820253_INSPECTIONS_20171231

NUH I N UAHULINA
Department of Environmental Qual

S i I :Two _ t
Z 101 Zs
of Visit: ®-Com fiance Inspection O Operation Review O Structure Evaluation O Technical Assistance
in for Visit: Or Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: JLU& I County: SU Region:%
Farm Name: ��
�G� Utz �d"""�S Owner Email:
Owner Name: p h,,l_ -Y (V t`�l Phone:
Mailing Address:
Physical Address: Facility Contact: C��ii
�tr V41 S 4f Gvf`G Title: Phone:
Onsite Representative: i r' Integrator: ?. S (
Certified Operator: �0 E� Lq e-/ UM Certification Number: 0 0 /,SCE
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
urrent Design CurrentPop. Wet Poultry Capacity Pop:
EMS
Cattle Capacity Pop.
Finish
La er
DairyCow
Feeder
2(� tQD
Gb
Non -La er
D , P,onl
Design Current
Ca aci P,o
DairyCalf
o Finish
Dai Heifer
o Wean
D Cow
o Feeder
ElBoars
Non -Dairy
o Finish
Layers
Beef Stocker
Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
Other ;,
Other
Turkeys
Turkey Poults
10ther
Discharges and Stream Imoacts
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)
z. 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� o�❑ NA ❑ NE
[:]Yes ❑ No E�J`NA ❑ NE
❑ Yes ❑ No [rNA ❑ NE
❑Yes ❑No
❑ Yes B14o
Cl Yes ErNo
[EWA ❑ N E
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: - 3 Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
❑ Yes
U-No'-0 NA
ONE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No NA
0 NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2 3 N
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
-e'1 o ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[D-A1cr- ❑ 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
[4 -lqo— ❑ 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
[ oo ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[�o ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes. check the appropriate box below. ❑ Yes N`To ❑ 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
indow ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C� i3 1-1 s'(T
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
❑ Yes
❑Ko
❑ NA
❑ NE
❑ Yes
[lo-
❑ NA
❑ NE
0 Yes
❑- OT
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
0 Yes Dl] o ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[]No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
FfNo
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? if ves, check the appropriate box below.
❑ Yes
to
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
0 Yes
[31�o
[] NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'?
❑ Yes
C3 No
DNA ❑ NE
Page 2 of 3
21412015 Continued

[Facility Number: $ I I Date of Inspection: ve_
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E `No
N ❑ NA []NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [J o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
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.
[:]Yes H1190
❑ Yes EfINo
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes Eg,<o ❑ NA ❑ NE
❑ Yes Q-i'To ❑ NA ❑ NE
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[3 too
❑ 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
CT Imo
❑ 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
Ef l o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E N
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to bette)t(t14 10-11 r explain siit7uations (use additional pages as necessary).
1SA14-e- '9" V �}
to �3c�8— 69,C —Gie,f
Reviewerllnspector Name: �� t- 1. ( VL2' Phone: (i- V3 3- 33 �
Reviewer/Inspector Signature: , l Date:
Page 3 of 3 21412015

Type of Visit: 7Routine
pliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: M Arrival Time: , 3::, Departure Time: [v County: ' ' l Region:
Farm Name: I'''_rttn,,L F.J+kS _ - Owner Email:
Owner ]Name: �jCtL _ 14-(I/` L1 Phone:
Mailing Address:
Physical Address:
Facility Contact: Ct,t.,h -5 l�C<✓` �t Title:
Onsite Representative: �f
Certified Operator: "i lk21t WtA-,'A
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
q,1? S
Certification Number: !l% 0 1 :SG� _
Certification ]Number:
Longitude:
Dest n� Current
„
Design Current
Design Current
Swine
Ca act^�1?o
' p ty p
Wet Poultr y
GaapRactty Pop Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
od 1
Non -La er
D . Poultr,
Design Current
Ca achy _`' Po
"
DairyCalf
DairyHeifer
D Cow
Non-Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
Qther
_-
Other
-
La ers
Non -La ers
Pullets
Turke s
Turke Points
Other
Discharges and Stream Impacts
. 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 ves, 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 C3-N—o ❑ NA ❑ NE
❑ Yes
[—]Yes
❑ No
E2-KA
❑ NE
❑ Yes
❑ No
[3TIA
❑ NE
[:]No
[�14A
❑ NE
❑ Yes
❑'tVo
❑ NA
❑ NE
❑ Yes
ffNo
❑ NA
❑ NE,
Page I of 3 2/4/10I5 Continued

Fatilit , Number: - jDate of Inspection: t I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No E2-19-A ❑ 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?
(i.e., 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 [ o ❑ NA 0 NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7_ Do any of the structures need maintenance or improvement?
[:]Yes [ to
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
i
❑ 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 L__I No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [2No
❑ 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): A5'-A W( u.UCt. 96 i
13. Soil Type(s): (1
14. Do the receiving crops differ from those designated in the CAWMP?
El
r
✓ to
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ErNo
❑ 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
dNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[5'No
❑ NA
❑ NE
Re uired Records & Documents
I9. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
M NNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? Ifyes, check
❑ Yes
dNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement`? If ves, check the appropriate box below. ❑ Yes E 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 ff No
l
23. if selected, did the facility fail to install and maintain rambreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

FaZi lity Number: jDate of inspection: /t1-7
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
f:J o
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[] Yes
E� "o
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
L1 No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
E2-1go
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[3No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[ "e o
❑ 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)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[:I —No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes dNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ff No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑10 ❑ NA ❑ NE
Date: it((0
24 015
Reviewer/inspector Signature:
Page 3 of 3

B 1 rL S ►'_Pr�C�
r
Type of Visit: -Q Cance Inspection O Operation Review Q Structure Evaluation O Technical Assistance j
Reason for Visit: Routine O Complaint Q Follow-up O Referral O Emergency O Other Q Denied Access 11
Date of Visit: Arrival Time. Departure Time: County: Region:
Farm Name: �-�++t ��"`'t Owner Email:
Owner Name: c1 r"� ti Phone:
Mailing Address:
Physical Address:
Facility Contact: Ct,
Onsite Representative:
Certified Operator: .. S h� `L
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator: VL1 6 =�
Certification Number:
Certification Number: 16 o l s o �
Longitude:
Swine
Design Current
Capacity Pop.::...
Wet Poultry
Design
Capacity
Current
Pop..
Design Current
Cattle Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
I C oo
Non -Layer
DairyCalf
Feeder to Finish
-"
DairyHeifer
Farrow to Wean
1
ig
D n
Current
Cow
Farrow to Feeder
Dr. Po_uI
Ca acit
l'o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
'�
`a
Turkeys
Other
Turkey Poults
Other
!
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [6-No. ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [:]Yes ❑ No [E�<A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[.-lqA ❑ 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
[37No
❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[—]Yes
E!J'No
❑ NA ❑ NE
of the State other than from a discharge?
Page l of 3 21412015 Continued

