820258_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

� �> ( .l I-I'v r lY-) kSL-)
ivision of Water Resources
Facility Number - 5 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: om ance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: QRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: `Y- y Arrival Time: a Departure Time: i ' d County: S f1 fd A) Region: rl 70
Farm Name: � �p _J X q-e- jj if Owner Email:
Owner Name: t—A-V'tt_S it Phone:
Mailing Address:
Physical Address:
Facility Contact: C, �,i, /S 1-3aTitle:
Phone:
Onsite Representative:
�/
Integrator:
Certified Operator:
�`J�la
ILL
('' l� cti
r,C
Certification Number: - 1936 �
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish
Wean to Feeder 'Z&uo - CU
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
La er
Non -La er
Design Current
Dry Poultry Canacitv Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharp-es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[:]Yes p-N-o ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes ❑ No [?]-NA ❑ NE
❑ Yes ❑ No
[:]Yes [ o
❑ Yes ❑No
[ql�A ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: - $' Date of Inspection: o� j utfLr-/��
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[3-1do
❑ NSA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
ETINA
❑ 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
❑-Ko—
❑ 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
Io
❑ 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
0-NIF
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
L o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑-<o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [2'�lo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C-(Al i� n , -,:, It c "
13. Soil Type(s): a
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [sT1,do ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑-N—o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes D-X6_❑ 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 ❑-ble- ❑ NA ❑ NE
❑ Yes [Z�� ❑ NA ❑ NE
Required Records & Documents
/No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Ea ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Q'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
[Jj Nto� ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[j]� ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection: Tv/I/len
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
E5--M° ❑NA ❑NE
❑ NA ❑ NE
❑ Yes ©-ilq� ❑ NA ❑ NE
❑ Yes FZNo ❑ NA ❑ NE
[]Yes NA ❑ NE
❑ Yes E-N-6 ❑ NA ❑ NE
❑ Yes [�'1 o ❑ NA ❑ NE
❑ Yes ED,? o ❑ NA ❑ NE
❑ Yes No
❑ Yes [] o
❑ Yes []-<o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
n--(, 5 P— 4,7
— Tu-300c) � � S (
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone
Date: Q g
21412015

'Type of Visit: {7 Compliance Inspection U Operation Review Q Structure Evaluation (D Technical Assistance
aI
Reason for Visit: Koutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 5(EllArrival Time: (jam Departure Time: County:. -7A-)14_ Region:
Farm Name: y"UC Owner Email:
Owner Name: �,j � n V Mf T.Ax, Phone:
Mailing Address:
Physical Address:
Facility Contact: C4,11 -f 1 s �i p .�t�•�[� Title:
1!
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: w r ` `s
Certification Number: /?& & Z
Certification Number:
Longitude:
Design CurrentDesign
❑ No
D�A
Current
Design Current
Swine Capacity Pop.
WetPoultry -
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder ), e o a 40 �
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Cnrrent
Dry Cow
Farrow to Feeder
D a P,_ouit ,
Ca acitymP,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
-
Turkeys
Other __ -
Turkey Poults
Other
Other
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify 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 [3`1Qo ❑ NA ❑ NE
❑ Yes
❑ No
D�A
❑ NE
❑ Yes
❑ No
[3 -NA
❑ NE
❑ Yes ❑ No
❑ Yes ED -No
❑ Yes No
E], -?4A 0 N E
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 2/4/2015 Continued

Facili Number: Date of Inspection:
S'kL
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? ❑ Yes E]-N—o ❑ NAS❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ < ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �o n NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes [ No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [:allo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes []"No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [3rNo ❑ NA ❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes []'Ao ❑ 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 F] 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
ab
12. Crop Type(s): 1 o rvL 0(uf �c--, S r4 LiJ�
13. Soil Type(s): X/_
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 [ErfVo ❑ NA ❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E] -?40 ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application'?
❑ Yes
E31�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E3<o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[� No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No 0 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 E]1 o ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes El"No ❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facility Number: -eXS7 Date of Inspection: M
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ YesTo [DNA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑Yes D No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the 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 2<o
❑ Yes E3<o
❑ Yes io
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes [al�o ❑ NA ❑ NE
❑ Yes []"No ❑ NA ❑ NE
❑ Yes [rNo ❑ NA ❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
[2"No
❑ NA
❑ NE
❑ Yes
[3"&o
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: { 1
Reviewer/Inspector Signature:
Page 3 of 3
0
(7-:1, s P- ({`7
tG .e.(( �q1e-- 3 ok-_4 &s
Phone: — 3 -33
�! J 1
Date: I's 4
2/4/20!

