820169_INSPECTIONS_20171231

NUH I H CAHULINA
Department of Environmental Qual

Li
E ' ` I ;Il,i" r l°. Div Sion of Water R ..... sottrCe
I ! � , �
Facili Number ✓ Division of Soil andWater Conservzttion ii'''
1
0 Other'Agen N I, :l.li,r . ' IE i �!+f� lalY'i { {Itl+qi
Type of Visit: C�omppliance Inspection Operation Review O Structure Evaluation p Technical Assistance
( Reason for Visit: tcoutine 0 Complaint 0 Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: �� Departure Time: ; N� County: �■---- Region: /
Farm Name: �}Tr ���r5&:ej�ZKopez7 511`- Owner Email:
Owner Name: 31-e'cf` Phone:
Mailing Address:
Physical Address:
Facility Contact: (32wxYr jvvoec Title:F! .��15c. Phone:
Onsite Representative: integrator:
Certified Operator: Certification Number: 3
Back-up Operator:
Location of Farm:
Wean to Finish
Wean to Feeder
O-o
3 D �
Feeder to Finish
C7rJ0
Farrow to Wean
�j
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Certification Number:
Latitude: Longitude:
I I I �FI��i i:s .i�id i {I ! {l ,+I� Ii111„�llfl S 4Yt Y..:�3!lilflllil�llllia
I`peSi o Cnrrentri­h. Deli n '61,&nt' �I .# ('"+I;IIEi 1191is :..l iili i ijI . li "
;� I Iti 1; tg „j I ..{ a ! , I:���� �::i�. Y, k!!�� I i ai! fir n I 1�
;I II .�';� .., ! 4 f� Des gn C.0 e t u
l: ' ,{ i�lII.:.li€EI;�{IIEIIE , el.' {r.� at �; I ;�[�?i � IE9-,l nY; rEY41;j1'111RI�1 ? �
Swine Capacity�Po I i Wet, Poultr 'Ca sett ! Po a 11 � 1 'Cattle i{ ,I, �+ I ;11 r Ca aci
I
} t i'�
p �' Y p , Y i , I , . p { I; p. t�..,,;.
�i.
LayerFfDaiV I+
Non -La er r +r
v` I:
#, '.I.4 - ,Y�41 illl
I Designs jCarientp�rI!�Dry ,Y I h 'r I'Y V 'I E i I,!?I {rYit
,,:-, D ,'Foust �sCa 'aci IliI:Po „rl
j
Layers„,
Non -Layers i,"''
Pullets I
TurkeysF!
I 1 I r s s[ I+ YI It' rrr 1 H�
Other TurkeyPoults I I I I I
Other' Other+�91ll,nul I,i lv�lt4 11[y'",tld}P�17+i�xlEi1NI+� II II�IItl{d}q�, p jli{ilt rl�Ir{rtI{ IiI�'
IIYI i.111Y1{lf! 'II1,I�IIIIIFi� 9 1 gIY.�3,lk���]l��f�4I111iIIII I �II��i1 Ilil I� lil�ulf€frFlii lH�li7 ll�I�'IEi
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Cow
Dai Calf
Dai Heifer
Cow
Non-Dai
Beef Stocker
Beet Feeder
Beef Brood Cow
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
Q-No
❑ NA
❑ NE
❑ Yes
[D iVo
❑ NA
❑ NE
Page 1 of 3 2/4/1015 Continued

' Facility Number: ZZ - 72= 1 Date of Inspection:
\ Waste Collection & Treatment
°i 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: JVVr' / ,"-5 r.� �co c•�
Spillway?: /
Designed Freeboard (in): -
Observed Freeboard (in): _ 37 3_2
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E]--No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
DNA
❑ 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
to
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
F '' 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
[3 o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ 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): &'- rt Jcc Inrrrp
13. Soil Type(s): _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [(] N� ❑ 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 [3 Z ❑ 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
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? Ifyes, check
the appropriate box.
❑ Yes / No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes CfNo ❑ NA ❑ NE
❑ Yes F3No ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

/L'�-
' F'acili Number: - ©ate of inspection: fir/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
affirm ��r�ar��d ) f"rr-40
No ❑ NA ❑ NE
t..71fe ❑NA ❑NE
[:]Yes Io
[:]Yes ❑-Nb
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes Fglgo ❑ NA ❑ NE
❑Yes [] o ❑NA ❑NE
❑ Yes E3-&o ❑ NA ❑ NE
❑ Yes L'J '"o ❑ NA
❑ Yes ❑ No' ❑ NA
❑ Yes No ❑ NA
[:]Yes Fa/No ❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
Reviewer/inspector Name: _�� � _ ��--�u���-"-` Phone: ,9,-Ip
Reviewer/Inspector Signature: Date: "Wolk�
Page 3 of 3 21412015