Facili Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes []-T1'o"_ ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No L' -< ❑ 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 C3No 0 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 C!No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4fi were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
�No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[2No
❑ 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
[3No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [:3 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): Y9'Ca/`"'4 56-0
13. Soil Type(s): LA
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ['Rio ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes []f'N'o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [�JNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
C;r&o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[�To
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
❑ No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other: I
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ff 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 �O'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 21412015 Continued

ft Of
[Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ;Q-io' ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [9J ❑ 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 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes []d o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes E2 6 ❑ 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?
If yes, contact a regional Air Quality representative immediately.
❑Yes []N ❑NA ❑NE
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
fo
❑ 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
E2,1qo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E�J No
❑ NA
❑ NE
33. Did the Reviewer/lnspector 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 #). 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).
04
Reviewer/Inspector Name: [ W U41 Phone: 'i 3
Reviewer/Inspector Signature: Date: IV/
Page 3 of 3 21412015

Type of Visit: (D'ZRoutine
!lance Inspection O Operation Review p Structure Evaluation p Technical Assistance
Reason for Visit: O Complaint 0 Follow-up O Referral 0 Emergency 0 Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: County:{ Region:
FarmName: Sa•�rs� Owner Email:
Owner Name: l� Phone:
Mailing Address:
Physical Address:
Facility Contact: Cu i S ez J'[u e`G`l Title:
Onsite Representative: <<
Certified Operator: o�l� 5-141 el— i:0.
Back-up Operator:
Phone:
Integrator: 1 -" 3
Certification Number: C
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
D igullLeurreNt
Swine Capacity Pop.
ri Poultry { ;Capacity
Pog.a.Cattle
` ' , Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
1, b
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to FeederD'r,P,oul
'i "Ca aci
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Nan -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
K.
Turkeys
-_
Other
Turkey Poults
Other
Other
Discharges and Stream Impact
l . 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 PN.orE] NA ❑ NE
❑ Yes ❑ No
[—]Yes [:]No
❑Yes ❑No
❑ Yes -�No
❑ Yes ETNo
L]-fqg'❑NE
B-NA ❑ NE
[]-CIA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412011 Continued

Facili' Number: C 77 - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structurai plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
2-11-5_�EI NA ❑ NE
❑ No 0-N-A' ❑ NE
Structure 6
❑ Yes B 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 DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
CErIV
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E3 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA
❑ 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 0 ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 1 L� r�I ic�t �t s G C�
13. Soil Type(s):
❑ NE
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E'lGo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
IJ 110
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Q'1 o
❑ NA
❑ NE
acres determination?
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
UN-o
❑ NA
❑ NE
Reguired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑'No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
FrNo
❑ 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
EfNo
❑ 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
0 No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[!fNo
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Facility Number: - Date of Ins ection:
IF
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes 4E] No
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check 0 Yes o
the appropriate box(es) below.
Failure to complete annual sludge survey 0 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 ®'1Go
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
NA [] NE
0NA [—]NE
�NA NE
�NA NE
Yes 0-No ❑ NA 0 NE
❑ Yes E]rl�o ❑ NA ❑ NE
Yes [3'<o NA ❑ NE
Yes ETNo 0 NA NE
Yes
E:rNo
NA
NE
[:]Yes
6No
NA
NE
F] Yes
EfNo
NA
NE
aj 12d
V �qqy
Reviewer/Inspector Name: l Phone: (�
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412014

I
i ype or visit: tdrx:omptiance inspection V Vperation Keview V structure Evaluation U Technical Assistance
Reason for Visit: P'Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: U / Arrival Time: Departure Time: �County: Region:
Farm Name_ r� rarm Owner Email:
Owner Name: R_e 6 �S'Q,.r� rgQ� Phone:
Mailing Address:
Physical Address:
Facility Contact: j V -- Title: e.)Woeh — Phone:
Onsite Representative: Integrator: 1217p !`iy
Certified Operator: _ Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Y �Desegn Current
Design Current
Swine Ca aci Po
P h' P•
ult Ca acts Po
Wet Po ry� }� ty ..�,p.
Cattle Ca aci Po
p ty p.
r� �
__
Finish
La er
DairyCow
Feeder
Non -La er
DairyCalf
o Finish
FpFarrow
DairyHeifer
o Wean
Design Current
Cow
o Feeder
w
D o P,oul :Ca a Po
Non -Dairy
Farrow to Finish I ILa
ers
Beef Stocker
Gilts
Boars
..,_. _..
Non -La ers
Pullets
Turkeys
Beef Feeder
Beef Brood Cow
a ,
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 PNo ❑ NA ❑ NE
❑ Yes [:]No
[:]Yes [:]No
❑ Yes ❑ No
❑ Yes 5INo
❑ Yes fallo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 51No ❑ 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 nNo ❑ 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 W No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes K[ 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): V ee
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [ g No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [kNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �g No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ;allo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [] Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes IM No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [a 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 [ja No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes t4_No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Ins ection: p—•
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [BNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge'? If yes, check ❑ Yes 5g-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 [a No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ®' No ❑ NA ❑ NE
Other lssues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 I. 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 a No ❑ NA ❑ NE
❑ Yes S No ❑ NA ❑ NE
❑ Yes CS No ❑ NA ❑ NE
❑ Yes
No
NA
❑ NE
[:]Yes
® No
❑ NA
❑ NE
[:]Yes
® No
❑ NA
❑ NE
❑ Yes
C&No
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
ReviewerAnspector Name: r7
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412011