Type of Visit: O7Routine
liance Inspection -0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: r Arrival Time: Departure Time: County: Region:)
Farm Name: jti[ jli �[ptrt'��.� Owner Email:
Owner Name: a��,�y✓�`G(� Phone:
Mailing Address:
Physical Address:
Facility Contact: c4A("-' Title: Phone:
Onsite Representative: Integrator:
Certified Operator: J�Cv� _ f'� �— Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design C*urrent
_
Design
Current
Design
Current
Swine - =Capacity Pop.
Wet.Poultry
0.
Capacity
Pop.
Cattte Capacity
Pop.
Wean to Finish
La er
a. Was the conveyance man-made?
❑ Yes
Da' Cow
Wean to Feeder q>
❑ NE
Non -Layer
❑ Yes
❑ No
Da' Calf
Feeder to Finish
"' `�-_�''' ;—:= 9
Dai Heifer
Farrow to Wean-
- °-• -
Design
Current
D Cow
Farrow to Feeder
D : Poiultiy.
Ca aci
Po .
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Beef Feeder
Boars
Pullets
of the State other than from a discharge?
I 113eef Brood Cow
m
Turkeys
Others. _
Turks Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
ZNo
[DNA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
dNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[�NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
&NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
fNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
2No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Faciti Number: Date of InsRection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ YesNA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No LJNA ❑ NE
Structure 1 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 ❑ No ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4fi were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
LAS o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑-ITo-
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste -Application
10. Are there any required buffers, setbacks, or compliance alternatives that need Yes -No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes P9'!Ko ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ YesET-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 ga o ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ 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 -
2 1.
ther:21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes L'J No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facility Number: - Date of Inspection: u
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �J No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey f7 Failure to develop a FOA 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 ONo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes g/No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
4 110
❑ 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
QXo
[DNA
❑ 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
dNo
❑ NA
[] NE
permit? (i.e., discharge, freeboard problems, over -application)
3 L 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
E4,
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
[:]Yes
F!I�No
No
❑ NA
❑ NE
34. Does the facility require afallow-up visit by the same agency?
❑ Yes
E
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
2/4/2015

Type of Visit: (Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: [7 1 Arrival Time: O D Departure Time: ► p c7 County: Region:
Farm Name: A4 -
Owner Name: K c, /`-z_-7yt A-
Mailing Address:
Owner Email:
Phone:
Physical Address: `
Facility Contact:sT7"-- W �! / r. ^- Title: Phone:
Onsite Representative: —.5 Integrator:
Certified Operator: �� Certification Number: g -a
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Design .Current
Capacity Pop.
01) 0 7
We# Poultry
La er
Non -La er
D , P,oul
Design
Capacity
Design
Ca aci
Current
. P -op.
Current
Po .
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
v
Turkeys
Turkey Faults
HOther
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 allo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[] Yes ❑ No
[—]Yes [&No
[-]Yes [,S No
❑ NA ❑ NE
❑ NA ❑ NE
E] NA ❑NE
Page I of 3 2/412014 Continued

.[Facility Number: jDate of inspection: r / ?—
Waste Collection & Treatment
. 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
allo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
FANo
❑ 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
allo
[DNA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[Z No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[ No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �No C] 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): t1 wX12J // 5 '14—
Z t
13. Soil Type(s): %v
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [RNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes EJ 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 ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes V No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No
❑ NA [] NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
0 NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facili Number: - Date of Inspection: 7�
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes f2� 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 to provide documentation of an actively certified operator in charge? ❑ Yes @ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus toss 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
J3 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
[Z 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
allo
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[4No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
CE�No
❑ NA
❑ NE
Comments (refer to _question ff): Explain any YES answers and/or any additional recommendations or any. other comments.
Use drawingsof facility,.to,.better explain situations (use additional pages as necessary).
Reviewer/inspector Name: _ S,Y�
Reviewer/inspector Signature:
Page 3 of 3
Phone:
Date: ,f— / 72
2/4/2011

