820121_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

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Type of Visit: ompliance inspection Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Q Routine Q Complaint Q Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: �' Arrival Time: D'!3 Departure Time: County:
Farm Name:G9'Owner Email:
Owner Name: a Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: ` 0/717 Title: % r/ Phone:
Onsite Representative: Integrator: $"dZz=a
Certified Operator: �'�_ Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
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Wean to Finish �jl La erDai Cow"
I Wean to Feeder i� Non -Layer '€ �� Dai Calf
Feeder to Finish �li : i�y1�Ii' j4Pj ir'il¢1 h[g !� I pll�"Es E I Dai Heifer
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Farrow to Finish 11 La ers 11 Beef Stocker :' €
Gilts 1�1111 Non -Layers i p Beef Feeder
I Boars `, Pullets �'?€ Beef Brood Cow
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ii.Turke s
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Other Other
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Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes &No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
❑ Yes ❑ No ❑ NA (] NE
❑ Yes ❑ No
❑ Yes M_No
❑ Yes allo
❑NA NE
❑ NA ❑ NE
[]NA ❑NE
Page I of 3 21412015 Continued

Facili Dumber: - Date of Inspection: 77;6"_
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):�
Observed Freeboard (in): p� )
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 0 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 KNo ❑ 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 [ffNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [R, No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground . ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 tbs. ❑ 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): �/`� cam.
/ a
13. Soil TYpe(s): �f9et `v Yh
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes allo [DNA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [SNo ❑ 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 0 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 [allo ❑ NA ❑ NE
20. Does the facility fail to have all components ofthe CAWMP readily available? Ifyes, check ❑ Yes Callo ❑ 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
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall (] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes allo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes allo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Y Faclfl Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes JZ[No
t!
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 'ED-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 provide documentation of an actively certified operator in charge? ❑ Yes [M 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 JZNo' ❑NA []NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes ELNo ❑ NA ❑ NE
❑ Yes 5jNo ❑ NA ❑ NE
❑ Yes 0,No
❑ Yes [&No
0_11es CKNO
❑ NA ❑ NE
❑NA []NE
❑ NA ❑ NE
Comippme`1ptq (refer,.to question #)'Explain any YES answers andlar airy additlonul recomritcndations orairy ether comments ,
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IT e;drawipgss.�oi�fac�l€ty;to,;bettcr:explain;sltuations[(usc�additional'pagesus'necessary)
Reviewer/Inspector Name:
Reviewer/inspector Signatut
Page 3 of 3
Phone:
Date:,
21412015

'f ivision of Water Resources
)Facility Number ®- �--t �i _ i O Division of Soil and Water Conservation
fy
0 Other Agency
Type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: CIRoutine 0 Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: IF Arrival Time: OfS Departure Time: /J b County: SAW
Farm Name: �l.Q.�-� Owner Email:
Owner Name: WILtVr&% ski r�'�. �u e"'t- i �ot4 Phone:
Mailing Address:
Physical Address:
Facility Contact: PMk('G 14) ► tet—t Title:
Onsite Representative: t
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
Other
Latitude:
Region: FZ-0
Phone: ,,'
Integrator: Yet I? `_5
Certification Number: �L( s J
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -Layer
Ury Poultry
Layers
Non -Layers
Pullets
Turkeys
TurkeyPoults
Other
Design Current
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?
Longitude:
Design Current
Cattle Capacity Pop.
Daily Cow
Dairy Calf
Daia heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [E'1qo__ ❑ NA ❑ NE
❑ Yes [:]No Ef'NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No E] 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 eNA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ZNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ENo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facilit 'Number: jDate of inspection:
W§§te Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �fo ❑ NA ❑ NE
a. Ifyes, is waste level into the structural freeboard? ❑ Yes ❑ No L�rNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 02
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[f' o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[5No
❑ 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
[XNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[ 2"No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[ 3 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[frNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
allo
❑ NA
❑ NE
- ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind DriftA ❑ Application
Outside of Approved Area
12. Crop Type(s): N,I►4ttio 6 try
13. Soil Type(s): 'f`r V4 / VO (�
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
[21lGo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E: rKo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[3Io
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ErNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [TNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [�!rNo [DNA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design D Maps ❑ Lease Agreements ❑Other:______
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [] No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes VI'No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

FaciII Number: Date of Inspection:
24IDid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes L`J ' o
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ETNo
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?
24. 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 [3 No 0 NA ❑ NE
[-]Yes E2 No ❑ NA ❑ NE
❑ Yes C;J'No ❑ NA ❑ NE
❑ Yes 210'No ❑ NA ❑ NE
❑ Yes 0No ❑ NA ❑ NE
❑ Yes [ J] qo ❑ NA ❑ NE
❑ Yes E!�No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or. -any additional recommendations or any other comments.
Use`drawings of facility to better explain situations (use additional:` ages as necessary).
U Vo -3 De- 6 Fsr
Reviewer/Inspector Name:. L �` D V Phone: 3— 9 3 3
Reviewer/Inspector Signature: Date: �3
Page 3 of 3 21412015