Dim's -I'v1 01103
Type of Visit: ('Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Q! Routine 0 Complaint O Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: , Q Departure Time: Q4 County:
Farm Name: hh+!iz jJp3 y� Owner Email:
Owner Name: !J-�Ga�LSC _ Phone:
Mailing Address:
Physical Address:
Region: FM
Facility Contact: g�_�%den0n , Title: Opg& Phone:
Onsite Representative: Integrator: M—J9
It q
Certified Operator: Certification Number: 14Q3%
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
� a L
Cur a Des Cu went Design Current
�
Swine Cap ty Poy t . Ca acr '1?op ��Cattle Capacity Pop.
p Wet Poul ry p ty
can to Finish Layer
W
Discharges
and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure ❑Application Field ❑Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (]f 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 R No [] NA ❑ NE
[:]No
❑ Yes ❑ No
❑ Yes ❑ No
�] Yes
[] Yes No
❑ Yes No
[] NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 2/4/2011 Continued

Facili Number: - o�i Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 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 U 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
5� 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
tR No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
5j 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
FK] No
❑ NA
❑ NE
maintenance or improvement?
Waste Aoolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
R No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below.
❑ Yes
50 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): CMta I 8ff imAtS I Y
13. Soil Type(s): / V e- s
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
!8 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
U 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
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
to 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.
C@ Yes
❑ No
❑ NA
❑ NE
10 Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
� No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
'E[ NA
❑ NE
Page 2 of 3 21412011 Continued

Facili Number: In - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes $a 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
g No
❑ NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
Q No
❑ NA
❑ NE
❑ Yes
El No
❑ NA
❑ NE
❑ Yes
g No
❑ NA
❑ NE
❑ Yes
f?j_No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
a►, ?I�e tbe- 1� ca li b _ Rx� � I RR--), , The rake Wed- Wa1 Q'ci�at 7
-the-Cal; haW r*, At Q e cro r seoi a7 � �lege add y
S y) -C-ormro
LAW
Reviewer/Inspector Name: S'
r
A n _
Reviewed]nspector Signature:
Page 3 of 3
Phone: q[Q—W— �jCC7
Date: a 3
21412011

Lagoon Name, S for's illwa .
1
2
3
4
5
6
7
Design Freeboarda Last: Recorded in
Observed freeboard'::::::
51ud a Suive' . DAte'
Slud a Depth': ft
Liquid Tr#. Zone
Ratio Slud a to Treabiien't Volume if> 0.45
Date out of com 'liance/ POA? : .
ActualDesign
Test Date Crop Yield 6MA-7 Transfer Sheets
pH Fields j _ Wettable Acres RAIN GAUGE
Lime Needed WUP Dead box or incinerator
! °
Lime Applied ; Weekly Freeboard -.� Mortality Records
Cu-I ✓ Zn-I 1 in Inspections Check Lists �W
Needs S (S-I425) VQ ` ;: ;; 120 min Insp. Storm Water
Needs P uh i t ? Weather Crxies
aste Date:;
PulUt=ield i ' Soil Crop Acres PAN Window Max Rate Max Amt
C a4s 015,
f
Verify PHONE NUMBERSand affiliations
Date last WUP FRO FRO or Farm Records
Date last WUP at farm. Lagoon #
App. Hardware 1 I Top Dike
j Stop Pump
1 ' Start Pump
Conversion- Cul 3000=1108 Iblac; Zn-I 3000= 213 lb/ac
is .
PulUt=ield i ' Soil Crop Acres PAN Window Max Rate Max Amt
C a4s 015,
f
Verify PHONE NUMBERSand affiliations
Date last WUP FRO FRO or Farm Records
Date last WUP at farm. Lagoon #
App. Hardware 1 I Top Dike
j Stop Pump
1 ' Start Pump
Conversion- Cul 3000=1108 Iblac; Zn-I 3000= 213 lb/ac
is .

i ype of visit: %:y g.ompuance inspection v uperanon xevtew V structure t±;vaivatton V i ecnnicai Assistance
Reason for Visit: 10 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: �5Y A F1 I Departure Time: aj County: , ,y S(YI Region:
Farm Name: /yt Owner Email:
Owner Name: �i� ya'��S(?�=5_ Phone:
Mailing Address:
Physical Address:
Facility Contact: r?'b 's,""d-e!sry, Title: nw�� Phone:
Onsite Representative: qff 6 _&5ya�� Integrator: � R
Certified Operator: 'Jiv1d-- ff h .SQ ji-- dr Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
- Design Current - _ Design- Current
Swine Capacity Pop. Wet Poultry Capacity Pflp.
Wean to Finish La er
Wean to Feeder Non -La er
Feeder to Finish =
Farrow to Wean Design Current
Farrow to Feeder DP,o11t : Capaci Pa
Farrow to Finish La ers
_ -Design Current
Cattle @apacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Turkeys
Turkey Poults
Other
ji
Beef Brood Cow
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 Eallo ❑ NA [] NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [] No
❑ Yes No
[:]Yes No
❑ NA ❑ NE
❑ NA [] NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: - 25 Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
M No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[:]No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
CR 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
CaNo
❑ 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
Eg No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
M No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
n No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
r'No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
N No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside ofAccepta�blle Crop Window ❑ Evidence of Wind Drift ❑] Application Outside of Approved Area
12. Crop Types}: e1 t�CILI. 1T�(} dl � , S all "Ib n Itr
13. Soil Type(s): Afi`
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes fg-No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �R No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes No [] NA ❑ NE
Re aired 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 CR 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 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [R 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
CR-NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - a:)Date of Inspection: 1,f
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 1ja No ❑ NA ❑ NE
25. is the facility out of compliance with pen -nit 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?
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 CA WMP?
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
tR No
❑ NA
❑ NE
❑ Yes
❑ No
[RNA
❑ NE
❑ Yes
CR No
❑ NA
❑ NE
❑ Yes t!§ No ❑ NA ❑ NE
❑ Yes CRNo ❑ NA ❑ NE
❑ Yes
UNo
❑ NA
❑ NE
❑ Yes
CR"No
❑ NA
❑ NE
❑ Yes
[S No
❑ NA
❑ NE
[:]Yes
Ea -No
❑ NA
❑ NE
omments.,(refer to question #): ExOlain a6v YES answers and/or any additional recommendations or any other comments$
Use drawings of facility to better e%p1ain situations (use additional pages as necessary). a.
wife -('ali ad do.,olnpd&� cil<<�.
Iv i �I need caI i"hl- o) i`.s
1, Pl e 9,�;f new o-n-e say le -b�?v y�� s��a�•.
Good let rdi.
Reviewer/Inspector Name
pan
Phone: [phone]�1A1
Reviewer/Inspector Signature:
Page 3 of 3
Date: _JUP abc3.
21412011

