820239_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Quaff

type of visa: LAU0MDuanee inspection %,j operation meview V btructure Evatuanon V iecnmcai Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral Q Emergency Q Other O Denied Access
Date of Visit: Arrival Time: Departure Time: ro County:S'4W Region:
Farm Name:) L"iL� -3 Owner Email:
Owner Name: 7ZJ'jz 0 (K �FvJvls i{ LG Phone:
Mailing Address:
Physical Address:
Facility Contact: 15 _ kV-� � it Title: Phone:
Onsite Representative: t Integrator:�s
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swlne
Wean to Finish
an to Feeder
Wder to Finish
Farrow to Wean
Design Current
Capacity Pap.
aiA C�c) S
Wet Poultry
La er
Non -La er
D . P�oul
Layers
on -Layers
Pullets
Design
Capacity
Design
Ca aci
Current
Pvp.
Current
P.o
Design Current
Cattle Capacity Pog.
Da' Cow
Dai Calf
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other.
Other
Turke s
Turkey Poults
HOther
Discharees and Stream Impacts -
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes [D-NO'❑ NA ❑ NE
[—]Yes [—]No D-NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
B-1'TA ❑ 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
DIVA ❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
❑-M
❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
�2�o
[] NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

1
N�
Facility N ber: - Z 3 Date of Inspection: ,`P�'u
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q.No-�❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No El -KC ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): u
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes U3-No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes f] "o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes r]. o' ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes E o'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 E5 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [] o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window
`� ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C � n f
13. Soil Type(s): JJ 0 kLAjc.yo ckc-o
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes
! 2 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
to
❑ 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
Ls""
❑ NA
❑ NE
Renuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
C! 1"o
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
[IN
[DNA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
L� —Ko
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
L.
❑ NA ❑ NE
23, if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes l2� 110 ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili N mber: qg, - 7 3 Date of Inspection: ,7-t, cne,/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E]-Ko ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3-N-b__❑ 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 I_`_T'`"' ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certif cation? ❑ 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 L.rJ Nb ❑ NA ❑ NE
❑ Yes Lr�-iaO ❑ NA ❑ NE
❑ Yes Eg No ❑ NA ❑ NE
❑ Yes 20<o ❑ NA ❑ NE
❑ Yes 0-No
❑ Yes 0 �o
❑ Yes []-No
❑NA ONE
❑NA ❑NE
❑NA ❑NE
Comments (refer to question #`) Plaii any�YES answers and/or any additional recommendations or4kny otherkcomments.
Ilse drawings of iacilty.to'better. eaplam situations (use additional pag"`es`as necessary):
".
D- It 7
c-t,c( Rio-
Reviewer/Inspector Name: �!
Reviewer/Inspector Signature:
Page 3 of 3
Phone:% 733
Date: • � Llt4 1
21412015

.V
ivi`sion of Water Resources
Facility Number ®- 3 `% ®Division of Soil_ and Water Conservation
� Other Agency
Type of Visit: OCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ; Qt] Departure Time: ' pp County: Region:
Farm Name: Owner Email:
Owner Name: fiT2-- C_ t-a r&t I J C _ _ Phone:
Mailing Address:
Physical Address:
Facilit
y Contact: re ly j__7o <� � Title: � W Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number: 9-
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
..
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
-
Wet Poultry
La er
Ncm-La er
.
Design° C>urrent
Capacity Pop.
=� -- Design C+urrent
Cattle ECapacity Pop.
Dairy Cow
Daia Calf
Feeder to Finish
= Design Current
Dr. Poult Ca 'aeit .._- P,o
DaiEy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
La ers
Layers
Beef Stocker
Gilts
Beef Feeder
Beef Brood Cow
Boars
jPullets
Other
Turkeys
Turkey Poults
:t
Other Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (Ifves.. 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 gC No ❑ NA D NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:)No
❑ Yes ® No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 25 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):!
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes C�g_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 [a No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes J�] No 0 NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes IS -No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any pan of the waste management system other than the waste structures require ❑ Yes allo ❑ 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. 0-Yes 2KNo ❑ 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
eejof Approved Area
12. Crop Type(s):9'"11'!
13. Soil Type(s): J ab N 5/ runt, v I )(2- / Oh i n-)/z'-
14. Do the receiving crops differ from those designated in the CAWMP? '
❑ Yes
Z[No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
2Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
O No
0 NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[K'No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E' No
❑ NA
❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes.. check the appropriate box below. ❑ Yes & No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes JKNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes IQ No [DNA ❑ NE
Page 2 of 3 21412015 Continued

[Facility Number: - g Date of Cns ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [R.No ❑ NA ❑ NE
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes EZ 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
P.No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
E, No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
B No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
,LNo
❑ 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
M No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
MNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
� No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[RLNo
❑ 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 expWn:.situations (use additional pages as necessary).
0
Taw
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone:r~f1� `3ois/
Date: /a —
21412015

