820257_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Type of Visit: QrCompliance inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: err outine O Complaint O Follow-up 0 Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: p p Departure Time: ,; County:Lyt Region: P�p go
Farm Name: ��/`yy-� �� Owner Email: ��
Owner Name: G O Phone: Qd 91
Mailing Address:
Physical Address:
Facility Contact:
Title: eW,07le Phone:
1 L.
Onsite Representative: d5rez_'_el Integrator: r�
Certified Operator: � j2f,2,1 is A 44 -,e Certification Number: /4 d fa lS
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current Desiga Current
Swine
Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
„.,..
Wean to Finish
Layer
I
Dairy Cow
Wean to Feeder
(p€v
Non -La er
I
Dairy Calf
Feeder to Finish
" ° '"
Dairy Heifer
Farrow to Wean
Design Current
D ,1?oul Ca aci P.o
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
jBeef Brood Cow
Turkeys
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 0 ❑ NA ❑ NE
0 Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
[:]No
[:]Yes
I ;S 0
❑ Yes
E31�o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: - Date of Inspection: tf
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
L7 "10
❑ 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
[EN
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[ErNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
21 o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
B-<oo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes EJ 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):d-
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
Q-I�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
23'N' o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[] Yes
Lr3-71O
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
O—No
❑ NA
❑ NE
_Required Records & Documents
I9. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[r]'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[ o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists El Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes DNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑r Ko
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [�"1 o
❑ NA [] NE
❑ Weather Code
❑ Sludge Survey
DNA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: Date of inspection- /—
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[3 No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
�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
[a o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
E] No
❑ NA ❑ NE
U
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[] No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[3<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
[r - o
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[] No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0- o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ONo
❑ NA
❑ NE
Reviewer/Inspector Name: _5 Phone:
Reviewer/Inspector Signature: Date: /L !--
Page 3 of 3 21412015

t
• Ui�i'sion of�Wa'ter Resources;.
Facility Nttm6eDivon of Soil and Water Cuuservanon
i� Other Agency.
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: / —t 7 Arrival Time: O Departure Time: I / ,' County: ] Region: / X
Farm Name:Owner Email:
Owner Name: ✓ Phone:
Mailing Address:
Physical Address:
Facility Contact:Title: f w E'"J Phone:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification [Number:
Certification Number:
Longitude:
ll6
k 1 1
E yfi'
Design
Current
Design Current
Design Current
Swine=
Capacity
�N.IPop 1Fill,1-
Wet Poultry
Capacity ',;� Pop: ;i
Cattle Capacity Pop.
ii
Wean to Finish
La er
Dairy Cow
Wean to Feeder
b
Non -La er
i I" '
Daig Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean
D , Poul
Desigp
Ca aci
Current `'•
Fop. '
D Cow
Non -Dairy
Farrow to Feeder
Layers
Farrow to Finish
�•,i
��
IN
"�A�'.
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Non -La ers
IPullets
Turkeys
Boars
Other
Turkey Poults
Other
Other
„iFir,
-":;;.YYWW�f6t®ull.�i.e'w hkXd.a .:L:s� .4,W-d.
f III7F
�fiUpRLNIWiIEilf��t:sM.e�ynW�y.
,
_:+elYa�i' W 3 .
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [0-No [] NA ❑ NE
❑ Yes [] No
[] Yes ❑ No
[] Yes [:]No
❑ Yes ® No
❑ Yes allo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: - Date of Inspection: //~—�/—
Waste Collection & Treatment
i 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes R] 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
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.)
Structure 5 Structure 6
❑ Yes -I. No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[8--No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
� Yes
[:]No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
� No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
®. No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
D..No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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):/�°c
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 1K 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
allo
❑ NA
❑ NE
I S. is there a lack of properly operating waste application equipment?
❑ Yes
JR No
❑ NA
❑ NE
Re aired Records _& Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ' Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
_2 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[l No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facility Number: - 1 jDate of inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes RVo ❑ NA ❑ NE
r
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ELNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes P No DNA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes P No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Use drawwgs ofifactW,to!better explain situations _I' additional pages.as,a
7�o�v
t
y
I
Reviewer/Inspector Name: 7-_z-_-
Reviewer/Inspector SiLmature:
Page 3 of 3
❑ Yes M No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes gt No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes
12 No
❑ NA
❑ NE
❑ Yes
[allo
❑ NA
❑ NE
❑ Yes
L�LNo
❑ NA
❑ NE
ons or any..gtner. cc
Phone: %/��3Z�913
Date:-2
21412015

of Visit: 13'Compliance Inspection O Operation Review O Structurt
in for Visit: Grioutine O Complaint Q Follow-up O Referral O
Evaluation
O Other 0 Denied Access
Date of Visit: 7yJ Arrival Time: ` .`ca0 Departure Time: I ]County: s Region: T
Farm Name:, iV-)r �U/O t' Owner Email:
Owner Name: /7e Phone:
Mailing Address:
Physical Address:
Facility Contact: �44n,3 ' 4'LL "' Title:
Onsite Representative: I�
Certified Operator:�.�
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: / D
Certification Number:
Longitude:
Design Current
Design
Gnrrent
Design fsurrent
'We,16 Capacity Pop.
Wet Poultry
Capacity
Pap.
Cattle Capacity Pw
Wean to Finish
Layer
Dairy Cow
Dairy Calf
Wean to Feeder I JNon-Layer
Feeder to Finish
-
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D , Paul
Ca aci
P.o
Non -Daily
Beef Stocker
Farrow to Finish
Layers
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Turkeys
Other,_:,
-Turkey Poults
Other
I
10ther
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Q No ❑ NA ❑ NE
[—]Yes ❑ No
[:]Yes [:]No
[:]Yes [:]No
[:]Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
[DNA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I 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 �N .o ❑ 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?
(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 2 No 0 NA ❑ NE
❑ Yes [allo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental hreat, notify DWR
7. Do any of the structures need maintenance or improvement? MYes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E. 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 Annlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes jKNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [KNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): �ZacZ4�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes K'No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [;_No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes allo ❑ 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 [g No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
Re aired 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 Ej 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. 10 Yes ❑ No
Waste Application ® Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 0 Yes 0 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

[Facility Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes jallo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [KNo 0 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 allo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ELNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes C�L No ❑ NA ❑ NE
❑ Yes 6No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
[:]Yes allo ❑ NA ❑ NE
[:]Yes ® No
❑ Yes No
[:]Yes fallo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments {rejer3ta gnesixon, Explainany�VE5 ansrvers'andlor.any additional HIM—n-R, anv other cotgtiients.
Use drawings ofEfacaiity=to Hefter e�rpiain�sit attons`(use addthonal=pages. as necessary}
IeTl"
�yjt�u/ �. �pT-t � 7-p
4�
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: 2/L3y3`�'�/S1
Date:
21412015

Im
(Type of Visit: {3Compli�nee Inspection O Operation Review 0 Structure Evaluation Q Technical Assistance I
Reason for Visit: C��'Rouutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: L Departure Time: i 'D County: O —Region:
Farm Name: -e7 >-d ,(%z.� !dam ' Owner Email:
Owner Name: `� ✓ ✓ i 1{� Phone:
Mailing Address:
Physical Address:
Facility Contact: ^ �,�j� j j / f �jy— , Title: '1l _�� Phone:
Onsite Representative: �Y - Integrator: _197.F
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design
.....
.,ent_ i
,
Desi gn
C urrent:._
Design Current
Swine
_Cur.
Capacity.
Pop.
=
W_,et Poultry
Capacity
Pop -
Cattle
Capacity Pop.
Wean to Finish
La er
Dairy Cow
can to Feeder
Q 0
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
frrent
...:
Dry Cow
Farrow to Feeder
rp aci
Pop.
Non -Dairy
Farrow to Finish
Layers
I
Beef Stocker
Gilts
��
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turks s
Other-
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes fo-No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:)Yes [:]No
❑ Yes �&No
❑ Yes [>3_No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3
21412014 Continued

]Facility Number: - Date of Inspection
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 ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _ l
Observed Freeboard (in): _
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes Callo ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes E�],No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 25-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 [25-No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes fNo
❑ 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 ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
Window
12. Crop Type(s): jKrr11v, .�_. QU7 ✓�� x�
13. Soil Type(s): rr --
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Wo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Ca -No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Jallo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
allo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�KNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
'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. ;a —Yes j2t,14o ❑ 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 ONo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [ ATo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - = Date of Inspection: —2-— /,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [21-No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes allo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of fast survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes jo No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
0 No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
J4
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
El No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
O No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Vo No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
&I No
❑ NA
❑ NE
Comments (refer to guesbon,#). Explain any YES answers and/or anyadditional. recommendahonsa thercommen
tse �...w
Use drawings of facility to better explain situations (use additional pages as necessary). 4-r a
Reviewer/Inspector Name: J / molts' Phone: D
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412014

i ype of visit: ky-t�umptiance Inspection U Vperation Keview U structure Evaluation V I ectinical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: r �/ Arrival Time:; p. py_ Departure Time: County: Region:
Farm Name: �� ([/ra /tiz et*-- Owner Email:
Owner Name: z Phone:
Mailing Address:
Physical Address:
Facility Contact: ��,r7 ;�p`j ; Title: L�JTd,�/` Phone:
Onsite Representative: Integrator:
Certified Operator: .;�; 11_1 __ Certification Number: /SY
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
mwiwilia
Design Current.
Design
Current
Design Current
Swine
Capacity Pop.
`'Vet Poultry
iN
Capacity
Pop.
Cattle Capacity Pop.
Finish
La er
DairyCow
Feeder
eCJ
Non -La er
Dai Calf
o Finish
"" ' -
Dai Heifer
o Wean
r
Design
Current
D Cow
o Feeder
D . Poult .
Ca aci
Po .
Non -Dairy
o Finish
La ers
Beef Stocker
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
urke Poults
IT
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 Jallo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ®,,No
❑ Yes 6-No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
[DNA ❑NE
❑NA ❑NE
Page I of 3 21412011 Continued