p.
Type of Visit: —Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Q' outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: O Departure Time: I 1,0- County: 0-- Region: a
04,
Farm Name: /j ae!f y Owner Email:
Owner Name: Kareem 7� [,i�ne/rY�^- Phone:
Mailing Address:
Physical Address:
Facility Contact: �<arr-k- Title: Odiner`'
Onsite Representative:A.-w _ Integrator:
Phone: fy z- !
Certified Operator: Certification Number: /L' 7S
Back-up Operator: �'rt-�r,� (�11��j^r-•-� Certification Number: --'Z>
.4 Z
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b_ Did the discharge reach waters of the State? (If yes, notify 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 [allo ❑ NA ❑ NE
Yes ❑ No
Yes [:]No
[:]Yes ❑No
❑ Yes [& No
[:]Yes 0 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA [] NE
Page I of 3 2/4/2011 Continued
Design C ent
Design
Current Design Current
Swine
Capacity 'op
Capacity
Pop kCattle' Capacity Pap.
4``WetPoultry
R
Wean to Finish
Layer
airy Cow
Wean to Feeder
[ppD e'7I INon-Layer
I
ai Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
_
Design
Cetrrent D Cow
Farrow to Feeder
g D . 'Pout
Ca act
�,:w;
1'0 : * Non -Dairy
Farrow to FinishLayers
¢der.ii
r
"w `S
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
`" Pullets
Beef Brood Cow
Turke s
Y
Turkey Poults
Other
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b_ Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
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 [allo ❑ NA ❑ NE
Yes ❑ No
Yes [:]No
[:]Yes ❑No
❑ Yes [& No
[:]Yes 0 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA [] NE
Page I of 3 2/4/2011 Continued

Facility Number: Date of Inspection: A ��
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): :;,16
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
allo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[� No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[. No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift/ ❑ Application Out/side of Approved Area
12. Crop Type(s): t//¢i/i7�a� .�-/r✓1�1�i (G�// t Gvh r�/.� Q'��
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 [R No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [aNo ❑ 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 Z No ❑ NA ❑ NE
❑ Yes gj No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Desigm ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [3j 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 [a No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [E�-No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: - Date of Ins ection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [Q 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 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 [allo ❑ 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 �Z 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
[S No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[:]Yes
® No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA
❑ NE
/�`Y bDx � f r`i-t 5A9Svc,- � WprfC r a-f7PIL yQcc {sCcVY ��3 Or
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Q' �''�Q a
Date:
114/2011

Type of Visit:ompl�pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 01 outine 0"Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 3; 3 O Departure Time: i 3 County:
Farm Name: ,— ^_T7_ N ttr Owner Email:
Owner Name: Gz rcr� f#— (�C� at /Y r Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: �,rz..l i,c��'r"---t_. Title: vt rr' Phone:
Onsite Representative: Integrator: /nom/,p air7cel
Certified Operator: 6r. Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify 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 &No ❑ NA ❑ NE
[-]Yes ❑ No
[]Yes []No
❑ Yes [] No
❑ Yes No
[:]Yes No
E] NA [D NE
C—] NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 2/4/2011 Continued
Destgn ,Current` ,
Desi 0 cent
Design Current
Swine
Capacity Po
Wet Poul try
Ca act Po �,.
p typ Cattle Capacity Pop.
Wean to Finish
Layer
Da Cow
Wean to Feeder
(oOD %0
Non -La er
DairyCalf
Feeder to Finish_"
Dai Heifer
Farrow to Wean
Design Cti-rent-
D Cow
Farrow to Feeder
D , P,oult ,
Ca acttyPo
Non -Dairy
Farrow to Finish
Layers
113eef Stocker
Gilts
Non -Layers
Beef Feeder
113cof Brood Cow
Boars Pullets
Turkeys
Qther
_
Turkey Poults
=
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes &No ❑ NA ❑ NE
[-]Yes ❑ No
[]Yes []No
❑ Yes [] No
❑ Yes No
[:]Yes No
E] NA [D NE
C—] NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 2/4/2011 Continued

Facility Number: - Date of ins ection:
—1
o
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
(51 No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[�LNo
❑ 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
❑ NA
Identifier:
18. is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
Spillway?:
Required Records & Documents
Designed Freeboard (in):
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Lallo
❑ NA
Observed Freeboard (in):�
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�No
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i -e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
®, No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
� No
❑ NA
[j 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 a]tematives that need
❑ Yes
� No
E] NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 5g No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 ibs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift [:]Application Outside of Approved Area
12. Crop Type(s): ;-Zk'r. n... /4 - rf
13. Soil Type(s): AJ p
14. Do the receiving crops differ from those designated in the CAWMP?
aYes
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
(51 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Lallo
❑ 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 CR 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 K[ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes F;71 N
[:]NA [:]NE
E] Weather Code
❑ Sludge Survey
[:INA [:]NE
No
❑ NA ❑ NE
Page 2 of 3 2/412011 Continued