I Type of Visit: (9L-e6mpliance Inspection CV Operation Review O Structure Evaluation O Technical Assistance
�d�
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other O Denied Access
Date of Visit: D % Arrival Time: : y Departure Time: Countys, v--- Region:l� 17
Farm Name: / a ,-,7, 3 Owner Email:
Owner Name: 1-,--af2*7 Phone:
Mailing Address:
Physical Address:
Facility Contact: le. �Y �- Title: 8 Lu'- -r- Phone:
Onsite Representative: Integrator: I-P3i Y
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design On en
Swine Capacity Pop. Wet Poultry Capacity Pop.
Desigtt Cnrrent
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Dairy Calf
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
[7
Non -La er
Design .. Current
D . Poul Ca aci P,o
airy Heifer
Wry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars Pullets
Turkeys
Other - - Turkey Poults
OtherI INLIOther
Beef Brood Cow
Discharges and Stream Impacts
Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
C. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 2!] > 4 ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes [:]No ❑ NA ❑ NE
2. is there evidence of a past discharge from any part of the operation? ❑ Yes �R No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes �- o ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

}
Facili Number: - 3 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 structure 5
Identifier:
Spillway?:
Designed Freeboard (in):`�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
BNo ❑NA ❑NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes CA No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
W 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
® 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
JZ] No
❑ NA
❑ NE
maintenance or improvement?
Application
_Waste
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
El No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
5 .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
t 2. Crop Type(s): AeZi iAJO, /6Ar/ rr�T / �'d �'� /--e--
,
13. soil Type(s):Cs
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes
Pg,,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
O No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
allo
❑ NA
❑ NE
18_ Is there a lack of properly operating waste application equipment?
❑ Yes
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 allo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes �No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

t
lFacRity Number: - Date of Ins ection://`730—%571
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [3 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes EZI 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 [:]Yes ® No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes &No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes 0. 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
[R No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAVRVIP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
EE]-No
❑ NA
❑ NE
Comments (refer to question #): Explain any;YES answers and/or any addlrhonal recommendations or=any other comments
Use drawings of: facility to better explain'situatrons.fuse additional pages as necessary).. ,
N law P1T-
Reviewer/Inspector Name:
Reviewerllnspectar Signature:
Page 3 of 3
Phone: Z1_P-N3-L 3300
Date:
21412014

,1
n
type or visit: Q>­rcampnance inspection V tiperanon meveew V btructure Evamation V Iecnmca1 Assistance I
Reason for Visit: tine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:—fl Arrival Time: nth Departure Time: County: sarSA^- Region: F:�O
Farm Name: e- it lyuLLjf Z Owner Email:
Owner Name: " 197i 74 r r_.11 Phone:
Mailing Address:
Physical Address:
Facility Contact: �'fJg.-- ryJ,�fTitle: -- Phone:
Onsite Representative: J R-*- Integrator: ,��/ 's%f1 w.'_
Certified Operator: S'� Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Pointry Capacity Pop.
Wean to Finish Layer
Design C•nrrent
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder 1& 0 Q
INon-Layer_l
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
D , P,ouitry Ca aci Po
Layers
Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
10ther
Discharges and Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes RNo ❑ NA ❑ NE
❑ Yes 0 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
C] 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
Callo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3
21412014 Continued

r
Facility Number: - 3 Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [8,No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): �}
Observed Freeboard (in): .27
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes [S No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
�No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
3Q 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
§�LNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below_ ❑ Yes jo 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 ❑ jEvidence of Wind Drift ❑ Application Outside of Approved Area /
12. Crop Type(s): C' !n /5 .SCrr-e ff,-r'nc,-olo- ✓ r l:-rie�-j -
13. Soil Type(s): T1,1-4 Pam
14. Do the receiving crops differ from those -designated in the CAWMP? ❑ Yes I& No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes ONo ❑ 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
(2LNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Sg No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[R No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
0 No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [::]Design []Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ELNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes jj�-No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA [] NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

IFacWty Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Callo
❑ 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 to provide documentation of an actively certified operator in charge?
❑ Yes
ZNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
12 No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
® No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Cg 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
0 No
❑ NA ❑ NE
pen -nit? (i_e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
kNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[allo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
C�J.No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
51-No
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any.: other comments
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone:
Date:
21412014
Page 3 of 3