[Facility Number: - ,� Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q 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): 2--
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes R No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
IS, 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?
j23,Yes
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
gNo
❑ 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 0—No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):su
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0�_No ❑ NA ONE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes _E;jNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:)Yes L&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 }KNo ❑ NA ❑ NE
❑ Yes jj?]�No ❑ NA ❑ NE
Reguired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes A.No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0No ❑ NA ❑ NE
the appropriate box.
❑WLP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes M No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ®, No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �o
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 214120I1 Continued

Facility Number: - Date of Inspection: —
24. Did the facility fail to calibrate waste application equipment as required by the permit? [-]Yes KNo ❑ NA [] NE
I
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes KNo ❑ 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 R No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? 0 Yes 10 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
5? No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
allo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fait to notify the Regional Office of emergency situations as required by the
❑ Yes
N No
❑ NA
❑ NE
permit? (i.c_, discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
RNo
❑ NA
❑ NE
❑ AppIication Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
JANo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
gLNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
fg-No
❑ NA
❑ NE
10,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:Q�y�33Oo
Date:
21412011

'm
hype of visit: W Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
RI
eason for Visit: QrRoutine 0 Complaint 0 Follow-up 0 Referral O Emergency O Other 0 Denied Access
Date of Visit: wao Arrival Time:�� Departure Time: +� County: S s Region: Ego
Farm Name: ell'24 Owner Email:
Owner Name: d ry f Phone:
Mailing Address:
Physical Address: �� ��I lie LA
Facility Contact: Llrj ALph f n Title: MQ'►gg'P Phone:
Onsite Representative: b_PA A 1r Aj QA6— Integrator:
_U
Certified Operator: VVd"11LYy lfa OKI Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Cattle
Da' Cow
Da Calf
Design Current
Capacity Pap.
Wean to Feeder
Non -La er
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Gnrrent
D . P,oul Ea aci P,o
La ers
Da Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Other
Other
Turkeys
jMkey Poults
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 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
10 No
❑ NA
❑ NE
❑ Yes
DaVo
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Ins ection. Qn
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 0 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 J>_� 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 Ta 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 NJ 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 V%[No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes gg No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes C'No
[DNA
❑ 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 ofWind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): (2 6-101 BP/MA- 667-2-P, SN Q i r1 Q011, Q V&J �
-
—
13. Soil Type(s):
2
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes R No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? []Yes NJ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable []Yes [2 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 C] 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 No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes M No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ® 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
M NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - a Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes & No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ® No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes �] No ❑ NA [] NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
® No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
C-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
U No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
tg No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes N No ❑ NA ❑ NE
F
omments (refer to question#): Explain any YES answers and/or any additional recommendations or any other comments - r
edrawings of facility to better explain situations (use additional pages as necessary).r<
�?leggyrno �'s����,� � CIO"
leui ► qe. 1 iMed-
adr Wf�_G11al)rj cre jxot fkl &mid Lj 60dayhr ► rig
Salke f e,
�SNOS(` St.<rV yvdS--�'Q'aDl�. Thls Ir+s��'fral �I�t It<r•P ar �Vrrd'1?'�'��
i f a Neft ce of Vi'ofdh"
�� �f h4'� 1-� eaf_.. }>>�g,e G�D�L�e
QJegje_ Cq(l'br* +� is year,
A,
a
�, N �, 1� � derwerk Wn ew 01c ,
1. 3 otc f, -e ids h a ve Q V &y A9f A ?ii c level (a 01 a s f Rome
rescr�,te w,�hl �'h 3od iy �+dC s�b�,(� r��v( �-� �uye ul-aam'aldl
o•� �a- a 43 f ns�ec'ho^) ,
�n�lf_r AAA; look oua- of r"°�°1Q� in k0t, 301k ,
pefHrw4riU i71 vo111 mtrO-Pt'l.
NA"l c 41 1 ho�esa►��? dot o� �iarrL&Corr3.
Reviewer/Inspector Name: Phone: `
Reviewer/Inspector Signature:
Page 3 of 3
Date: �e Dt6d0 13
21412011

Facility No. Farm Name E%& k&— Date Q4D 6 3
Permit _,-,'COC -47" OIC� NPDES (Rainbreaker PLAT Annual Cert Daily Pipe)
FB Dro s
Lagoon Name, S forspillway_
1
2
3
4
5
6
7
Design Freeboard 1 Last Recorded in
Observed freeboard
Sludge Survey Date MNaen,a
Sludge De th ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume ifs 0.45
Date out of com IianceLPOA?
Soil es# lar.�ty4 d''ti�r6PaP .
ate Crop Yield Transfer Sheets f,
pH Fields Wettable Acres RAIN GAUGEZO. ,,
Lime Needed WUP Dead box or incine
Lime Applied Weekly. Freeboard laa-11Mortality'Rec
Cu-I Zn-I 1 in Inspections ✓ Check Lists,
Needs S (S-I<25) 120 min Insp. Storm Water
Needs P Weather Codes
.,
..Li
ill
tt i
1 -
�.. 7
►Ti
Verify PHONE NUMBERS nd affiliations
Date last WUP FRO 5-4Yloy FRO or Farm Records
Date last WUP at farm Lagoon #
App. Hardware Top Dike 54
Stop Pump Sk
Start Pump r{
Conversion- Cu-I 3000= 108 Iblac; Zn-I 3000= 213 Iblac

C�
�1
'
C�

01W 7U1 001a,
M. i"vision of Wate QuaEity
Facility Number ® as Division of Soil and Water Conservation
©Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
ivs
Reason for Visit: outine O Complaint 0 Follow-up 0 Referral Q Emergency Q Other 0 Denied Access
Date of Visit: LL L1l� Arrival Time: ;QO Departure Time: , (S P H I County: Region: �Fft
Farm Name:Ebia b& i},',�/a s 1:&: m Owner Email:
Owner Name: _ Qcy }q 1 V j Phone:
Mailing Address:
Physical Address:
Facility Contact: rVQyng-_ Wq#f Title: (� >� r Phone:
Onsite Representative: way np— T c' t*-s _ Integrator:
Certified Operator: WN fine_ h49 U Certification Number: 1091
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Designer Current,,= Design�;Current Design Current
Swine Cs ac Pow ° Wet Poult . Ca aci Po{ x *� p
P . h P ry p: P3 apa ity op.
Azziattle c
Wean to Finish Layer DairyCow
Wean to Feeder ]Non -Layer Dai Calf
�� . ,:
Feeder to Finish- -
Farrow to Wean D`esign�Current
-�; *-
Farrow to Feeder D . P,ouI Ca aci 1'0
Farrow to Finish Layers
Gilts Non -Layers Beef Feeder
Boars Pullets Beef Brood Cow
Other ' * Turkeys
TurkeyPoults
Other Other
Discharges and Stream Impacts
Dairy Heifer
D Cow
Non -Dairy
Beef Stocker
L Is any discharge observed from any part of the operation?
❑ Yes
[2 No
[] NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[—]Yes
❑ No
[] NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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
E'No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/10II Continued

JFacilq Number: - Date of Ins ection: Q � �
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a�
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
D NA ❑ NE
❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 0 No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes N 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 GjNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 0 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
VNE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need [] Yes ❑ No
❑ NA
E' NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [:]No
❑ NA
aNE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA ONE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA Q 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 uired Records & Documents
I9. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ® NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ® NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [] No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [] No
❑ NA ONE
❑ Weather Code
❑ Sludge Survey
❑ NA ® NE
NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: -
Date of Inspection: Injiffla0Q.
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA 0 NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA 5J'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:
25. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA ® NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ® NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑ No ❑ NA ® NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes 0 No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes 2[ No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ❑ No D NA NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? C�g Yes ❑ No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 0 No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes � No ❑ NA ❑ NE
} l l Owvr ~b chick on SI B r-es 1 d uQ ! Tern vl -Prl a, ycrr, b���U , s(vc�y e wus rer►d-
r�Ol`Fo ins -h�0�, a,t�bl,ard WfiPy
3 wv e�` � s crap �' Yv� � �'��+o�� /-Q -�-f -h ` � 6 t��d
0n �h s -(W , boc+ 1 s � rt ,s �d
a boo I S coor of h y sl `* Vr-f ack lood of I i iler) OVI S jVe0d_ OC401M, per
od ucer &e +hck I0a& is a 6a u+ 3 S ra'wok"?" - l pad,Pi-s J par flodi"'C'er.
S-e 1Q cues a, -the `� D 0 4 01"is fdi° 0 9 �? �d �
T s�r�-che�k�oL � � � ,9
wh a so, I rm he 4o See what war If, pva
C`m e >^ a wa Its d ; d n� ha ve s 1Lo �
added, -(oCod ab0L 3-�I InG ol 6yai �"4�
IG,Ind� r"c mix, C �� IA Co �-
� a '� ���r hjr,�'jy- lao kr1,�e-f�re JweV4) zs1 rnea� t scga C vP>r i'e Q0.hiCk�l 1QVfYg-F 1'iQy � ar a[ j.foS�P btfhs'�
c- Cvb{ � �l r ©n�.ve ern h'p I Lyv �
r �t3r y'mn� l oe� Wll r rNAI� �rrror� C (ls (�►,ee a�I,er��d�e
��es;d�a1J OlvE W --H� rn axI4 q ins ir�ai f �{ fig�&t-rPf .
l
Reviewer/Inspector Name: �Qn�h �Q'-P/ _ _ Phone: q�d-4�3-3�iU(i ICY
Reviewer/Inspector Signature: kv Date:
Page 3 of 3 21412011