S �kR&-/n
!vision of Water Resources
Facility Number ®- O Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Olioutine 0 Complaint�Follo�w-up Q Referral Q Emergency Q Other 0 Denied Access r�
Date of Visit: Arrival Time: cyl 11 J Departure Time: County: SAOI� Region)-'
Farm Name: j 5.�lr s Owner Email:
Owner Name: 040V4c Phone:
Mailing Address:
Physical Address:
Facility Contact: G061 Title:
Onsite Representative:
Certified Operator: i
Back-up Operator:
Location of Farm:
Swine
Latitude:
Phone:
Integrator: -_"' 6 1
Certification Number: -[ �d6 5- L
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
L_jNon-Layer
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
r `�
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Pullets
Other
Pou
Design Current
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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
C
Beef Brood Cow
❑ Yes Ta ❑ NA ❑ NE
1
❑ Yes ❑ No N ❑ 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 F_.;�IGA ❑ NE
[:]Yes ❑-Ro ❑ NA ❑ NE
❑ Yes [. No ❑ NA ❑ NE
Page 1 of 3
21412015 Continued

h acillt Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[ETd'—❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No [5-IqW-
❑ 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
[a'Nb ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
WNo
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑ 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 Vo ❑ 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 21'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes C::fNo ❑ NA ❑ NE
maintenance or improvement'?
11. Is there evidence of incorrect land application'? If yes, check the appropriate box below. ❑ Yes EYNo ❑ 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 ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): a L✓,&
13. Soil Type(s): G &-,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes []-ado ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [ o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the_ irrigation design or wettable ❑ Yes [2'M ❑ 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 Q No ❑ NA ❑ NE
❑ Yes []!INo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
®No
[DNA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[5-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
[a<o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[-]Yes
&No
❑ NA
[] NE
23. If selected, did the facility flail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
&No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued
i

FacilkNumber: - Date of Inspection:YL
;4. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑-i o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes S 0
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ETI�o
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 nbn-compliance of the permit or CAWMP? ❑ Yes Q N' o ❑ 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 2rNo ❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments.
Use.drawings of facility to better explain situations (use additional ` ages as necessary).
-a­� t (7
C J rr r7 .o - 3.5 3
joe(co( (C95� .94v L c
j�
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
r
Reviewer/Inspector Name: { b LG
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes Ko ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes Q�o ❑ NA ❑ NE
[]Yes [rNNo ❑ NA ❑ NE
CO VL�`�v_/
lv-'3o�-� U
Phone: E3 i
Date: ot otf4'
21412015

Q! Ms C 7 A.L. L' 16.13D
!, %Mivision of Water Resources
Full* Number l�>bJ - I 1 �1� O Division of Soil and Water Conservation
O Other Agency
Type of Visit: 0 Compliance Inspection Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: ;Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: ro County:
Farm Name: , GL-a �� �✓� -_ Owner Email:
Owner Name: "Y r-L--44_ �Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: , j(--mtM& f G tj i 'ti iq Mom-, Title: Phone:
Onsite Representative: t Integrator: at 5
Certified Operator: < < Certification Number:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish a
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
Other
Certification Number:
Latitude: Longitude:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -Layer
Design Current
Dry Poultry Capacity Pop,
La ers
Non -Layers
Pullets
Turkeys
Turkey Puuets
Other
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharees_and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [3-N-5 ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [-]Yes [:]No [R-M ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No B-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 ❑'FTA ❑ 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 ZNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facili Number: - Date of Inspection:.
Waste d1lection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes^ ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No E;kiQA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:P.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes Q.46
❑ 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 2INo
❑ 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 [Ej1Qo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes F;11<o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes [B'Ro
❑ 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 [:�IQo
❑ NA
❑ NE
Excessive Pending ❑ 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
[20No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[5No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�Ne
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
QNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ErNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ZNo
❑ 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 0No
❑ 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 �VNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

FacUity Number - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [3Yes [Blio ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other lssues
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 �io
❑ Yes [3"No
❑NA ❑NE
❑ NA ❑ NE
❑ Yes [jNo ❑ NA ❑ NE
❑ Yes C?'No ❑ NA ❑ NE
❑ Yes [;]i o ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
dNo ❑ NA ❑ NE
Z7 No
❑ NA
❑ NE
[fNo
❑ NA
[3 NE
[]No
❑NA
❑NE
(Comments (refer to question #): Explain anyYES.answers and/or any additional recommendations,or anyother comments.. I
Use drawings of facility to better explain situations (use additional pages as,necessary). .
y
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412014

Type of Visit. tDebmpli nee Inspection Q Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: 04outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Tlme: ' Departure Time: �p County: Region: f rW
Farm Name: CJ tercn Owner Email:
Owner Name. (l awv C- n tr "k Phone:
Mailing Address:
Physical Address:
Facility Contact: <E:vtvkc-C �c�l F� �^r Title: Phone:
Onsite Representative: ? t Integrator: IV
Certified Operator: t Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Currcnt
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
I
I Dairy Cow
Wean to Feeder
Non -La erA
Ed
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dt, Paul
Ca tiacl
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
on -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Dischar es and Stream Im acts
1. Is any discharge observed from any part of the operation? [:]Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? Yes ❑ No ❑ 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
A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ 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 21412014 Continued

Facilityumber: - Date of Ins ection:
I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes (11No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes ❑ No E]INA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 03:Xo� ❑ 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 EDA<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 rest, 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? ❑ YesErNo"
❑ 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 io ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
n No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes
to
❑ NA
❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Barc Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved
Area
12. Crop Type(s): �� Cal Yt'l "-L L
�u�
13. Soil Type(s): b
14. Do the receiving crops differ from thos designated in the CAWMP?
❑ Yes
[g,'Iqo
❑ 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
�o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E "'o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E<o
❑ NA
❑ NE
Required Records & Documents
�o
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes
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?
[:3 Yes
❑ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
do
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facility ]`umber: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ZIXT--❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[P-M6"
❑ NA
❑ NE
❑ Yes
❑,Ko_
❑ NA
❑ NE
❑ Yes EK0 ❑ NA ❑ NE
❑ Yes �No
❑ Yes 20
r
❑ Yes 21"No
❑ Yes 'C31<0
❑ Yes M-Ko
❑ Yes [2-Ko
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA 0 NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. f
Use drawines of facility to better explain situations (use additional uaees asnecessarv). I
a1.t 'j r9 ✓1 `T - 1 V - f
G ffe4a,4 v t
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 33 _33A
Date: p
21412014