ivision of;Water ResourceC ;q'" 1-q:1
'1 .�•, ,1 i�.l .!....,.FacillityNumber ,. Ir iQ Division of:Soil and N?ateronscrvation��ij�4iiY �C
I "�I " ixl� a.:�i •� ,J. Q� , g Y.I, ' �i J� Other A enC s _ ." =L t 1�� „',�G hl i�•�rl •IVir� �d' Pd:'Ji h I �� 6�
Type of Visit: C�om�pliance Inspection Q Operation Review Structure Evaluation 0 Technical Assistance
Reason for Visit: C�J itoutine Q Complaint 0 Follow-up Q Referral Q Emergency 0 Other Q Denied Access
Date of Visit: Arrival Time: ;gyp Departure Time: County: Je-' Region:
Farm Name: !d / ?4—Vf►v�- Owner Email:
Owner Name: �j �C ;�'rI rdlnt6 C_ Phone:
Mailing Address:
Physical Address:
Facility Contact: � � ryjc or—�_ Title: YZC=L d l Phone:
Onsite Representative: OcY`L- integrator:
Certified Operator: ezY?�C %�/� /�%�1���— 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
Gilts
Boars
i
Other' ; I
Design Current
Capacity • Pop.
Latitude:
Longitude:
` i)esIgo Cujrent ' � ` �� Desig
Wet,Poultry ,
Capacity
Pop. -.,'.a, 11,
Cattle I CSpae.
I.
Layer
��,.,
Dairy Cow
]Non -Layer
Dairy Calf
}H-
s''i
Dairy Heifer
uDesign
'Current' '
Dv Cow
Di �PoultrICa
aci
Y'1'o �.
Non-DaiEX
Layers
fi''if
Beef Stocker
Non -Layers
i:,
Beef Feeder
1
Pullets
'''
„:.,
Beef Brood Cow
Poults
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 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 2—No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [R No
❑ Yes allo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: jDate of Inspection: l�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �r� — n`,, 1,•,�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �?
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes allo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a.
❑ Yes
� No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ZNo
❑ 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
jj§-No
❑ NA
❑ NE
maintenance or improvement?
Waste Awlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
J5� No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes PQNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): J��.l1f> �v{� *",
✓.-E/
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [a No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [�kNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
kcl�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Yes
Q No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
R 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 W No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 91 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: Date of Inspection:
-f 7
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[] Yes
�o
❑ NA ❑ NE
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[] Yes
allo
❑ 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
[RNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
�No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
allo
❑ 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
Q No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
allo
❑ 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-
NNo
❑ NA
[] NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
O No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E. No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
54-No
❑ NA
❑ NE
Comments (ref& to question #) Explain atiy'YESianswers a.nd/o'r any;udditional,'.recomiriendations or any other c' mi iments'?;
_i..,..: >>,:F,; i a .{kI b � ,� ', 9,
� riiNii i,,
Uie,drawings offaeility to betteriex iain situations)(use:u'dditionill.pages,as necessa ).,, -, , =.,g,. -.,, ; I.r�;.,rn�.. ,6,,6E t�.h,,,.;,,i It,.1�i,11 ..;l.l,.�l.��
Rev iewer/Inspector Name:
� �­
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date: /;,-?- 2 �
21412015

j Q2,01vision of Water Resources
Facility Number I vat- - 0 Division of Soil and Water Conservation
O Other Agency
Type of Visit: Q-itmpliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency Q Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time:FL ' County: -
Farm Name: Owner Email:
Owner Name: ;; yr Phone:
Mailing Address:
Physical Address:
Facility Contact: �,�rrr' �%%p Title: 22�z- 10
Onsite Representative: t 3/'r�--
Certified Operator: /97-- /v e�l 1 mCsa/`C_
Back-up Operator:
Location of Farm: Latitude:
Phone:
Region: /C�—> C-}
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pap. Wet Poultry Capacity Pop. Cattle
Wean to Finish
Wean to Feeder C') 000
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Layer
Non -La er
Dry Poultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
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?
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?
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes �o [3 NA ❑ NE
❑ Yes ❑ No
[] Yes ❑ No
❑ Yes ❑ No
❑ Yes L&No
[:]Yes WO
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
_
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
5§,No
❑ NA
Y
❑ 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: �_3
Spillway?:
Designed Freeboard (in): / %-
Observed Freeboard (in): 3.3 3 c_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
ZLNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[3 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
EZNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 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 Approved Area
12. Crop Type(s):
13. Soil Type(s): r L'o
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 ❑ 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?
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes [allo ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes [allo ❑ NA ❑ NE
❑ Yes [K No ❑ NA ❑ NE
❑ 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 � No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes RNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑• NE
Page 2 of 3 21412015 Continued

Facili Number: 113ate of Inspection: — —
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes 7SNo
❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes &No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes jo No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes KNo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes E[No
[3NA ❑ 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 [K No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes � No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes jo No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes RNo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ® No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes fg-No
❑ NA ❑ NE
Comments (refer, to question #) °Eaiplain.any YES`answers^and/or:any; additional recommendations or any other comments s;
Use drawings of.facility. to'better explain situations`.(use_additional pages as'necessary).
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date: �,� —"'� 2� / 4
21412015

Facility Number ®-
fO Division of Water Resources
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: ompI nee Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ErRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: C 0 Departures Time: ! D c'a County: p-•--Region: /=70
Farm NameOwner mail:
Owner Name: jgl-"A �i cl ����/ �f G Phone:
Mailing Address:
Physical Address:
Facility Contact: �/` r /)�00P-C- Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Latitude:
Phone:
Integrator: /Yt.)-5
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La cr
pfl EatI INon-Layer
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Layers
Non-L
Pullets
Poults
Design Current
Po
Dischames and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: [3 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?
Longitude:
Design Current
Cattle Capacity Pop.
DairyCow
DairyCalf
DairyHeifer
D Cow
Non -Dairy
Bcef Stocker
Beef Feeder
Beef Brood Cow
[:]Yes �To ❑ NA [3 NE
❑ Yes []No
[]Yes [—]No
[]Yes ❑ No
❑ Yes J, No
[]Yes �Z No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