Type of Visit: '0 Compliance Inspection 0 Operation Review Q Structure Evaluation p Technical Assistance
Reason for Visit: aRoutine O Complaint O Follow-up O Referral p Emergency p Other O Denied Access
Date of Visit: Arrival Time: ffl�(QA M Departure Time: County: P ai, Region:
Farm Name: 11. b ' Owner Email:
.Owner Name: Phone:
Mailing Address:
Physical Address: 1_rt
Facility Contact: Wag Ae WA Title: owyo Phone:
Onsite Representative: Integrator: Hip
Certified Operator: Certification Number: c~ gjg7
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
S w,ne p
Deps, Current¢~
g
Ca ac, :Popp l
'Vet Pouttr?
Dent Current
gn
CapacttyPopCattle
Design
Capacity
Current
Pop.
Wean to Finish
I
Layer
� �
DairyCow
Wean to Feeder
Non -Layer
DairyCalf
Feeder to Finish
- -
DairyHeifer
Farrow to Wean
Design' Curreitrf
D Cow
Farrow to Feeder D . Poul Ca aci P,o ._
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Other
rj
Turkey Poults
Other
Dischar es and Stream Impact
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes UM ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA 0 NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [:]Yes ENo ❑ 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 S No ❑ NA ❑ NE
of the State other than from a discharge? '13W
Page I of 3 21412011 Continued

[Facility lumber: - Date of Inspection: j
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):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�R No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
Cj�No
❑ NA
❑ NE
8. Do any of the structures 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
[�ZNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers. setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
I . Is there evidence of incorrect land application? If yes, check the appropriate box below. RYes ❑ 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): .0QodaI a_ a n-e - Sma)14� OL�'1f
13. Soil Type(s): fh'� S 6tC -
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes tR No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ 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 allo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [a Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield 0120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes g NoZP!17NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No J"NA ❑ NE
Page 2 of 3 21412011 Continued

Facifl Number: - a51 I jDate of inspection: $ a
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 150 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [R No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No f�JNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
CR No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
t3 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately,
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tle drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
['allo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Callo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
(a No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
g Yes
❑ No
❑ NA
❑ NE
-7, p��easec�� o� �� �edJ o, inSVP cf layo�, o��l��lj Exre�l��-9 �a� ��$ a, 10yot,�7j
15,Fie lda wo-t 1rmed4-11lssvti)mo-,
l l , �rvas ncr l opt 1 a�00� iA yQ�v- At{ gmaj a, be�� , ?fie s 1 r
vye�-1 f k2d* bea os�� h r� p IrSci�
W��r i1*tcycnoot lkthe hCA-,. � W
P
a+,MUF We le spayeve rie-edop ` �y�voa�a aor3.7he
d �n ifs ra wd wafyIh a 1� �Oi P)Wa A61,
bk Vieake Ala new Ae G1)dl srs e� yy y ma�-hs, sn� ��e�r � )a,� � I
Rod\ it's U/-e. elf(eok h � chd f) � Ye /red i b �'houldf be neChPc n J'
Ifa�c�S
a� Tv V 'to fv C"
3y . �-b1lowvf heededio Ve5 ud9eld r rf wo r rpr►a�C ��� �� oL �c 005m+�1
�e �'Oy06 ore ok a r is ha
ve a ,9 00d s*rd�9`dss,
t
T-M rued-
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Phone:
Date:
Page 3 of 3

Facility No.
Farm Name
Eli ld
Date e lay �-
Permit COC
✓
OIC,
NPDES (Rainbreaker PLAT Annual Cert Daily Pipe)
rim
irlifU �i±�111i�---------
Lagoon Name, S fors illwa
1
2
3
4
5
6
7
Design Freeboard / Last Recorded in
Observed freeboard
Sludge Survey Date
)113111
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA?
Soil Test Date Crop Yield c/ Transfer Sheets _Y_]
pH Fields Wettable Acres RAIN GAUGE
Lime Needed WUP ✓ Dead box or incinerator
Lime Applied 5~ aot Weekly Freeboard Mortality Records
Cu-I Zn-I 65.) 1 in Inspections Check Lists
Needs S (S-1<25) 120 min Insp. Storm Water
000 .---_---
�
Verity PHONE NUMBERS and affiliations
Date last WUP FRO 51` ,,OW FRO or Farm Records
Date last WUP at farm Lagoon #
App. Hardware Top Dike 159
Stop Pump 441
Start Pump 5a
aYl
Conversion- Cu-1 3000= 108 Ib/ac; Zn-1 3000= 213 Ib/ac

Type of Visit: aCCompliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine Q Complaint Q Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: `� 'L�U Arrival Time: T Departure
Farm Name: Yk:f
Owner Name: Y1/Ay
Mailing Address:
• r vi r
County: Region: -% o
Owner Email:
Phone:
Physical Address: Eli C 1 } jjci'l
Facility Contact: dyn.� ��"� Title: Phone:
Onsite Representative: �/�/ 7 Integrator: M
Certified Operator: Tv'WA Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design "Current w Design�urrent
Swine Capacity Pop Wet Poultry ` Capacity Pop x
h,:i::�:'`'0+5 a�.,p a,Fk y .. MA.'.
Design Current
Cattle Capacity Pap.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
, l;oul
�, :: :'
Design�Current
apace �*�
RNon-DairyD
Ca aci Po
DairyHeifer
Cow
Farrow t o Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Turke Poults
Other
Beef Brood Cow
[3tlier .�1
Otlter
Layer Dai Cow
Non -La er Dai Galf
Discharges and Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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)
1 Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes &'No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
E3 No
E3 NA
❑ NE
❑ Yes
[g No
❑ NA
❑ NE
❑ Yes
CK No
❑ NA
❑ NE
Page 1 of 3 2/4/201I Continued

1117acility Number: 1�6 Date of Inspection: —7
- Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes JRNo NA NE
a. If yes, is waste level into the structural freeboard? Yes 0 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 tallo
[3 NA 0 NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a
E] Yes [)r No
0 NA 0 NE
waste management or closure plan?
If any of questions 4-6 wereanswered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
raYes El No
0 NA 0 NE
8. Do any of the structures lack adequate markers as required by the permit?
0 Yes allo
0 NA [:] NE
(not applicable to roofed pits, dry stacks, andJor wet stacks)
9. Does any part of the waste management system other than the waste structures require
0 Yes [XNo
0 NA 0 NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
Yes �; No
[:] NA 0 NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
E3Yes E
0 NA 0 NE
F1 Excessive Ponding Hydraulic Overload 0 Frozen Ground E] Heavy Metals
,�JNo
(Cu, Zn, etc.)
F1 PAN F� PAN > 10% or 10 lbs. Total Phosphorus [:] Failure to Incorporate ManuTe/Sludge into
Bare Soil
M Outside of Acceptable Crop Window 0 Evidence of Wind Drift E] Application Outside of Approved Area
12. Crop Type(s): CL2�21 fet, 4k - **1 Pnlyre - Swl I Cgov (�, V5
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? 0 Yes rqNo [:] NA 0 NE
IV-
15. Does the receiving crop and/or land application site need improvement? Ej Yes [R No 0 NA ONE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable F] Yes allo [—] NA [—] NE
acres determination?
17- Does the facility lack adequate acreage for land application?
Yes
CR No
0 NA
F] 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
MT No
NA
0 NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
[11"No
NA
[:1 NE
the appropriate box.
E]WUP E3Checklists 0 Design E] maps Ej Lease Agreements
Other:
2 1. Does record keeping need improvement'? If yes, check the appropriate box below,
Yes
0 No
NA
[:] NE
Ej Waste Application Weekly Freeboard tRVaste Analysis Soil Analysis
OWaste Transfers
0 Weather Code
F-lRainfall 0 Stocking[:] Crop Yield 0 120 Minute Inspections 0 Monthly and I " Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:] Yes
tS No
0 NA
0 NE
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
E] Yes
[D No
�A
ONE
Page 2 of 3
21412011 Continued

P &I,JeCL 'Po 3
Facili� Number;
Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge'? If yes, check
18 Yes
❑ No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ®Failure to develop a POA for sludge
levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: ,ddP
1
o LA V l�
Q
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
® NA ❑ NE
Other Issues
28. Did the facility fait to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29_ At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit'? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 5) No ❑ NA ❑ NE
[:]Yes
0 No
❑ NA
❑ NE
❑ Yes
S No
❑ NA
❑ NE
[]Yes
0 No
❑ NA
❑ NE
1P Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional: recommendations or,anywther comments.
Use drawings of facility to better.explain situations,(use;additional-vat=es as necessarv).
-J�43y. Sj,.� rvos rOY_ al* bevm e 1a m � TOALary�- dek�,�
A. sera-k- I-e has b .l ma, ,C defa f II, y o, 1e
� -to be_ dole onk wlwela
`jo e+ +hLs pp_wl f a,d_ a� p li F014 y n �� 4o ch a4 - a� allL l e_
h #S been re'r 0.4 �r -top 06,berm .
f �
�im�way s <�►� a� w r`n 0+ 1, JOIS /acre , tetds 4-ee i� ,9 D0d JAa f&,
�
ai, A+ lea-� ? S ra evm4f W,6 e- Co d r f4 cGh Q
�- � �ecQ� e�IQ�►
Sam � �J a-� g6t � o d o . p�� w as n 1 r �
c o vA,ymLCA
Reno,-ds c-e rn
G ood jo b Owl Spa, -ti)w_j be na l)= h e gr wa l arc 1 %
tl �le� -s- r� n fpd rv�,pjf,"µ`/'/` cad a��
Ord n4L 0-
Reviewer/Inspector Name: ! on s(' 1,e _ Phone: 9IM33-3MW-%)
Reviewer/Inspector Signature: Date: I
Page 3 of 3 ff Al2 ll a o'
J