A
3
Type of Visit: 8'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ,�yA�rrival�Time Departure Time: �'i�7 County:
Farm Name: �p // i-Ife r. of r Owner Email:
Owner Name: Phone -
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: �'�s�G- Integrator: [�,f
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Region: EZ
Design Current
DestgnCu ent
Design Current
ne
Capacity Pop.
WON
Wet Poultry
Capacity
Pop.
Cattie Capacity Pop.
Wean to Finish
La er
Non -La er
-
Dairy Cow
Dairy Calf
Dairy Heifer
Wean to Feeder
v
Feeder to Finish
Farrow to Wean
Design
Cgrre::.nt
Cow
Farrow to Feeder
D P,oult ,
Ca aci
Po
Non -Dairy
Farrow to Finish
ILayers
Non -La ers
Beef Stocker
Beef Feeder
Gilts
Boars
I
IPUIlets
Turke s
Beef Brood Cow
Wln-
Other
Turkey Poults
Other
Other
Discharges and Stream IMBacts
1. Is any discharge observed from any pan 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 allo ❑ 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? 11
Page I of 3 21412011 Continued

Facili Number: %- Date of Inspection: O —ram t3
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
D NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):T
Observed Freeboard (in): _70
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�]C 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
P3No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
JD No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes RjNo ❑ 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): V !/� EE—LX lJj_/� 1 GX Z:;2
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
[ILNo
❑ 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
Z 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
Lj�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 4 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Zj No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes � No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

IFacHity Number: - 40 q I Date of Inspection: k f
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 CaNo
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
[] Yes
No
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
® No
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
34. Does the facility require a follow-up visit by the same agency?
- ❑ Yes
;g-No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #f): Explain any YES answers and/or any additional recommendations or any:ather 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: �d ov
Date:
21412011

P-- 0D_V-6I;;E-=Pc r)3 79
Type of Visit: l�Comp . nce Inspection U Operation Review O Structure Evaluation U Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: rrival Time: ' D (7 Departure Time: : iv County Region:/`
Farm Name; Sl Jn;'f�, %r�.t_ Owner Email:
Owner Name: j �. ,g�% d" m i -f it Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: QW /1 Phone:
OnsiteRepresentative: �jc�*.--� Integrator: %fftl�pi
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Desagn,Current -
Design Current
Swine
Ca Po
p ty pt
Wet Poult
try
�z
C•apac�tyPop
Cattle Capacity Pop.
,ace
can to Finish
Layer
Dairy Cow
can to Feeder
on
Non -Layer
Dairy Calf
Fceder to Finish
SMER� r
Dairy Heifer
Farrow to Wean
.
t
Dry Cow
Farrow to Feeder
D , P,oul
Ca ace Po .,
Non -Dairy
Farrow to Finish
dT-1
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
n
Turkey Poults
NJ Other
10ther
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 2!.No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. is there evidence of a past discharge from any part of the operation? [—]Yes Eg—No ❑ NA [] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes E.No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

' Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Eg-.No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
V, 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
Wo
❑ 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
joNo
❑ 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 JZ�o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): fGr' (/0v`-t.'S tYd l �z� 5 L ur �G f
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?
L&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
ENo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
3 No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
®, No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
[] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
R[ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
RLNo
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ;gNo ❑ 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 F] No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [�j No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 5Q No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
g 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
i� 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
J4 No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
K No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
S No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers;andlorrany additional recommendations or::any other comments R: r
Use drawings of facility to better explain situations (use -additional pages as necessary). Fs
�xr►n ;.S T!% i fb �-'S� rOL iJrct3 F`ctt,.c e%�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: J
Date:
21412011
Page 3 of 3

•
` Evi'sion of Water Quality �� _� jf-�j-"-f/
Facility Number I� - 3 f ®Division of Soil and Water Conservation
Other Agency
Type of Visit: Gk�_pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Iteason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: r,, Departure Time: County: Region:�
Farm Name: Owner Email:
Owner Name:_Phone:
Mailing Address:
Physical Address:
Facility Contact: Sr e' / rI-e-Xell Title: dGvh,rr' Phone:
Onsite Representative: Integrator:
Certified Operator:«_ Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Ctir ent
F Design Current
Swine
Capacity Pop. Wet Pointry
@specify'
Pop:.` Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
Layer
DQ Non -La er
Da Cow
Da' Calf
Feeder to Finish
�`
" '"
Da Heifer
Farrow to Wean
Design
Cui ren,t
D Cow
Farrow to Feeder
... P,oWt .
Ca aci
pop-
Non -Dairy_
Farrow to Finish
Gilts
Layers
Non -Layers
Beef Stocker
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Other
Turkey Pouets
Other
Other
Discharges and Stream impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[] Yes P�No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes E&No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes EL No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3
21412011 Continued

Facility Number: 3 rDate of Inspection: 1p �
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [allo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): —
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ® 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 N No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes n No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): j5�54w
13. Soil Type(s): ✓v%kes IrC K ✓;1/
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
12-Yes
❑ 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?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Z 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
❑ 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
El No
❑ NA
❑ NE
Page 2 of 3 214/2011 Continued