F'acili Number: 59,5Z - Date of Inspection: D--
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes rMNo ❑ 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):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[-No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[&No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
E& No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[LNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
[R No
❑ NA
❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Z[ No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes j0'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): �r�/ -'_ vt✓Yo/
13. Soil Type(s): �-�--
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E,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
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[n No
❑ NA
❑ NE
[:]Yes lam, No
❑ Yes 0 No
[:]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. []Yes C,No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ Yes PU[ No ❑ NA ❑ NE
❑ Yes [N No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes CS No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 21 No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes � No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [Z 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 CE No ❑ NA ❑ NE
❑ Yes CR No ❑ NA ❑ NE
[]Yes L3.No ❑ NA ❑ NE
❑ Yes [A No ❑ NA ❑ NE
❑ Yes
R No
❑ NA
❑ NE
❑Yes
®No
❑NA
❑NE
❑ Yes
[Z No
❑ NA
❑ NE
Comments ,(refer to;questlon #):Explain -any YE,S,answers and/or,any additional.recommendati_ons or,any,otlier�co' tiinents
Use drawings of faclli t6 better ez lain situations (use a[lditio`nal Ages a9mecessa
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �jQ-33
Date:
21412014

9
V'Divlslon of Water Resources
Facility Number ®- %� 0 Division of Soil and Water Conservation
Q Other Agency
Type of Visit: ompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Q<outine Q Complaint Q Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date,of Visit: Arrival Time: ; 31D I Departure Time: j? County:
Farm Name: ve ! GVA/ Owner Email:
Owner Name: ;Jrd- I4/.tsCS % Phone:
Mailing Address:
Physical Address:
Facility Contact: ofx ey- f w-e- Title:
Onsite Representative: Z `/?y�y3? /i%aD / tr
Certified Operator:010,0/'Z
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder k,00
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Region:
Integrator: /il U t'pliy rr
Certification Number:
Certification Number:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Pullets
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:
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[—]Yes ®.No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes [] No ❑ NA ❑ NE
2. is there evidence of a past discharge from any part of the operation? ❑ Yes allo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 2LNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facilit Number: - Date of Inspection: j-
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:
�T
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
m No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
[jQ 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
[Z No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes gNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop /Windo/w ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): ��17� 1,9i eVjr-y�
13. Soil Type(s):di�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes � No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes © No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �1 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [@ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ENo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

l;acili Number: I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes fD No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 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 E4No ❑ NA ❑ NE
❑ Yes Z, No ❑ NA ❑ NE
❑ Yes �0 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes �No
❑ 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 pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: /r/9 -tea
21412014

:;
f, ivision of Water Quality
Facility Number . ®- /%� 0 Division of Soil and Water Conservation 1% :�'t3
0 Other Agency
Type of Visit: ompliance 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 0 Denied Access
Date of Visit:. Arrival Time: Departure Time: County: a,— Region:
00,
Farm Name: %[Jyn}. /V!lrf�+ry�✓t-�jJl�,� %/'N'G Owner Email:
Owner Name: K�ye• r 1za/AvlI C Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: N` Pnlw Rah /?-
Certified Operator: Vfin.'
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:
Phone:
Integrator: O"f
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
L
ayer
O
Non -La
Pullets
Poults
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?
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
DaiEX Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ®_No ❑ NA ❑ NE
[:]Yes [:)No
[:]Yes ❑ No
[:]Yes [:]No
[:]Yes ELNo
[—]Yes L&No
❑NA [3 NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facill Number: - Date of Inspection: / 7-1
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: Mpr �F"�'•
Spillway?:
Designed Freeboard (in): -
Observed Freeboard (in): 4� q
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0-No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
E No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
CE-No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ZLNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes (VI -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):/'yytGy��
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 21 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [Z No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
191 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E&No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [] Maps ❑ Lease Agreements []Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ®-No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [Z No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes UZ�N
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
o ❑ NA ❑ NE
Page 2 of 3 , 21412011 Continued

Facility Number: - Date of Inspection: -1 ---/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes El No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ra No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes (4 No ❑ NA ❑ NE
❑ Yes [1 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
[g No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
C&No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
eejl;�� UJDrly e-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
7.3 a--10 .3-0
111'r n--� ll
Phone: Y733VD
Date: /f--7�-j�
21412011

ivision of Water Quality �..-
[Fac:ility Number ®- �. % 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: ��ompiiance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Oxom�utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: � DepartureTime: OD County:
Farm Name: �- p p1 r— r 10"" Owner Email:
Owner Name: g4o,1, ) d r,r L zG Phone:
Mailing Address:
Physical Address:
Region: FW'D
Facility Contact: �'�,-r /Ylcap�r� Title: z— tee, Phone:
Onsite Representative: Z rr— Integrator: MfAyg
Certified Operator:Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Swine
Latitude:
3 Jrprj
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
a�I Ion -Layer
Wean to Finish
Wean to Feeder
Other
Other
Discharees and Stream Imuacts
Ury Poultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Longitude:
Design Current
Cattle Capacity Pop.
IDairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
1. Is any discharge observed from any part of the operation? ❑ Yes P No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes [] No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ❑C No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued
1. Is any discharge observed from any part of the operation? ❑ Yes P No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes [] No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ❑C No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued
Page 1 of 3 21412011 Continued

Facili Number: jDate of Ins ection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [& No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: u'- )F�11 rL
Spillway?:
Designed Freeboard (in): / � _ /9
Observed Freeboard (in): 'Vo (,
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes .® No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes ® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures
require ❑ Yes ® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ 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 � No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Cj� No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
C@ 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 5� No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [] Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [—]Yes IM No ❑ NA [] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [0 No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Faeility Number: Date of Inspection:
/�-
24. Did the facility fail to calibrate waste application equipment as required by the permit?
f
❑ Yes
E] No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
® No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
[) Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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 ® No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes [K No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑Yes
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 pages as necessary).
Reviewer/Inspector Name:
Phone:yJ 33D
ReviewerlInspector Signature: n r Date:
Page 3 of 3 21412011