Wa6ility Number: a S77) Date of Inspection: -7
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 E] Yes JR No NA E] NE
the appropriate box(es) below.
M Failure to complete annual sludge survey E] 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?
E] Yes
CR No
NA
F] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Yes
[:] No
NA
NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
Yes
No
NA
NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
Yes
No
NA
NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
[�kNo
[:j NA
NE
permit? (i.e., discharge, freeboard problems, over -application)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Yes
W No
NA
NE
El Application Field [:] Lagoon/Storage Pond F] Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Ej Yes
�jNo
NA
NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
0 Yes
to No
Ej NA
0 NE
34. Does the facility require a follow-up visit by the same agency?
E] Yes
�q No
[3 NA
E] NE
S 1�_ yvaj- r 61 �&t u r ento ba 0 it s f I o vol , N �j e) oz/, 4o h-e—
S IX eL oil-er,
ty, L' yvasspak jg-�j�
11VR_ s 41 jo- s-lo-trIae,-e, Fifld'_r are I /i� dshafe-
yoo
Q i, Ai I -ftA -) s fm e u,,�,b -yvq-e- (_o, atGded d b, j�
7 soly
ays P Y7
1,0,40t lf� y
el A3
Ca tie J,
VCV1 M14 - al j dol�d-
�ecords­ Ore 1'�
Gcojob O-e- hol 011" fil-14
bpe
Reviewer/Inspector Name: Phone':
Date: a 5r
Reviewer/Inspector Signature: pad
Page 3 of 3 2,412011

FaciktY No. t&)-)T-
) Farm Name 0111tbeb) k'tl'ffr Date
Permit COC 01C NPDES(Rainbreaker
FB
Drops
PLAT Annual Cert )
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboaFd- (in)
Sludge Survey Date
Sludge Deeth (ft)
Liquid Trt. Zone (ft)
Ratio Sludge to Treatment Volume
Calibration lda-­te--Wfoj=�����MG-
Actual Flow
Design Width
Soil Test Date Wettable Acres
pH Fields WUP
Lime Needed Weekly Freeboard
Lime Applied Si9 Do I I 1,37/c?c- 1 in inspections
Cu-I �-Zn-[,. 4-,-- 120 min Insp.
RAIN GAUGE
Dead box or incinerator
Mortality Records
1, Iq
NUCU5 r fvv vveainer uoou5
Crop Yield Transfer Sheets
5-01111
"to
Waste Analysis Date
71a I 111
-7
- 60 Day
+ 60 Day
N Amt (lb11000 Gal)
pH
-7,-)
Pull/Field
Soil
Crop
Acres
PAN
Window
Max Rate
Max Amt
18)
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm
FRO or Farm Records 5 �
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-1 3000= 108 lb/ac; Zn-1 3000= 213 lb/ac
App. Hardware

W�
r4
19
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit P Routine OComplaint OFollowup OReferral oEmergency 00ther [] Denied Access
Date of Visit: Arrival Time: Departure Time: County: -SAW03 Region:
Farm Name: 171 la behi. NO 1+9 FZ7//�7 Owner Email:
Owner Name: YVQnp Ka fts Phone:
Mailing Address:
Physical Address:
FacWty Contact: itiq ru-, Ly I V Title: Phone No:
_P
I
Onsite Representative: 'A Mn Integrator: M— V4
YVA -)
Certified Operator: n'P C_ M�A Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 =I = " Longitude: =0=1 ="
es
I
esign
urgent
U&# ac
r
'y
an to Fin ish
Layer
Dairy Cow--T--
an to Feeder
I abo
0 No-n-Layer
El Dairy Calf I
Feeder to Finish
_j
El Dairy Heifer
Farrow to Wean
El Dry Cow
El Farrow to Feeder
[:1 Non -Dairy
El Farrow to Finish
Layers
0 Beef Stocker
Gilts
0 Non -Layers
0 Beef Feeder
Boars
El Pullets
0 Beef Brood Co
Li I urkeys
El Turkey Pou Its
Other
El Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Yes
fgNo
0 NA
0 NE
Discharge originated at: 0 Structure El Application Field 0 Other
a. Was the conveyance man-made?
Yes
0 No
ONA
ONE
b. Did the discharge Teach waters of the State? (If yes, notify DWQ)
0 Yes
El No
El 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)
0 Yes
0 No
El NA
E] NE
2. Is there evidence of a past discharge from any part of the operation?
[j Yes
"RNo
El NA
[:1 NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
S�No
El NA
El NE
other than from a discharge?
12128104
Continued

1:
Facility Number: —jSr) I Date of InsPection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes
E NE
'� No [I NA
a. If yes, is waste level into the structural freeboard?
0 Yes
D No El NA El NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Frecboard (in):
Observed Freeboard (in):
5- Are there any immediate threats to the integrity of any of the structures observed?
EJYes
1p No El NA [:1 NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-sitc which are not properly addressed and/or managed
El Yes
No El NA El 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?
aYes
JVo [I NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
tN No E] NA El NE
(Not applicable to roofed pits� dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
El Yes
P No El NA NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
[RNo [--] NA NE
maintenance/improvement?
I I.. Is there evidence of incorrect application? If yes, check the appropriate box below.
El Yes
allo El NA El NE
El Excessive Ponding El Hydraulic Overload D Frozen Ground El Heavy Metals (Cu, Zn, etc.)
OPAN EIPAN>10%orl0lbs El Total Phosphorus El Failure to Incorporate Manure/Sludge into Bare Soil
El Outside of Acceptable Crop Window El Evidence of Wind Drift El Application Outside
of Area
12. Crop type(s) Ops fa I Rom,7 vda- FoA*-e - 5ma I/
13. Soil type(s) B111dD2 S
14. Do the receiving crops differ from those designated in the CAWMP?
Yes
19 No
D NA
1:1 NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
'RNo
El NA
0 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre detennination ?
El Yes
q No
[] NA
El NE
17. Does the facility lack adequate acreage for land application?
El Yes
t@ No
D NA
El NE
18, Is there a lack of properly operating waste application equipment?
1:1 Yes
[*No
[:1 NA
El NE
co-omments t
���ALEXPlain-llanvffy']E answep an itions rifanylo encommen
RU.Se idirFa-a�MwWin����iiin-rsitga—ti =ditionailpa
gesjasjnecessar�yj--=
Nd
Reviewer/Inspector Name Phone: o I cN:F
Reviewer/Inspector Signature: Date: Nr-x.,, -is,
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection KUM
ReQuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? E3 Yes No El NA [__1 NE
20. Does the facility fail to have all components of the CAV*1MP readily available? If yes, check El Yes E;�No El NA El NE
the appropriate box. El W­UP El Checklists [I Design El Maps E:1 Other
21. Does record keeping need improvement? If yes, check the appropriate box below. jj� Yes El No El NA [:1 NE
El Waste Application D Weekly Freeboard El Waste Analysis 15J Soil Analysis 0 Waste Transfers
El Annual Certification
ORainfall ElStocking E'CropYietd Ej t20 Minute Inspections El Monthly and I"
Rain Inspections
E]WeatherCode
22. Did the facility fail to install and maintain a rain gauge?
0 Yes
Q No
[:1 NA
El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
El No
J.:;�NA
El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
R1 No
El NA
[I NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
Q No
[:1 NA
El NE
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to sceure 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 Revi ewer/] nspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
El Yes RNo
0 Yes El No
E:1 NA [I N E
[2rNA El NE
[:]Yes
'V.UNo
EINA
[:1 NE
El Yes
12rNo
El NA
D NE
0Yes
I?I-No
El NA
El NE
[:1 Yes 1KNo El NA El NE
[_1 Yes 0 No [__1 NA El NE
[j Yes 'k) No [I NA [I NE
I rc�, wd ( ts, Pie
-7, 0';! 0-, )0a'-P- sik moy, rid-e a4.L),-*_sVevyq11s
pp""" , 'A 0_�
Q4 baci�esfcfe_
�
01, Pleo_,� ot4ol cl So' 'Y_�e_j -RY- Do Oct Out t�' a 010
I N
M �7
35-, fleae, i�) vd sc.-�
Pi, omik ret erd-r 1� re�
Addaim a) hdfft, f76f &I 34we Corr,
L -1 h 0 Soi
A4J 1111� 110 old 4,
choet A If*
1111qthtt, vired Pen
-eon �s.
omt- h Vj- Vei�' baL/j�j �eof+� isspe-r. +0 F: PZ.,
Page 3 of 3 12128104