Facili Number: C} Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ®No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to 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 concem?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ® No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes [5j No ❑ NA ❑ NE
❑ Yes W No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
LK No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
ZLNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes
Rg.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). ';. ,,.,..�g,�� • °,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: fjC}->,M 330 0,
Date:
21412011
Page 3 of 3

Type of Visit �pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: / Arrival Time: ; p c7 Departure Time: County: 0'L Region:
Farm Name: pt � Owner Email:
Owner Name Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: -�-L Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =]' E:]' = Longitude: =° 0' = W
Design Current
Swine Capacity Population
Design Current
Wet Poultry Capacity Poplation
Design
Cattle Capacity
Current
Population
to Finish
❑ Layer
❑ DairyCow
to Feeder /'Oo p�'�D
❑ Non -Layer
❑ DairyCalf
El r to Finish
-
DairyHeifer
w to Wean
Dry Poultry
❑ D Cow
w to Feeder
❑Non-Dai
w to Finish
EGilts
❑ Layers
❑ Beef Stocker
❑ Non -Layers
❑ Beef Feeder
❑ Pullets
❑ Beef Brood CoTurke
s
7
❑ Turke Poults
❑ Other
Number of Stnsctures:
Dischar es & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
K.No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
J&No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
;R-No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: � — 3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes B No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Lj j
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
�9No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
® No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7_ Do any of the structures need maintenance or improvement? ❑ Yes
No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes]
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes
RNo
❑ 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
RLNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or I O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CA W M P?
❑ Yes
JZ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
®—Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[9- No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
R No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
SNo
❑ NA
❑ NE
Comments+ refer #o uestion # Explain an YES answers and/or, an recomrrnendatrons nr an `other cowmen "
, ftol' 9 )• p y y
;,Use drawin s �of facility to better explain srtuattons. (use addition al pages as necesary)
�7
Phone: r7
Reviewer/Inspector Name�� 3
Reviewer/Inspector Signature: Date:
Page 2 of 3 LZI-16/U4 C.onrutuea

Facility Number: Date of Inspection 1-
Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 91 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 ❑ Desig
n ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ®-Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard 5. Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes KNo ❑ NA ❑ NE
❑ Yes
Eallo
❑ NA
❑ NE
❑ Yes
JRNo
❑ NA
❑ NE
❑ Yes
i[ No
❑ NA
❑ NE
❑ Yes
nNo
❑ NA
❑ NE
❑ Yes
Z..NO
❑ NA
❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes O.No ❑ NA ❑ NE
[]Yes ANo ❑ NA ❑ NE
❑ Yes 19 No ❑ NA ❑ NE
❑ Yes 10 No ❑ NA ❑ NE
12128104

fl
Type of Visit
ompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
ctine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other [I Denied Access
Date of Visit: !F "� Arrival Time: Departure Time: `D County: �"`� Region;�
Farm Name: �� _ /ram �� NuOwner Email:
Owner Name: SG,97Z6— i �'� . Phone:
Mailing Address:
Physical Address:
Facility Contact: s /'zn7 T //'/:T fl // Title: fl&lyll� Phone No:
Onsite Representative: /� Integrator• ,/i1sw11 _
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
0
Back-up Certification Number:
ED u Longitude: F] o E:J, = u
Design Current Design Current Design
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity
Current
Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
Wean to Feeder
DO
ILI Non -Layer
❑ Dairy Calf
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ DaiEy Heifer
Dry Poultry ❑ Dry Cow
❑ Non -Dairy
❑ La ers
❑ Beef Stocker
❑ Farrow to Finish
-Layers
❑Beef Feeder
Gilts
Boars
E❑
❑ Pullets
❑ Beef Brood Co
Turkeys
❑ Turkey Poults
❑ Other Number of Structures:
Other
❑ Other
Discharges & Stream Impacts
i _ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made?
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 Wo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
®.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? ❑ Yes 9 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes KNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes fallo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [.Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuetures lack adequate markers as required by the permit? ❑ Yes RNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes P .No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes M�No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes [&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) i�Yll� /L'/Jrr1 / 40U--ea�—_"j 15u',9 .xfr An,"fir/f
13. Soil type(s) /J,9A4_6_1 p,,y & //,,- / Gh ,
{
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?
ERYes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination 7
❑ Yes
U. No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
LgNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
%No
❑ NA
❑ NE
Comments (refer to questiod;9) Explain"arts YES answers andlorjany recommendationsiar a, n} other comments.
d - s
Use drawings+of.facihty to better egplatn situations. {use's."dditaoital page°s as necessar}} l i!
00
i k 4e_ AID L 51z"yk�f
Reviewer/Inspector Name �. ` �" r h f' mil# x� Phone:/D-3 ��c'� 0
Reviewer/Inspector Signature: Date:
!L/Lof UV l.Unl"Tueu

