signature: Date: 119
Page 2 of 3

Facility Number: — Date of Inspection
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes allo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes B No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
W No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
RNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E�No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
5kNo
[INA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
A o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[allo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
KNo
❑ 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
5kNo
❑ 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
RNo
❑ 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
RNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
X No
❑ NA
❑ NE
12128104

i ✓ jTwa5 11-z3-z009
Type of Visit &Compliance Inspection O Operation Review O 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: %/-%(, -D 9 1 Arrival Time: ,%�0.� �¢�, Departure Time: %/: 30 County: .S+ saJ Region:
Farm Name: i "A"=, P5 6 r�i r'a"ti _ Owner Email:
Owner Name: —Jao4,s e—S f / Phone:
Mailing Address: �Z-�0 ck,,,rc�Ge. 4o(
Physical Address:
Facility Contact: es f- Title: QWfJw Phone No
•
Onsite Representative: (frcc c o r� Tech.. MSra,�C_ /H Ply, Ar-0 t..J')
, Integrator: --
nj
Certified Operator: Operator Certification Number: AlAr
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 =' f--] « Longitude: = o [--] ' = u
Design Current
Design Current
Design Current
Swine Capacity Popula6an
Wet Poultry Capacity Population
C►attle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
Feeder to Finish 6
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non-Dai
❑ Farrow to Finish
Layers
❑ Beef Stocker
Gilts
ers
WTurkeys
❑Beef Feeder
FBoars
❑ Beef Brood Co
Other
❑ Other
❑ Turkey Pouits
❑ Other
Number of Structures:
I
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
❑ Yes
El No
/
D A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[ ETA
❑ 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
[lfo
ElNA
ElNE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
[IB Yes
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: S — /02 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes
,��
[3 o
❑ NA ❑ NE
a. I f yes, is waste level into the structural freeboard?
❑ Yes
D o
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 117
Observed Freeboard (in): _ 33
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
B o
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
[I Yes
,�.,,//
l3No
❑ 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) notify DWQ
7. Do any of the structures need maintenance or improvement?
El Yes
-thh�reat,
EKO
ElNA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
ElYes
[3' o
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
El Yes
,.,�
LTNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
Yes
Ell
��
SNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
CNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) t rw, �. c� �. iF1 a J S c«�.; 4! rL. �.+ �O , S • J
13. Soil type(s) /Vb h L S
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes
N//o
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
,L.�T,,
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
�2<
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
,L�I�No
LTNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Na
❑ NA ❑ NE
Comments refer to uestton'#) Ex lain an YES answers and/or an recommendationssoraasty other�;comments
Use drawmgs,of facility to better explarn sttuaHons. (use add,tional ilqIngr';ZnM
necess1
90'...5 tn) 4v-,c.s ­-4 di l_c_ . A6
h:. r h o ur 5 [ cj c f i �-• c c �ti�+ l i e r— c� r� �.7 a v fGaci I iu s-6b__� - 4o a_%--6 47 1 .'S 4. Cc �_✓ 6'.d
-- rr
Reviewer/Inspector Name F_9 j t /�2 V e_� .S Phone: WO •'V31, 0 tD
x:_5
Reviewer/inspector Signature: Date: //-/b -7100 9
12128104 Continued

Facility Number: Date of Inspection -/
Required Records & Documents
19. Did the facility fail to have 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. [I WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes
Q Flo
❑ NA
❑ NE
❑ Yes
EK.
❑ NA
❑ NE
2 L Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stacking ❑ 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
B<o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E3<o
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as"required by the permit?
❑ Yes
❑ NA
El NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,�l �'To
LSNo
❑ NA
❑ NE
"No
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
To
❑ NA
❑ NE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0
❑ 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?
El Yes
,�
e 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 D o ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application) ,.,�
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? El Yes ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes 0190 ❑ NA ❑ NE
12128104