Facility No. i�--�Farm Name F� I i '4A ws— Date 1106
Permit COC
OIC NPDES (Rainbreaker PLAT Annual Cert)
F13
Drops
Laqoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard (in)
Sludge Survey Date
L
Sludge Depth (ft)
Liquid Trt. Zone (ft)
-AO
1A IS
Ratio Sludge to Treatment Volume
Design Width
Actual Width
--)�
Soil Test Date
W �-�) Wettable Acres RAIN GAUGE
pH Fields
WUP Dead box or incinerator
Lime " Needed
Weekly Freeboard Mortality Records
Lime Applied
1 in Inspections
Cu-1 Zn-I
120 min Insp.
Needs �—
Weather Codes
CroD Yield
Transfer Sheets
Waste Analysis Date
ZEM
Pull/Field Soil Crop Acres PAW Window Max Rate Max Amt
1--70 -
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike n-0
Stop Pump 5D,0
Start Pump
Conversion- Cu-1 3000= 108 lb/ac,- Zn-I 3000= 213 lb/ac
App- Hardware
aeA F8 de) i�,, hr� 6"!-f
Fiee bW 1--i-,_7

13 ( �s D-L�f 111q10?
J!F Fluaonservan
===,.57cifity IN SA A— a
genc
"M
Type of Visit (b
Compliance Inspection
0 operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
(9 Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time. County: Region: f kO
Farm Name: El f-�q bj!f Owner Email:
Owner Name: VV11!jf1'P CL//-IIS- Phone:
f
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator:Wo V n e- C' Yy Operator Certification Number: AVIA a WIN
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = ' E]' = " Longitude: = o =' = "
11�1�1!i I I 'urren;l
'n C
S TiPopul;a
ti
.; 10
10 Wean to Finish
29 Wean to Feeder 1
t P.TUR T.W. NO a c
IE] Layer I I
LEI Non -Layer 1_ I
urrent
I
El Dairy Calf
.goo
Feeder to Finish
_j
La yers
El Non -Layers
Ej Pullets
El Turke s
Turkey Poults
IE] Other
0 Dairy Heifer
[3 Dry Cow
El Non -Dairy
El Beef Stocker
El Beef Feeder
El Beef Brood Cod
0 Farrow to Wean
El Farrow to Feeder
10 Farrow to Finish.
JEJ Gilts
JEJ Boars
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
[I Yes
N No
El NA
El NE
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
El Yes
[:1 No
El NA
0 NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
D Yes
0 No
El NA
NE
c. What is the estimated volume that reached waters of the State (gallons)?
L___
—
I
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
El Yes
E]No
EINA
NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
JR No
[I NA
NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
0 Yes
ErNo
[] NA
NE
other than from a discharge?
12128104
Continued

[Facility Number: S Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storrn storage plus heavy rainfall) less than adequate? El Yes IgNo D NA El NE
a. If yes, is waste level into the structural fireeboard? [:1 Yes Ej No El NA El 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?
E]Yes
IBNo
DNA EINE
(.ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
[:1 Yes
RNo
[] NA El 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?
U Yes
El No
[:1 NA D NE
8. Do any of the stuctures lack adequate markers as required by the pen -nit?
[:]Yes
1PNo
[]NA EINE
(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
19 No
[:1 NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
JZqNo
[:1 NA D NE
maintenance/improvement?
11. Is there evidence of incorrect application? Ifyes, check the appropriate box below.
D No
D NA [I NE
'�_Ycs
El Excessive Ponding '01-lydraulic Overload E] Frozen Ground El Heavy Metals (Cu, Zn, etc.)
[JPAN EIPAN>10%orl0lbs El Total Phosphorus D Failure to Incorporate Manure/Sludge into Bare Soil
El Outside of Acceptable Crop Window El Evidence of Wind Drift E] Application Outside of
Area
12. Crop type(s)Cnfl_Aa I B-emvda -4jieq POi-A*,e; Small Cow,), 0,,&ji4
13. Soiltype(s)
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
10 No
El NA El NE
15- Does the receiving crop and/or land application site need improvement?
[] Yes
JRNo
El NA D NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El Yes
[9 No
0 NA El NE
17. Does the facility lack adequate acreage for land application?
El Yes
RNo,
0 NA El NE
18. Is there a lack ofproperly operating waste application equipment?
[:] Yes
LRNo
[:1 NA [:] NE
'answers an or lei
0..Mmcnts�(irefei"I.. q estion #): Explain any YE�ij d/ any'recommen a n 0
Use drawings of fat'ility to better explain situatioii's.�..(usiii.dilit—ii-)niI naf!8 as� necessa
Reviewer/Inspector'Name
20AV SCftELIF�i Phonet� 1,�0) 433
Reviewer/Inspector Signature: P'4'Li Date: Oct 1q- a oo q
12128104 Continued

I
Facility Number: S-2), Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? [I Yes 1PNo [I NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check Yes W No El NA [I NE
the appropriate box. El WUP E3Checklists 0 Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. [I Yes PNo El NA El NE
El Waste Application [I Weekly Freeboard 0 Waste Analysis El Soil Analysis El Waste Transfers 0 Annual Certification
EIRainfall 0 Stocking El Crop Yield El 120 Minute Inspections [:1 Monthly and I " Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25, Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAVR"?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
3 1. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, ever 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?
E]Yes
Jallo
El NA
El NE
El Yes
[:1 No
DNA
El NE
El Yes
LXNo
El NA
El NE
D Yes
R No
0 NA
El NE
[I Yes WNo El NA [:1 NE
E]Yes El No [RNA [:1 NE
El Yes RNo
El Yes 9­No
• Yes RNo
• Yes JgNo
E]Yes ERNO
El NA E] NE
I--] NA El NE
El NA 0 NE
El NA [I NE
El NA El NE
El Yes tjrNo 0 NA El NE
(Oee f- J!�Yot;j b�) _0. (E�
_7/ Reov_ Mov bac�j _10W , _ _ b, I A
1, Vk)0je_ J'Irnt'�- a, hti5 rn a v'1nL,6,, 5�blid� sp'� t1'eld-S
-�D C e-ve,*7 Or a bal$ q Coo ya Ilo?j la t le N-Al IV77)tf
Were- OK , ko (;4dejee /,--
'Poce
S vl
A avi I'A _�c add- 4=15L_ 0110�� elk
�9
01, Sol) AnA Afj ov+�o Pal�l� , Plqrinj�l io 116- )1 get)
12128104

'Facility No5�_,)5_7 -Farm Name >akdh kvo& Date 01
Permit COC
P. I
01C
FB
Qrops
N_
H, 3
NPDES (Rainbreaker PLAT Annual Cert )
Tagoon
1,/
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard (in)
Sludge Survey Date
riq
Sludge Depth (ft)
Liquid Trt. Zone (ft)
Liz
Ratio Sludge to Treatment Volume
-
FIM �-ffl
Ms.,
Actual Width
Soil Test Date Wettable Acres RAIN GAUGE
pH Fields T� WUP Dead box or incinerator
Lime Needed Weekly Freeboard Mortality Records
Lime Applied 1 in Inspections
Cu-I - Zn-I 120 mininsp.
Needs P Weather Codes
CrOD Yield Transfer Shee t s __7;�� -,:�Aon I LaV, PLO, (5�%
Waste Analysis Date.
N Amt Ilb/1 000 Gal)
Pull/Field Soil Crop RYE PAN Window Max Rate Max Amt
0-
010
Verify PHONE NUMBERS and affiliations
Date last WUP FRO A- Date last WUP at farm
FRO or Farm Records kc Lflqh�
Lagoon # 153k
Top Dike
stop Pump �Aq,q
Start Pump 5ZIM
Conversion- Cu-I 3000= 108 Ib/ac-, Zn-I 3000= 213 lb/ac
App. Hardware
war

'� I�tJ 13 Ala iDg
Type of Visit 9ccompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 4i-Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Fia— Arrival Time: Departure Time: County: t?M S
T r 11 S.OM
Farm Name: �� C 1 fGd►� Olt�� ! Owner Email:
a a �nm4
Owner Name: Vy#;f )v Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: I �✓Q S Title: 01vol-ei, Phone No: O 3-7t-7711-
Onsite Representative: QynP _ t' ya 1Fa Integrator: MWDhl Paml v�+t �y
Certified Operator: W&4 l# C. WUITs Operator Certification Number: �yA
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 e 0 t = " Longitude: = ° 0 I = W
€ Design Current, Design Current Design Current
Swine _ Capacity Populate u - Wet Pouf C•apa ty P�opu[ahoo C ttlee Capacity Population
Fth.,
to Finish ❑ Layer ❑Dai Cow
to Feeder a n ❑ Non -La er ❑Dai Calf
er to Finish ❑ DairyHeifer
w to Wean Dry Poultry ❑ D Cow
w to Feeder Non-Daiw to Finish La ers❑ Beef Stocker
Non -La ers
❑ PulletsBeef Feeder
Beef Brood Courke s❑ Turke Poults
ther
um erso � roc ores:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Qk'No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2_ Is there evidence of past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
fNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number-06a Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storin storage plus heavy rainfall) less than adequate?
0 Yes
IN No El NA 0 NE
a. If yes, is waste level into the structural freeboard?
[I Yes
Ej No El NA [I NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed FreeboaTd (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
D Yes
C9 No 0 NA [I NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
0 Yes
U No El NA EINE
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?
RYes
[I No El NA [__1 NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
12 No El NA 0 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
E]Yes
EX No [I NA 0 NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
Wo 0 NA [I NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
E]Yes
allo [I NA [:3 NE
D Excessive Ponding El Hydraulic Overload 0 Frozen Ground El Heavy Metals (Cu, Zn, etc.)
El PAN EIPAN>10%or]Olbs E]Total Phosphor -us El Failure to Incorporate Manure/Sludge
into Bare Soil
El Outside of Acceptable Crop Window El Evidence of Wind Drift [:1 Application Outside
of Area
12. Crop type(s) ( Aly, P&LA -ISCA
13. Soil type(s) go B
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
RNo
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
E] Yes
CR No
EINA
ONE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
D3 No
El NA
[j NE
17. Does the facility lack adequate acreage for land application?
0 Yes
1�3 No
[__1 NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
;J-No
ONA
[:1 NE
IReviewer/Inspector Name I T t� nw, Phone: 710 q33-33VQX3M_3
Reviewer/Inspector Signature: 4 1�_Oc ca akooff
x6 � Date: A I
Page 2,of 3 V 12128104 Continued