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
❑ Yes DSZlo ❑ NA ❑ NE
❑ Yes E2FIyo ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑ Waste Transfers ❑ AnnuaI 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
D�LNo
❑ NA
❑ NE
❑ Yes
9No
❑ NA
❑ NE
❑ Yes
C&No
❑ NA
❑ NE
❑ Yes
MNo
❑ NA
❑ NE
❑ Yes
19 No
❑ NA
❑ NE
❑ Yes
Wo
❑ NA
❑ NE
❑ Yes
M-No
❑ NA
❑ NE
❑ Yes
E4No
❑ NA
❑ NE.
❑ Yes
EgNo
❑ NA
❑ NE
❑ Yes
Eallo
❑ NA
❑ NE
❑ Yes
LgNo
❑ NA
❑ NE
❑ Yes
P-No
❑ NA
❑ NE
Additional _Commentsandlor�Dr�awmgs -- � = "• - -
12128104
12128104

vision of Water Quality
FDivision of S
eroil and Water Conservation I<
OthAgency IY!
Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit C -Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3p Arrival Time: i/�: (� Departure Time: County: ats Region:l�
Farm Name: ��r /%�C�lC`/�� Owner Email:
Owner Name: �.'T �l� Phone:
Mailing Address:
Physical Address: ,vi
Facility Contact: �� A %L L11 Title:
Onsite Representative:
-�-
Certified Operator: S—
Back-up Operator:
Phone No:
Integrator: fi
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 e = ' F7 14 Longitude: = ° 0 4 0 «
Design
_f�"
Current �Destgn� �Current� - Design Current
Swine :
LC, i -5-5-c i t Ul
Population Wet Poultry - Capaa opulation Cattle Capacity Population
❑ Layer ❑ Dairy Cow
IQ Non -Layer ❑Dairy Calf
"" - ❑ Dairy Heifer
❑ Wean to Finish
® Wean to Feeder
01710,5_7
❑ Feeder to Finish'``'
❑ Farrow to Wean
Dry Poultry ❑ Dry Cow
❑ Farrow to Feeder
- ❑ Non -Dairy
❑ Farrow to Finish
I❑
La ers
r ❑Beef Stocker
❑ Non -La ers
Feeder
El Pullets
❑Pullets ❑ Beef Brood Co
❑ Turkeys 6.
❑ Gilts
❑Boars
ro
Other
❑ Other
❑ Turkey Puults
❑ Other 'Number of Structures:
_
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
(,2 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
®,No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
'No
ElNA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued
i. "A

Facility Number: ` —v{ jq" Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes PRNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
10 No [I NA [I NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
MNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
;K No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes
&No ❑ NA ❑ NE
maintenance or improvement?
+
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[3 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[K No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 6 r
--
13. Soil type(s) Vi94,,,4 mod.
- r
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
(R No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
® Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
JSNo
❑ 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
5,No
❑ NA
❑ NE
fit1 Q �C! ��CU�f3' �(�YX�ir • �
�a Su,oC fir? 1 rye•
Reviewer/Inspector Name I iry Phone:/0��33DO
Reviewer/Inspector Signature: Date:
"gv t uJ J 2t✓coivv a.ws99""r

Facility Number: Date of Inspection
'
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
[--]Yes
KNo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check
❑ Yes
E.No
❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
14 No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ t20 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
[@ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[9No
❑ 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
[0 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P9 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[Z 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
�2 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
18 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
®No
❑ NA
❑ NE
Page 3 of 3 12128104

Division of Water Quality �i►+� v
Facility Number 3 g 0 Division of Soil and Water Conservation 1,,PfZrb7
0 Other Agency
Type of VisitC'ommppliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit , tine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: :lam County• W~' Region: 7r0
Farm Name: A"V1_ %V; ±J e_r Z/ Aliv r"'5cf7i"Y_ Owner Email:
Owner Name: _ i % G4I e Phone:
Mailing Address:
Physical Address:
Facility Contact: 5� �^Title: Phone No:
Onsite Representative: J`�+�p� Integrator: #Ww=4
Certified Operator: Operator Certification Number:i2-f--77
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = = I E] P Longitude: = ° = 6 [� «
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
Wean to Feeder 0 0
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Capacity . Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: ©
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes X[No ❑ NA ❑ NE
[I Yes
❑No
El NA
ONE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
QQNo
❑ NA
❑ NE
❑ Yes
[.No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection —)—D
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
❑ Yes R No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): c�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 9No ❑ 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? l
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 29No ❑ 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
RNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
A No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
C&No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl�❑ AApplication Outside of Area
12. Crop type(s) Ijyjt�/�Tf re5ru =
13. Soil type(s) �Dh N �f mac ZV t �/ :� / j i
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
[XNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
® No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
® No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
A No
❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment? ❑ Yes
Mo
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name Phone:
Reviewer/Inspector Signature: Date:
-.41 12128104 Continued