Facility Number: - Date of Inspection: — /3
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other lssues
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes jKNo ❑ NA ❑ NE
❑ Yes Ea No ❑ NA ❑ NE
❑ Yes CR No ❑ NA ❑ NE
❑ Yes
[3 No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
� No
C:] NA
❑ NE
� �' � 8-�- �drs•-..mss / tv�r ��.,.� C� � r Ura-si^b �.�r , l ��� 1�.� :..�
�d5 74, rro5 ,-,'—� NY rc�a ail - �: �- ��•
Ta
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 7%dam
Date:
2/4/2011

I
f'Pl-t""
n of Water Quality
Facility Number ®- I�J.J O Division of Soil and Water Conservation
Q Other Agency
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: QHlo`utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: p ; D Departure Time: j ; oc7 County: Region: rg 0
Farm Name: rn ; ,--FZ jJrAr fzr! ` UJ
Owner Email:
Owner Name: K a r)e r� 4V o- r r el,- Phone:
Mailing Address:
Physical Address:
Facility Contact: 1A*rfr:1 Title: &W -VA e.,-- Phone:
Onsite Representative:Integrator: qtr
Certified Operator: q jr f Wo, i, re r` Certification Number: 7.W
Back-up Operator: 7d -e-- jAla q-,-^- Certification Number: %?"()
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify 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 [&No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 2/4/2011 Continued
Desigu Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry ,.
:Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dai Cow
can to Feeder
(p
Non -Layer
Dai Calf
Feeder to Finish q l
Dai Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dr, P,oult ,
=Ca achy
P,o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other-
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [&No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 2/4/2011 Continued

Facility Number: - pate of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes n No ❑ NA ❑ NE
6. Are there structures on-site which are not property addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
[—]Yes
❑No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7_ Do any of the structures need maintenance or improvement?
❑ Yes
ZI 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)
❑ NE
the appropriate box.
9. Does any part of the waste management system other than the waste structures require
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ON o
❑ 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 p 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):ct' r« e-
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes ❑No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[—]Yes
❑No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
[—]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 p 120 Minute Inspections [:]Monthly and I" Rainfall inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? []Yes ❑ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: jDate of Inspection: ` %-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [S No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes M No ❑ NA 0 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 [Z No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concem?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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 0 No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes [RNo ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [Q No
❑ Yes EQ No
❑ Yes E. No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use.additional pages as necessary).
�%fTr.� ✓ Z �e,�ls `� your
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
214/2011

III
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: D14outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: a _ Arrival Time: Departure Time:l a� County:. Region: ^-Z) -
Farm Name: dl : K17 �u S rhl
Owner Name: Is a e 4—A A r11 ne !-✓' r ,;,t
Mailing Address:
Physical Address:
Owner Email:
Phone:
F
Facility Contact: ('t Cf/`r ti iA- L,U a/`l'e'• Title: iC2,1 r! Phone:
Onsite Representative: S7`ei� Uj,*rr x Integrator: u�
Certified Operator: ��—L..��.�► �i[J�+cfPrr'V Certification Number: f8'D
Back-up Operator: a fYy�_ uJa �, Certification Number: -7
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 Callo ❑ NA ❑ NE
C] Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes C9,No
❑ Yes 0 No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA E] NE
Page I of 3 2/4/2011 Continued
Design Current
Design
Current
- Design Current
Swine
Capacity Pop.
W. ,et Poultry ; Capacity
Pop.
Cattle = Capacity Pop.
�U.
Wean to Finish
[Layer I IDairy
Cow
Wean to Feeder
p %ora
]Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to WeanWE
Desi n
Current
Dry Cow
Farrow to Feeder
£ . _.D , Poul `6'a,ci
P.o .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
`Turke
s
Other
Turkey Poults
Othcr
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 Callo ❑ NA ❑ NE
C] Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes C9,No
❑ Yes 0 No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA E] NE
Page I of 3 2/4/2011 Continued

Facility Number: - Date of Inspection:IF
❑ Yes
® No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
Waste Collection & Treatment
® No
❑ NA ❑ NE
the appropriate box_
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[Z No
❑ NA
❑ NE
t
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Eg No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[Z No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA ❑ NE
Identifier:
❑ Yes
to No
O NA ❑ NE
Page 2 of 3
Spillway?:
2/4/2011 Continued
Designed Freeboard (in): 19
Observed Freeboard (in): �y j
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
[Z 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
Ea No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
I L Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes IQ 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): �Jo if
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 5a 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?
IT Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes [g No ❑ NA ❑ NE
❑ Yes LA 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
® 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
Eg No
❑ NA ❑ NE
❑ Waste Application 0 Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge'?
[:]Yes
®,No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
to No
O NA ❑ NE
Page 2 of 3
2/4/2011 Continued