FlFacility Number: TX --Z Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Elyes JZNo EINA EINE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes CRNo [I NA El NE
the appropirate box. 0 WUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes El No El NA 0 NE
D Waste Application [I Weekly Freeboard V3 Waste Analysis [I Soil Analysis El Waste Transfers El Annual Certification
0 Rainfall D Stocking El Crop Yield El 120 Minute Inspections [:1 Monthly and I " Rain Inspections E] Weather Code
22. Did the facility fail to install and maintain a rain gauge?
E] Yes
(RNo
[] N A
[] N E
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
El No
NNA
El N E
24. Did the facility fail to calibrate waste application equipment as required by the permit?
CR Yes
[:1 No
El NA
El NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
[:] Yes
[R No
[:1 NA
[:1 NE
26, Did the facility fail to have an actively certified operator in charge?
El Yes
[Y�No
0 NA
[I NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
El No
%NA
El NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
IR No
El NA
0 NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
C9 No
El NA
El NE
and report the mortality rates that were higher than non-nal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
RNo
0 NA
EINE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fall to notify the regional office of emergency situations as required by
Yes
91 No
El NA
EINE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
Yes
No
0 NA
ONE
33. Does facility require a follow-up visit by same agency?
El Yes
No
El NA
EINE
iE.
xddki �C--otTiments74,4�,�','-"-'t'-"
U_Ijrl�
W/d D
AL
7, 0 n e- m or barey ot 0,i jooi Nq Pie&
_9V'refl, Wne� seed a mvtcl)
Nwt -40 VP V evr, S&"e_
)Y. on f on /0 qe- I 11m, ?_ symed / e) I
C_ I? C/C b 1k 1000 Lf '+ 0 IS+
q
10, So&, a 6M
VV( _r Me er fff'A
OAe V044e_
J,Z'r lh4, 4V �1 S'0' '9 004 V/'0 ya�ef
KWL 4o re(,q I i lv� Me 0 -Ro iv d 0%. 4, 0 v wt-) ji,9,A '�m. ChAle-
�relnmef a, ftoi.- ove4o-,
Page 3 of 3 12128104

Facility No.
Ar — -�()
-D & 0
Farm Name 60fl(0&C'j
Date laoW103-
Permit
COC
OIC
NPDES (Rainbreaker PLAT Annual Cert
11t;1111
WiMM
B Drops
A* 1-0�N4,
Lagoon
'1
3
—4
5
6
7
Spillway
Design freeboard
Observed freeboard (in)
Sludge Survey Date 1j0-
I i I rTt—n
Sludge Depth (ft) & %
aj
jq
n,
1
Liquid Trt. Zone (ft)
3
r' n..- -i.� -LA-
C�aa&-ation[)ate
smi Mon's
Soil Test
Ljjqjq
Date
1 in Inspections
pH Fields
Lime Needed
Crop Yield
Wettable Acres
120 min Inspections
Weather Codes
Lime A I' d
P7
"Sf_
50*?>1200
WUP
Weekly Freeboard
Transfer Sheets 707 X7-
Cu
Needs P—
Zn —u—
Rainfall >1" t�—
RAIN GAUGE
FA ". M- "T',
FM M, on, won,
N Amt (lb11000 Gal)
Pull/Field Soil Crop RYE PAN Window Max Rate Max Arnt
0, gr
03
Verify PHONE NUMBERS and affiliations set
Date last WUP FRO Date last WUP at farm 1% lc,�, App. Hardware IfIvi"k I#f
FRO or Farm Records
Lagoon # j I
Top Dike �4-00
Stop Pump 4"—
Start Pump 510
I?

ONS J,��-4-07
99 Division of Water uality
Facility Number 0 Division of Soil and Water Conservation
I (I nther A—ncv
TypeofVisit IR Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit %Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other [I Denied Access
Date of Visit: 11540—Ti Arrival Time: Departure Time: County: Region: FJQQ
Farm Name: C+OACI I Rmy, Owner Email:
Owner Name. Wayne WaAi Phone: 91 Q IRID-2 4-rb
Mailing Address: 3-7)1 Ca bbq4, P*� yd
Physical Address: C I IA]b @?Bag
Facility Contact: Title:
Onsite Representative: Wal a P_
I
Certified Operator: _Waik wo
Back-up Operator:
Location of Farm:
Svdne
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
JEJ Other
Phone No:
Integrator: I.Ifghx 13 ro oy)
T f
Operator Certification Number -
Back -up Certification Number:
Latitude: =0 =6 Longitude: =0= [=
Design Current Design Current
Capacity Population WetPoultry Capacity Population
0 ayer
Q&00 lc-�300 10 Non-Layet
Dry Poultry
ElLayers
0 Non -Layers
El Pullets
El Turkeys
El Turkey Poults
10 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 man-made?
b- Did the discharge reach waters of the State? (if yes', notify DWQ)
Design Current
Cattle Capacity Population
El Dairy Cow
I
El Dairy Calf
I
Dairy_Heifei
Dry Cow
El Non -Dairy
El Beef Slockei
,[I Beef Feeder
JE1 Beef Brood Cow,
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?
E:]Ycs ERNo DNA El NE
Ll Yes
El No
El NA
El NE
Ll Yes
El No
El NA
El NE
El NA
[I NE
0 Yes
El No
El Yes CgNo [INA E:1 NE
E] Yes -P!(N. D NA El NE
12128104 Continued

FFacility Number: 18;)L - Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
Yes
R No 0 NA El NE
a. If yes, is waste level into the structural freeboard?
D Yes
0 No C1 NA [I NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?-
------------
Designed Freeboard (in): QLJ
Observed Freeboard (in): a to
5. Are there any immediate threats to the integrity of any of the structures observed?
El Yes
yNo El NA El NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
El Yes
VNo El NA El 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?
-4'45 4 Yes
JVNo El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
1Z No El NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
El Yes
RNo El NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
RNo 0 NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes
VNo
El NA El NE
El Excessive Ponding [:1 Hydraulic Overload [:1 Frozen Ground E] Heavy Metals (Cu, Zn, etc.)
EIPAN EIPAN>10%orl0lbs El Total Phosphorus Ej Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window E] Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) Berm do- I P q&eq-4fax 9M q cyalh I 0j
13- Soil type(s) '908
14. Do the receiving crops differ from those designated in the CAWMP? El Yes
VNo
0 NA D NE
15. Does the receiving crop and/or land application site need improvement? [:1 Yes
NJ No
[:1 NA El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre detertnination?El Yes
91 No
El NA El NE
17. Does the facility lack adequate acreage for land application? El Yes
NNo
D NA El NE
18. Is there a lack of properly operating waste application equipment? El Yes
VNo
El NA El NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facitity to better explain situations. (use additional pages as necessary):
tReviewer/Inspector Name Phone: Clio q33-3-300
e 'Iewe
R ewe
e,, r/Inspector Signatureo mom Sc..h ull�r Date: I alql 0-7
12128104 Confinued

FacilitTNumber-%',� Date of Inspection
Required Records & Documents
19� Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check
the appropirate box. El WUP 0 Checklists [:1 Design [I Maps El Other
El Yes 52 No El NA El NE
[] Yes 5�No El NA El NE
21. Does record keeping need improvement? If yes, check the appropriate box below. lj�Yes [:1 No El NA D NE
El Waste Application El Weekly Freeboard IffWaste Analysis El Soil Analysis [:1 Waste Transfers E] Annual Certification
[71 Rainfall El Stocking El Crop Yield El 120 Minute Inspections El Monthly and V Rain Inspections [:] Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the pen -nit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30, At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
3 1. 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?
El Yes
S�No
El NA
El NE
D Yes
EJ No
ONA
El NE
E] Yes
CR No
El NA
El NE
El Yes
RNo
D NA
0 NE
[:1 Yes
E2 No
[I NA
[__1 NE
El Yes
El No
[!JNA
El NE
El Yes CgNo [3 NA [I NE
El Yes RNo El NA EINE
0 Yes ER No [I NA El NE
I--] Yes CkNo [I NA 0 NE
El Yes
D9 No
0 NA
F-1 NE
El Yes
9 No
El NA
El NE
Additional Comments and/or Drawings:
r �&
WIN ef, rVQ I I Of- 14TI) JWb.'jhh0 -P;Xek
4ie- MOV
90al
Loje,bresf0-Cne*_ hymjOnlojoa) needrs��d�l amoct#?,
Is, PjetUr_e4WTm&ktr a�;)4 1"Ichei hurw� 19/9
Wajt "jyf)s_ vie4bic 1&0 01a -e
Lal1jae befiv -el) vv aj aw lysl
OC
S S ao P le, -b be- no i 4 off -for ;ool , VYWLI be- yr &-t vjef�' I t f+a;f� 1111irop* 14
-Seva) -i0he_+ai(f,,j Wme_ -old of -year,
51i'd
,9e_,5VfV1
7
12128104