Facility Number: 90j Date of Inspection ` f�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes A No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [Z%No ❑ NA ❑ NE
the appropiate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes aNa ❑ 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 Eallo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 54 No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
U, No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
C.No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
91 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
allo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
&No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[.No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[&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
ZI 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
PSNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
®,No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Type of Visit O-Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: fl Departure Time: ��.3 (7 County: y"" Region:
Farm Name: SGU ��Gh r AL r_.5 - fz Owner Email: .01
Owner Name: S ` — in ifGHc%l Phone:
Mailing Address:
Physical Address:
Facility Contact: 5 -/g zyz2h �11 Title:
Onsite Representative: _!rA- e_
Certified Operator:
Back-up Operator:
Operator:
Phone No:
Integrator: zW& , IX
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o =' 0is Longitude: 0 0 = I ❑ "
Design C+urrent
Design
Current Design Current
Swine Capacity Population
Wet Poultry Chap city
Population Cattle Capacity Population
❑ Wean to Finish
I I❑
La er
❑ Dairy Cow
Wean to Feeder
L2 6 0 0 1,49, (o 16 C7
❑Non -La er
❑ Dairy Calf
❑ Feeder to Finish
%T...
❑ Dairy Heifer
El Farrow to Wean
x:; �4
Dry Poutry��.,•..
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
El Farrow to Finish
❑ ers
❑ Beef Stocker
❑ Gilts
❑ N ers
❑ Beef Feeder
❑ Boars
Nets
❑Pulle
❑Beef Brood Cow
Other
❑ Turke s
❑ Turkey Poults
_ # �-
❑ Other
❑Other
Number c struetures:
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 M No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
4 No
❑ NA
❑ NE
12128104 Continued

a
Facility Number: — Date of Inspection
tr Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
(2 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
EX No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
(9 No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed
❑ Yes
KNo
❑ 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
ZtNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
E9 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
KNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
KNo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. 9 Yes JRNNo❑ NA ❑ NE
ElExcessive Ponding ElHydraulic Overload [IFrozen Ground ❑ Heavy Metals (Cu, Zn, etc.) a +
❑ 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 Outsides of Area /J /
12. Crop type(s) B_inrr f�'r, %u'ss�Ifir��i? �Gr/ih��'`_ i'iy'l�ceX /�Y�'✓.St P'c',
13. Soiltype(s) /fn i Q f !& x Vd I e- _/ rig h i S
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
/J .
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ yes
IT Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[Z�Nyo� ❑ NA ❑ NE
l�o ❑ NA ❑ NE
No ❑ NA ❑ NE
�No ❑ NA ❑ NE
Z,No ❑ NA ❑ NE
I ®Uerapf
e-rP-
16-
T
Reviewer/Inspector Name , , y ,.-- Phone: 331)o
Reviewer/Inspector Signature: Date: OP(�
I-Mgc.4 uJ uununuea

yl
Facility Number: — Date of Inspection
►j Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes CRNo ❑ 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 ❑ Other
21. Does record keeping need improvement? if yes, check the appropriate box below. (Kyes �❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ElWaste 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
CRNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
(4 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
la, No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
jo No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
J[ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
CKNo
❑ 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
W 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
2g No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
,@ No
❑ NA
❑ NE
Additional '.Comments and/or Drawings
w
Page 3 of 3 12128104

