820249_INSPECTIONS_20171231

NUH { H UAHULINA
Department of Environmental Qual

IM
ivision of Water Resources
Facility Number l� - Division of Soil and Water Conservation
Q Other Agency
Type of Visit: O Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: f- Arrival Time: 'D Departure Time: , r,) County: Region: Q
Farm Name: Owner Email:
Owner Name: fl'Jtr /1 e Atone:
Mailing Address:
Physical Address:
Facility Contact: L94v%,► r_y itle: Phone:
Onsite Representative: ,�sr.e�c� Integrator:
Certified Operator: _ �� Certification Number: 7
Sack -up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2_ Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[-]Yes Q'No DNA ❑ NE
❑ Yes ❑ No
[:]Yes [:]No
❑ Yes ❑ No
❑ Yes E:[,Nv
❑ Yes 12-No
❑ NA D NE
❑ NA ❑ NE
❑ NA NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

[Facility Number: - 17 Date of Ins ection: A-1^ /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �2(
/
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [ 1qo ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes []'I Io ❑ NA
D 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 EEJ o ❑ 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 Eo ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ETKo ❑ NA
❑ NE
maintenance or improvement?
. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes ED-�o ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 71,1117,IIJ[L /0 7-1,�45
13. Soil Type(s): E j �,�j Z j¢-u _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes LA "'o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes D-1�o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [r N DNA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes <o ❑ NA ❑ NE
❑ Yes Ea 110 ❑ NA. ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes e'llo ❑ 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 Q'No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes D-1 o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

[Facility Number: jDate of Inspection:
• 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ETNo
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes [:J�o
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes E3<o
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA 0 NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
[-]Yes ETNo ❑ NA ❑ NE
❑ Yes to ❑ NA ❑ NE
❑ Yes ❑-Mo ❑ NA ❑ NE
❑Yes [3 o ❑NA ❑NE
❑ Yes
�o
❑ Yes
E3,?s'o
❑ Yes
ETNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional vases as necessarv).
Reviewerllnspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: / .3D3- S/
Date: —'0;;e6z4Ef
21412015

Type of Visit: ('Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: (31 routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: L Arrival Time: / Departure Time: ,'� County:s'---- Region:
Farm Name:
Owner Name:
Mailing Address:
Owner Email:
Phone:
Physical Address: /�
Facility Contact: / y,t —r ,�, zee Title: 1�7LUr,7-er` Phone:
Onsite Representative: Sir, �_ Integrator:
Certified Operator: /LY1 YL }J Certification Number: /?Q x
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Swine
Wean to Finish
Wean to Feeder
Design Current
Capacity Pop.
Wet Roustry
La er
r
__
D . Pout
Layers
D esign
Capacity
Design
Ca aci
Current
Pop.
Current
P,o ,
Design Current
Cat#!e Capacity Pop.
Dai Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Turke s
Turke Poults
-
Other
Other
Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes R No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [&No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes allo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

FaciliNumber: -it Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EkNo ❑ 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?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes 21,No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [&No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? [:]Yes allo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2]LNo
❑ 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 or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E3,No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): 7D'T /xy ,1 .3 ,LET ',.,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ®.No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
[:]Yes allo ❑ NA ❑ NE
❑ Yes [allo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
[&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
M 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 [No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 10 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 jo No DNA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 10 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes .3 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
® 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
OL No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[8-No
❑ NA
❑ NE
Comments (refer to question #I): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary):
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 7 `
21412015

S-__ - __b i6
Type of Visit: .Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: outine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: F 7c7 Departure Time: ; p J County:Region:
Farm Name: I _ Owner Email:
LL
Owner Name: �`yn �� S �� 7"+� �yGe Phone:
Mailing Address:
Physical Address:
Facility Contact: . �Yt7rn i Z_ Title: ,Qt'e al Phone:
Onsite Representative: �% Lam— Integrator: -'l i�c.
Certified Operator: Certification Number: / 9V 7/
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design.. Current Design Current Design Current
Swine
Capacity ; Pop... Vet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
can to Feeder
p
Non -La er
Dairy Calf
Feeder to Finish
' "" ""
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D . Poulir, Ca aci $o
Non -Dairy
Farrow to Finish
Lavers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
NJ 113eef Brood Cow
Boars
Pullets
Turkeys
:.
Qther
Turkey Poults
her
"'"' Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes R-No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
[:]Yes ❑ No
[:]Yes M-No
❑ Yes 9ZLNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: - Date of Inspection: iv7290VL
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 I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _je2_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes allo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[:]Yes
�0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
5� No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
F21No
D 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
�No
❑ NA
❑ NE
maintenance or improvement?
I I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift E]Application Outside of Approved Area
12. Crop Type(s): Or_rt LVj't_ / Bc' ��T'YPI /� I kU / J
13. Soil Type(s): /jD 1j GULL �j 1
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Jallo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes kqNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes j. No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes �2 No ❑ NA ❑ NE
❑ Yes 2, No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
JZ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
JZ 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
RNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I ° Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
UNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes allo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: IDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No
i
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes [N No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes Z No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes r No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34_ Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[:]Yes MNo ❑ NA ❑ NE
❑ Yes [Z No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes & No ❑ NA ❑ NE
❑ Yes Callo
❑ Yes JZ No
❑ Yes b N
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/inspector Name:
Reviewer/Inspector Signatut
Page 3 of 3
Phone:
Date:
21412015

Type of Visit: Q5 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: Owner Email:
Owner Name:, � %y r- �� "l.yG Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: ��Q�r Phone:
Onsite Representative:Integrator: m Tj
Certified Operator: 6 — Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Region:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design Current Design
Wet Poultry . Capacity Pop. Cattle Capacity
La er Da' Cow
Curren#
Pop.
Wean to Feeder
p
O
Non -Layer-
Da' Calf
Da' Heifer
D Cow
Non -Da'
Feeder to Finish
Farrow to Wean
Farrow to Feeder
.'
Design Current
D . P,oaltr C aci P,o
Layers
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
tither
Other
Turkeys
Turkey Poults
I 10ther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes E No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [Z No [DNA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes [2-No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