&rL+e4 01"S 3fotn ovi
0
Type of Visit 0 Compliance Inspection 0 Operation Review @11 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other El Denied Access
?-025-07 1 Arrival Time: Departure Time: County: _SAzq02SJ Region:
Date of Visit: L
Farm Name:
4 J je2 Owner Email:
Owner Name: Wa,,1e_ 1JqA1—_5 Phone: (510
3 �es-
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = 0 Longitude: = 0 = I = "
esil "Ren
rfr nt
lv�
esign
9
Mc
e oul
'04.1 1
VAOF ity,,,ri � 0 114 0
e Q aci
• to Finish
aver
Dairy Cow
• to Feeder
on -Layer
Dairy Calf
eeder to Finish
Dairy HeifCT
Farrow to Wean
0 u
U
El Dry Cow
Farrow to Feeder
El Non -Dairy
El Farrow to Finish
s
10 Beef Stocker
Gilts
El Non -Layers
Beef Feeder
Boars
El Pullets
10 Beef Brood Cowl
El Turkeys
Turkey Po
Other
Oth r
um e o
El Yes E]No [INA MNE
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 man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
El Yes E]No EINA ONE
El Yes El No El NA NE
0 Yes El No D NA NE
El Yes [] No [_1 NA ONE
El Yes El No [I NA RNE
12128104 Continued
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 man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
El Yes E]No EINA ONE
El Yes El No El NA NE
0 Yes El No D NA NE
El Yes [] No [_1 NA ONE
El Yes El No [I NA RNE
12128104 Continued

FFaciliqNumber:T2
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[3 Yes
No El NA
El NE
a. If yes, is waste level into the structural freeboard?
El Yes
No El NA
El 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?
El Yes
No D NA
El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
Yes
No El NA
El 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
El No 0 NA
NE
S. Do any of the stuctures lack adequate markers as required by the permit?
[I Yes
[:1 No El 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
[I No El NA
0 NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
El No El NA
R1 NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
0 Yes
[j No E] NA
)9 NE
0 Excessive Ponding El Hydraulic Overload [I Frozen Ground El Heavy Metals (Cu, Zn, etc.)
EIPAN E:1PAN>10%or101bs El Total Phosphorus El Failure to Incorporate Manure/Sludge
into Bare Soil
El Outside of Acceptable Crop Window [:1 Evidence of Wind Drift [I Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
[_1 Yes
[] No
0 NA
NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
[:3 No
[:1 NA
NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El Yes
El No
El NA NE
17. Does the facility lack adequate acreage for land application?
0 Yes
El No
El NA
NE
18. Is there a lack of properly operating waste application equipment?
Yes
[:1 No
[:1 NA
00 NE
AU
��.Comrnents Oefer to question Explain-any�V�ES.answers and/or any recommenidationg,or�any,,Othericommi�'!�S
tu
Vse drawing�'of facifity to better explaiwsi ations. sa
.(use additional pages as neces
y
Reviewer/Inspector Name ' K'c K .. J�'e. e
Phone. 2LCA>3
3 3-3
Reviewer/Inspector Signature- R4-_� Date: 3 — r) g— Zoo 7- 1
�Vagez (,Pj a I -IlZaVU4 uonnnuea

F acility Number: eZ Date of Inspection
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes El No [I NA P NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes El No E] NA [M NE
the appropriate box. El W`UP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes El No Ej NA 0 NE
El Waste Application El Weekly Freeboard El Waste Analysis El Soil Analysis El Waste Transfers 0 Annual Certification
0 Rainfall El Stocking [:1 Crop Yield El 120 Minute Inspections 0 Monthly and V Rain Inspections E]WeatherCode
22. Did the facility fail to install and maintain a rain gauge? D Yes El No E] NA EM NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes El No 0 NA V1 NE
24, Did the facility fail to calibrate waste application equipment as required by the permit?
0 Yes
E]No
[:INA
ONE
25. Did the facility fail to conduct a sludge survey as required by the permit?
[:1 Yes
El No
El NA
[M NE
26. Did the facility fail to have an actively certified operator in charge?
0 Yes
0 No
[] NA
0 NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
[__1 Yes El No NA
P NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes [:] No NA
R9 NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes El No [:1 NA
MNE
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?
El Yes El No El NA
P9 NE
If yes, contact a regional Air Quality representative immediately
3 1.
Did the facility fail to notify the regional office of emergency situations as required by
[I Yes C3 No 0 NA
[,9 NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes El No 0 NA
�9 NE
Page 3 of 3 12128104

Type of Visit la Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /2'/9'O(c Arrival Time: Id 9.'00Departure Time: County: Region: dfr'-0
Farm Name: Ge rm % �5_Aa"c �a rµ,,_ Owner Email:
Owner Name: �JCL4 KC— 0 41-15 Phone:
Mailing Address:
Physical Address:
Facility Contact: Gt1d' ��- Inf�kl- Title
Onsite Representative: ���.., Nam_ 04.t
Certified Operator:
Back-up Operator:
Phone No: p
Integrator: 1My , 6/d7+✓/V
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 1:1 o = 1 = 1f Longitude: = O = I = u
EMU DCurrent
Design CIur ."
Design Current
Swine Capact�ty Pulation
Wet'Poulltry
Capactyapulation
Cattle C*apacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
Wean to Feeder IZ&po .7 5i4o❑Non-La
er
❑ Dairy Calf
❑ Feeder to Finish
-
❑ Dairy Heifer
❑ Farrow to Wean
D Pouf
El Dry Cow
❑ Farrow to Feeder
n'�?hyR
''
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
El Beef Stocker
❑ Gilts
❑ Non -La ers
❑ Beef Feeder
❑ Boars
❑Pullets
❑ Beef Brood Cod
Other❑Turkey
❑ Turkeys
Points
❑ Other
❑ Other
Number of Structures:
Discharges & Stream impacts
I . Is any discharge observed from any part of the operation?
❑ Yes
[;9 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
❑ Yes
[PNo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
❑ Yes
No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Wo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Lacility Number: fZ —Z Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus stonn storage plus heavy rainfall) less than adequate? El Yes [:jNo El NA El NE
a. If Yes, is waste level into the structural freeboard? [I Yes [9 No El NA EINE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
ldentifier�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3,0
5. Are there any immediate threats to the integrity of any of the structures observed? Yes [X No El NA ONE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed [__1 Yes [;FNo [:INA El NE
through a waste management or closure plan?
If any of q u estions 4-6 were answered yes, and the situation poses an immediate pu h lic health or environ mental th reat, n otify DWQ
7. Do any of the structures need maintenance or improvement? 0 Yes [if No El NA [__1 NE
8. Do any of the stuctures lack adequate markers as required by the permit? E]Yes VNo EINA EINE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require El Yes [,V No El NA [j NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes 1;9No [I NA [_1 NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes [WNo El NA [I NE
El Excessive Ponding El Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.)
EIPAN 0PAN>10%orl0lbs 0 Total Phosphorus El Failure to Incorporate Manure/Sludge into Bare Soil
El Outside of Acceptable Crop Window E] Evidence of Wind Drift El Application Outside of Area
r -
12. Crop type(s) L3 e VA- , J,— t' e /1�tz "'d
13, Soil type(s) Eo S
14. Do the receiving crops differ from those designated in the CAWMP?
11 Yes
I No
[:1 NA
D NE
15. Does the receiving crop and/or land application site need improvement?
[I Yes
E?PNo
El NA
El NE
16- Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El Yes
1� No
El NA
El NE
17. Does the facility lack adequate acreage for land application?
El Yes
[A No
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
[jNo
[I NA
El NE
Comments (refeito question ft Explain any YES answers in d/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
__1 Phone: r7/0,4_?3-33-30
Reviewerfinspector Name tc-
Reviewer/inspector Signature: Date: 7 ZO 0
F-Uge Z 4vj .3, 1 _11261W uonnnuea

Facility Number:
Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? D Yes YNo El NA ONE
20. Does the facility fail to have all components of die CAWMP readily available? If yes, check El Yes EgNo EINA El NE
the appropriate box. El WUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. [I Yes OgNo El NA [I NE
El Waste Application El Weekly Freeboard 0 Waste Analysis El Soil Analysis 0 Waste Transfers El Annual Certification
ORainfall ElStocking E]CropYield 0 120 Minute Inspections El Monthly and V Rain Inspections El Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
V No
[I NA
D NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
9No
El NA
D NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
[:1 Yes
[)fNo
[-] NA
ONE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
Wo
El NA
EINE
26.
Did the facility fail to have an actively certified operator in charge?
I--] Yes
'�27 No
El NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
O'No
[:1 NA
El NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
VJ No
El NA
El NE
29-
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
0 Yes
2f No
El NA
El NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
[M No
[:1 NA
El 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
0 Yes
[9 No
El NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/] nspector fail to discuss review/inspection with an on -site representative?
El Yes
VFNo
[:1 NA
El NE
33.
Does facility require a follow-up visit by same agency?
[I Yes
%No
El NA
El NE
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other El Denied Access
Date of Visit-, Arrival Time: Departure Time� Countv: —&4—n
osa4 Region: f7ZE-0—
Farm Name: 6F W44ff
S Owner Email:
Owner Name: Phone:
Mailing Address: _3 71 ce.
A16
Physical Address:
Facility Contact: 4,lgv., 4-,�t/cuys Title:
Onsite Representative: I Z17e
Certified Operator: Ld&yde --IAIaA
Back-up Operator:
Phone No:
Integrator: /C0/"0"-.
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [:�]' [--]' = " Longitude: = 0 =' = "
Swine
10
Wean to Finish
I
I I
R'Wean
to Feeder
1-2 6, 0
A200
0
Feeder to Finish
El
Far -row to Wean
El
Farrow to Feeder
El
Farrow to Finish
El
Gijts
1:1
Boars
Other
Other
Design Current Design Current
Capacity Population WetPOultry Capacity Population
E]Layer ::I I
10 Non-Layet 1 .1
Dry Poultry
El Layers
El Non -Layers
El Pullets.
urkeys
El Turkey Poults
El Other
Discharges& Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: D Structure L1 ApOication Field El Other
a. Was the conveyance man-made?
Cattle
Design Current...
Capacity Populadon�
El Dairy Cow��
El Dairy Calf
El Dairy Heifei
El Dry Cow
0 Non -Dairy_
El Beef Stocket
El Beef Feeder
El
Beef Brood CoLj
Number of Structures: I
b. Did the discharge reach waters of the State'? (Ifyes. notify DWQ)
c. What is the estimated volume that reached waters of the S[alc (gallons)?
d. Does discharge bypass the waste management system? (If yes., notify DWQ)
2. Is there evidence of a past discharge I-rom 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 DIN"o [:1 NA El NE
Ej Yes
El No
El NA
El NE
El Yes
No
NA
El NE
NA
El NE
Yes
No
0 Yes
BN o
El NA
El NE
El Yes
CTNo
El NA
El NE
12128104 Continued