(Type of Visit: U-Co fiance Inspection C� Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 EmerQencv 0 Other 0 Denied Access
Date of Visit: V Arrival Time: '.30 1 Departure Time: County; _,�
Farm Name: a/a'.- Owner Email:
Owner Name: i--Lc. Phone:
Mailing Address:
Physical Address:
Region; :D
Facility Contact: (a'-t'a't�//f�ppr� Title: =en � t- Phone:
Onsite Representative: �'�r�/' ,/%i0oi'� / rTnr.�l'taO/ Integrator: ,.
Certified Operator: f(yppr Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Il
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
v1'et Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
(vD?7
'3
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Imnacts
1. is any discharge observed from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[] NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
(R No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[N No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
5Z No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: Aloe- n
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in): N
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
®No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
EL Yes
hff'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
®No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [S No ❑ 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(sT ZZle l-e-
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes [4 No ❑ NA ❑ NE
❑ Yes Z No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑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 [K No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes ES 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 E&No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other;
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ® No ❑ NA [] NE
❑ Yes [3No ❑ NA ❑ NE
❑ Yes V No ❑ NA ❑ NE
❑ Yes [SNo ❑ NA ❑ NE
❑ Yes C&No
❑ Yes 0 No
[:]Yes rM, 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 additlonul.pages as necessary). ,
Reviewer/Inspector Name:
Reviewer/inspector Signature;
Page 3 of 3
Phone:
Date: Z/,
21412011

015ivision of Water Quality
Facility Number 0 Division or Soil and Water Conservation
0 Other Agency
Type of Visit &66mpllance Inspection 0 Operatlon Review 0 structure Evaluation 0 Technical Assistance
Reason for Visit tlYRoutine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: a Arrival Time: / D D Departure Time: ! O rJ County:
All
Farm Name: f2 Akej� :i'7 'W2mr�r'z� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Region: �,/�;U
Facility Contact: 1-:2 ►'ryr ff1g221`e— Title: 4Ej:22lt �:rA!5=CA Phone No:
Onsite Representative: Oa Integrator:
Certified Operator: N ,/1�1J�_ Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ ry O D OO Non -Layer
❑ Wean to Finish
Wean to Feeder
Feeder to Finish
El Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
El Gilts
El Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
El Pullets
❑ Turkeys
❑ Turkey_Poults
❑ Other
Discharses & Stream impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure El Application Field El Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Longitude: = ° = ` Q
Design Current
Cattle Capacity Population
❑
DairyCow
El
-Dairy Calf
❑
DairyHeifer
❑
D Cow
❑
Non -Dairy
El
Beef Stocker
El
Beef Feeder
El
Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: ZI
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?
Page I of 3
❑ Yes [21No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes W No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
12128104 Continued

Facility Number: —
Date of Inspection
1 Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ONo ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: /.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 37 3p
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[� No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
'L'N-,No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
ER 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
El Yes
ra o ❑ NA FINE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
29 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
&No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) TO
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
,RNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
15� 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
Reviewer/Inspector Name f - �� _ Phone: 91yD-�1_3DC 3-5
Reviewer/[nspector Signature: Date: /';Z -7 —";Zd/�
Page 2 of 3 12128104 Continued

Facility Number: .:— Iff Date of Inspection
Required Records_& Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes BNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �RNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
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
3 l . 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
�ZNo
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
®No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ER No ❑ NA ❑ NE
❑ Yes
i4 No
❑ NA
❑ NE
❑ Yes
EgNo
❑ NA
❑ NE
Additional .Commefits and/or.Drawmgsi
Page 3 of 3 12128104

'a41-KtS lz - z.z -- zoo 9
/b9
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: ,Arrival Time: Departure Time: I 4"O'gos. 1 County: Scth�psorl Region: FP_o
Farm Name: WYNN A)urSery /%Ld AfODYC. 1�4 Owner Email:
Owner Name: �Iae.IL Ri.r e.r Fav,••..-s Phone:
Mailing Address:
Physical Address:
Facility Contact: t'e-e-Y o aY C-- Title: �� S�' mot" Phone No:
Onsite Representative: , """"�� Nola a �� �— Integrator:
,Or+t►S � G wart. f00
Ni00!: �� Ke�►IJ y N Operator Lr-z2.ication Number: 22000
Certified Operator: .,. p
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o ❑ ❑ Longitude: 0 0 0 1 ❑ "
Design C►urrent
Swine C•apaclty Population
❑ Wean to Finish
Design
Wet Poultry G rp Weity
❑ La er
C►urrent
Population
Dcslgn C►urrent
Cuttic C++ap �ci y Population
Dairy Cow
® Wean to Feeder IY6&D
13&0(7
I ILI Non -Layer I
I
❑ Dairy Calf
Feeder to Finish 13350
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
Gilts
Boars
FTurke
1133,510
1
Dry Poultry
El Layers
Non -Layers
❑ Pullets
El Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
El Beef Stocker
❑ Beef Feeder
El Beef Brood Cow
❑ s
❑ Turkey Pou Its
Other
Number of Structures:LLJ
❑ Other ❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
+(_1' No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
El Yes
❑ No
CTNA
LNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
3<A
❑ 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
[�NA
[I NE
Is there evidence of a past discharge from any part of the operation?
El2. Yes
,❑,,__,,
�S��
L,� NNo
El NA
NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
B <o
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number:
Date of Inspection 1Z-/--T ,7
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a, if yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: 11ursovy 7td M:-t_ W A/e-NrVSev
Spillway?:
Designed Freeboard (in): / 9
Observed Freeboard (in): 23
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes E No
❑ Yes No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
❑ Yes B No ❑ NA ❑ NE
❑ Yes LKo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes L7 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes 2No ❑ NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,/
9. Does any part of the waste management system other than the waste structures require El Yes E No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L''J No ❑ NA ❑ NE
maintenance/improvement? ,_ ,/
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes L'J No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) lBerw. c. c� (l+a j 4 pas#urtr)• Cornw— c. L-4-13c4,J.S S�wil 6,ari`nI �O,S %4e%i�%cr Sew+ erA�r++�cCS
13.
Soil type(s) 316L"1 Q N (8,S)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
,�/
L7No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
3 No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
E No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
ZNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
[ No
❑ NA
❑ NE
,.. ''. F j Sy«i i $X', V.s .�:q S 'q. 'K'&
Comments (refer tv yueshpri;#) Explam any YES answers andlor4ny'recommendations or�any other�cvmments.�4¢.^�
- }€t�d'F;� � 3 kr�.w,�v�"k X�y � fit @, ''±za
Use,dreivirRgs,b facility to kietter explain"situations: {use additional pu ;es as necessary)5 -� x x ..�
x S'xm,r
ReviewerllnspectorName iC„k Phone: 9/0,433,3300
Reviewer/inspector Signature: Date: /2-17'-ZC O9
12128104 Continued