) icili Number: - Date of ins ection:
/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
D NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): i
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
fa 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
JZ 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
Q No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
12 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
� No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
,® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes j,No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑/Eviidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):�'�---
13. Soil Type(s): po 10"Z-T 4u
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ®No DNA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes L_21 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
Q No
❑ NA
❑ NE
18, Is there a lack of properly operating waste application equipment?
❑ Yes
0 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
[allo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design [:)Maps [-]Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [}1No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
[DNA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

iW
�,
Facility jDate of ins ection: —/�
24. Did the facility fail to calibrate waste application equipment as required by the permit? C] Yes [F�No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 2 No
2T 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?
29. 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 the 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 allo
34. Does the facility require a follow-up visit by the same agency?
❑ Yes MNo
❑ 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 #): 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: 67—.
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date: /
21412011

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine O Complaint 0 Follow-up O Referral O Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ' DID I Departure Time: County: Region:
Farm Name: rT- an Owner Email:
Owner Name: _�r�sf y at �r �.�, �} D j.� y phone:
Mailing Address:
Physical Address:
Facility Contact: v Title: Phone:
Onsite Representative: f�� Integrator: "_
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current Design
a
Capacity Pop.We#Poultryapacity
La er
Layer
'' Design
Ca aci
Layers
Non -Layers
Current
Pop.
Current
Eo_ .
- Design Cnrrent
Cattle °. Capacity Pop.
Dairy Cow
IDairy Calf
Dairy Heifer
Dry Cow
Non-Dai
Beef Stocker
Beef Feeder
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Pullets
Beef Brood Cow
M01ther
-
Turke s
urke Pouets
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Pg No ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes ❑ No
❑ Yes ❑ No
❑ Yes JZLNo
[:]Yes P1 No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes v No ❑ NA [3 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): ^ 9
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? D Yes R No
❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ® No
❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ® No
❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes gj No
❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [-]Yes rz;A No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop TYpe(s): Zrrnr_ 4udb, /BU �e*-fr, -j /25� / GU,4 1-5
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Reuuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
eu 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 4K No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [] Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [—]Yes N No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes � No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection: r
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
14 No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes Ca No ❑ NA ❑ NE
❑ Yes ®No
[:]Yes No
❑ Yes ® No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Reviewer/Inspector Name: Phone: XIa--!{33-�53 00
Reviewer/Inspector Signature: Date: q
Page 3 of 3 21412011

jv1 61HJ A3113
Type of Visit: is Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: futRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ® Arrival Time: la; { Departure Time: County: S�S4 Region:
Farm Name: K
Owner Name: Neka,fiaj&4lCr_-
Owner Email:
Phone:
Mailing Address:
Physical Address:
Facility Contact: iL.py�- Title:
Onsite Representative:��
Certified Operator: -1ow9f1 N' n()f) cc#-:+.
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: M`-B
Certification Number:
Certification Number:
Longitude:
Swine
Design CurrentDesignCurrent
p ty _ p. tryp� ty,-Pop.
Ca _ace. Po Wet Poul Ca ct�
Design Current
Cattle Capacity Pop.
Wean to Finish
iry Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish.....`
Farrow to Wean
Farrow to Feeder
==©esegnnr'Current
D , P,oultr Ce aci Po
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Boars
-
MIOther
Other
—.Layers
Non -Layers
Pullets
Turkeys
Turke Poults
Other
Beef Feeder
I
113eef Brood Cow
Dischart<es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes E] No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

FaciliNumber: JDate 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 I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: I
CR No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in)PT_2_Eul�
Observed Freeboard (in): D137
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [a No
❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [U No
❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? Yes ❑ No
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No
❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:)Yes 1�3 No
❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land 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 Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes gc]' No
[—]Yes No
(—]Yes No
[:]Yes ® No
D Yes 1@ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑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 (2 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes t2] 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

Facili Number: - Date of Inspection: 3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ® Yes ❑ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes W 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 to No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No [�j NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i_e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes [>_� No ❑ NA ❑ NE
❑ Yes [�j No ❑ NA ❑ NE
❑ Yes 1>--j No ❑ NA ❑ NE
❑ Yes JFK] No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
0 No
❑ NA
❑ NE
Comments (refer to question ff): 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).
� )Q b�01 kj
CQlfbraM _f)74t?a
9had- b cpcfino
y�� i't��n oW
Vl,mp� be&, o�b �,ql tom► old now, Th f la�cr� )fveLr
et p ca j l brawl as soy7 o r
9 ,�C�fe �v$� �P f��slwd ec�i�no � T ete now haL�
)sra��oo e Thr°s, shr c� el�h,� b'!� re,70 ,4 f�a, _ �lah
0 vTu n/&dr 10 Jfe if �� cup be vs�
�, � ark o�fsl�ye)
b h aXm✓m Plohl), Coln peJ�r -excei(�I ' will
(�0Oo �, C -'e
Chkith berms, a_ 9f � are I�as3�avP1 1e�
fi-Q! 5, /a I W ic�i Sh oqL
IS, T e td�ria� �►��d�
Reviewer/Inspector Name
t } Gln -x rJr1 1 Phone: 131 U- 4 33- 3 �U tTii
Reviewer/Inspector Signature:
Page 3 of 3
Date: Uyr} p y, a o 13
21412011