Facility No<7�a�3 Farm Name
Permit _,-, COG
VIV.OWNEI
L r�l
Date (U 1d(01I.)-
OIC_ NPDES (Rainbreaker PLAT Annual Cert Daily Pipe)
'Lagoon Name, S forspillway
1
2
3
4
5
6
7
Design Freeboard / Last Recorded in
Observed freeboard
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume if> 0.45
Date out of com liance/ POA?
'' 1, F= 7#X' O6r[ /
Design F ow (gp,m�—jfijjj0
be sign ..
ActualDiam.rij�-------
Soil Test Date
pH Fields
Lime Needed D
Lime Applied r
Cu-I Zn-I --
Needs S (S-1<25)
Crop Yield 6favkn 116N(e-j
Wettable Acres
WUP c�
Weekly Freeboard
1 in Inspections
120 min Insp.
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
Mortality Records
Check Lists
Storm Water
Pull/Field
Soil
Crop
Acres
PAN
Window
Max Rate
Max Amt
b6v Izl
)O ;
�. S
-� -�1c
5:a
A0
1L/ c c-(,
Verify PHONE NUMBERS and affiliations
Date last WUP FRO FRO or Farm Records
Date last WUP at farm Lagoon #
App. Hardware Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Ib/ac; Zn-I 3000= 213 Ib/ac

r ype or visit: Rgi_ompttance inspection v operation xevrew V structure Evaluation V Ieennical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: jj()jjLJjjD Arrival Time: Departure Time: County: J
Farm Name: n or 6_Ft�_ sOIjkfj per. L&A Owner Email:
Owner Name: _kerb 5q-d?r j&) Phone:
Mailing Address:
Physical Address:
Facility Contact: 4b s1ihd+t,4 Title: ©w,?/_ _ Phone:
Region:
Onsite Representative: Integrator: 11 d
Certified Operator: ✓° rbtt � �,j� _ Certification Number:
AW4 199-3
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
'Current
'
,R .
Desig n
Design Cu}r
rout
Design Current
Swine �Cap�aeity . Pop.
Wet Poultry . Capacity .Pop..
Cattle " Capacity Pop.
Wean to Finish
La er
airy Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
"`
Dai Heifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
Dr,P,oul_ Cap aci - Po ,
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Beef Feeder
Gilts
Non -La ers
.�.�.� °
s
PulletIlk
Beef Brood Cow
Turke s
,11Boars
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? (1 f yes. notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes P No ❑ NA ❑ NE
❑Yes
No
❑NA
❑NE
❑ Yes
[] No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes. notify DWQ) ❑ Yes [] No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ 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 21412011 Continued

[Facility Number: Date of Inspection: 101 I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 5] 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): 19
Observed Freeboard (in): 5p
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes CR'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
ER 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
�g 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
5INo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
5'No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
f�No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift Application Outside of Approved
Area
`❑
�}
12. Crop Type(s): lh I Damyd a Pajwe' Slmll m�,ih 011,9'JfiPr.( Ij
13. SoilType(s): A—yi)le k
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[RNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ 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
g] No
[] NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Pj Yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available" If yes, check
❑ Yes
15a No
D 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 fA No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [] Weather Code
❑ Rainfall [:]Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No IONA ❑ NE
Page 2 of 3 21412011 Continued

]Facility Number: Date of Ins ection: f
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 'NEt�!S'
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
[] Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
❑ No
N NA
❑ NE
❑ Yes
N No
❑ NA
❑ NE
0Yes el No ❑NA ❑NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes U No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
0 Yes
fR No
❑ NA
❑ NE
33_ Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[F No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
0 No
❑ NA
❑ NE
Comments (refer to.question ft Explain any YES ansWirs•and/ar,any additional recommendations or�any other comments. .
Use drawings.of facility.; to better explain situations (use„additional=pages as necessary).
bores C ornt+" e [apm slots h-e"t- 1(ht�.tfl,
hargooa- Co✓er,
JOA wf Ij Mall PP%t J Cor , Pip
r
as4 sidle- -�.� e"ffi6) �hl.r y�ar .Pk6e_ d OJ111aie SVrW n*f YW,
viek ca Il b(A:h) ' flora,
aj, P feo e jei rva& so>hfl - Y),ex-ftie yap-,xf,
Re c -d 5- ove i'YJ j Dodd. s h o f e.
1&U0 ia,a1 nape Q 6a,'P n- 0) r �t�- COO,
7,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
3o� Sr—hnel'Or
Phone: q�o-y33-3� DCP�
Date:
21412011

Facility No. Farm Name Date labW
Permit COC
OIC NPDES (Rainbreaker PLAT Annual Cert )
FB
Drops
Lagoon
1
2
3
4
5
fi
7
-Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
Sl�dQe �x�►�, �>>N;t ���
Design Flow
Desi n WidthActual
Width
Soil est DatePdJe— Wettable Acres RAIN GAUGE
pH Fields &lq WUP Dead box or incinerator
Lime Needed .2' ; Weekly Freeboard {L Mortality Records
Lime Applied 1 in Inspections
Cu-I >f Zn-1 ✓ Sis-3S 120 min Insp.
Needs F t_ Weather Codes
Crop Yield Transfer Sheets 1drs'—i 4 ) 11:z-f1 i
FAMITTM- '
F13 n R
. W. 176'i2q.�
;A
�i'
--- ---
K314821 _
r.
000 Gal)
PulUField
Soil
Crop
Acres
PAN
Window
Max Rate
Max Amt
P ins
ao s
r x-o� '
.s
J' ='
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm
a#, ) L
FRO or Farm Records
Lagoon #�
Top Dike
Stop Pump Start Pump 40 2 wQ3iOlm
Conversion- Cu-I 3000= 108 Iblac; Zn-I 3000= 213 lb/ac
App. Hardware