Facility Number: 92 —14, 9 Date of Inspection
Required Records & Documents ,,,�
19. Did the facility fail to have Certificate of Coverage & Permit readily available? [I Yes ETNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes LJ No ❑ NA ❑ NE
the appropriate box, ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections /❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? El Yes BNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [F No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 2/No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? El Yes LJ No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes Lr No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes 2 No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Q 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
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
N
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
B
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
12128104

✓ $,tW4.15 /-Do 'O9 Kr,
Type of Visit () Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Q*IR utine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: %Z^16-dg Arrival Time: /2;/0 Departure Time: /2:3o County: 'M YasL/ Region: r'
Farm Name: „ 71� /4e4 rL 6.v /WYNe- Amrsmn� Owner Email:
Owner Name: R`tc�k_ R'.yw ICY ,S TLL-c- Phone:
"
Mailing Address:
Physical Address:
Faeility Contact: rrrr V- A06r L Title: 'A,cs—� Phone No:
Onsite Representative: (: re e jC MCC re Integrator: 1Y14j
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o = 6 ❑ i, Longitude: = o ❑ ' ❑
Design Gurrent
Design Current
Design Current
Swine
Capacity Population
Wet Pouitry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
Wean to Feeder 13604
❑ Non -Layer
❑ Dal r Calf
2feeder to Finish
O
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
El Stocker
❑ Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Coyd
❑ Turkeys
Other
❑ Other
❑ Turke Pouets
❑ Other
I
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
BNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
aNA
❑ 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
ETNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
0 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Brvo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

A
Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E(No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
El"No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: Y % at� XoA'--C.
Spillway?: q0 Nf3
Designed Freeboard (in):
Observed Freeboard (in): q .32
5. Are there any immediate threats to the integrity of any of the structures observed?
El Yes
L�'} No
El NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
Q 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
[INA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
,[JNo
L?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
ErNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
2a
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s) _ tuv.do._ t 3 J �rN Ltee &AS .
t WIN�V i4NNuk.�S
17 IQ.S .�
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
3'1�o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
2f' o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? El Yes
ETNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
2ON'o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EJ No
❑ NA
❑ NE
Reviewer/Ins ector Name ''� f� "'`�' ` `"
p i.c,.� ��/u sm < ,,�.�� � ,��; � ����a��Phone: 9/L?. 5133.33ZZ
�d
Reviewer/Inspector Signature: Date: /Z —%6 — U4 8
Page 2 of 3 12128104 Continued

Facility Number: RZ— fb Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes LJ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other El"
21. Does record keeping need improvement'? If yes, check the appropriate box below. ElE
Yes l 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
[YIo
ElNA
❑ 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
B<o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the pertnit?
❑ Yes
[3<o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[3`5o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[Ko
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[3 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
B-5o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
['No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El[ Yes
��
No
[INA
[INE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[3/
❑ NA
❑ NE
Additinnttommettts andli r.'Pir trig ... a .' �.zr. ' . �. s... ��
Page 3 of 3 12128104

Facility Number
.40 Division of Water. Quality
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 0 Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: /�� �fS,h.,, Departure Time: /Z.' 20 County: dM oN Region: ARO
Farm Name: l e.d. Ntoov-L f.+rn�t /k1VAtc, NaYScr y Owner Email:
Owner Name: �� k �` r-� F;,vk.%-s t- LC Phone:
Mailing Address:
Physical Address:
Facility Contact: G e-c_ v- Kkt c r-t_ Title: i Phone No:
Onsite Representative: �1-e Grndi't �iK /�enY�. Integrator: r�►'��+4,�� ,,_
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e ❑ 6 = Longitude: 0 ° = ` = "
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
10 Wean to Finish I I
Feeder to Finish 3 So
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La et
Dry.Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Dischary-es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non-Dai
❑
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 M No ❑ NA ❑ NE
❑ Yes
[j3 No
❑ NA
❑ NE
❑ Yes
[3 No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
® No
❑ Yes
�Z No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12128104 Continued

1 �
. Facility Number: Sz — f (p Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes M No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ® No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: uV5 -T?e-L Moore_
Spillway?:
Designed Freeboard (in):
y �r
Observed Freeboard (in):
5: Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
N 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
M 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 $0 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [A No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area y
12. Crop typc(s) Ck__(L.S r /%y 56 y6�R,vS . Cs+ritJ, W .Sues/G,r,iNeD.5.) A-44 0,1hf,�
13. Soil type(s) g
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
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
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
a
Reviewer/Inspector Name ; e.kti �e*y �13 Phone: 9/0, f/33 .3360
Reviewer/InspectorSignature: 9." RQ.., Date: /Z—/7--2007
12128104 Continued