Facili Number: jDateof Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [3 No
s� 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes ®,No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other Issues
2$. 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?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ NA D NE
❑ NA ❑ NE
❑ NA ❑ NE
[DNA ❑NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 5� No ❑ NA ❑ NE
❑ Yes [8 No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes No
[—]Yes ® No
❑ Yes ®-No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone:'!r�/�j-r3�`Da
Date: 17_—_2-o f
2/4/2011

Type of Visit O'Gompliance Inspection 0 Operation Review 0 Structure Evaluation 0 'technical Assistance
Reason for Visit 0<outine 0 complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: j/D- / Arrival Time: /Q' Departure Time: l r� County: Region:
Farm Name: OM4�Z. �1%c�S� Owner Email:
Owner Name: A� d'V e z- LL�a,r�i-� Phone:
Mailing Address:
Physical Address:
Facility Contact: %�Y _ �ii�.f"��'t— Title: AV"z"yry` Phone No:
Onsite Representative: '� _ Integrator:%%kT�r�w�'�
Certified Operator: All _G(�QrrF►•-� Operator Certification Number: A. zot�
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o Longitude: = ° u
��Design , Current
. _. �Capacety Population
Desrg Current -'
Wet; Poultry _Capacityw Popul hon
Design Gucrent
Cattle Capacity Population
❑ can to Finish
❑ La er
❑Dai Caw
® Wean to Feeder
❑Non -La er
❑Dai If
❑ Feeder to Finish
a. Was the conveyance man-made?
airyHeifer
❑ Farrow to Wean
DrylPoultry -
❑ Dry Cow
❑ Farrow to Feeder
`"'g " ' "' --
El Non
El Farrow Farrow to Finish
❑ La
-Dairy
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
... _
Other
Turkeys
E]Turkey Pouits
❑ NE
ti
❑ Other❑
Oth er
Number of Structures:
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
RNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b" Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�&No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
g.No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

Facility Number: — Date of Inspection
i
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ERNo ❑ 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): 3V
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ yes RNo [INA ❑NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes RNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes RNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[5�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
UZNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
0 N
❑ NA EINE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop ��iru
type(s) %r 1; .� ,.,�.- A . A7r
13. Soil type(s) /N)c
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
E9 No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
[RNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
® No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
® No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
RNo
❑ NA ❑ NE
Reviewer/Inspector Name Phone: gjo -413333W
Reviewer/Inspector Signature:Date: _/
Page 2 of I 1&-76/u4 t,onnnuea

Facility Number: Date of Inspection
Required Records & Documents
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 04 -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 appropirate box. ❑ WUP ❑ Checklists
❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes [&No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ t20 Minute Inspections ❑ Monthly and V Dain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
&No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
RNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JRNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[RNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
KNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
9No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
&No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
5kNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
(4 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
29 No
❑ NA
❑ NE
Additional Caminents and/or Drawin s "' °�� 3 t
Page 3 of 3 12/28/04

I
Type of Visit &'Iff5impliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Q16utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ® Arrival Time: (7 Departure Time: ', l7� County: Region: LOLL
IV
Farm Name:nT� t_ Owner Email:
Owner Name: _<Gt+' e:2 _ fi- L(Phone:
Mailing Address:
Physical Address:
Facility Contact: :�]� �t'Y>~ "/a AI r- r•%- Title: Art r e- Phone No:
Onsite Representative: _ 5'ora.�_ Integrator: !s
Certified Operator: �s�-�- Operator Certification Number: g�ytl
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 ❑ l =1 W Longitude: = ° ❑ I ❑ u
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
C&No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
DesignCurrent
Design Current
Design Current
Swine
Capacity Population
Wet Poultry
Capacity Population
Cattle Capacity Population
❑ Wean to Finish
10 Layer
❑ No
❑ Dai Cow
92, can to Feeder o '�
❑ Non -La er
❑ Dai Calf
❑ Feeder to Finish
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Dai Heifer
❑ D Cow
❑ Non -Dairy
El Beef Stocker
El Beef Feeder
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ NA
❑ Turke s
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State
Other
FE]
❑ Turkey Poults
❑ Other EEEJNumber
of Structures:1
❑ NE
other than from a discharge?
-1
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
C&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)?
-71
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
R No
❑ NA
❑ NE
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
J0 No
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