01K zrv1 I a ts-lo m
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ® Arrival Time: `Rs� Departure Time: ,00 p County: Region: —
�-t
Farm Name: _.1�shnoI— M rr Owner Email:
Owner Name: -ej B, Bee Phone:
Mailing Address: 400 Ova) Rk Gin iD 3 aMs
Physical Address:
FacilityContact: 6nmlTitle: _OW'1.6— Phone No:
Onsite Representative: Integrator: M- R
Certified Operator: 4 Operator Certification Number: AyA 19g07
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude:[--] e E] Longitude: = ° = g
Des°s It Current
Design Current
Design Current
Swine
Capacty-Pt p lation
Wet Pateltry Capty Population
Cattle Capacity Population
to Finish
❑ La er
El Dairy Cow
to Feeder
❑Non -La er
El Dairy Calf
r to Finish
3 a
-�' - :: -
Dai Heifer
w to Wean
❑ D Cow
w to Feeder
❑ Non-Daiw ry
to Finish
FGilts
a ers❑
8eef Stocker
on-aers
❑ Beef Feeder
Pullets
❑ Beef Brood Co❑Turke
Turke s
Po ❑ Other
Humber of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes D "No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ERNo ❑ NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes 1�fNo ❑ NA ❑ NE
other than from a discharge?
Page I of 3 12128104 Continued

Facility Number: g 3• — Q Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
JgNo ❑ 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): 319
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
RNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
§1No ❑ 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?
�R Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
10 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[]Yes
CRNo ❑ 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
N] 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) C�fiAIJ I J*M ✓jf�o -ffQ.,
iJ
13. Soil type(s) NoA Ls
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
I & Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes]
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
" E ;4 Phone: �I f~}-�{}-33QQ x3�
Reviewer/Inspector Name _ 3
Reviewer/Inspector Signature: Date: o1Q�
n „o � ,.r x 1?/7R/OQ !`nnfinuad

Facility Number: ga. — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 13 No ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWW readily available? If yes, check ❑ Yes N No ❑ NA ❑ NE
the appropiate box.
❑ WUP El Checklists [—I Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes C5i No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes NNo ❑ 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
:R No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
U NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
10 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
®'No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ERNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
tH No
❑ NA
❑ NE
General Permit? (le/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Q No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
A``dditronal�Comments anchor Drarvtngs3,Some- ba-f- s l a9oa, -fio (t Pn s, de ¢� Ple6p_ add -b pi
etas crsfv 9, �,n,-e, 4 rn v[ CA
S� s1�Z*17Z
t►wafo[o,� fa aoo8�al�ha�� fair, had a� erci�fion,
me'l l k-e r' e rad s,
[Md �` aj rilGila; no
-7,sr�to la�aa� baPs 7` o rna�
Page 3 of 3 12128104

Facility No. Ta-Time In Time Out Date
Farm Name aye) _ Owner
Owner BIMS Address & Phone Cell Phone
Site Rep Integrator Operator No.
Backup No. BIMS OIC No.
COC / Circle: ener l or NPDES (Rainbreaker PLAT
Annual Cert )
Pop. Type Design Current Pop. Type Design Current Pop. Type Design 11 Current
Observed
''--_---
001 ILI-- 133' cis,
Soil Testy Crop Yield 120 min Inspections
PH Fields lnj Lagoon Rain Gauge �- Transfer Sheets
Lime Needed 1 Weekly Freeboard Spray/FB Drop
Cu ✓ Zn Rainfall >1" l
Wettable Acres ✓ 1 in Inspections ja�r/� 7
U"1 0 -il�� nn Fy
r-Rp Vvok 62, - Z),+ a) _
Pull/Field I Soil Crop Pan Window
Comments %&,J
� t'� --33f

Type of Visit compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit V Routine 0 Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of visit: Arrival Time: i
le: l J� Departure Time: County
Farm Name: K^r"� 4Z_, -al rA Owner Email:
Owner Name: 'M ' J� Phone:
tj
Mailing Address:
Physical Address:
Region:
Facility Contact: 3 Title: �� �l X Phone No:
Onsite Representative: Integrator:{ ems
Certified Operator: r`` Operator Certification Number: n
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = [ Longitude: = c a i
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
110 Non -Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Dairy Calf
❑ Dairy Heifer
El D Cow
ElNon-Dairy
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Co
INumber of Structures:
eeder to Finish
Dry Poultry
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ La ers
❑ Non -Layers
❑ Pullets
[I Boars
Other
❑ Other
❑ Turkeys
❑ Turke Poults
❑ Other
Discharges & StreamImpacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA El NE
❑ Yes
❑ No
A
ElNE
❑Yes
❑NoA
z
❑NE
❑ Yes
❑ No
ANA
❑ NE
❑ Yes
IQ No
❑ NA
❑ NE
❑ Yes
❑ No
S�NA
❑ NE
Page I of 3 I Z/28/04 Continued