'> CiMivislon of Water Quality
Facility Number - [IgT] O Division of Soil and Water Conservation
Q Other Agency
Type of visit: Getompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 04o'utine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: � Arrival Time: Departure Time: County:.
Farm Name: } fE C �- ` t`4.&" '=aYvtj Owner Email:
Owner Name: Wta� ~ Cn Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: Title: Phone:
Onsite Representative: t± ( Integrator:
Certified Operator: i Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -Layer
Non-
Pulle
Other
Poults
Design Current
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop,
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Bcef Stocker
Beef Feeder
Beef Brood Cow
[:]Yes ©-<o ❑ NA ❑ NE
[] Yes
❑ No
[
❑ NE
❑ Yes
❑ No
[-NA
❑ NE
❑ Yes ❑ No
❑ Yes [31TO
❑ Yes f No
[j-1gA ❑ NE
[DNA ❑NE
❑NA ❑NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
Zs storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ 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 e-1qo_ ❑ 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
❑-�
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
10
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[E Zo
❑ 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
ZTNo
❑ NA
❑ NE
maintenance or improvement?
Waste Anylication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Cj"No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes 0--No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload [] 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): 19, S
13. Soil Type(s): %%{?
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
LQ "'o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[3 o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
GI'No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
°
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yeso
WN
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes ! <o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes Ta
❑ 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
D Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
�No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facili -
2,'j. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 9;o0o
NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑Yes NA ❑ NE
Ld
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 2<0 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E].Na- ❑ NA ❑ NE
Other Issues
2$. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [ No ❑ NA ❑ NE
❑ Yes MKo"— ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes E J l�o
❑ Yes �o
❑ Yes [?No
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Comments (refer to question #): Explain any YES answers and/or any additional:recommendations or any other comments.:
Use drawings of facility to better explain situations (use additional panes as necessary).
GJ'L�'_'A
J
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
-Uj oo 0CgI
Phone: i 10
Date:
2/4/20I4

C _'\
iv sion of Water Quality
Facility Number -awl O Division of Soil and Water Conservation
O Other Agency
Type of Visit: 70'Utine
ance Inspection Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: f Arrival Time: Departure Time: County: �a.,_ Region:
Farm Name: tIy/(liti Owner Email:
Owner Name: WD�"/Q-� ._., Phone:
/7
Mailing Address:
Physical Address:
4 ,, 1
Facility Contact: t`0jA%4c4 J, l Title: ]?
Onsite Representative:
Certified Operator: lC
Back-up Operator
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean ;
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
to--0TV
V PR
hon
Integrator: '
Certification Number: 1(f? l 6 C
Certification Number: �"i r .5,7
Latitude: Longitude:
Design Current
Wet Poultry Capacity Pop.
La er
Non -La er
Dry You
Layers
Non -Lay
Pullets
Other
Poults
Design Current
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dai Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ® ❑ NA ❑ NE ,
a. Was the conveyance man-made? [:]Yes [:]No CSANA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No [;[-hi71 ❑ 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 [ ..>M ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [ 10 ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

aeili Number: Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[5 M
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[]P o
❑ NA
❑ NE
Structure l 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
[E do
❑ 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
[j_)Ier
❑ 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
P;�No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[a Vo-
❑ 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
�Io
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
L ]Xo'
❑ NA
❑ NE
❑ Excessive Ponding [] Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs. ❑ 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): $ J4vm�(
13. Soil Type(s): &6 14
14. Do the receiving crops differ from those designat d in the CAWMP?
❑ Yes
E1,110
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Q No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[;lo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[hfo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
CffNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
nNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Ef No ❑ NA [] NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis []Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? []Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: -I Date of Inspection: C
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑oKo"" ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes NA ❑ NE
the appropriate box(es) below.
�] Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge Ieve] s
❑ 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 Vo ❑ NA ❑ NE
Other Issues
28. Did the facility fait to property dispose of dead animals with 24 hours and/or document ❑ Yes []Ko ❑ 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 rNo ❑ 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
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 ReviewerlInspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [�io
❑ Yes 61d O
❑ Yes
❑ Yes
❑ Yes
❑NA ❑NE
❑NA ❑NE
a ❑ NA ❑ NE
N9, NA ❑NE
o ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional paces as necessarv).
0 5.3
F -w4
Reviewer/Inspector Name:
ReviewerlInspector Signature:
Page 3 of 3
Phoney t -43S—
Date:
21412011

Facility Number ®- 1 �, O Division of Soil and Water Conservation
O Other Agency
type of Visit: omplianec Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
lheason for Visit: 0.1koutine O Complaint 0 Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: 61-, W Departure Time: County: Region: E&
Farm Name: i�i c �.,arti4h � U a IL'f Owner Email: T_
Owner Name: VNC\ NM b Phone:
Mailing Address:
Physical Address:
Facility Contact: & k4n t, Mt k A fy\�) Title: Q w t` F,j'1L Phone:
Onsite Representative: t4\-'3AS'0 M"-'icaa.b Integrator:
Certified Operator: 'N\-t cit., Certification Number: -1'7�,7
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
oars
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Nan -La er
ury routrry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Discharges and Stream Impact
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)?
Longitude:
Design Current
Cattle Capacity Pop.
Daja Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [/lo ❑ NA ❑ NE
[:]Yes [:]No
[:]Yes [:]No
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of a past discharge from any part of the operation? [:]Yes gNo
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes " NO
of the State other than from a discharge?
Page I of 3
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ 'NA ❑ NE
❑ NA ❑ NE
21412011 Cantu