Facility Number: AVL— Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[9 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): %9
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ES No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
[RNo
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[SNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
allo
❑ 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
allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
10 No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
[ROutside of Acceptable CropWindow❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 54 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ® No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes D No ❑ NA ❑ NE
IJC. 1 4_" X(
r , pe11-6 C0�yJ W LjuP 40<,
L7v
_T�: 5 . ) j7X_1__
J9at�p( �l'ti— J -C ciu 1(.tli,t d [W6 y o K (j � rd 7—o .
Reviewer/inspector Name y, _ - _ Phone•
Reviewer/inspector Signature: _ Date: / (J—J 3 2,20'0
12/28/04 Continued

i Facility Number: — pate of Inspection Vb 41�
Rc aired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes V 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 appropirate box. ❑ WUP ❑ Checklists ❑ Design g ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
9 Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [21 No ❑ NA- ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes KNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,K No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
0,No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
RNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
NNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
R No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
'
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ERNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
KNo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
L9 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
KNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
I �- Q1 , ti �GtfG 5�1� % Ll �I� t�r� /T N �7�,j ✓liJ/N��i�.
eg
sl a"41"o 'moo
P,3-.5- G'/�� fvf.�,rl' �4 �fZyY PG's I`D t Op
jjTo
�l mcg=,G l�1 �►t 70 �. (� F 7
tA; A �c —`r� { D
1212&a4

0
Type of Visit Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up Q Referral O Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: 1 Departure Time: �Coun Region:
Farm Name: ren �� Nu /—.5 ff/"1 Owner Email:
Owner Name: __ GC/` E=/� if C-5 7�ci -e-' Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: _'Sro�f� _
Certified Operator: �STrv� tet/
Back-up Operator:
Phone No:
Integrator:, _
Operator Certification Number: Z CMMO _
Back-up Certification Number:
Location of Farm: Latitude: =u =' =„ Longitude: 00 =, = "
Swine
Design
3a Re
Current
Population
Design Current
Wet Poultry Capacity Prop iation
❑ Layer
Design Current
Cattle Capacity Population
❑ Dai Cow
❑ Non -Layer
❑ Dai Calf
❑ Dai Heifer
Dry Poultry : a,
❑ D Cow
❑ Non -Dai ry
❑ Layers
❑ Beef Stocker
❑ Non -La ers
❑Beef Feeder
Na
❑ Pullets
❑ Beef Brood Co
other than from a discharge?
_-
❑Turke s
Other _
❑ Other
12/28/04
Continued
❑ TurkeyPoults
❑Other
Number of Structures:
❑ Wean to Finish
Wean to Feeder (� [�
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation? El Yes &No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑Application Field El Other
a. Was the conveyance man-made? El Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) El 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) El Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [I Yes QNo ❑ NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State El Yes JX
Na
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

' Facility Number: — Date of Inspection
f No
❑ NA
❑ NE
Waste Collection & Treatment
Z1 No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes 5LNo
❑ 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 [RNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
[-]Yes 9No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes ® No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes 21 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 J4 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes t,No
❑ NA
❑ NE
maintenance/improvement?
1 I . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E4'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Area
12. Crop tyPe(s)
13. Soil type(s) Q
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes RNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
f No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
Z1 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
RNo
❑ NA
❑ NE
i.rb
.f);.P, -•Y ,.YFommentfer toy' uesttoW# Ex lain an YE5 answeis and/or an recommendateons or aUse drawigsof facility to better�explarn sttuateons {use a dditeonal,pageslasrnecessary):
- Y.=xx,
C" h
(if V ,Pv
Reviewer/Inspector Name~ -U-[:—' �-- Phone: a P33�1/�
Reviewer/Inspector Signature: Date:
Page 2 of 3 12/2$/04 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes C5No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21, Does record keeping need improvement? If yes, check the appropriate box below. J.Yes ❑ No ❑ NA ❑ NE
® Waste Application ❑ Weekly Freeboard &Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23_
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[3No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
54 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
KNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
EjNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
allo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
allo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
E4No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
R No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
R No
❑ NA
❑ NE
Page 3 of 3 12128/04