L
Facility Number: 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 [4 No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists ❑Design ❑Maps ❑Other
.21. Does record keeping need improvement'? If yes, check the appropriate box below. ❑ Yes [XNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes P No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�9 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
M No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[E 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
[jO 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
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit'? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

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: /d �/D—D/ ,,Arrrival Time: ; Q Departure Time-, 5; Q County:-SRIQSd
nwI Region:
Farm Name: ZF 10,6'srP� o-.o&r Z/c/,4d& A/arsePL—j Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address: 1,
Facility Contact: Gre-e.Y Aore., Title: 7;7` _ &Dew . Phone No:
Onsite Representative: (90'ee-+^ A0,6k e— I X 2A4 Above Integrator: My4gL' �ro �..�i✓
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: ❑ o ❑ 4 ❑ Longitude: ❑ ° ❑ 1 ❑
Design t►urrent
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle C►opacity Population
❑ Wean to Finish
❑ Layer
iry Cow
Wean to Feeder
❑ Non -Layer
iry Calf
Feeder to Finish O
❑ Dairy Heifer
❑ Farrow to Wean
Dry PoulEry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
ElBeef Stocker
El Gil
❑Non -Layers
❑ Beef Feeder
❑ Boars
El Pullets
❑Beef Brood Cow
❑ Turke s
Other
❑ Turke Points
❑ Other
❑Other I I
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes C5 No ❑ NA ❑ NE
❑ Yes
[ffNo
❑ NA
❑ NE
❑ Yes
[M No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[9No
❑ Yes
[gNo
❑ NA
❑ NE
❑ Yes
R No
❑ NA
❑ NE
12128104 Continued

` Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: u r
Spillway?: q
Designed Freeboard (in): ! r
Observed Freeboard (in): Zs� 27 off
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes (M No ❑ NA ❑ NE
❑ Yes V No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes W No ❑ NA ❑ NE
❑ Yes [VNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [N No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [9 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes PO No ❑ NA ❑ NE
maintenance or improvement?
Waste Ai mlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes (Z No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ®No ❑ NA ❑ NE
❑ Excessive Ponding [:]Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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) &eirhif
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [21 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes] 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 [Z No ❑ NA ❑ NE
Comments (refer to question #) Explain any YES answers and/or any recommendations or any other comments
Use drawings of facility to better explain situations. (use additional pages as necessary):
AL
I
ReviewertIns ector Name
p # G K - - - - Phone: O -333�0
Rcvicwer/Inspector Signature: Date: /O -/D — Z40 (p
rage z 0f s «i-16iv4 q_onrrnuea

Facility Number: gZ — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 5eNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [INo ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design ❑Maps El Other
21, Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [A No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
((No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
1p 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
9No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[jNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
1;yNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
VNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O 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: .2: r//� Departure Tinte: :�S County: Gi ! Region: (Z
Farm Name: / aor r &ein (V h !! Seer^ Owner Email:
Owner Name: L21 c & R+'v Ev 17iJtvu Phone:
Mailing Address: _�Ua►c_ [ _ _ Lnvr �i5 Cyy5/
Physical Address:
Facility Contact: lak"60-.- place e Title: Phone No:
Onsite Representative: a ye ft- 'nq 00re / J 1 k, Al otr-t - -� Integrator:
Certified Operator: ®LU&P.% ___ o r`ie Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
can to Feeder
feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: = e 0 & = Longitude: 0 ° ❑ I 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
` ❑ Layer
❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
DisebaMes & 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? '
Cattle
Design Current
CI
Capacity. Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ 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 Q/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[HNo
❑ NA
❑ NE
❑ Yes
dNo
❑ NA
❑ NE
12128104 Continued

Facility Number: k2 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes []"No ElNA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ E 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
❑ Waatciarp�n—. ❑ Wee Waste Analysis ❑ Soil -Analysis-- O W.asteZransf= ❑ Annual _Certification
❑ Rainfall ❑ Sweking ❑ GrepA4,.ld ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes [J(No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [TNo ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
QIo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[v No
❑ NA
❑ NE
26.
Did the facility tail to have an actively certified operator in charge?
❑ Yes
QONo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
dNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[9 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[5No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[� No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[jNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
,�/
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Ell� Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
LVNo
❑ NA
❑ NE
��3d44Sc£`-'
Additi7o ffil Comments�,ancE/or, Drawings F , <� „, # ,t t 3 ,
12128104
12128104

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 9No ❑ 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: Al.l +dike
Spillway?:
Designed Freeboard (in):
Observed freeboard (in): — n2_ AX
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [YNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [9No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes &No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [� No ❑ NA ❑ NE
maintenance/improvement? ,,,//
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes O 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/Siudge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) r
13. Soil type(s) 3 a w
14, Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 9 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 9No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, ❑ Yes EYNo ❑ NA ❑ NE
17, Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ,_�,/No ❑ NA ❑ NE
El!,� Yes No ❑ NA ❑ NE
Comments {referito;quc is Ion}�Explaln9atiyYSansw s antilor a y�ecommegdation_s or any other com111 ments.
Use drawiinngs�af�a�cilityi oo,b tter xptiiin situntinns�n(use addition lip ges ris a r�y�);:
Reviewer/Inspector Name ` ( i.'`�`
�: �r� '`'r�==°^ � �-7"4N Phone: 110
Reviewer/inspector Signature: ' Date: 7— ( 9 — a
12128104 Continued