Faclii Number: $a - a,\ Date of Inspection; 10 (k
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): r'
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
[2No
❑ 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
E;�No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
O�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
[2f No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
vdNo
❑ 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): IS .
13. Soil Type(s):sf\Follt y Qyk{�.�1 is ���ti MacLs1� f� t
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[ o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E2'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[S?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 Cgof4o ❑ NA ❑ NE
❑ Yes [ *'No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes E'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes [vYNo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps D Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes QNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis D 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 [v"No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [;�No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

I
Facili Number: a - 1XI Date of Inspection: /Q J a
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[2No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
rVrS;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
[�No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
2"'No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
ErNo
❑ 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
NMO
❑ NA D 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
DNo
0 NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[5No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
CZNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
["No
❑ NA ❑ NE
Comments (refer to question #): Explain any: YES answers and/or any additional recommendations or any other comments
Use drawin s of Facili to better ex lain situations (use additional ages�as`nece'ssaiy
�t' Q�1!~fA7 L.A�4ot� $�`s�c,E. �riv(IVC;`f CC)t�•���-�£,D�� c'3�C11'�.
aF TkP" Sow
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Q1p`:R •1 MBA
Date:
21412011

sti Sys I o a 1 I r C� l -
1)i'vision of'V1'ater Qualify
Facility Number $ �. - �d I Division of Soil and Water Conservation
QQ Other Agency
Type of Visit: ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: to Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: jp [ Arrival Time: Departure Time: Q� County: $ U
Farm Name: N" U �0-/M [ Owner Email:
Owner Name: _ j Ihh -.el'&YR �G b Phone:
Mailing Address:
Physical Address:
1 Lan
�
Facility Contact: M 16, NcLan b Title: _Owe-pr• Phone:
Region: M
Onsite Representative: H I E�h (IcLojnb - - . _ Integrator: HU 6— f /6yt
Certified Operator: I I {+10e, MC—" b Certification Number: 99270
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design
Current
Design
Current
Design Current
Swine Capacity
Pop.
33JtM'I
F 'ap, a c i t7v=
1
0 Kc--attle
Capacity Pop.
Wean to Finish
Layer
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
fare P,oultr�
C_a acit
P,o
Non-Dal
Farrow to Finish
ers
Beef Stocker
Gilts
Non -La ers
jBeef Feeder
Boars
Pullets
113eef Brood Cow
Turkeys
©thcr
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes 5a-No ❑ NA ❑ NE
❑ 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
g No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
PTNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

FacilityNumber: a• - a Date of Inspection;
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? ❑ Yes 52 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): Lee+alae q, B 1HS
Observed Freeboard (in): 3 a ^ b `
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
t' No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a
15] 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?
OYes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�jNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
R No
❑ NA
❑ NE
maintenance or improvement?
Waste ADDIleation
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes §{ No ❑ NA ❑ NE
maintenance or improvement? TT''
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Pa No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
bd No
❑ NA
Lj NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
2[ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
O No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
5;� No
❑ NA
❑ NE
20. Does the facility fail to have ail components of the CAWMP readily available? If yes, check
❑ Yes
1p 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 KA No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No RNA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: a. -
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 first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility'? If yes, check the appropriate box below
Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ NA ❑ NE
❑NA ❑NE
[:]Yes
2No
❑ NA
❑ NE
❑ Yes
[] No
CRNA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
Yes
❑ No
❑ NA
❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
'®'No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
Er No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
RrNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any.ad litional reco6imendation5;nr any, oth`er'coirisnents : , `
Use drawings of facility to better explain situations (use additional pagesA`s necessary).
7, P&rrdrob In s�r �ayc io paavlo ff—. Nov— stead_ old r*
y on�
C < ©a 1a 06) (5) SHe_ - drle1 U
9 A , 0,�7 W11(need—tod-eal 04-10746 04S-O, WU
% e dalY ea-,
3(, d(d drd i(e_ t`obab v4dey
� �' � ►sorb ��c�uer has �e���e�, i�-�'iinn�� �a
New coioins I ook olx�,
(0� roc 9
4
Reviewer/inspector Name:
Reviewerhnspector Signature:
Page 3 of 3
Phonelt&_q.
Date: Ont (0, aQ
—T'�
21412011

Facility No. Qa~ f d I Farm Name . /J E?4 ( Date I
Permit COC 'k,� OICT NPDES {Rainbreaker PLAT Annual Cert )
r ... =- MIMI�
Lagoon
1
2
3
4
5
6
7
S illwa
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
f ? R I offth/'
Actual Width
Soil Test Date Wettable Acres RAIN GAUGE
pH Fields WUP Dead box or incinerator
Lime Needed gip_ Weekly Freeboard Mortality Records
Lime Applied 1 in Inspections
Cu-I \/ Zn-1 c/ 120 min Insp.
Needs P Weather Codes
Crnn Yielr� �s 1 i1gjl,4 Trnncfpr Shppt.Q
MEMO
%rify PHONE NUMBERS and affiliations
Date last WUP FRO gjJa10-) Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-1 3000= 108 iblac; Zn-I 3000= 213 Iblac
App. Hardware