Facility Number: — Q Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes M No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No RNA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3pi
S. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.) ❑Yes No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes kNo ❑ NA ❑ NE
8_ Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes PQ 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 VNo ❑ NA ❑ NE
maintenance or improvement?
Waste Annlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes &o ❑ 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 Drift ❑ Application Outside of Area
12. Crop type(s) & M �1 , � C_lv d� S
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
)Q No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
19No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Od No
❑ NA
❑ NE
s
Comments (refer. to question #): Explain any YES=answers and/or any recommendations or any other cmmoents '. .
Use drawings of facility to better explain situations. (use: additional pages as necessary):
Reviewer/Inspector Name U ' — Ct 1 Phone: �
Reviewer/Inspector Signature: Date: 2o Zvi
Page 2 of-3 12178104 Continued

Facility Number: Z — Date of Inspection ZU
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes *0 ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes [[�"No
❑ NA
El NE
the appropriate box.
ElWUP ❑Checklists El Design ❑Maps ❑Other
/'
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes 0 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
XNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ANo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes so No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes '1?�No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
I (NA
❑ NE
Other Issues
28_ Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes RNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes VNo
❑ 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 '�LNo
❑ 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 )QNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes � No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes kNo
❑ NA
❑ NE
Additional. Comments and/or Drawings: Wr.`
n Z ,
-~ C-50n
N► � � n�,,ro�reme� �5 -� booths .
Page 3 of 3 12128104

Facility No. Time in f o 3 . Time Out Dat J
Farm Na-mee rn Integrator
Owner Site Rep
Operator No. b�
Back-up No.
�1
CDC Circle: Cenl NPDES !
C
Design
Current
Design
Current
Wean — Feed
Farrow — Feed
Wean — Finish
Farrow — Finish
ed — Finis
`j
Gilts 1 Boars
— can
Others
FREEBOARD: Design
Sludge Survey
Crop Yield
Rain Gauge
Soil Test / Wettable Acres
Weekly Freeboard Daily Rainfall
Spray/Freeboard Drop
Weather Codes Z 20 min Inspections
Waste Analysis:
Date Nitrogen (N)
WV
Observed
Calibration/GPM J 3
Waste Transfers
—
Rain Breakef—
PLAT
1-in Inspections
I t Z
Date Nitrogen (N)
Pull/Field Soil Crop Pan W ndow
o C
f

L
Type of Visit Wcompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Z Arrival Time: l Departure Time: I County: Region: FR V
Farm Name: 3� -ABM G S �S7 EOwner Email:
Owner Name: J I M t1Ay� 2,C ST Phone:
Mailing Address:
Physical Address:
r
Facility Contact: :��� l=`,—T Title: Phone No:
Onsite Representative: —S VA rn kA LAC S� �T Integrator: ae-E-t 'S�Tl� _
Certified Operator: , t"` U��T _ Operator Certification Number: Iqd q
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 e = ` = « Longitude: = ° = 1 = u
Swine
Design Current ..
Capacity vPopulat n'et Poultry
DP
Design
Capacity
Current Design
Population Cattle Capacity
Current
Population
❑ Wean to Finish
3 ❑ Layer
❑Dai Cow
❑ Wean to Feeder
�� Non -Layer
�
��
� ❑Dai Calf
r eeder to Finish
❑ Farrow to Wean
❑ Farrow to Feederx
El Farrow to Finish
❑ Gilts
❑ Boars
3 � 361 Z f'�-
'-p -� <
. Dry Poultry
El Layers
�;.,El
ti ❑Non -Layers
❑ Pullets
�'
❑ Da Heifer
- ❑ D Cow
El Non -Dairy
Beef Stocker
❑ Beef Feeder
El Beef Brood Cowl
ures:
❑ Turkeys
❑ Turkey Poults
❑ Other I'KlOther I
Discharees & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
14 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
VNA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
CJNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
f�
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
F'ONA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
NiVo
//R'N'
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
o
❑ NA
❑ NE
other than from a discharge?
Page I of
12128/04
Continued