Facility No.Farm Name v D —Date i
Permit COC OIC ✓ NPDES (Rainbreaker PLAT Annual Cert Daily Pipe }
FB Dro s
Lagoon Name, S forspillway
1
2
3
4
5
6
7
Design Freeboard / Last Recorded in
Observed freeboard _
d
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
�7
Ratio Sludge to Treatment Volume ifs 0.45
Date out of compliance/ POA?
Actual 1jam.
oyo Laou,
Soil Test Date I�1 tettable
op Yield CAA Sl [�J Transfer Sheets 11�
pH Fields ll ,` I Acres RAIN GAUGE
Lime Needed 560-95CO WUP Dead box or incinerator
Lime Applied YEl Weekly Freeboard Mortality'Records
Cu-I Zn-I-I � i 1 in Inspections T Check Lists
Needs S (S-1<25l 1,, tIB 120 min InSD. Storm Water
Needs- - ..-
..
..
r* ,
Verify PHONE NUMBERS and affiliations^` u..�
Date last WUP FRO FRO or Farm Records "l - f �w
Date last WUP at farm Lagoon # C con -vo -ms*
App. Hardware Top Dike
Stop Pump
Start Pump 4 (;b f ,- tya "--A
Conversion- Cu-I 3000= 108 Ib/ac; Zn-I 3000= 213 Ib/ac t 6�
Lb
11
[2. 110 'i

t"':.' - Division of Water Quality .
Facility Number ®- a Division of Soi! and Water Conservation
d Other Agency
Type of Visit: ZCompliance Inspection 0 Operation Review p Structure Evaluation 0 Technical Assistance
Reason for Visit: t$ Routine O Complaint O Follow-up O Referral 0 Emergency O Other Q Denied Access }�
Date of Visit: l Arrival Time: Departure Time: County: s Region: F/�D
�Q'L-
Farm Name: aB K
Owner Name: —Jane f ve
Mailing Address:
Physical Address:
Owner Email:
Phone:
r � Facility Contact: �`/jm I >P} lr Title: � ! ��,j
G7 dA "ip- Phone:
Onsite Representative: -J^ 1 Integrator: —
Certified Operator: -3-QM CUCertification Number: NOW
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Desi n Current
pRi
wine
IrF
r
� We�oul � Cap tty
C Pop ptCapac�'ty
- .
ean to Finish La er
Dai Cow
ean to Feeder
Non -La er
Dai Calf
eeder to Finish
arrow to Wean
arrow to Feeder
_ +
` : Design
•; D . 1?oult ; a Ca aci
Current
P,o
Dai Heifer
Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Beef Feeder
Non -Layers
Boars
Pullets
Beef Brood Cow
-
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes N No ❑ NA ❑ NE
❑ Yes [—]No
❑ Yes [—]No
(—]Yes [—]No
[—]Yes [�j No
❑ Yes 10 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 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
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): I _^
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
Q3 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
P No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
Vg 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): CnIAR 8em
13. Soil Type(s):
A(%
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'?
❑ Yes
�E 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
t7g] No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Eg No
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
5j No
[] NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ta No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes � No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to instal I and maintain a rain gauge`? ❑ Yes JE No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
[DNA ❑ NE
NA ❑ NE
LCU
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
N No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[R 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
❑ 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
10 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
U 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
[B 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
®"No
❑ NA
❑ NE
Comments (refer to question #i7 Explain any YES answers and/or any additional recommendations or any other comments =
Use.drawings-of facility to better exp iftf"situations (use additional pages as necessary).. _ . .
e cu�' 1�Dad� � dr 4v` s;d>P l� ayoo? sl o�J aboi o?ce
� m ltio� ad11 u 'b t � � � lac ,
{5 r P�
o ca l � kri b�e`�e � d o'� odd /c IL�>_ bask wo% �
a y_ pie, d Y'�
yveW di I 0,oe0- 00L V(essLor-e­
r,Jje was e Iez, �-F 31►- 3la 1aota, �, -�I�h Paoe'er Q�j � 'f� U
b .tea rV as s r� 4��� a� aces , Scm-e1
}pad i s r n "t`h,e Yvoj fe ta see �f Itmd ea•7 beiAX
N �a�e . a -V - cif la snc�arlChet 44� l�r� `�
� r`�r I �+�s�t��R-i t C I i.°Gfi Gam' .
Nd mvc� �vm M9 O�D� f � ova- al s1 9e_ SP ` alGt �/Dy�h&-
old d Pf be a,7�e .
rna ah _Ovand JO& 1 emo-J
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 10—
Date: np a�l
21412011

or
Facility No. g�� Yq Farm Name J'A k Date
Permit COC ✓ OIC —,--, ,c�{`•, , NPDES (Rainbreaker PLAT Annual Cert Daily Pipe )
FB Dro s
Lag8on Name, S forspillway
1
2
3
4
5
6
7
Design Freeboard I Last Recorded in
Observed freeboard
Sludge Survey Date
3j
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA?
EtRrzTffr6 571r .------�
ActualDiam.
7 t!'-------
Soil Test Date Q�aS I 1 Crop Yield �( fl �� Transfer Sheets
pH Fields Wettable Acres RAIN GAUGE
Lime Needed WUP Dead box or incinerator
Lime Applied ©✓ Weekly Freeboard ✓ Mortality Records
Cu-I Zn-Pq�6v� )-. 1 in Inspections Check Lists
Needs S (S-1<25) 120 min Insp. Storm Water
-. P Weather Co. -
RIM
C
►f. '�
it
. 1�;
r r
r �
I
► '
Mi
3433 X I C NOf} L��' 137 % o.p �� J
Verify PHONE NUMBER$ an affi ations
Date last WUP FRO 1\11`C�7- FRO or Farm Records
Date last WUP at farm 3114100 Lagoon #
App_ Hardware Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Ib/ac; Zn-I 3000= 213 Iblac