W 0 (Ks 1a130110
Facility Number �a a
Iblvision of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 15 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 10 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: r County: Region:
Farm Name: G WO F � Owner Email:
Owner Name: �i 1 1' i lz_ P _. M(�i<Q�t '1 Phone:
Mailing Address:
Physical Address:
Facility Contact: 1 11a, r i,Lanb Title: (()lyn`Pr Phone No:
Onsite Representative,:` i'f 1 11r.1 f]I9'I�J Integrator: t-1� B
Certified Operator: f I' I(-fon M R l ccim b Operator Certification Number: `�n 87 767
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: r7e = 6 = 1{ Longitude: = o = ` = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
-.1 El❑ La er
ION n-La er
Dry Poultry
Non-L
Pullets
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes QNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
�'No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: -- Date of Inspection a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes W No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 0�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 5'No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures 6n-site which are not properly addressed and/or managed ❑ Yes E�,1Vo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? (Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �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 CRNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes tZNo ❑ NA ❑ NE
maintenance/improvement'?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes '�2 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
0
�0-' Sri
7
1
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[R'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
tZNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
9No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
-!�rNo
❑ NA
❑ NE
Reviewer/Inspector Name r Phone: y3�3
Reviewer/Inspector Signature: %In, Date:
Pine 2 of 3 _ 12128104 Continued

Facility Number: $ — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WDP ❑ Checklists ❑ Design El maps El Other
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [RNo ❑ NA ❑ NE `'I
21. Does record keeping need improvement? If yes, check the appropriate box below. 9Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard 'Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield .❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
f�'No
❑ NA
❑ NE
❑ Yes
❑ No
U NA
❑ NE'
❑ Yes
qNo
❑ NA
❑ NE
❑ Yes
BNo
❑ NA
❑ NE
❑ Yes
®-No
❑ NA
❑ NE
❑ Yes
❑ No
tl NA
❑ NE
[]Yes ff No ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes E9 No ❑ NA ❑ NE
❑ Yes Dlo ❑ NA ❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
E?rNo
❑ NA
❑ NE
i
Aiditional'Commen.ts.and/or;Drnwings:
1 1 a
000
IS� Gul c�a��sllc� la tin war �eryo�k� �,�, u�.csh,� ,
alp lVO&sc,V�j � ��j �" ���s loo tea �3 M&A 0ka sal i �
�
r�
Laf4-�r s
sores �va eve �bvq#d a� g 81 1V i^At-)Aan he A'6@ t 41 jV1'0.
PAV 4�- eve, r jr 40 t_1
M2V, cvrtros i nS I ky .
Page 3 of 3
12128104

Facility No. �Farrn Name HCI A h J Date
Permit ""', COC ✓ OIC_ NPDES (Rainbreaker PLAT Annual Cert )
FB
Drops
i .
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
L��
Calibration Date
In- Jul
ERMINE
Actual Width
r�l r�-------
V
✓
Soil Test Date
pH Fields
Wettable Acres
WUP Ll
RAIN_ GE /
Dead box r incinerator {-
--Lime Needed Vh
Weekly Freeboard-
Mortality Records
Lime Applied Z�60Q
1 in Inspections �—
Cu-I `" Zn-I
120 min Insp. �—
Needs P �� ^ N
Weather Code
CropYield �'a
Transfer Sheets
Waste Anal sis Da e
- 60 Da
+ 60 Da
N Amt (lb11000 Gal)
7,1
:.
..
..
Y .
r , . r, MM
WWAM
: �,
■r
Verify PHONE NUMBERS and affiliations \, t . , ANI
Date last WUP FROq(ia(,,-) Date last WUP at farm I4n'b)(ON
FRO or Farm Records c: o
Lagoon #
Top Dike � 'D � 10
�
Stop Pump �� 4 -rlU%dL hd1'�.
Start Pump ya,t?✓
Conversion- Cu-1 3000= 108 Iblac; Zn-I 30 0= 213 Iblac
App. Hardware

13IM 5 /- OV YZOl4
2 H1z1
1Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
ReasonforVIslt Cl Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: z'31-09 Arrival Time: /:35 Departure'Iime: 2:5 .+� County: SQN' SGN
Farm Name: l#ClaAkI0 AWAgS Owner Email:
Owner Name: /„rf ^� 41clg"eb Phone:
Mailing Address:
Physical Address:
Facility Contact: �'/�%�n1 /:�C%RSKE� Title:
Onsite Representative.�`�%e�la _
Certified Operator:
Back-up Operator:
Phone No:
Integrator:�����
Operator Certification Number:
Back-up Certification Number:
Region: �R�
Location of Farm: Latitude: = e =' =" Longitude: = o =' 0 "
Design Current Design Current
Swine Capci�ty Population Wet Poultry Capacity Population
Design C►urrent
C►attic Capacity Pop lotion
❑
Wcan to Finish
❑ La er
❑ Dairy Cow
❑
Wean to Feeder
n-La er
❑ Dairy Calf
Dairy Heifer
❑
Feeder to Finish
12800 1
❑
Farrow to Wean
Dry Poultry ❑ Dry Cow
ElNon-Dairy
❑ Layers
❑ Beef Stocker
❑ Non -Layers
El Pullets El Beef Feeder
❑ Beef Brood Co
❑ Turke s
❑ Turkey Poults
❑Other Number of Structures:
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
El"No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
O NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
1A
❑ 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
fA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Ej o
❑ NA
[IN IS
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
o
ElNA
[INE
other than from a discharge?
12128104
Continued

r
Facility Number: 62 — /Z/ Date of Inspection
Waste Collection & Treatment ��
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes ,L�� oo [I NA ❑ NE
ElLS
a. If yes, is waste level into the structural freeboard? Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: /1/
Spillway?: 170
Designed Freeboard (in): 2
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
ETNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
BINo
❑ 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
+Li' No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
2<o
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
BIC
❑ 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
[f 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 Drifl ❑ Application Outside of Area
12. Crop type(s) �e rw ciG., �� , .Small r�ro;,v (0,5, J ftJi�, -r fl�nluq
rage'
5u %
�•r•cv 1¢n�ucu2 S
��//
13. Soil type(s) A>A �K, ifary4At
—
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[] No
❑ NA
❑ NE
No
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0 1
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
NNo
❑ NA
El NE
hF�
17. Does the facility lack adequate acreage for land application?
Yes
Elrl
l.,, NNoo
El NA
NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[B o
❑ NA
❑ NE
�Phone: `I{O•43�3
DZ � 0Reviewerllns actor Name ReY
Reviewer/Inspector Signature: Date: /Z 3/ --ZOO
12128104 Continued