Facility Number: a — (� Date of Inspection b
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �kNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes RNo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
ZL4 11
Desig0'0*oard (in):
Observed Freeboard (in): :317c/
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
NNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
*o
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
MYes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
�lo
❑ 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
[I Yes
E�No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
,,.-��""
L&No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
Mo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12. Crop type(s) I&Y MU � C Y os
13. Soil type(s) NOtr 0( k
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
)9 No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
[:]Yes
No ❑ NA ❑ NE
IT Does the facility lack adequate acreage for land application?
❑ Yes
V) No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
V No
❑ NA ❑ NE
40 e-e and e Sc
�r�� -�-o �re � en-� r•e �n'I�X�n c� � l.V i 1 � �' I ]asa � �' �
Reviewer/Inspector Name
Phone: p� D3 33,00
Reviewerllnspector Signature: Date: V CT
Z�
Page 2 of 3 12128104 Continued

• Facility Number: Z.— vZ Date of Inspection O ��
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes' VNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes Wo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes %No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
rVy�NNO
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
MNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
UNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Wo
❑ 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
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes]
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge. freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
IQ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
CdNo
❑ NA
❑ NE
Additional Comnmer( and/or Drawings:
A�
` I
e- 5 o r t �o r aw c— Q.l_.V r cn 4' wo_s4 C ayla l r 0.( 1
c� ►'+-+ i Yl V
�4 f t n C�lJli a.�.,c�. �o�e _ N c� r►e c e� yc,ror zero
Page 3 of 3
12128104

�
Facility No. Time In � Time Out Date O o�!,��)
Farm Name Z__� Integrator
Owner _., ._ Site Rep
Operator No. wq-
rT_
Back-up
COC t
C
Circle: General
Design
Current
Design
Current
Wean - Feed
Farrow - Feed
W
Farrow - Finish
Feed - Finis
i
Gilts 1 Boars
Farro - can
Others
FREEBOARD: Design Observed
Sludge Survey Calibration/GPM ✓ 1 `� ' �vr
Crop Yield
Rain Gauge '
Soil Test�-
Weekly Freeboard
Spray/Freeboard Drop `N% -f
Weather Codes
Waste Transfers
w RR'' Breaker
PLATy c? Wettable Acres
Daily Rainfall 1-in Inspections
120 min Inspections
Waste Analysis:
Date Nitrogen (N)
C,
Date Nitrogen (N)
a� Z
Pull/Field Soil Crop Pan Window
r►�
5

., -
V
A Division of Water
Facility Number Y ® D�2 Division of Soil and Water Conservation
0 "her
Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit & Routine O Complaint O Follow up Q Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: ; QV Departure Time: County: Region: FJ26
Farm Name: e e } Owner Email:
Owner Name: c-s_f_ Phone: /r9 ►ti� 7- SI
Mailing Address: y,?30 c4c.cr ..4 / Ue�Q�^ �i,tiT��. /VG V3ao1c,
Physical Address: 0/r_ c..s-0^u
Facility Contact: Title: Phone No:
Onsite Representative: �_d � ,� "A+ Integrator: Pr- G,Y-�\uWL S'-e_wjg r�
Certified Operator: i3G.s (^ Operator Certification Number: „ � / Y-do:z
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: 0 ❑ ❑ Longitude: ❑ ° ❑ , ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
DY7
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ `Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharp,es & 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)
Design Current
Cattle Capacity'. Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
El
—
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
I
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
E:
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ® No ❑ NA ❑ NE
❑ Yes W No ❑ NA ❑ NE
12128104 Continued