l
,oy
Division of at Quality
IFSERRNNE er g� �� 3 O Division of Soil and Water Conservation
{'� Other Agency
Type of Visit Q Compliance Inspection O Operation Review U 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: ,E -t"f+ Arrival Time: Departure Time: County: -k++tso'n Region: Fl?o
Farm Name: ,& Alvrsio.,. Owner Email:
Owner Name:_ Sip �.1la�e% / Phone: 910 -90' G
Mailing Address: ___ 3 t� 3 %��� �., ,. 64 cn^eh __ _�od J G /, „,4o,
Physical Address:
Facility Contact: S c or% /yf , te�r_� �/ _ _ Title:
Onsite Representative: S co 1`f" /?7Tl�e� eel
Certified Operator: �,i,'ii.'. �, M7 J�deli
Back-up Operator:
Phone No:
Integrator: Alai )C 41-CJw02
Operator Certification Number: -7-2 57
Back-up Certification Number:
Location of Farm: Latitude: F--I e F­I 7 = 1f Longitude: ❑ o ❑ 7 ❑ i7
Wean to Finish
[,'Wean to Feeder (�ov �
Feeder to Finish
Farrow to Feeder
Boars
,g
❑
❑ Farrow to We
❑
El Farrow to Finish
❑ Gilts
❑
Other
❑ Other
Y ^Design Current A . Design Current 1 e> ti.. Design Current
�� A at„„„
Swine�Capacity Population ii Wet Poultry Capacyty Population @attle �.ai.` Capacity Population
El
❑ La er ❑Dai Cow
Y
❑ Non -La et ❑Dai Calf
Dairy Heifer
M
D Cow
ElNon-Dairy
❑ La ers ElBeef Stocker
❑ Non -La
ElPullets ers ❑ Beef Feeder
❑ Beef Brood Cowl
ElTurkeys
❑ Turke Poults
❑O_ 4 {F
ther-rrof Structures•
an
El
Mumbe
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Y ^Design Current A . Design Current 1 e> ti.. Design Current
�� A at„„„
Swine�Capacity Population ii Wet Poultry Capacyty Population @attle �.ai.` Capacity Population
El
❑ La er ❑Dai Cow
Y
❑ Non -La et ❑Dai Calf
Dairy Heifer
M
D Cow
ElNon-Dairy
❑ La ers ElBeef Stocker
❑ Non -La
ElPullets ers ❑ Beef Feeder
❑ Beef Brood Cowl
ElTurkeys
❑ Turke Poults
❑O_ 4 {F
ther-rrof Structures•
an
El
Mumbe
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
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}
El
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
0!o
❑ NA
ElNE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
©'No
❑ NA
❑ NE
other than from a discharge?
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:
Spillway?: ZD
Designed Freeboard (in):
Observed Freeboard (in):
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 lsd'No ❑ NA ❑ NE
❑Yes El No El NA ❑NE
Structure 5 Structure 6
❑ Yes [IIo ❑ NA ❑ NE
❑ Yes O'�Io ❑ 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 0q<o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
04o
❑ 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
U—no
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
e- o
❑ 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 [:IPAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12. Croptype(s) FESG��
13. Soil typMs) �'o�in /°;.Jr4.: Re ley
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
O No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
9-fllo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`
❑ Yes
❑ No
❑ NA 9 NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA []'CIE
18. is there a lack of properly operating waste application equipment?
❑ Yes
ONO
❑ NA ❑ NE
Comments (refer to question #>ry: Explain any YES answers and/or any recommendations or any other comments.
Use drawings oflity to better eap faciiain situations. (use additional s a pages necessary):
.=5
7eye, Grvr.i /r.'cf a. l.',vry y �S>/i,-y fLft
Reviewer/Inspector Name �1�t/f ��aw fjfy Phone: 1 gl ; S ��f auk. ; :• 0
Reviewer/inspector Signature: Date: `1 $
12128104 Continued

Facility Number: g�2_ —_7 - Date of Inspection
Required Records & Documents ,�
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Ey, Yes o ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
D,14
❑ NA
❑ NE
the appropirate box. ❑gyp+ ❑ Checklists ❑ Design' ❑ N,japs--' ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box �elow. ElYes
3 - 2 -!p Z? 4 -,- -� 1 !�- "1-; 0. 8.;t
ElKo
ElNA
❑ NE
17
❑ Waste -Application ❑ meekly -Freeboard- ❑ Waste -Analysis._ El god-Anaby,%is ❑ Wasteq'-rans€ers- ❑ ol•Co#ifeatiorr
❑ Raaafall ❑ Stocking ❑ Er6 Yield ❑ 1-20 Minute Inspections ❑ N4onthly-an i lI:aifnspections_❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
��
D-f o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
E4<E
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
tl'INE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
t KE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑Ko'
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑-<
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [2'�o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
D<o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
0<o
❑ 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
01 o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Q-16
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
�o
❑ NA
❑ NE
-21 1?eV,'e14.1e Scv nf_ o1 111C /?GW �J�rihr'7 GUriGl+l�,v'75 k,,'/-4 /"ir`, 1414dell,
'0"se L'Sfee. FI-ee 4ocrrt� Ci�It<r`I`! �Gr.�FQ//! I�JGnlftl,/ Gr7Gr / `"
, 41 f 1
ke.E�o,ng �c�ur C�u,•1� ��� .SI-oc�C,•„� /`Et<i/c15 pn /''Un,+,, /-/,•S lF.G�i
C 'ne
Cf i , eL-,
f v.,r/"r'��
f/
1.:.•:•rcldu'J l��l�, C/�`f�s
12128104