r
Facility Number: I'Z --/21 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes FNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ETNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge? ElYes Llo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ['1/NNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
L��I,, NNo
❑ NA
❑ NE
El Yes
L_► NNo
El NA
El NE
ElNYes
L9 o
❑ NA
❑ NE
❑ Yes
I J No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawinas:
❑ Yes & No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
eN.
❑ NA
❑ NE
❑ Yes
EJ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12/28/04

F O Division of Water Quality
Facility Number O Division of Soil and Water Conservation
0 Other Agency
Type of Visit (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
-7114'9
Date of Visit: Arrival Time: - Departure Time: County:' f Region:
y�Pfl
Farm Name: I-11, _Camb I`(,frn r 1a, Owner Email:
Owner Name: -pf MC Lam b Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator: � 1114on Hr 1 near b
Back-up Operator:
Location of Farm:
Phone No: pp
Integrator:' �� D
Operator Certification Number: 9-7 r
Back-up Certification Number:
f
-Latitude: =° 0; Longitude: ° [�«
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dai Heifer
E]Dry Cow
El Non-Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: 10
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 �Q No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
MNo
❑ NA
❑ NE
❑ Yes
J-No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

r
a
Facility Number: a — Date of Inspection I ! ! f 0 $
/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes [SrNo
❑ 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
, f
Identifier:
Spillway?:
Designed Freeboard (in):�— a y
Observed Freeboard (in): ag
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes EfNo
[INA
ElNE
(ie/ large trees, severe erosion, seepage, etc.) 01
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes RNo
❑ NA
❑ NE
_ through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes ;K No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? []Yes fRNo ❑ 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 fRNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes C"No ❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 5a'No ❑ 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 ElApplication Outside of Area
12. Crop type(s) Co#,Jo j1 BP/M✓da (2) - S& 41 , hl/1'�r}�17�•L7 �, SyrAllfr� YI�II f
i
13. Soil type(s) Ayl (,4 Mot ivy n
f j ✓ /
" 14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
r
RNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
S Yes
&No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
[RNo
❑ 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
9No
❑ NA
❑ NE
Reviewer/Inspector Name I- _� _- _ — — Phone: tg10) Ll33_3300
Reviewer/Inspector Signature: Date: -7 t J 09
Page 2 of 3 U 12128104 Continued

. Facility Number: Date of Inspection
g'a, -- 4� i—ir r r E,t
RRe aired Records &_Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have al{ components of the CAWMP readily available? if yes, check ❑ Yes 5kNo ❑ NA ❑ NE
the appropirate box.
❑,WUP [I Checklists ❑Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes M"No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
`0. Did the facility fail to conduct a sludge survey as required by the permit?
126. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
i
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were igher than normal?
30. At the time of the inspection did the ose an odor or air quality concern?
If yes, contact a regional,Air Quality repreesenti# immediately
31. Did the facility fail to notify the regional office of emir kusituations as required by
General Permit? (iel discharge, freeboard problems, over app4v*)
Did Reviewer/Inspector fail to discuss review/inspection with an on -site esgnta ive?
33. Does facility require a follow-up visit by same agency? ����
f5,
❑ Yes
&No
❑ NA
❑ NE
❑ Yes
❑ No
�;J•NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
®'No
❑ NA
❑ NE
❑ Yes
[R^No
❑ NA
❑ NE
❑ Yes
❑ No
CO NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
[]Yes
J No
❑ NA
' ❑ NE
❑ Yes
R-No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
�RNoy
❑ NA
❑ NE
❑ Yes
JR-No
❑ NA
❑ NE
�p .._ -.:a. _r 2M ,� �,.g
AilditionalCommeiits andlor Drawings ,,`
©wn fir )also Yhaw fols toy *ed�_ -qo, riogPo4s) plej� sOc -j
AL
Also elft +o Yrofk o, L417 nea- )o�1 ` m-Yvo)+1n.� �oy--
Csla-e m m y ,
iVill "4401ime. fire r soo,� ,
Good.. ' 9raJs cln I yove). A -Pe w ba-,e S f As.
Kele (if 01 wo,I &) ys;r be>b- let, ao08". s
,)
(Attldoi� IN owl'
Page 3 of 3
12128104

SM-37q (o
ility No. $a wla_J Time In Time Out Date
Farm Name ma.mam tfcLh b Integrator
Owner Site Rep
iOperator No.
Back-up
1►ra
COC Circle: General or NPDES
Design
Current
Design
Current
Wean -- Feed
Farrow — Feed
Wean — Finish
Farrow— Finish
Feed -- Finish
$O
Gilts 1 Boars
Farrow — Wean
Others
FREEBOARD: Design Observed rq R_
Sludge Survey �a1it 10��-��I� �" 4`7 Calibration/GPM 1 �d—IAA—SV �aj
Crop Yield Waste Transfers r/
Rain Gauge Rain Breaker
Soil Test Wettable Acres PLAT
Weekly Freeboard Daily Rainfall 1-in inspections
Spray/Freeboard Drop
Weather Codes 120 min Inspections
Waste Analysis:
Date Nitrogen (N)
4 13 01 Z.4 - —Z
3.0
Date Nitrogen (N) OX ,
44 L(A 107t j �. 0
121 - _1
Pull/Field Soil Crop Pan Window