Ao S, f0 rP
Zn a
7a�
- � �BAc Coy
Cr.� D 5 Qc- (,59DTO ",-)
3/a
12

blKs _Jyf IhW
IV[ on of Water Quality
Facility Number $� a, - �- t i—J O Division of Soil and Water Conservation
Other Agency
Type of Visit: 'Gk Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: a Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit 1Ia
Arrival Time: S? I Departure Time: a; County: ryE�$Qti r Region:
Farm Name: up PC Owner Email:
Owner Name: �/j y,Q t Ndsol i" rc* Phone:
Mailing Address:
Physical Address: 5Hk hl0chell LQW k&
Facility Contact: Title:Phone:
Onsite Representative: �a -,ef
Integrator: M—B _
Certified Operator: Gm�!�(��Qy Certification Number: 11079
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design C►urrent
Des g Current
Design C►urrent
Swine Capacity Pop.
WetPoultry=„CapacityPo��
Cattle Capacity Pap.
z
Wean to Finish
Wean to Feeder
pQ
La er
Non -La er
Dai Cow
Dai Calf
Feeder to Finish
airy Heifer
Farrow to Wean
Desi n C went
Dry Cow
Farrow to Feeder
Farrow to Finish
D FoulCa aci Pop.
Layers
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[B No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
5jPo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 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
❑ 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
tff No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a
❑ Yes
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
P No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? 1f yes, check the appropriate box below.
❑ Yes
RNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes F] No
[:]Yes CR No
❑ NA
❑ NA
❑ NA
❑ NE
❑ NE
❑ NE
❑ Yes [2 No ❑ NA ❑ NE
❑ Yes [a No ❑ NA ❑ NE
❑ Yes No [] NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other-,
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes N No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
NA ❑ NE
Page 2 of 3 21412011 Continued

F cifi Dumber: jDate of Inspection:
24_ Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes V] No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 4a 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 Ievels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
2fi. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes CS No NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No 50 NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
53 No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[] Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[] Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[:]Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[:]Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA
❑ NE
vaiid/or.any additiunal;ree
_.
V�6, wo(k (, bore— sratr a, taro) Ivik s ,
1S1 Lrm�_, ar flits s ff)h a ©IC)
a,' Play. soil 014 s is 10 a Olt,
s�" Pia e mail' cai bra-�"ty,., � [�cltde_ WeM� c�ian�- a,d_ bask �ol�,f
1
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
J D0') .Schrl-P)&- _
Phone: T 2 334300 (0MT
Date: i
27412011

Facility No. $_Farm Name _ Date
Permit COC ✓ 01C_ NPDES (Rainbreaker PLAT Annual Cert )
Lagoon
1
2
3
4
5
6
7
-Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
j
Sludge De th ft
Liquid Trt. Zone (ft)a
Ratio Sludge to Treatment Volume
t,
Design VVidth
Soil Test Date Wettable Acres RAIN GAUGE
pH Fields WUP ✓ Dead box or incinerator
Lime Needed Weekly Freeboard Mortality Records
Lime Applied —'�p 1 in Inspections^
Cu-1 Zn- 120 min Insp.
Needs P Weather Codes
Crop Yield Transfer Sheets
Waste Analysis Date
- 60 Da
+ 60 Day tail 11
N Amt Ib/1000 Gal ,
H
.-
..
WA
a y 37,5 G q1
/ y PHO NUMBERS and affiliations
Date I st WUP FRO at K) Date last WUP at farm App. Hardware
N55
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Ib/ac; Zn-I 3000= 213 Ib/ac

Type of Visit (1fCompliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit (!3kRoutine Q Complaint Q Follow up Q Referral Q Emergency Q Other El Denied Access
Date of Visit:
Arrival Time:
Departure Time:
{%
County: Som g5o)
Farm Name: -if�k
Owner Email:
Owner Name: ,funnel Nelsi
,
I
!' {
Phone:
Mailing Address:
Region: LIL_
Physical Address:
Facility Contact: �G4f1 Itr 1'Yd1 Q!1 C0fll (9[) Title HLIjageC Phone No: qqo— q300
Onsite Representative: U44
.e-Integrator: 17
Certified Operator: � � ►v _J"ci4 J�` Operator Certification Number: 190
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e = s = u Longitude: 0 e Q ' =
Design Current
Design Current Design Current
Swine
Capacity Population
Wet Poultry
Capacity Popn.l.ation t!attie Capacity Population
Wean to Finish
❑ Layer
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑Structure El Application Field El Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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 UNa ❑ NA ❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes V�No
,
❑ Yes �} No
Page
1 of 3 12/28/04
❑NA El NE
❑ NA ❑ NE
Continued

Facility Number: — a Date of Inspection Lill i_1J_10
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? ❑ Yes F�tNo ❑ 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 UNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes JRNo ❑ 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? ER Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes WNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes tXNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l 0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Vo the receiving crops differ from those designated in the CAWMP?
U Yes
W No
LI NA
LJ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
(RNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
R No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
UrNo
❑ NA
❑ NE
Reviewer/Inspector Name a F ! `ar d A -G 112 Phone: _
Reviewertinspector Signature: pA Date:
Page 2 of 3 U 12128104 Continued

41
Facility Number:'�Jk, --a Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 50 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes JgNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JRNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i " Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (iel 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
13 No
❑ NA
❑ NE
❑ Yes
❑ No
UNA
❑ NE
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
59 No
❑ NA
❑ NE
❑ Yes
W No
❑ NA
❑ NE
❑ Yes ❑ No ® NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [9 No ❑ NA ❑ NE
❑ Yes EgNo ❑ NA ❑ NE
❑ Yes
Ej No
❑ NA
❑ NE
❑ Yes
fRrNo
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
34, 1�-Ah _" Itr o) s f ra -0elks ' o l ay°0, a� �Oou' ids
c:� � bo��
VV o0(�y ��j �e ,_ �backj- e pf 1 d o�, , peek -to0 s�ta�► or
mood ed r dt- s �o.�F��C s'JA G aid c ovo- , lisId-e.►ks
� b
�C�e rM a, bad s oi i alks, pta�nl `v
Do' s ob tZied bl. s fd ba lam grais,
records , , yp leo" c 0(t�o` nA C alct.�af cols Cry new
.
d Sutve nP�� �1�.,j
Ow)i rl a Ion- o� li' o�
I reaF1 ,ml-2 oNP-
CoddrKmj CommhtOW) nab'DI frod`C,*- coflJ.
Page 3 of 3 12128104