„ , i . hsb :.J3,u` - - r E .a +;aq;{:-x_.,. •i.¢sr E .. 1 ..¢¢"><rrraaxay k' ES e.a., C y ', i:.Y'.+. ti ') r? f. . , , ".T• r , a, ;; :'i --, a p'�r at 1” -°i
2 ° •. 4
:;a }. e f,t i, •/� €/�% 'y g rEj} �C+li E �?{1JI[{p$ 1 ( Ey3{}'It df!a({ dE lE�t! 6 xt
i P '4.d�1iV�Vf'�• 1 aterQ4ality 3; 34.be.•
-,J,r,'i
i , : i.i;; (E =,1 OyD�vrslon of sailtandWa�r Goi�serv�itson d .$ t,,fddf': f3!E d !r
ON, t E r 't x s � E Bga i� � �T Y riI
¢ c! . 9 �3 ° ' d _d^ �`� t>rl� E fyitryLp i Ea.1;1 � 7= € �=a
p 9 'XIOi q fly- b.i�it "•' ad I { 'f' [ 7f3p fJ. ! „a iiip.l ,Fill t.fF
[ F ar , Othe((rl;A�%en ;��,... _.,�.x�=l ,;1, ..�,ry ,- �E�.. 9 ,:�„ n•,�.�
i'�@ '.•'!s 3� E EI fj¢i^E if ! E.' E ¢e Q tl P ta0 «Qai §i .9 <1fi4.:F.
a v P1,: 7r
3;•E�.x., s � ,5,,` L P8 3, Tic !. ,. ,. r,, ... €.`a',. F9.. ,, ..L .. > ,,, ,� Mtt i�,
Type of Visit i Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number y Date of Visit: 'JL' Time: 3
0 Not Operational 0 Below Threshold
© Permitted © Certified 0 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: .........................
Farm Name: ....... afr.... ar.... . �,�.................. County:... fro.........................................INA.......
....
Owner Name: .......�,1AC lf....... RlY.f,C........ ................................... Phone No:... ��/D -_ S3.?."..�17r?.....................................
MailingAddress; ....p:.e:.... d,i! .................. HoCrA �,F....r.....A14n...............904.......................r............................................................................
Facility Contact: ....�-rt per.......1..M.mag.A. I'm...Mwa ..Title:................................................................ Phone Noe ...................................................
Onsite Representative: ...GT[?r.....I�idv,': ,......� o...... � Qor..i....................... Integrator:_.InUt���....."�4f..rt,LKta.......................................
CertifiedOperator: ............................. I# ... . ................ . ............... Operator Certification Number:..........................................
Location of Farm:
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 69 Longitude • 4 Aj
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes l�vo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes Blgo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes Erf4io
c. If discharge is observed, what is the estimated flow in gal/min? t—
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes G—Nb
2. Is there evidence of past discharge from any part of the operation?
❑ Yes D�No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [31To
Waste Collection & Treatment ,
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes l_r <o
Structure l Structure 2 Structure 3 Structure 4 Structure S Structure 6
IdcntiGcr: .......... .... �....••........................g................................3.........................................................................................................................
/� r� r /,�
Freeboard (inches): a ZJ �D �f.
12112103 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,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes Er6o
❑ Yes 2-Ko-
❑ Yes Rio
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes [jRo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ❑ITo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [[3,No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes M'Kc-)
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type e
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑•AFC
14. a) Does the facility lack adequate acreage for land application? ❑ Yes B-l-o
b) Does the facility need a wettable acre determination? ❑ Yes 3-Ko
c) This facility is pended for a wettable acre determination? ❑ Yes 0-No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes [3' o
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes Ewo-
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑NO
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes 94?6,-,
Air Quality representative immediately.
uquestion,#rents(eer to.V -- nE.;..l �• : I a="n`73:1 y Ys
"fiFi d. P^: o3' 3 ,'fiP E ,3
a'i
odty j 1�r
i
a' w xplain ;answers and/or an dVaA
❑Fina
n
A,
Reviewer/Ins ector Name s��yy�su� 3 A'�� 't d i x P� Fn;� ¢ti. '' a '��sr (".I+(��
p /'jr /'F{' ` 'Bran rv..J: _ . '.. x.'.. .�.-.: „! ts�xr lt« —
r'. r�1i71':C �i�I LLi:
p Signature:
Reviewer/Ins ector 5i afore• Date: p
12112103 Continued

Facility Number: — Date of Inspection
Required Records & Document~
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes o
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, ❑ Yes S-W
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑X6
❑ lion Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes [-moo
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes Q-Ko
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application) ❑ Yes G-Mo
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes
28. Does facility require a follow-up visit by same agency? ❑ Yes ;Z�
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑o-
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
9-No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[}.S
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
;<"'
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
Q-N-6
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
allo
❑ Stoelcimg Form ❑ Crop Yield Form [346infaif ain
012OMimfl&Uspootiom ❑
12112103

Farm Name/Owner:
Mailing Address:_
Site Requires Immediate Attention:
Facility No. ZZ - /A 9
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 7 z 7 , 1995
Time: // '-IV,*
.6oe��'V-
County: =5 4* f lJzroA✓
Integrator: :S-'.ca k Phone:_ 9/O .532 - 7Z9
On Site Representative: 4e Phone: Tib .5'3 z ­q-y 3o
Physical Address/Location:e27L ZT-0 K Ca&,o%K 2,11e ,34vy_-�// .4t0:0-7
Type of Operation: Swine � Poultry Cattle
./
Design Capacity: 4a2c Number of Animals on Site: A 30ao
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 0 Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) �or No Actual Freeboard: f.Ft. Inches
Was any seepage observed from the l�Mr
(s)? Yes or& Was any erosion observed? Yes or®
Is adequate land available for spray? No Is the cover crop adequate? es or No
Crop(s) being utilized: Co `73 0 ZY-6 1C c M ; raid'
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings9 es or No
100 Feet from Wells? es or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or(&
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes o fo
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or(S If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on spec}fic acreage with cover crop)? Yes orSo
Additional Comments: NW­Z> s 4!,p 0 aglo. v
-VA! - 7i TE
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