Division of Water Quality Sy v
` Facility Number j Q Division of Soil and Water Conservation 07
O Other Agency
Type of VisitCornpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit kr Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: (7—/ Arrival Time: � O O
,Departure'rime: ® County Region: L—(
Farm Name: _ i ,:r Z ur PY _ Owner Email:
Owner Name: !�z Pee eL t� S *� Je[!�!i%!�K Phone: O—
Mailing Address:
Physical Address:
Facility Contact: Kae'Gwq- !�%1 i +•L _ Title: Phone
No:
Onsite Representative: Integrator: Z&a<,d1
Certified Operator: i! Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
,Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: 0 0 =4
= Longitude: =o=, =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
rC DO ❑ Non -Layer
Dry Poultry
Non -L
Pullets
LJ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes VqNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
Dd No
❑ NA
❑ NE
❑ Yes
J4 No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: VE— Date of Inspection `d
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural frceboard?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Z &&—i- G
Spillway?:
13. Soil type(s) _JOA T
Designed Freeboard (in):
Observed Freeboard (in):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
5Q No
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
j$j No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
No
❑ NA ❑ NE
through a waste management or closure plan?
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
KNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[a No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
18. Is there a lack of properly operating waste application equipment?
❑ Yes
9. Does any part of the waste management system other than the waste structures require ❑ Yes
9 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
0 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
g[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 ❑ E=vidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) A16Lhf,62f
Z &&—i- G
r
13. Soil type(s) _JOA T
_--
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
5Q No
❑ NA
❑ NE
Date:
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
KNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[ANo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
CR No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
PO -No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Per* uJ,�er-S Ile wats bya ki-^_
r
Reviewer/Inspector Name C5)re— 4'
Phone:
Reviewer/Inspector Signature:
Date:
12/28/04 Continued

w Facility Number:Date of Inspection ® %
Required_ Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP ready available? If yes, check []Yes R)No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes g No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes P! No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes R No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
9 N
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
14 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
JXNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
C4 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
§0 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
�9 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
5dNo
❑ NA
❑ NE
Comments and/or Drawings:
12/28/04

Type of Visit 6'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: `®` Arrival Time: Departure Time: County: Region:%
Farm Name: _ ��- 2 V jS L-✓, X Owner Email:
Owner Name: as r e^_ d-StGv-c m i Phone:
Mailing Address:
Physical Address:
Facility Contact: lcaeer,- Title:
,CA ✓ rr`
Onsite Representative: f
Certified Operator: sirr/�
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =0
=' [=" Longitude: = ° =' =
I)esigti' Cnrren#
Swine ap C#y Population
Design Current
Wet Poultry C►opacity Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
2LNo
Wean to Feeder
1on-Layer
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
❑ Dairy Calf
❑ Feeder to Finish
Dair Heifer
❑ Farrow to WeanD
® No
x '`
r '�
[y Pouttry �
❑ D Cow
❑ Farrow to Feeder
❑ Yes
KNo
❑ Non -Dairy
❑ Farrow to Finish
c. What is the estimated volume that reached waters of the State (gallons)?
❑ La ers
El Beef Stocker
❑ Gilts
❑Non -Layers
❑Beef Feeder
❑ Boars
❑ NA
El Pullets
❑ Beef Brood Co
❑ Yes
C.No
❑ Turkeys
❑ NE
Other r ''
BU
❑ Turkey Poults
RNo
❑ Other
❑ NE
❑ Other
Number of Structures: �]
Page 1 of 3
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
2LNo
❑ 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
KNo
❑ NA
EINE
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
g[No
❑ NA
EINE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
C.No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
RNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/2$/04
Continued

Facility Number: _.g Date of Inspection ®b
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure l Structure 2 Structure 3 Structure 4
❑ Yes RNo ❑ NA FINE
❑ Yes RNo [INA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes JKNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes RNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes KNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ® No ❑ 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 W No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
mai ntenance/improvement?
11- Is there evidence of incorrect 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 101bs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s) ,A1,9A
Reviewer/Inspector Name ', TCp a,.t_ Phone: 3 00
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�SNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
XNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
K No
❑ NA
❑ NE
17,
Does the facility lack adequate acreage for land application?
❑ Yes
KNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
B No
❑ NA
❑ NE
Comments (refer to question #)- Explain any(ES answers and/or any recommendations or any other comments :..
Use drawings of facility to better explain situations (use'additional pages as necessary) .
k d-` ' e. UL)W �C .
Reviewer/Inspector Name ', TCp a,.t_ Phone: 3 00
Reviewer/Inspector Signature: Date: — 40
Page 2 of 3 12/28/04 Continued