Lacility'Number dt i Ia�
v;
Division of Water -.Quality
�: a are,
0 Division of Soil -and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Iog' -41" I Departure Time: 14 K County: 04 Region:
Farm Name:
Owner Name: N` r 6+r1 f i' e- rce- ti►� clamL
Mailing Address:
Physical Address:
Facility Contact: Ak" 40-1 Ft\eirCk / iLLar4!qitle:
Onsite Representative:
N
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
Latitude: 0 0
Owner Email:
Phone: lg1Q S33-3224
Phone No:
Integrator: Pre_ iv. m S" r
Operator Certification Number:
Back-up Certification Number:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys,
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Longitude: = ° =' = "
Cattle
Design Current-
Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
i
Number of Structures: r a,
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 F No ❑ NA ❑ NE
❑ Yes ❑ No (PNA
❑ NE
❑ Yes ❑ No Y,NA
❑ NE
❑ Yes ❑ No RNA
ElNE
❑ Yes qNo ❑ NA
❑ NE
❑ Yes No ❑ NA
❑ NE
i
12128104 Continued

Facility Number: a Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
ElNA [INE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
MNA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
d
Observed Freeboard (in): 30
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
OiNo
[]NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
DONo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
t l . Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[ R No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ FAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
FNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
P No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes'
RNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name Phone: 10 — 700
Reviewerllnspector Signature: Date: q E
12128104 Continued

L
Facility Number: — Date of Inspection
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes I' No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes t?�No ❑ NA ❑ NE
the approprrate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes R 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 r 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
No
❑ NA
❑ NE
25. Did the facility fail to conduct Ia sludge survey as required by the permit?
❑ Yes
61 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
JD No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
5j 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
'�No
El NA
El 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
JKNo
❑ 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
BNo
❑ NA
❑ NE
12128104

LE
Type of Visit 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: 10 Arrival Time: •'Sr0 Departure Time: I 10 fit% rK I County: Cry Region: PAO
Farm Name: 6avv..PLem Owner Email:
Owner Name: M t [+p eh 1' 1G L vvJ9 Phone:
Mailing Address: l.t Yt
Physical Address:
Facility Contact: I rl� 4� ` v`'y`� Title: Phone No:
Onsite Representative: Integrator: I ire-miuy" s+kj&rJ
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e = 1 =di Longitude: = o = C =
64
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle C►apacity Population
❑ Wean to Finish
IQ
Layer
I
I
❑ DaiEj Cow
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
2$
10 Non -Layer I
a2
Dry Poultry
❑ i.a ers
❑Non-ts ers
I
❑ Dairy Calf
❑ Dairy Heifer
❑ D Caw
❑ Non -Dairy
❑ Beef Stacker
El Beef Feeder
El Beef Brood Cow
Number of Structures:
❑ Boars
U#he
❑ Other
El Pullets
❑ Turke s
urkey Pouits
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
5DNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
1P NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
P 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
�2 NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
1�_14 No
❑ NA
❑ NE
3, Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page 1 of
12128104
Continued

' Facility Number: — [ Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
N No
❑ NA
❑ NE
a. If yes, is waste level into the structural Freeboard?
❑ Yes
❑ No
N NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
II
Designed Freeboard (in): tq +I
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
P No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
29 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
19 No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes R 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 M No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [D No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 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
N No
❑ NA
[I NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q� No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
R] No
❑ NA
❑ NE
'Comments (refer to question #): Explain any YES answers and/or any recommendations or any other, comments
Use drawings of facility to better explain situations. (use additional pages,:asmecessary):
Reviewerllnspector Name I i Q,Ir- I Pho� 0 d
Reviewer/Inspector Signature: Date. r -33m
Page 2 of 12128104 Continued

x
Facility Number: `,Z—Date of Inspection io D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [,�rNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [X No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes � No El 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
10 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
PNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
1KNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
9 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
91 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[9No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�ffNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
P No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[5WNo
❑ NA
ElNE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
P No
❑ NA
❑ NE
General Permit? (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
Additional Comments and/or Drawings:
,1j . SgJ ' `a 5i5, u►; It be c0lec a%'-{*-✓ G9��g¢a.v►S �}eS AL
L
Page 3 of 3 12128104

Type of Visit A Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit • Routine 0 Complaint 0 Follow up 0 Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: a7 ly Arrival Time: A? 4/S— Departure Time: County: -t ►► Region:
Farm Name:
�anr6 �� m-s Owner Email:
Owner Name: Phone:
Mailing Address: .5r1 Ru n-fe r
Physical Address: _ 5�+^�a oFioh.. �, e►+ t o +-ter a S 4 743
Facility Contact: Title: Phone No:
Onsite Representative: 4eN Me Le w. � integrator: �e,�.u.,., SI'A.,�a#-X
Certified Operator: 14—e, Atp� _ /o .6 Aj Operator Certification Number: 1*0
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [� 0 =. = Longitude: 0 ° 0 4 0 4{
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish 2,0 a8'G 3
❑ Farrow to Wean
i
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer I I
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkex Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures: ELI
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
165
12128104 Continued

w 1
LFacilltyNumber: $.2 — /.2i I Date of inspection /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard {in}: � 7 h
Observed Freeboard (in): 3 -2 "
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Ai mlication
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
E No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifi ❑ Application Outside of Area
12. Crop type(s) a r �• (� �s�^f
o
/,� Le
/�
13. Soil type(s) a /i, [moo - e2& C ^/ A
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
Q No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
U No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA ❑ NE
icy:;to 6e
Reviewer/inspector Name GG� -r ,Q�x% `� � '' �k Phone:
Reviewer/Inspector Signature: Date: a2 140Fl
/ 12128104 Continued