Date cif Visit: Time: �= Oa
Facility- lumber a3 g
lNot operational 0 Below Threshold
® Permitted El Certified [3 Conditionali.- Certified E3 Registered Date Last Operated or Above Threshold:
Farm Name: — S,o-ft `II /Vsd,jey] Count.•: SQL bN Fla
SSc3 - 7�
Owner lame: S Go �" i- 1'h � �elr, � 14 Phone No: l � 4'
Mailing Address:
Facilih-Contact: Seat- M4.A'�_11 Title: Qk'^ter
Onsite Representative:
Certified Operator: l.-): a _. f'" `' k�L CA
Location of Farm:
Phone No:
Integrator: �1 c4 T A y ' 13raWAA
Operator Certification Number:
yO Swine ❑ Pouttry ❑ Cattle ❑ Horse Latitude 0' 0` 0" Longitude
Design Current Design Current Design Current
Swine Ca achy Population Poultry Capacity Population Cattle Ca adty Population
t'l = to Feeder oo ❑ Laver EN
Dairy
El Feeder to Finish ❑ on -Laver Non -Dairy
❑ Farrow to Wean
El Farrow to Feeder1 Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Plumber of Lagoons LLJ ILJ Subsurface Drains Present 11LJ Lagoon Area JLl Spray 1
Holding Ponds /Solid Traps 0 �: • ❑ No Liquid Waste Management System
Discharges & Stream Impacts
L Is anv discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is obsmed. was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notif.- DWQ)
c. If discharge is observed. what is the estimated flow in eaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
?. Is there cNidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection S Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure ? Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): a3
❑ Yes 0 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes JZ No
Structure 6
05IV3101
Ll
Continued

Facility Number: 7,2 — )3 7 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes] No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes © No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
If. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes No
12. Crop type -- r-C.s c "CC M,-i/e f, ', sumrn , 9 ^ . CA- Lr ..
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes [ ] No
b) Does the facility need a wettable acre determination? ❑ Yes ® No
c) This facility is pended for a wettable acre determination? ❑ Yes W No
15. Does the receiving crop need improvement? ❑ Yes ® No
16. Is there a lack of adequate waste application equipment? ❑ Yes Q No
Reatiired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
m No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
® No
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[I] No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
m No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
[11 No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[J No
24. Does facility require a follow-up visit by same agency?
❑ Yes
m No
25. ere any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Cowmen- (refer}to que'tbon #) *Erplatnlany, aE tanswers andlar any r`ecommen'dabons ©r any other comments_.
Use.,drawmgs of;faicihtytto betterfezplar i giWiitions. (usefadditional pages as necessary) ®Field Copy ❑Final Notes
w
SOi� 5�•--rL�� 1R 1 �CLCri�74�. �y�r+�� ►1CrCOiCCC
G LGO+ o� i r cI T n Y+N r.
W4f}�- So..,p1�- la-S-o3 is i.t
...L
GaodZ #ars+�
�1
1+ C f G+� 4 �'ieAk �aJ �•w i-1.�� 1nc� �«.. Tesle-.YF�S) w:1J. rYa��'erc.t� saGsQ.
Reviewer/]nspector Name
Reviewer/inspector Signature: Date: 51
05103101 Continued

r
Site Requires Immediate Attention: N 0
Facility No. 2-- Z37
DIVISION OF ENMONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: �* , 1995
Time: 2"k
Farm Name/Owner: D 1� tlC .k iD L
Mailing Address: O ut�E_ o �r 13 C.t✓ �o�J L.
Coun
Integrator: Arrt t 1 C. Phone:_
On Site RepresentaPhone:_
Physical Address/Location : T n4C o�� 0 N ems- a L
Type of Operation: Swine Poultry Cattle
Design Capacity: `Z- to Number of Animals on Site: 2_'-o
r
D_E..M Certification Number: ACE �`�� DEM Certification Number: ACNEW
Latitude: LongitudeO
: • w
Circle Yes or No
Does the Animal Waste Lagoon sufficient freeboard of I Foot + 25 VMT 24 hour storm
(approximately l Foot + 7 inches) es No A foal Freeboard:FtInches
Was any seepage observed from the n(s)? Yes o No as any erosion Osqrvedvp Yes or Ion
Is adequate land available fQr spray. Y or No Is the cover crop adequate? es No
Crops) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from DwellinjPL2Yes
100 Feet from Wells? t
Isthe animal waste stockpiled_ within 100 Feet of USGS Blue Line Stream? Nc
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue
Is animal waste discharged into waterstate by man-made ditch, flushing system,
similar man-made devices? Yes k No If Yes, Please Explain.
No
event
J
ie: Yes or 0e)
or other
Does the facility maintain adequate waste management r volumes of manure, land applied,
spray irrigated on specific acreage with cover crop). Yes No
Additional Comments: a 00 0 7 u.A V"
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.