' FAcility No.. cl— `- Farm Name a 3 K Date 10(?I{
Permit COC
OIC_ NPDES (Rainbreaker PLAT Annual Cert )
FB
Dr0 s
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
Calibration Date
Design Width
Soil Test Date t i1 Ito Wettable Acres �f RAIN GAUGE
pH Fields WUP T Dead box or incinerator
Lime Needed Weekly Freeboard J Mortality Records
Lime Applied 4otl,n�J� 1 in Inspections
Cu-I Zn-I k i 120 min Insp.
Needs P Weather Codes
Crop Yield Transfer Sheets; /F
wast-e Analysis - -
rinrr•�amrr:�
mfi�i=
so
J
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Iblac; Zn-I 3000= 213 Iblac
App. Hardware

a 1H5, Ut/i 91310
0
Type of Visit
Compliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: ' County: -'>Qn7 Region: "
Farm Name: Tb 14 _ �j�, ,, _ Owner Email:
Owner Name: ZGM',PS 1 t �!y- Phone:
Mailing Address: �O �TCIUI n _ 1 .13E'-korD 093T.�
Physical Address: -{
Facility Contact: V C Title: I�w� Phone No:
Onsite Representative:il a4:ej ' z*r_ 0'-z Integrator: �" o/ 6"_ 6/1)WO
Certified Operator: `]v(M'0S N f t� r Operator Certification Number: 1 ?07 r
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 00 =' =" Longitude: =° 0 6 0 it
Design
Capaulation Wet Poultry Capacity
232l
Current Design
Population Cattle Capacity
C►ugenne
Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Dry Poultry
❑ Dairy Heifer
❑ Dry Cow
❑ Non-Dai
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
El Farrow to Finish
❑ Gilts
❑ La ers
❑ Non -Layers
❑ Boars
u
❑Pullets
❑ Turkeys
❑ TurkeyPoulin
Other
❑ Other ❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes R No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes JR No
❑ Yes 2,No
❑ NA ❑ NE
❑ NA ❑ NE
12128104
Continued

Facilitr� Number: a — a
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
15JNo ❑ 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
15kNo ❑ NA ❑ NE
(ic/ 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
CR No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
JR No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
D No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
1�1 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
IR No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
15INo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
"g ) p :y ansers and/or any reco�mm e tt i }or anv other comments
Comments refer to uestiou # Ex ia�n an YES
{ q
Use drawEn s of facility to better explam situations: (use additional pages as necessary,.)
T
Reviewer/Inspector Name Db + S E( * �� �,� Phone X
Reviewer/inspector Signature: Date:
1212810 Continued

Facility Number: a, —a Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 151No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 5 Awo ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JqNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
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
IRNo
❑ NA
❑ NE
❑ Yes
❑ No
UNA
❑ NE
❑ Yes
UfNo
❑ NA
❑ NE
❑ Yes
1;�No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
❑ No
[5kNA
❑ NE
❑ Yes
'® No
❑ NA
❑ NE
❑ Yes
&No
❑ NA
❑ NE
❑ Yes
JENo
❑ NA
❑ NE
❑ Yes
�ErNo
❑ NA
❑ NE
[--]Yes
9 No
❑ NA
❑ NE
❑ Yes gNo ❑ NA ❑ NE
12128104

FacilitW No. Y9 'Farm Name
• A
Permit- �� COC✓
Pop.Type Design Current
y w k Date
OIC
NPDES (Rain breaker PLAT Annual Cert )
....
0©©0©00
Ibbserved freeboard (in)
SludgeSurveyDate�X
-------
.. - Depth a
-
Soil Test Date Crop Yield
pH Fields Wettable Acres
Lime Needed WUP
Lime Applied phi Weekly Freeboard i
Cu v-,-' Zn Rainfall > 1 "
Needs P _ 1 in Inspections
120 min Inspections
Weather Codes
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
Waste Analysis Date
• 111
Pull/Field
Soil
Crop
RYE
PAN
Window
Max Rate
Max Amt
r
S-0
1-7
7
t-Alt
1
win
(00
i
ACI
In
w�
I
K,
S
5
Verify PHONE NUMBW�;114100
iations �11 15J
Date last WUP FRO Date IaAVU�atYarm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
App. Hardware

13IKS V1 I Ia)IM
Type of Visit a Compliance Inspection Q Operation Review Q Structure Evacuation Q Technical Assistance
Reason for Visit 0 Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other El Denied Access
Date of Visit: QQ : V on F&
dD Arrival Time: i30 Departure Time: � Q County Re ig'
Farm Name: D:B k Owner Email:
Owner Name: yaj2! �Q 1 ±i+1�/[t, Phone:
Mailing Address: L96PotfClIU - Qo_b&p $38d
Physical Address:
Facility Contact: Title: Phone No:
IV Representative: L��S 4" u � M-B F f`
Integrator: 1 _
Certified Operator: f 1 Operator Certification Number: AW gO79 _
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 = I = 11 Longitude: = ° = I = u
Design Current.,
Design Current Design Current
Swine
Capacity_ PopulaVZILM
tion Wet Roultry
Capacity Population Cattle_ . Capacity Population
.�.
❑ Wean to Finish
❑ Layer
Wean to Feeder
❑ Non -Layer
IJ Feeder to Finish
�=
1]ryP a u try
❑ Farrow to Wean
❑ Farrow to Feeder
❑ La ers
❑ Non -Layers
El Pullets.
"
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Turkeys
�' �'�
Other
r ❑ TurkeyPuults
❑ Other
� ❑Other
Number of Structures:
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Discharges & Stream Impacts
I . Is any discharge observed from any pan of the operation?
❑ Yes
EjNo
❑ 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
E'No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
J'No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number:$a —fit( 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?:
Designed Freeboard (in): j 9 ,LUBIHS
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 CRNo ❑ NA ❑ NE
[--]Yes [--]No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes CffNo ❑ NA ❑ NE
❑ Yes 5NNo ❑ 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? 9Yes &No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes JRNo ❑ 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 1KNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EjrVo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes tffNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
RNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
5d No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
IRNo
❑ NA
❑ NE
`IC1 emmaents (refer to�questton #) �Egplam any Yts answers an[Vor any recommendations or any other comments.
wings of fa to better explain situations: (use sifdIttonal pages as necessary)- �;
L
Reviewer/Inspector Name �'�
�Ci�Al.E1 ER Phone: 911330O 3
Reviewer/Inspector Signature:
Date: a009
Page 2 of 3 v 12128/0:7 Continued