Facility Number: g..), — �,�/ Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [%No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
® Waste Application ❑ Weekly Freeboard ® Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
a Rainfall ❑ Stocking 5a Crop Yield [X 120 Minute Inspections [M Monthly and 1" Rain Inspections W Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes OlNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 42 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[M Yes
❑ 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
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[� No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[0 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
ERNo
❑ 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
[Z No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
EN No
❑ NA
❑ NE
Additional Comments i
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12128104

(Type of Visit I C.,/ompllance inspection O Operation Review O Lagoon Evaluation j
Reason for Visit too Routine O Complaint O Fallow up O Emergency Notification O Other ❑ Denied Access I
Facility Number late of Visit: Time: o
Not O erational C Below Threshold
M"Permitted OrC ertified ©Conditionally Certified © Registered Date Last Operated or Above Threshold:
FarmName: ..... !Cl.,ow.,k............ Foxor".}.c? ................................................................. County:..... r ' !......................................................
OwnerName:............ _IAA!1..................... . N�................................................... Phone No:... !.r�..- .T.'°.��R........................... I.........
Mailing Address:.......... 1121YII.......... ; ` k......RA-1...................................... ............ Lr�f.t� D!" ..........�L+................................... I....... ..'en .raz....
FacilityContact: .............. M �. ` ......... �................ Title: ..... hLuP E&.......................................... Phone No:C....'........4......................._..........
Onsite Representative: .........��.I_R*j................... (.c�.r�°...................................... Integrator:..._.14 Mn �...........................
Certified Operator:,... .e! i � P.MCGu-�o Operator Certification Number:,,., , r q34; ,,,,,,,,,,,,.
Location of Farm:
Erlsl�wine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude • 4 "
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3, Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ............... . I...............................................................................................................................................................
Freeboard (inches): �_•Z ;.,GS
12112103
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
[2io
❑ Yes
['No
❑ Yes 2 0
Structure 5
Continued

Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes R"No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes 0 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 2rvo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes B No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes VNo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes �No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type &4MAJ& atVk 1 t_ SfA41I Arj, ', V% , am . Sa��LarrS . "&+' Oeft A �
13.
Do the receiving crops diffWwith those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
[!] No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
YNo
b) Does the facility need a wettable acre determination?
❑ Yes
9fNo
c) This facility is pended for a wettable acre determination?
❑ Yes
Y'No
15.
Does the receiving crop need improvement?
❑ Yes
2�No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
2lo
Odor Issues
I7.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
[ 14c.
liquid level of lagoon or storage pond with no agitation?
18.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
81�o
19.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
(�No
roads, building structure, and/or public property)
No '
20.
At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
U
Air Quality representative immediately.
0

Facility Number: C6 g. _ .;, j Date of Inspection '� o
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes 0N0
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.) ❑ Yes M-Ko
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [r 0%
❑ 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
B1 o
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
[JNo
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
[g4o
(ie/ discharge, freeboard problems, over application)
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
BNO
28.
Does facility require a follow-up visit by same agency?
❑ Yes
[Vigo
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
GK40
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
[moo
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
01I0
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
[HQo
34. Did the facility fail to calibrate waste application equipment? ❑ Yes [-lo
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes 21go
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

I Facility Number 2 !
Date of Inspection
Time of Inspection ' aD 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: registered El Applied for Permit (ex:.1.25 for 1 hr 15 min)) Spent on Review I�
Certified El Permitted or Inspection includes travel and processing)
❑ Not Operational Date Last Operated:......................................................................................».............................................................
Farm Name: ...L..'..iCL 0.Y! U.......Fn_ �............................................_...... Couiaty:.... }!*'I�. ?.........................................
Land Owner Name:&J..j P r.�Y.I .........C.L&1-16................................... Phone No: ...ftrp).....tgi—...22103...............................
Facility Conctact:.........(in ...... J!x.!.0 �-0..!' 1I.J.......... Title: �e..!I�.e.. ................ Phone No( 03 p)..Cla1 ,Z.Z�o............
MailingAddress:.....g .....]rl�:+ x .......................................................... �.! h .t...r V................................... 1992 ..
OnsiteRepresentative:......Y`............................................................................ Integrator:.....W4fsn..t�a�.ix5.
Certified Operator: .&1.1.�?1.�..... �................ .0 (,rgllA QI,...IrL............. Operator Certification Number:.............�...f. ............,
Location of Farm:
Latitude ' 4 « Longitude 0 4 '•
Type of Operation and Design Capacity
Gepgral
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water'? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in ga!lmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes KNo
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes No
Continued on back

1.
+�. Fac lity Number:.,
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Struc(Slres (Ijggoons an&or IfoldingJ!onds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure3 Structure 3
+7C .......at.. ..... .... �2............
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
Immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes No
❑ Yes
❑ Yes gNo
❑ Yes /"'
10,
Structure 5 Structure 6
WasteAgpligAtlon
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ...�l .ir1�1. 5�., . � lY.e........................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For Cc[titied Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes o
❑ Yes //RNo
❑ Yes �lo
❑ Yes P No
❑ Yes ANo
❑ Yes No
El Yes No
El Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes O(No
❑ Yes 0 No
❑ Yes W No
Corriments,'(refer to question.#) �Explain'ariy YES answers andlor' any, recommendations of any other comments ,,' ` � r y
Use: drawmgs,of facility to better explain situations'',(use additional pages as necessary)
ReviewerlInspector Name
Reviewer/Inspector Signature:
Date: 9 --I S'--�1 I
ec: Division of Water Quality, Vier Quality Section, Facility Assessment Unit 4/30197