151K -.Jvj j oiao lm
Type of Visit Q Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: ( � (p Arrival Time: Departure Time: a� c County: Region:
Farm Name: _4_ &bA Sa4?,- o3 F" _ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: �Ttt b �Wts& Title: owl Phone No: 9Q
-
Onsite Representative: Ib ' adle)jol Integrator:
Certified Operator: uAv1 d 1 Operator Certification Number:_
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 e = = « Longitude: = o ❑ - 0
Design Current
Design Current
Design Current
Swine C**opacity Population
Wet Poultry Capacity Population
Cattle Capacity P. pularion
❑ Wean to Finish
IEJ Layer
❑ Dairy Cow
Wean to Feeder
Q
❑ Non -La er
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ La ers
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
ElBeef Brood Co
ElTurkeys
Other
❑ Turkey Pouets
❑ Other-
❑ Other
Number of Structures:
DischaMes & 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 'J No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
9 No
❑ NA
❑ NE
❑ Yes
19No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: '— 553 Date of inspection[
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
❑ Yes
V No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): C�r
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
W 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
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? CR Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes i No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11 _ Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes N No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) L 00;'!t21 De�m,d# a tA7P
13. Soil type(s) Ali
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 acre determination ?
❑ Yes
JP No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
JR No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
IN No
❑ NA
❑ NE
Comments (refer to question #) ''Explain any YES answers and/or any recommendations or any.other comments
IJse drawings tft facility to better explain situations. (use additional pages as necessary):
C
Reviewer/inspector Name 1LS ! Phone: 33— ''� 3 )
Reviewer/Inspector Signature: Ipmolp.r Date: 067_i3 Z) d J
12128104 Continued

Facility Number: a —a Date of inspection 3 Q
Ree uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? 0 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 ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JP 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? ❑ Yes �FK] No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No R NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
tO No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
9 NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[9No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
0 NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
W No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�RNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
RNo
❑ 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
IRNo
❑ 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
allo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[RNo
❑ NA
❑ NE
P, ptem, jW,,2� COCA Nmi #- 0vallable iflye" �'rj
air VV04e-son p (j a,;e-t304 ± (ao ears, PtaLce, s olj
asx �QlOrj Siv d9 e- S vrve i o�D la
E rarfieur ore Yve l bv4tA by`Fi bPr-
izUm ►S 1n S shade ova Il dr
Page 3 of 3 12128104

Facility No. ',a a53 Farm Name �`j^i Date
Permit ti7 COC OIC_
MIN
NPDES (Rainbreaker
PLAT Annual Cert)
Lagoon
1
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
SI �e Eia�•;PiCa, L*)N �)0 tom,
NOR -
Actual'
a�
Design Width
F
----
Soil Test Date , - Wettable Acres RAIN GAUGE
pH Fields 6'7--7. j WUP Dead box or incinerator
Lime Needed 0 Weekly Freeboard Mortality Records
Lime Applied 1 in Inspections
Cu-I `,- Z c/ 120 min Insp.
Needs P 3 Q o* D Weather Codes
Crop Yield (5UND Transfer Sheets rwp 5,)10-/ni�lrn
. r .Kroll
_�'
M
. r .
RIO
•
Pull]Field
Soil
Crop
Acres
PAN
Window
Max Rate
Max Amt
P'
Verify PHONE NUMBERS and affiliations
Date last WUP FRO �5-10-q(o Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Ib/ac; Zn-I 3000= 213 Ib/ac
App. Hardware

Type of Visit 0 Compliance inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 9 Routine 0 Complaint 0 Follow up Q Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Lofli Departure Time. County: S111A& Region: Ly
�
Farm Name: #ff NAP S Owner Email:
Owner Name:91bA Phone:
Mailing Address: C old'{ _ `Hai(2113 D8yq--
Physical Address:
Facility Contact: rr__ Title: Phone No:
OnsiteRepresentative: &.D Integrator: M7 l�0►
Certified Operator: �n A4— Sr.�ruOperator Certification Number: 4wA 1993r
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e = 1 = " Longitude: 0 ° = 1 = u
Design C•nrrent
SAine C•anacity Population
Design Current
Wet Poultry Capacity Population
Design
Cattle Capacity
Current
Population
❑ Wean to Finish
❑ Layer
airy Cow
Wean to Feeder oZ
❑ Non -Layer
airy Calf
❑ Feeder to Finish
❑ Dairy}heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
La en
❑ Beef Stocker
❑ Gilts
Non -Layers
rE
❑ Beef Feeder
❑ Boars
Puitets
❑ Beef Brood Cowj
Other ii-i
Turke s
❑ TurkeyPoults
❑ Other
❑Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
RNo
❑ 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
M No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
C!ErNo
❑ NA
❑ NE
other than from a discharge'?
12128104
Continued

Facility Number: a, —a Date of Inspection l_'J
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes §6 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
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
C9 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
tEj 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
(R No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? [:]Yes
N 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
0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
tRNo [I NA ❑ NE
maintenance/improvement?
] 1. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
ONo ❑ NA ❑ NE
❑ Excessive Ponding [:]Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs El 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) E-e mlide- MY Q. Nape , E
13.
Soil e s) A
h'F{
✓
IS' a=
t
14_
Do the receiving crops ditTer from those designated in the CAWMP?
❑ Yes
CR No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
t@ No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
R No
❑ NA
❑ NE
17_
Does the facility lack adequate acreage for land application?
[I Yes
SNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
KNo
❑ NA
❑ NE
p 3 y.
Use -draw in(s of facility to better explains tuition � y pages O°s.or any other comments.
Comments (refer to uestion s n a add n or a a es as necessati')
Reviewer/inspector Name S[' �/ Phone: �o �(
ReviewerAnspector Signature: Date: a I as 00
1)/)R/OQ C nalirtuvd

Facility Number:% — :S3: Date of Inspection
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
W No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�a No
❑ NA
❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps
p ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
P No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
IR No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
51 NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
191 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
"ONo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
&NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
9 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
RNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
O No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ONo
❑ NA
❑ NE
vv�e I j j<,e&o o7 4 recorder t
a5 L2f+ -09rm `�r' 5d4� �s1�'e lad ro7 aa04. �1%flPd 3�'0 b�
YvI S.I. e Svlve ,
a� So ArnQ( fl3- rn Ifve,S Ohre- b&c d ov4 iil Y7&mil
Y
rA I ��e- mo-e- ��d� Uf 1vg e ply
_�_*e Ad & �.
y�
12128104