• Facility Number: at{ Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes SNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ['No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to property 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
EgNo
❑ NA
❑ NE
❑ Yes
❑ No
[9 NA
❑ NE
❑ Yes
'® No
❑ NA
❑ NE
❑ Yes
5No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
❑ No
ZRNA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes IR No ❑ NA ❑ NE
❑ Yes bg No ❑ NA ❑ NE
❑ Yes 5allo ❑ NA ❑ NE
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
CYNo
❑ NA
❑ NE
Additional`Gomutents an'd/ur Drawings:
T�
�. Plw cf- bade b-dhe, eAeroatA on bockside- d- �00' b0 - `
a I. �iMe keep crof fPcad-S (-� PJ WAr IfIakd .
004- 104k1!, `gym, 4 recofdi
Goads 1a<91°iDjr' a ✓e/-
Page 3 of 3 12128104

'Facility No. 3- a} Farm Name K Date
Permit ^� COC "� OIC f NPDES (Rainbreaker PLAT Annual Cert )
FB Drops
Freeboard
1
2
3
41
5
B
7
Desi n
BIMS
Observed in
Slud a Survey Date Perm Liquid ft
3
a Sludge Depth ft
a
%%Ills-. - L4,,,4 z 4. T sif= r 4?-1
Design Flow
Design Width
Actual Width
Soil Test Li111'
pH Fields pH La oon_
Lime Needed z--k ..� O►"
Cu �_ p-0
Zn _ _ ,e
Wettable Acres
Crop Yield CLf
Rain Gauge ✓
Weekly Freeboard ✓
W n — ,4p,,--
Rainfall >1" ✓
1 in Inspections -
120 min Inspections
Transfer Sheets
Pull/Field
Soil
Croo
Pan
Window
Se y- N C'
- 61 P ('
47A,Bj)52
— e-
�9-�
11
i�
100
-
)4tL Jill
IAA, = 0• 6�_ [.0 o h�= xa &i;t-
i.;��'I� a4419 ro�

Type of Visit It Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit A Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Acceess-sj�'-�
Date of Visit: p Arrival Time: Departure Time: ��T County. Region: ` —Iw
Farm Name: kN ,111�_
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: T` t
Onsite Representative t
Certified Operator:
Back-up Operator:
Title:
Owner Email:
Phone:
Phone No:
[��
Integrator: CIA A
Operator Certification Number: 5
Back-up Certification Number:
Location of Farm: Latitude: =o =' E:T Longitude: ❑ ° ❑ I = u
Design Current
°Design
Curren#
Design Current
Swine Capacity Population
Wet Poultry Capacity
Population
. C�aitle� C*opacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
can to Feeder
❑ Non -La er
❑ DairyCalf
❑ Feeder to Finish
�{R'
l$ - ❑ DairyHeifer
❑ Farrow to Wean
000t1.4
Dry�l'oultryd , .
4'I
❑D Cow
❑ Farrow to Feeder
""°
'''
Non -Dairy
❑ Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
Non -Layers ers
�? ❑Beef Feeder
❑ Soars
❑ Pullets
ElBeef Brood Cowl
- `*.e _
❑ Turkeys
Other
❑ Turkey Poults I
f �
ef Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes )� No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
M NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
aVA
/ —
El 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
_�x
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: C — Date of Inspection
Waste Coll cg tion & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes KNo []NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes t@ 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 ANo ❑ 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 ElNA ElNE
through a waste management or closure plan? 0
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 o ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �io El NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ' `1
4. 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 K\No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes %No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o ElNA
ElNE
15. Does the receiving crop and/or land application site need improvement?
ElYes
rNo❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
K No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.- I
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name V AZA�l C �- Phone `` yy c CD
Reviewer/inspector Signature: Date: �� !y'
Page 2 of 3 72128104 Continued

Facility Number: Z. Date of Inspection if
Reyuire&Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes '[ANo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �[No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
O] No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rambreakers on irrigation equipment?
❑ Yes
❑ No
06 NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[ KNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
XNE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
Z No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ANA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ANo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
WNo
❑ 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
kt 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
>rNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
D(No
❑ NA
❑ NE
Additlofial`Commentsard/or Drawings:Elf
S C,64,lre U46n 9 1 D 1-4 0101

Facility No. �Z ^� Time In Time Out�� Date
Farm Name `-}�� Integrator _ 1 (� '��'
Owner Site Rep
Operator No.
Back-up No.
COC Circle: �ene or NPDES
Design
Current
I
Design
Current
can - Feed
Farrow - Feed
can - T i ITis h
Farrow - Finish
Feed - Finish
Gilts I Boars
Farrow - Wean
Others
;FREEBOARD�-9.dge Survey
Crop Yield
Observed
Calibration/GPM
Waste Transfers
Rain Gauge Rain Breaker
Soil Test Wettable Acres PL
Weekly Freeboard -� Daily Rainfall v 1-in Inspections
Spray/Freeboard Drop _1•
Weather Codes 120 min Inspections
Waste Analysis:
Date Nitrogen (N)
Date Nitrogen (N)
Pull/Field
Soil
Crop
Pan
Window
All-
ct —0 L
Y-V v.
_ Lo'S
Lk):gr n►�
tUJ
1)0
o C_
/�
0 0 �) 0 C� W\6