rFacility Number:
Date of Inspection
Waste Collection & Treatment
EINA
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[I Yes
EKo
F-1 NE
a. If yes, is waste level into the structural freeboard?
[I Yes
0 No
El NA El NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?: P1 0
Designed Freeboard (in), c-a?tj
Observed Freeboard (in): ,��2 1
5. Are there any immediate threats to the integrity of any of the structures observed?
Yes
3<o
El NA El NE
(ie/ large trees, severe erosion., seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
[71 Yes
9'f4o
El NA El 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?
E]Yes
D<o
[JNA [] NE
8. Do any of the stuctures lack adequate markers as required by the permit?
[__1 Yes
3<o
[:) 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
El Yes
D'N� o
El NA [:1 NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance altematives that need
[:1 Yes
0"No
El NA [:1 NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below.
[__1 Yes
[�Ko
El NA [I NE
El Excessive Ponding El Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.)
El PAN [] PAN > 10% or 10 lbs El Total Phosphorus El Failure to Incorporate Manure/Sludge
into
Bare Soil
El Outside of Acceptable Crop Window [:] Evidence of Wind Drift Application Outside
of Area
12. Crop type(s)
13- Soil type(s) &'n44
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
gf� o
[] NA
El NE
15, Does the receiving crop and/or land application site need improvement?
0 Yes
0,<o
El NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'!El
Yes
El No
El NA
17. Does the facility lack adequate acreage for land application?
El Yes
El No
El NA
O'�
18. Is there a lack of properly operating waste application equipment?
El Yes
Q<o
El NA
0 NE
1".i q�k
Reviewer[Inspector Name Phone: f/0-'/R6-/!;-4// eW7Xj?o
Reviewer/inspector Signature: Date:

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Xs M4. El NA ONE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes [j;�<o [I NA El NE
the appropirate box. El W
'Pt" El Ch
,peKists El DeWn El kjaj!rs' [I ojWr
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes [:1 No [:1 NA E:1 NE
0 W-&-��tion E:1 Wtrkty�� El Wzqc-�� El S"4oiziyst 0 WftffW-TT=mfm 0 AmmM-ff� �Ion
EIR-&iftku OSt"k-inmg- [-I Crop Yield El El I wRthly at;d I " Rain inspec4ions El
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreak-ers on irrigation equipment?
24. Did the facility flail 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
2& Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
3 1. 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/] nspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
En 4 Ou r'Agal M, - "la �O IV.-, S Sa
101,11e 5, clolo
El Yes
9-no
El NA
El NE
El Yes
El No
El NA
91�E
[I Yes
[:1 No
DNA
[2'lq E
El Yes
El No
0 NA
919E
El Yes
ED-No-
El NA
El NE
El Yes
El No
El NA
EI<E
El Yes [;Ko El NA El NE
El Yes
DNo
El NA
El NE
El Yes
2No
El NA
El NE
El Yes
ErNo
El NA
0 NE
El Yes
E3N'o
El NA
El NE
El Yes O'&o El NA El NE
12128104

(Type of Visit 0 Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: 8 3tf Time: fDi 3D
O Not erational Q Below Threshold
Permitted [}Certified [3 Conditionally Certified © Registered Date Last Operated or Above Threshold : -------
Farm Name: ..: E1 r Zq�fa� 4 1�/a 77�s F401M County:........: yP.s.Q'j ................. ..........
Owner Name: W��r A.G ...... ti✓a{s _. ..... Phone No: y.:..I `'�y. d..............................
Mailing Address: ..... � 7 �.......... ........./...........
Facility Contact: W4 v&C .._...... kVc-.II1......_...--- Title:
Phone No: _ ..._ . _.....
Onsite Representative:._._.j!✓p.3E�_ _ -----. -_.. Integrator..... /i�r✓c
.......A/y
Certified Operator: ............. Z%p yI ation Number:.. �?/ ­­c
Location of Farm:
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 1 46 Longitude • 4 "
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes [Q'1Qa
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes [3-M
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) El Yes RNo
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes GN-o
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ag-0
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [�TO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway [:]Yes B-No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ..............1........ ......
Freeboard (inches): 2
12112103 Continued

Facility Number: Date of Inspection
Rewired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? 0 Yes El -No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
('e"WP' 4addists, C��' Palo, etc.) 11 Yes 9-NO
23. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes UNo
[I Waste A lication EjFmabeard— [3 Wwte A=&Air.- [] Seil SamphBg—
S '.�ff -;;, 511 -:2 - -7V -) /. 7
24. Is facility not in compliance with any a&licable setback criteria in effect at the time of design? 13 Yes am
25. Did the facility fail to have a actively certified operator in charge? 0 Yes am
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
Oe/ discharge, freeboard problems, over application) [I Yes aM
27. Did Reviewerfinspector fail to discuss reviewlinspection with on -site repres entative? E] Yes O-NO
28, Does facility require a follow-up visit by same agency? Yes B-M-
29. Were any additional problems noted which came noncompliance of the Certified AWMP Yes []-No
N'PDES Permitted Faeffities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) 0 Yes O-W-
31. If selecteA did the facility fail to install and maintain rambreakers on n-rigation equipment? OYes ONo
32. Did the facility fail to install and maintain a rain gauge? 0 Yes ONo
33. Did the facility fail to conduct an annual sludge survey? 0 Yes ONo
34. Did the facility fail to calibrate waste application equipment? 0 Yes 0 No
35. Does record keeping for NPDES requfted forms need improvement? If yes, check the appropriate box below. 0 Yes 0 No
OStockingForm OCropYieldForm ORslinfall Ohispection After I" Rain
0 120 Minute Irtspections 0 Annual Certification Form
12112103

jFadfity Number:
Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, Yes Ewo_
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or [:1 Yes EMq0-
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/mprovement? D Yes S?No`
8. Does any pan of the waste management system other than waste structures require maintenancerimprovement? El Yes Ei<
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level El Yes 044br'
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? 0 Yes D-Ko-
11. Is there evidence of over application? If yes, check the appropriate box below. El Yes S-No
[I Excessive Ponding PAN [3 Hydraulic Overload [] Frozen Ground [I Copper and/or Zinc
12- Crop type _2 A',11
& H. A
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWIVIP)? 0 Yes EPCO
14. a) Does the facility lack adequate acreage for land application? 0 Yes P-Ko-
b) Does the facility need a wettable acre determination? 0 Yes S-No
c) This facility is pended for a wettable acre determination? Ej Yes M-No
15. Does the receiving crop need improvement? 0 Yes 9-No
16. Is there a lack of adequate waste application equipment? [] Yes 0-No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below 0 Yes [I No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? El Yes []No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, Yes 13'No
0
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 0 Yes U-No
Air Quality representative immediately.
;�'� I
Copy [] Final Notes ; � I,
0'1' X"
C'�'/ 6/0"'X
One
4
J _/_0 4� e
S
X, 00'7
eslaAo f�� qVe 0/ 447�$S C 0 ve.� S,;
Revieweraupector Name 6e
ReviewerAkspector Signature: N,,14
Date:
'_2 't
12112103 Condnued

Site Requires Immediate Attention
Facility No. '� 7- - Z-5 7
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
Farm Name/Owner:
Mailing Address 15
County: —
Integrator:
On Site Representat,
Physical Address/Location:.
DATE: 1995
Time: 146D
Phone:
p_ - Phone:_
-S Z-
sq?
A (11 4*t-k c "
Type of Operation: Swine�)-JLN,.. Poultry — Cattle
Design Capacity: - E3 Z� Number of Animals on Site: o L2
DEM Certification Number: ACE_ DEM Certification Number: ACNEW_
Latitude:— Longitude:— 0 —"—"
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Yes or No A,-wal Freeboard: -a -Ft. ];aj ches
Was any seepage observed from the
r
Is adequate land available(�,T SPT�Ly�
Crop(s) being utilized: U '� J cl
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin (Y3�eor No
100 Feet from Wells? Yes 0
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Y%esd
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue " e: Yes or No
Is animal waste discharged into water of'­� state by man-made ditch, flushing system, or other
similar man-made devices? Yes d��o If Yes, Please Explain.
Does the facility maintain adequate waste management records (v
,glLqes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes ok.N�o
Additional Comments:
-S�& --W\10 r.3� �_ �
Inspector Name
)? Yes ok&-�as any erosion q>sop4pd? Yes o(E)
No Is the cover crop adequater( �Yr No
cc: Facility Assessment Unit Use Attachments if Needed.