Facility No.%_Farm Name S Date q[ a 4 ()Y{
Permit COC OIC NPDES (Rainbreaker PLAT Annual Cert )
Pop.Type Design Current
Design - - ....
-------
11lbserved freeboard (in)Slud
�_-----
ge_qur-vey Nate
'------
Liquid Trt. Zone (ft)
Actual
Lam'-------
1esign Width^�-------
Soil Test Date 86107
pH Fields^
Lime Needed
Lime Applied
Cu R�_ Zn
Needs P
Crop Yield ✓
Wettable Acres
WUP .I
Weekly Freeboard ✓
Rainfall >1"
1 in Inspections
120 min Inspections
Weather Codes
Transfer Sheets
RAIN GAUGE
Waste Analysis -Date
MYM.r§"�p
Pull/Field Soil Crop RYE PAN Window Max Rate Max Amt
I , 5 �, SO
Venry HHUNt NUMULK i and affiliations
Date last WUR FRO CfD n(0 a as 1 App, Hardware
K*c ` 11 fob G
FRO or Farm Recess
Lagoon #
Top Dike 53,00
Stop Pump
Start Pump
f—

b(Hi 1011-11Dg 0vs - --
1 ype of Visit I,6 Compliance Inspection U Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit $i Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date o1 Visit: S Arrival Time: 1 71W Departure Time: �, County: Region:
Farm Name: _ j*t SllriQ'f¢.!0'ti+-? Owner Email:
Owner Name: 11?r h# - s Phone:
Mailing Address:
Physical Address:
Facility Contact: Hfll2 Sa/Y,i'Plf(h Title: OW Phone No: ft-D331 C
Onsite Representative: �c21"p
Integrator: � D�
Certified Operator: W_Ad 44 Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [= 0 0 6 = fl Longitude: = ° =1. 0
#f
-M
�
De
w rE
_
I s esign Current
�5tti
Desi n Imo..
Swut e
acp
pity
,4,_, t Poultry
Po ulati n�,w
R
CapagCity Population , CattleF== �y�y C specify Population
❑ Wean to Finish
- _ � ... ..Z.._
❑ Layer
❑Dai Cow
R Wean to Feeder
Q
a�
D33D 411E]Non-Layer
El Dairy Calf
❑ Feeder to Finish
�. '""F`'"' "
❑ Dai Heifer
❑ Farrow to Wean
El Dry Cow
❑ Farrow to Feeder
1DrylPouit ,
F.�'.
:
El Non -Dairy
El Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
�F ❑ Pullets
❑Beef Brood Co
❑ Turkeys
❑ Turkey Poults
L 1
#�
❑ Other
,' ❑ Other
4 Number'o€ Structtues: m
Discharees & 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 discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
Z. Is there evidence of a past discharge from any part of the operation?
❑ Yes
JgNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
INo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: n —a Date of Inspection 15
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
VNo
❑ 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): a
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
VrNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
Wo
❑ 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
IgNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
CR 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
XrNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
RNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes DrNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) Cmaj'��
( Bero,vda. �Jnvy SG os
13. Soil type(s) Aal
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes allo ❑ NA ❑ NE
I5. Does the receiving crop and/or land application site need improvement? ❑ Yes WNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes ERNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
I & Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
;R'No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recammeudatioas or any other comments.
Use drawings of facility to better explain sitaations. (use additional pages as necessary):
Reviewer/Inspector Name r , . C. �, % rf - /y� Phone:
Reviewer/Inspector Signature: Date: l S
Pape 2 of 3 U 12128104 Continued

. Facility Number:$ a, — Date of Inspection rn Is o 1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes RNo ❑ NA ❑ NE
3)t
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes UR No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design
g ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
X 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
EgNo
❑ NA
❑ NE
❑ Yes
❑ No
[SJNA
❑ NE
❑ Yes
(RNo
❑ NA
❑ NE
El Yes
JPNo
[3 NA
❑NE
❑ Yes
MNo
❑ NA
❑ NE
El Yes El No VNA El NE
❑ Yes 5No ❑ NA []NE
[--]Yes P? No [:]NA []NE
[]Yes 9No ❑ NA ❑ NE
[:]Yes C'No ❑ NA ❑ NE
❑ Yes jjj�No ❑ NA ❑ NE
[:]Yes f'No ❑ NA ❑ NE
$r >° rim- irk[(�� io a Vr(,Kft C7
V)ftn � f�7e_ -his -�qrl
P b �'a1,e on s rec&dto on as / d�fl lf),
�Ir age vse CctII � �'
fI }bI� {�t Sjdd 2 S✓tv7 �ih �f Q yew or-f o, citi d?O�-7, �
a3.9 � �'
Q 04 n - 6 ©,,6feq,(_ __�h�
rV2�l �e --fo'n q- rR(cdj. a33S zn T�de �' a
La450 Servo v5hoWf� �1-2n 2�c ,�1s I� �Div� Gl
/ h)jo,)caj av$a �r <I Ij 1f4 ., r�lj aa
Soo-ya�o-
41 'd � nor CIO-, IT) ca41� rot o, f'p�M a copy/
Page 3 of 3 12128104

Facility No. Rr-353 Farm Name }b Sa,d$so� Date
Permit COC
M
F8 Dro s
NPDES (Rainbreaker PLAT Annual Cert )
Lagoon
1
2
3.
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date Perm Liquid ft
,
Sludge Depth ft
-
Rii��
h�7------
Actual •
Design Wi.
���------
Actual Width
Soil Test Date
t%
1 in Inspections ✓
pH Fields
Crop Yield
Wettable Acres
120 min Inspections
Lime Needed
_
Weather Codes
Lime Applied
Transfer Sheets
Cu L� Zn lam
Weekly Freeboard /
RAIN GAUGE
Needs P
Rainfall >1"
Waste Analysis Date
- 60 Da
+ 60 Da
N Amt (Ib11000 Gal}
X1
--Itslot— e r tW4 -*P .
Date of last WUP FRO Date of last WUP at farm App. Hardware Max Rate Max Amt
Pull/Field j Soil I Crop I RYE I PAN I Window
Verify phone numbers and affiliations � - 4— c�+�

0 Division of Water Quality
Facility Number Q Division of Soil and Water Conservation
C% Other Agency
Type of Visit P 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 O�theyry�� ❑ Denied Access
Date of Visit: �(, jArrival Time: 1 Departure Time: Q County: -" ' "� Region:
4r Farm Name: SOn �F6,41-w Owner Email-
Owner Name: _11 '� rSOn Phone ql0 �-3 a _ X738
Mailing Address: _ rql� i z)o — 3 ( -(Cem
Physical Address: jj
Facility Contact: q�Q T _sh Title:
Onsite Representative: N
Certified Operator: 11
Back-up Operator:
Location of Farm:
Phone No
integrator:
Operator Certification Number -
Back -up Certification Number:
Latitude: E:j 0 0 I = Longitude: = ° = =
Design Current- Design Current Design Current
Swine. Capacity Population Wet Poultry Capacity Population Cattle Capacity Population.
❑ Wean to Finish
Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non-Layet
Dry Poultry
Pullets
Other
Poults
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)
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ®No ❑ NA ❑ NE
❑ Yes ❑ No NA ElNE
ElYes ❑ No NA ❑ NE
❑ Yes ❑ No P NA ❑ NE
❑ Yes o ElNA ❑ NE
❑ Yes rNo ❑ NA ❑ NE
12128104 Continued

Facility Number: t?)?-,— Date of Inspection tI p'1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes FNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No kNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ?A
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes UfNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes NNo
❑ 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?
El Yes �No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
��pq
El Yes l�No
El NA ❑ NE
maintenance/improvement?
``
IL Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes [ANo
❑ 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 W��i��ndow11,�, ❑1 E__vidence Wind Drift ❑ pplication Outside of Area
12. Crop type(s) ( taJ
,l s,�'r►'1M.61k1` 6' mc. 4�M r
�1
�Vl
13. Soil type(s) yqv f y%4 t/,7 Ice
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
PNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
nNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
MNo
❑ 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
05'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 Phone:N10 3 — 360
Reviewerlinspector Signature: Date: [h 61c
■Z1Z61U4 L onrrnuea

Facility Number: ROL— Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P]No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes PNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 73No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
PNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
M No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
®.No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[.NO
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
` LNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
CXNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
1P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
V3 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
Po
❑ 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
[P No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
allo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
nNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

0 Division of Water Quality
[Facility Number a a�3 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: % a Arrival Time: th Departure Time: t County: S d Region:
Farm Name: Y-v" Owner Email:
Owner Name: S oh Phone:
Mailing Address:
Physical Address:
Facility Contact: 110 ti A S"t?.t -oyi Title: Phone No:
Onsite Representative: 01'1 integrator: fir'`
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number.
Location of Farm: Latitude: = o = ' =„ Longitude: = o = , = «
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
v� aZ a ❑ Non -Layer
❑ Wean to Finish
Wean to Feeder
Feeder to Finish
El Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
El Gilts
ElBoars
Other
❑ Other
Dry Poultry
❑ Layers
ElNon-La Non -Layers
El Pullets
ElTurke s
EllTurke Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance than -made?
Cattle
] Dairy Cow
] Dairy Calf
] Dairy Heifer
] Dry Cow
] Non -Dairy
] Beef Stocker
] Beef Feeder
] Beef Brood C
Number of Structures:
h. Did the discharge reach waters of the State`? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation`?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes �No ❑ NA ElNE
❑ Yes
❑ No
W NA
❑ NE
❑ Yes
❑ No
;RNA
❑ NE
UNA
❑ NE
❑ Yes
❑ No
❑ Yes
WNo
❑ NA
❑ NE
❑ Yes
OTNo
❑ NA
❑ NE
12128104 Continued

. Facility Number: g�,— Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
IMNo
El NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
FNA
❑ NE
St cture 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3i if
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
(P 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 bh No El NA [I NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �No [I NA [I 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 T No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Q4No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 14 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
_ofrWind D,,rriift�,❑ Application Outside of Area
12. Crop type(s) _ lMt.;Ja C-• a7Q � S r 0"r4_�1 Oy a Ja
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes D9 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Q�No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 99 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 EO'-No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.;
Use dt avnngs of facility to better egplam situations. (use additional pages as necessary)�_r
a
T
Reviewer/Inspector Name { _ Phone:
Reviewer/Inspector Signature: Date:
Pagel off 12128104 Continued

Facility Number: — 5 Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes � No El NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [XNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes MNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? []Yes §gNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
(O No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
�9No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
P9NA
❑ NE
Other Issues
28_ Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
K) No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
V1 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
E] No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit 10 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: (,� Arrival Time: 8_' 3 t7 Departure Time: County: �,c,S.Q4 Region: /6580
Farm Name: eeAMCL- .5�.n5gtn.. 1-12 n1a Owner Email:
Owner Name: O He i6e_rf' Phone:
Mailing Address: _[�_�^�2?�_ 2-7�f f%.�•/1s NG
Physical Address:
Facility Contact: Weeded-i- Title.
Onsite Representative:
Certified Operator: 54;,aleccaq_
Back-up Operator:
J
Phone No:
Integrator: �dnae.'.r'....1Af.
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [� e =' [� is Longitude: ❑ ° ❑ f ❑ u
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
E Wean to Feeder (�
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
I _ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current._::-
Cattle Capacity Population`.:
❑ Dairy Cow
❑ Daia Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Coin
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters ol'the State (gallons)`.'
Number of Structures: EE
d. Does dischargc 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 discharce'?
.:I
❑ Yes [a Ko ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
3"No
❑ NA
❑ NE
❑ Yes
21o
❑ NA
❑ NE
12128104 Continued

Facility Number: �,2 —7s3
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑-Ko ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure ? Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?: no
Designed Freeboard (in): &
Observed Freeboard (in): , 1,6 "
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0'No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
©"No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
DTIo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
O'No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑iqo ❑ NA ❑ NE
maintenance/improvement?
] 1. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑Yes
[3'NO ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
-ZtD SO
�1
12_ Crop type(s)
.-
13. Soil type(s)�, _,.------ ---
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[]'No
❑ NA
❑ NE
15_ Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
D-1s1E
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
❑ No
❑ NA
aNE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ElNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[IYes
,E3-No
LI No
❑ NA
❑ NE
Reviewer/Ins ector Name
p Phone:f/�y9G-IS` v?�O
Reviewer/Inspector Signature: Date:
12128104 Continued