•- 1
.._..---- ..., ... .. ..
13 DSWC Animal Feedlot Operation Review
DWQ Animal Feedlot Operation Site Inspection,# ,
® Routine 0 Complaint 0 Follow-up of MVQ inspection 0 Follow-up of I)SWC review 0 Other
Date of Inspection /`v /D
Facility Number
Time of Inspection /Z,=?— 24 hr. (hh:mm)
®.Registered © Certified D Applied for Permit O Permitted 113Not U crational Date last Operated:
FarmName: ...............Tel.fft�P....23............................................................................... Coe�ntv:..... q;t^'............................ .......... .............
Owner Name: ........... 1.1�-............................................................................. ............... Phone No:........�r2 Y�!� 9................................................
....... .
Facility Contact: ......... �U!....: .....!!�� ...............................Title: ... Mk .............................. Phone No:..............,...,...............,.,..............
MailingAddress: ............O.....$.Px......... 2................ ......... ......................................... ... J`CC?Shyr. f G-.................................. 20-4.....
OnsiteRepresentative:.......... ........................................ I... Integrator:..........1<........................ ...................................
Certified Operator; ............ r`�M.... 1' j' . p ........ .... �.:1:.,................................................... Operator Certification Number ..........................................
Location of Farm:
.................. ai H.A
....
Latitude �' �` �" Longitude �• 0' �"
Design Current
Swine Capacity Population
® Wean to Feeder
3 Of7
3 po
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gifts
❑ Boars
Design Current Design Current
Poultry Capacity: Population Cattle , Capacity Population..
❑ Layer I I ❑Dairy
❑ Non -Layer I 1 10 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
----------------
Number of Lagoons / Holding Ponds 10 Subsurface Drains Present IEL
❑ No Liquid Waste Management S
'eneral
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 cal/min?
(1, Does discharge bypass a lagoon system? (lf'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 front a discharge?
on Area ❑ Spray Field Area
L�' --
❑ Yes &No
❑ Yes Q1 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design'?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes WNo
❑ Yes 0 No
❑ Yes ONO
❑ Yes JffNo
❑ Yes )ANo
❑ Yes E57N0
❑ YesNo
❑ Yes No
Continued �i back

Facility Number: �-
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes 4wo
Structures (Lagoons,11olding Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes - UB.No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: ........... .45...... ................I.............
............ I......................
Freeboard(ft): ............3• .. ................................................................................................................................................................................................
10.
Is seepage observed, from any of the structures?
❑ Yes
W No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
RNo
12.
Do any of the structures need maintenance/improvement?
❑ Yes
RNo
(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
'A No
n
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
R1 No
(if in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type Qzl......tn ... 54QsK1.L4rC ...� ��. t-vYst...... �.�1.......d�..... ±.4.r4.......�.is...
s'�n....
... r....R
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)•?
ROYes
G1 No
17.
Does the facility have a lack of adequate acreage for land application?
AZ Yes
0 No
18,
Does the receiving crop need improvement?
Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
MONo
20.
Does facility require a follow-up visit by same agency?
N Yes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
22.
Does record keeping need improvement?
❑ Yes
❑•No
For Certified or Permitted Facilities Oniv
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? $k`!7_ fi,
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? P/4— es o
25. Were any additional problems noted which cause noncompliance of the Permit? e5
[a No. viol ations 'or' de'ficiencie's.wer'not4dueing this,visit.-_ Nou.will receive no further
currespbtidepce about this'visit:: '
Comments (refer to question #.): Explain any YES answers gridYor any recommendations nr,any other comments.
Use drawings of facility to better explain situations .(use additional pages as.necessary)
01" a
tV O 1'---,vv .ts,0,61is5 .3prOL _r6eAs acres) (,O_t& "1 4e-,
IAO,N "Liu \v V� C"o- i-
7
7/25/97
w
Reviewer/Inspector Name ` . w
U C.
Reviewer/Inspector Signature: Date: b d
r.

Site Requires Immediate Attention:
Facility No. 9z - 9z
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
Farm Name/Owner: Z-4 �-
Mailing Address:_ POD
DATE: 7 , 1995
Time: -5_2�
W
--S-a/C z3
County: -'WA✓
Integrator: -X4 /<- Phone: -- s2�3Z — 72
On Site Representative: A• /w Phone: z- 7Z ;
Physical Address/Location: A r �X -6 62m+ :, LQr. OM Loy - 11 1.
5 ?� 1114
Type of Operation: Swine Poultry Cattle
Design Capacity: 3900 Number of Animals on Site: :� .39DD
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) es r No
Was any seepage observed from the lagoon(s)?
Is adequate land available fo�^ spr�ay? es or No
Crop(s) being utilized: L35Ti��.
Actual Freeboard: t Ft. Inches
Yes or®Was any erosion observed? Yes orb
Is the cover crop adequate?' es or No
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? es r No
100 Feet from Wells? near No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or(�o1
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue ine: Yes or N�]a
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o o If Yes, Please Explain.
Does the facility maintain adequate wa anagement records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
_ � �q @tTUlr
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.