Type of Visit 's Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit AWRoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: I 1 Arrival Time: Departure Time: County.,
Farm Name: Owner Email:
Owner Name: �-P_ C 114 Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representai
Certified Operator
Back-up Operator:
Title: _ D UOTW.:r Phone No:
Integrator: -Pf C r)i s C4
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: = 0 = g = Longitude: = o = 1 = u
Design Current
Swine Capacity Population
❑ Wean to Finish
Design Current
Wet Poultry Capacity Population
❑ La er
Design Current
Cattle Capacity Population
❑Dai Caw
E�Lwean to Feeder Z.&M
❑Non -La er
❑Dairy Calf
❑ Feeder to Finish
_ `
❑ Daia Heifer
❑ Farrow to Wean
❑ Cow
ElFarrow to Feeder'w=
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
Feeder
❑ Boars❑Beef
❑ Pullets❑Beef
Brood Cowl
❑ Turke s
_
❑ Other
❑ Turkey Poults
❑Other
Numberof Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Wo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
4&NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
UNA
❑ 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
`PNA
❑ 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
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: 'Z,—, Date of Inspection j! 8fo
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
O NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):Zq
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[ No
El ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
f _
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
R 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
[P No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
§j No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9_ Does any part of the waste management system other than the waste structures require
❑ Yes
1A No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
allo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
,D4No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
& No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
5No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
ft No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
.W _Y
Comments (refer to question ft Explain. any YES`.answers and/or any recomm6ndations.or any other comments
Use drawrngs'of facility to better egplaiq situations" (use additional pages as.necessary)
Reviewer/Inspector Name VII&TI NG� Phone:33o1a
Reviewer/Inspector Signature::HnEaDMQ�L
Date: v b
Z OD
I

Facility Number: Date of Inspection [Till 10L,
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes )Q No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes OVNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
0 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No N&A
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes .To
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
01ko
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
J No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[gNA
❑ 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
[P 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
[4No
❑ 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
IF No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
GANa
❑ NA
❑ NE
Page 3 of 3 12128104

Facility I40. Time In� Time Out 0=4Dat
Farm Name ::� �• Integrator �I
OwnerSite Reps
Operator mv.�,� -�.� 6Y�,(�k, i No.
Back-up � —� No.
COC Circle: CEenera or NPDES
Design
CuWe—nt--F
Design
Current
Wean — Fe
of
Farrow - Feed
can - Finish
Farrow- Finish
Feed - Finish
Gilts 1 Boars
Farrow - Wean
Others
FREEBOARD: Design
Sludge Survey 3 l kk-
Crop Yield
Rain Gauge
Soil Test
Observed
Calibration/GPM 1 2�
Waste Transfers
Rain Breaker
PLAT Wettable Acres
Weekly Freeboard Daily Rainfall V 9-in Inspections L_1�
Spray/Freeboard Drop �q_-U 41 I'S -7 1 fo R `7.12V g`ho Q Z- l k�
Weather Codes 120 min Inspections
Waste Analysis:
Date Nitrogen (N)
ti 1.
10
Date Nitrogen (N)
Pull/Field Soil Crop Pan Window
0

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ORoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: os- Arrival Time: l a'. va Departure Time: County: .SamomcT an Region:
Farm Name: S4p4dz T J r Owner Email:
Owner Name: T Ne- .� _ _ Phone: 7/0 - S13 -,Zk31
Mailing Address: �as�6o�o Al( _ �B
Physical Address:
Facility Contact: 1 ass— _ Al. H-YoT..,224 Title:
Onsite Representative: Teales
Certified Operator: Tel Ho.,e ec hL
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator• Coeroll s
Operator Certification Number: 60w /go'7!j
Back-up Certification Number:
Latitude: = o = 4 = A, Longitude: [� ° =
GOa oa
Design Current Design Current
Capacity Population Wet Poultry Capacity Population'
❑ La er
❑ Non -La er
-- --
❑ Wean to Finish
BVean to Feeder
1-2
Other_
❑ Other _
Dry Poultry
ElLayers
❑ Non -La ers
❑ Pullets
❑ Turkeys
El -urkey Poults
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure [IApplication Field ElOther
a. Was the conveyance man-made?
Design .Current I
Cattle Capacity Population
❑ Dairy Cow
El Dairy Calf
❑ Dairy Heife3
El Dry Cow
ElNon-Dairy
ElBeef Stocker
❑ Beef Feeder
ElBeef Brood Co
Number of Structures: EI "
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 G2 o ❑ NA ❑ NE
❑ Yes
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure [IApplication Field ElOther
a. Was the conveyance man-made?
Design .Current I
Cattle Capacity Population
❑ Dairy Cow
El Dairy Calf
❑ Dairy Heife3
El Dry Cow
ElNon-Dairy
ElBeef Stocker
❑ Beef Feeder
ElBeef Brood Co
Number of Structures: EI "
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 G2 o ❑ NA ❑ NE
❑ Yes
Number of Structures: EI "
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 G2 o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
El NE
El Yes
El No
❑ Yes
P<o
❑ NA
❑ NE
❑ Yes
2<o
❑ NA
❑ NE
12128104 Continued

Facility Number: 3 -ay Date of inspection 3 a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 91o ❑ 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: ` I
Spillway?: IIQ
Designed Freeboard (in):
Observed Freeboard (in):
S. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ElNo ❑ 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
914o
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
UNo
❑ 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
❑�iCo
❑ 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 [� No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
7a /oo rro
12. Crop type(s)-b?�rilrU�e Y �ghs , Lt/.:. ��� X"4-,-a.j 1 3e.p�,rrre
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes D'No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, ❑ Yes
❑ No
❑ NA
�E
17. Does the facility lack adequate acreage for land application? ❑ Yes
❑ No
❑ NA
2NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
�o
❑ NA
❑ NE
Comments.(refer Ito question ft Explain any.YES answers'and/or any recommendatiotts.or any other cot menu
Use drawings. of facility to better explain situations. (use additionaLpages as necessary):
Reviewer/InspectorName i /t'ta, (�IUronTlr✓ �� Phone: 5la'm-I y
Reviewer/Inspector Signature: Date: 3 - el -or
12128104 Continued