. .
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? [;�Ies ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑-lqo ❑ NA ❑ NE
the appropriate box_ ❑ / ❑ Ci c fists ❑ D00 ❑� ❑
21. Does record keeping need improvement? If yes, check the appropriate box below. [Files ❑ No ❑ NA ❑ NE
s-n---p/,S-- )-/cam ;0J
❑*asteApplication ❑JA4ek4;_ a d ❑ ❑geil-Aawy-ms Er-,r=m--T=sfi'rs ❑
0-Rainfall ❑sstm*ing- ❑ Cam— [5<20 Minute Inspections ❑AI&ad4-apd" 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27_ Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
9-No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
EINE
❑ Yes
❑ No
❑ NA
FerNE
❑ Yes
❑ No
❑ NA
U'9E
❑ Yes
Fe] No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
0'KE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes ETNo ❑ NA ❑ NE
❑ Yes 2No ❑ NA ❑ NE
❑ Yes O-No ❑ NA ❑ NE
❑ Yes
O-No
❑ NA
❑ NE
❑ Yes
B &o
❑ NA
❑ NE
Additional Comments and/or Drawings: -
24. Please 57a s4 vs:,,I �4, �cw _y7,�4-L
pp '67 tel✓r+.il c,1c, w.3«i �e A,Pa%er C&4 c0/,, ,
P
e- v.*e carpi L 14, Ke /f {
1q, Prad-cer h4s jol t:/
Or i i a� 7�`�1�.T r J l✓� y. S O ,fie t
°�• eat �+'C�t
•��Plr �r a,'�l Mq�/ t< cam d1�
-fie el Ce./
d � Gb►'r�6g[�
12129104

Type of Visit S Compliance Inspection O Operation Review Q lagoon Evaluation
Reason for Visit a Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
F_ Facility Number Date of Visit: �Time: �
O Not Operational O Below Threshold
-Permitted �r/tifiedd 13 Conditionally Certified (3 Registered Date Last Operated or Above Threshold:
Farm Name: ... !?!'Stet..(.......S���P1�r.�...... �`'crh _ County:.... ............................ ...... ...."0.......
Owner Name: kerd e,4- { k✓ 3 .Phone No:
Mailing Address:. A D . &j.)e _a'Z.`.%......
.._ !arrt //s_._._._ &yItij_. _...... _.... .. _......
Facility Contact: ...... --- Title: ..— ............ _.......... ...... ......... .... Phone No: ...... .....
Onsite Representative: .................................... Integrator: _At/17�............
Certified Operator:._ 'Eel ...._ ... Operator Certification Number: q q
Location of Farm:
T
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �_�• �� �" Longitude �• �' �"
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ®moo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes Q-N'0_
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ti
c. If discharge is observed, what is the estimated flow in gal/min? �r
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) El Yes ❑X6
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑­Ko
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes O No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 94N6—
Structure t Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier1................................... ..... ............ ....... .......... ....................
Freeboard (inches):
.12/I2103 Continued

IM
Facility Number: 22 Date of inspection / o
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �o
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes 91M
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 Q-No-
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes LINO
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
M_N6
elevation markings?
Waste_ Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
[ -W
IL . Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
&-N6
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type set.,,, S — ,r
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
91q'0
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
[moo'
b) Does the facility need a wettable acre determination?
❑ Yes
EI
c) This facility is pended for a wettable acre determination?
❑ Yes
9-No
15. Does the receiving crop need improvement?
❑ Yes
[-No
16. Is there a lack of adequate waste application equipment?
❑ Yes
D- o
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 PM
I9. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes EWo
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 U-No
Air Quality representative immediately.
Od field Copy ❑ Final Notes
- One
spot' o'.
A,,, sprc�
was soda 6/
wP�c�s b�� /11r.
11i�
rrpafrct
4e r,.,.-A
4,,/ /4e
coas&/ ,S
rsr" /Geover,9.
Reviewer/Inspector Name
Reviewer/Inspector Signature. -- Date. `j/-OY
LL/LL/t7.i
Continued

Facility Number: a Date of Inspection�jJ-�
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
9<0
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
(ie! , design., -maps atc•)
❑
B'90
23. Does record keeping need improvement? If yes, check the appropriate boa below.
❑ Yes
Eg-i6
❑ ❑ Fteabaard ❑ sV�ysis ❑ S6MIm tpher
1 S -> 3 -2 ,
�ility witgany applicable
24. Is f not in compliance setback criteria in effect at the time of design?
❑ Yes
S-Ko
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ ?6
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
27_ Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
0-N-o
28. Does facility require a follow-up visit by same agency?
❑ Yes
2i1TO
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
�o
NTDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
&?do
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form [:]Crop Yield Form ❑ Rainfall [-]Inspection After I" Rain
❑ 120 Minute inspections ❑ Annual Certification Form
12112103

Site Requires Immediate Attention: I/
Facility No. S 2 Z
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 7",---- 7 , 1995
Time: l% ,o 5—
Farm Name/Own
Mailing Address:
County: 5A m PsQ,J
Integrator: 3 -b K _ Phone:
On Site Representative: Pha
Physical Address/Location:. w K -_1
Type of Operation: Swine X 1 ' Poultry
Design Capacity: Z L no Number of
DEM Certification Number: ACE
Latitude: Longitude: ° —
Circle Yes or No
to -
.5.32 — Al 7,
-- S 3Z - �
Cattle
Animals on Site: Z & oD
DEM Certification Number: ACNEW
Does the Animal Waste Lagoon have su 5 nt freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes o No Actual Freeboard: Ft.-+1Z Inches
Was any seepage observed from the la5es
(s)? Yes orsIo Was any erasion ob ed? Yes o No
Is adequate land available for spray? r NoIs the cover crop adequate? es r No
Crop(s) being utilized: &S-TA c-yflfl-
Does the facility meet SCS minimum setback criteria? 200 Feet from
Dwellings? es r No
Wells? es or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yesor&O
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes orco
Is animal waste discharged into water of ke state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management records (vo mes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes o No
Additional Comments:
Inspector Name
100 Feet from
Signature
cc: Facility Assessment Unit Use Attachments if Needed.