Facility Number: ka —I Off. Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
M 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): ,1 �f " �j`/o 64--4
Observed Freeboard (in): 3 4 j'
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
91 No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
® No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4.6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
W Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
V1 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required'bvffers, setbacks, or compliance alternatives that need
El Yes
®No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes U 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. Croptype(s) _, P�r►,,,��ci �IicrTe� /¢linuc�./
13. Soil type(s) 1\119 4_
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 [0 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination` ❑ Yes [M No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [)B No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
ipare_ C�pd4s DV, AA�G Catiki i A
"0k3 e_n, rpLAKA
c..�, L,vga Yo•� a C Ou�c�
Reviewer/Inspector Name ��Qr �� Phone(-)/
Reviewer/Inspector Signature: Date: -I /_ 7 % o,
r 12128104 Continued
z

` Facility Number: Date of Inspection a 7 0_F
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ yes U No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E0 No ❑ NA ❑ NE
the appropiate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes V] No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
El No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
®No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
W No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
91 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
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29_
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EA No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
(] No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency'?
❑Yes
No
❑ NA
❑ NE
A°d`dibonai CoinMents:ao WPrawings:- EN
12128104

(Type of Visit (VCompNance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit t"loutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: 3 0 Tune: % �U
' p
Q Not O erational Q Below Threshold
ertuitted er ed © Conditionally Certified © Registered Date Last Operated r Above Threshold.: ..... ..._ _.. ..
Farm Name: .......!''" t....�w�-----------------_....._........................ County:............
Owner Name: ........ :_"` _ .. _� CS. . . Phone No:
L.r�fn ISd.
Mailing Address: q�3t7 3
FacMty Contact: .. .„L=' d. .---, -- . Title:.. „. Phone No:
Onsite Representative: Inteegiator.....�!+��{ _... ,
Certified Operator•`'''......._ .. _.... _...._......................... Operator Certification Number:...
Location of Farm:
M"Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �' ��� Longitude �• �' �"
Discharges & Stream Imoac�
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 0fN0
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes JrNo
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes E3�No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes �rNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes WNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ago --
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .......................... W -- -... - -..................... ..... ........_. --
Freeboard (inches): d D
12112103 _ Continued

Facility Number: UE / Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes Cl is
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes [I1*l6'
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 maintenancelimprovement? ❑ Yes to
S. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes EWo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes
elevation markings?
Waste_ Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes Evro
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type DeA.. A /-, U . A G,ru " �.4
13. Do the receiving crops differ with those desiinated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes #Wo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes U-N'o
b) Does the facility need a wettable acre determination? ❑ Yes V4b
c) This facility is pended for a wettable acre determination? ❑Yes ;Wo
I5. Does the receiving crop need improvement? ❑ Yes �I/o
16. Is there a lack of adequate waste application equipment? ❑ Yes 04
Odor Issues
17, Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes aKo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes N
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ��o
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 ❑ Yeso
Air Quality representative immediately.
'' ►^ 5 J_ S L
Reviewer/Inspector Name
❑ Final Notes
Reviewer/Inspector Signature:
12112103
Date: o p
Continued

Facility Number: $ _ �� Date of inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
MO
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
[].piece
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
EW6__"
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
&1_0
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
Q,No---'
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
—�
(ie/ discharge, freeboard problems, over application)
❑
ISO
27_ Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
Gof6`
28. Does facility require a follow-up visit by same agency?
❑ Yes
[New
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
m4iv—�
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
es
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
OIVo
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
�dt�
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
12112103

Site Requires Immediate Attention:
Facility No. QL �'—
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 6�, 1995
Time:
Farm Name/Owner:_ - r ! /.SeCs LgQfar.�,
Mailing Address:
County:_
Integrator:
On Site Ri
m
Phone:
Phone:
Physical Address/Location:
Type of Operation: Swine Poultry Cattle
Design Capacity: ;woo Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately l Foot + 7 inches) 1 or No Actual Freeboard: q Ft. Inches
Was any seepage observed from the lagoon(s)? Yes ar No Was any erosion observed? Yes or No
Is adequate land available for spray? Yes r N Is the cover crop adequate? Yes or No
Crop(s) being utilized: ,r
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin s? Ye or
100 Feet from Wells? Ye or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue ine:
No
Yes. or No
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No 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 or No
Additional Comments:
Inspector Nan
1 = - 9 q- `a7
A:�� 44-,
Signature 6/
cc: Facility Assessment Unit Use Attachments if Needed.

� � F

z