Facility Number: g� —� q Date of inspection 3 Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P'Ko ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes L;-tvo ❑ NA ❑ NE
the appropriate box. ❑ r ❑ Che�ts ❑ Dpg6 ❑ rjaar ❑ Ope
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9-N-o ❑ NA ❑ NE
❑ w4sie.,�tien ❑ e y ree ❑ ❑ $a+�s ❑ ns ers ❑ tion
❑ 1 €a —O-uaeking ❑erop�i`sc❑ 129 Minute lnspeeiion❑ ❑ wvathereade
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?
/, /t a ✓,'e,,..,d Y, a 441 ror,.rg
❑ Yes 2 o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
S-NE
❑ Yes
❑ No
❑ NA
ONE
❑ Yes
❑ No
❑ NA
�1E
❑ Yes
2 o
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
9'<E
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes 2-No ❑ NA ❑ NE
❑ Yes D ]oo ❑ NA ❑ NE
❑ Yes D-Ko ❑ NA ❑ NE
❑ Yes
E g'<o
❑ NA
❑ NE
❑ Yes
0 o
❑ NA
❑ NE
12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Date of N-i5it: ® Time: % �0
Facilin� Number
?Not O erational 0 Below Threshold
0 Permitted © Certified M Conditionally Certified ❑ Registered Date Last Operated or Above Threshold:
Farm Name: S` .� C''fa
Countv:
_ _ Sa ► . P SOS
''
Owner Name: -NavKe S �[O
II
t+ieV !i+
Phone No:
—_ i to S�Z
S& 3
f
Mailing Address: — 'as -to e�i _ Loop, i
�nsebo
�-o _ 1J G
z 83 s 2
1 r
Facility Contact: _ +e-S i-[Pswe-VL U'� Title:
Phone No:
Onsite Representative: � S �t)� tY L
Integrator:._
�+�
. (, rr~a it `S
�PoeA S
Certified Operator: ,ems _4o Key cu
Operator Certification number:
CIO -f p `
Location of Farm:
,Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 " Longitude ' �1 K
Design Current
Swine C'anaritr Ponnlatinn
Wean to Feeder
0
0
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Ca acity Population
❑ Laver ❑ Dairy
❑ Non -Laver 10 Non -Dairy
❑ Other
Total Design Capacity 2- (a QQ
Total SSLW
Number of Lagoons © ❑ Subsurface Drains Present ❑ La o0o Area JE3 Spray Field Area
.Holding Ponds / Solid Traps ❑ No Liquid Waste Management -System '
Discharges & Stream impacts
1. Is any discharge observed from any pan of the operation? ❑Yes jd No
Discharge originated at: ❑ Laeoon C] Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. if discharge is obsen-ed, did it reach Water of the State? (If yes_ notifi' DWQ) ❑ Yes ❑ No
c. If discharge is observed_ what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notif}, DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any pan of the operation? [] Yes S21No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes }VNo
Haste Collection 8- Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 0N0
Structure I Structure 2 Structure 3 Structure 4 Structure ; Structure 6
Identifier:
Freeboard (inches): /` 3
03IV3101 Continued

Facility Number: �,Z — Date of Inspection �� }
Re uired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ WUP�checklitW!cresigA�mapg; etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste ApplicatioK ❑ Freeboar' ❑ Waste Anal)pis ❑ Soil Samplinj/
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30, Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I " Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes KNo
❑ Yes RNo
❑ Yes 0No
❑ Yes 09,No
❑ Yes IN No
❑ Yes Jallo
❑ Yes allo
❑ Yes Mo
❑ Yes ANo
❑ Yes ;K No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
12112103

Facility Number: 8 — qq Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes KNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes allo
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ZNo
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 ❑ Yes No
elevation markings?
Waste Annlication
10. Are there any buffers that need maintenancelimprovement? ❑ Yes CKNo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes XNo
❑ Excessive Ponding -❑ PAN [:I Hydraulic Overload El Frozen Ground ❑ Copper and/or Zinc
12. Crop type-oermuota_ 5UV"VAt=r G[KKM(S ,_ seg6 &Lws . got _ grdfeed, E411ACt•'artK01t5
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 1$No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes [XNo
b) Does the facility need a wettable acre determination? ❑ Yes 5d No
c) This facility is pended for a wettable acre determination? ❑ Yes CffNo
15. Does the receiving crop need improvement? ❑ Yes gNo
16. Is there a lack of adequate waste application equipment? ❑ Yes 19,No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes DLNo
19, Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ZLNo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes NQNo
Air Quality representative immediately.
�Gtm�nts (refer tfl'y uestson #) Explain�aay YF.S answers anii/or any i�ecamm�la'tsons or a_ny ath_ er comm_tuts. _ _ -� '`
;Use draisrrtigs of laceLty to better sth�attnns. (pse additbonal pages as necrssary) r�= ❑Field Copy ❑Final Notes � � �Y
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Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
rzilzinl
!'nnlrnfiod

Site Requires Immediate Attention: IV O
Facility No. YZ — Z'f7
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
Farm Name/Owner:
Mailing Address: /.
DATE: Awszi Z. 1995
Time: // : 339
j Nursu-y / J ►k4r.�j manic
B&-K 5651 J Rose fora /VG Z73
County: w
Integrator: Myr h ocw-ii/ F�.�s Phone:
On Site Representati� i.-A"JM4 ., %biyt!$ ra.'4 Phone: 1'910 59 2 - 5-6 31
Physical Address/Location: 59 / 303
Type of Operation: Swine Poultry Cattle
Design Capacity: 2 o Number of Animals on Site: z &oo
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches)(S)or No Actual Freeboard: Ft. 0 Inches
Was any seepage observed from the la oon(s)? Yes or4 Was any erosion observed? Yes or 9
-Is adequate land available for spray? (& or No Is the cover crop ad T:V-k/
te? (e or No
Crop(s) being utilized: w C s Pa514►r_ /hi I/c f rSrrK. a� -
Does the facility meet SCS minimum setback criteria? tOO Feet fr m Dwellings? a or No
100 Feet from Wells? (�r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or(&)
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or N&
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or(& If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? ® or No
Additional Comments:
Ric.K ICe.VclS
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.