Facility Number: — Date of Inspection G�
Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [&No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JRNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
RSNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
JR No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JR1 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
R No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
H No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
�.No
El NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
24 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
J,No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12/28/04
Page 3 of 3 12/28/04

n
Type of Visit 0 Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit . 0 Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: l �J Arrival Time: : 30 Departure Time: County: , Sa.�s[� Region: �%
Farm Name: A Alwrsex Owner Email:
IF
Owner Name: K _ Wa.-�.Phone:
Mailing Address: /70e,
Physical Address:
Facility Contact: %farPn 414,,e, I Title:
Phone No:
Onsite Representative: &&y -e4 Warren Integrator:/hvr�li��S
Certified Operator: A66!i4 ? Operator Certification Number:_ 119 Rgo
Back-up Operator: %arras 6da/Y'C/1 Back-up Certification Number: 16 17
Location of Farm: Latitude: ❑ e = =46 Longitude: =0=1
Swine
Wean to Finish
'Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
�G�1(tor, I I ❑Non -La et T==J
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turk e s
❑ urkey Poults
❑ Other I P=�
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity. Population
❑
Dairy Cow
❑ Dairy Calf
❑❑ Dairy HeifedCow El Dry Cow
Non -Dairy
❑ Beef Stock
❑ Beef Feede
❑ Beef Brood
i
Number of Structures:
b. Did the discharge reach waters of the State'? (I f yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes E5<0 ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
R,--,<�o
❑ NA
❑ NE
[:1 Yes
[j " o
❑ NA
❑ NE
12/28/04 Continued

Facility Number: da —� S
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3
Identifier: _ 1
Spillway?: /10
Designed Freeboard (in):
Observed Freeboard (in): .910,
Structure 4
❑ Yes ❑4o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[Ilo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
Yes
❑ No
❑ NA
B<E
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
LSI No
❑ NA
EINE
through a waste management or closure plan?
❑ Yes
Ll!l>vo
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
91Qo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
ENo
❑ 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
�,�
I� No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [2t<o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
fov Po 1121
12. Crop type(s) vc� v (rr er
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes RNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
ET14E
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ;p
Yes
❑ No
❑ NA
B<E
17. Does the facility lack adequate acreage for land application?
❑ Yes
SZ
QPK6
❑ NA
lfJ•1gE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ll!l>vo
❑ NA
❑ NE
Reviewer/Inspector Name �%�aa�{ �, �� Phone: `'/Q- �Qd -/c-4/ &.1 %?o
Reviewer/Inspector Signature:
Date:
12/28/04 Continued

Facility Number: Date of Inspection g I -
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes EW. ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑-l*T- ❑ NA
❑ NE
the appropirate box. ❑ WUF- ❑ Ch ists ❑ Qm<gn'❑ Mq� lamer
QNt
Other Issues
7 d rECprd lClee,4vor^W Cr�,G� /�Gc �11�a��
/ tco�S, /0/ l�c""7
iFOrM
28.
21. Does record keeping need improvement? If yes, check the appropriate bx bel &4,
Y-�b �. Y V 7 3
�i
❑ No ❑ NA
❑ NE
aste Application ❑eel�+ee�eatd' El Waste Analysis ❑ ❑
mSte�rartsfers
❑
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
M'Ka'infall ❑Steen 9<rop Yield E -TO' Minute Inspections [mthly and 1"
Rain Inspections ©gather
Code
22_ Did the facility fail to install and maintain a rain gauge?
❑ Yes
E o ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No ❑ NA
❑Nt
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
9-iq0 ❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
L?fNo ❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑'< ❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
QNt
Other Issues
7 d rECprd lClee,4vor^W Cr�,G� /�Gc �11�a��
/ tco�S, /0/ l�c""7
iFOrM
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
,�,/
L� No
❑ NA
❑ NE
29_
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
3No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
�j
i
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
0<o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
PNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
,9No
LTJ No
❑ NA
❑ NE
A'cldtttonal Couin�i>nts and/or Drawings
n._
f, P-0-1ke r Lias
��¢.. {�¢�;n9 1��ee �oaro�
le w%„ n/ei se I.3-, 4, syn/na+��cf
f-1
7 d rECprd lClee,4vor^W Cr�,G� /�Gc �11�a��
/ tco�S, /0/ l�c""7
iFOrM
for a/�
{
/.70'901e
0 rr, C11 Elie f�tr,hdarc� G1ja>^�'
�j
i
12/28/04

�1�
Type of Visit ® Compliance Inspection O Operation Review O lagoon Evaluation
Reason for Visit *Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: �'/'7 oy Time:
Facility Number � �
0 Not erational O Below Threshold
®Wer•mitted Enertified [3 Conditionally Certified © Registered Date Last Operated or Above Threshold: .....� ... .
Farm Name: M"',Z County: ie.SOxr..._................ .... .. /�/lO.....,
Owner Name: _ �8trx2..... 5...........L✓�t t ~�Cn _ .... Plbone No:
Availing Address:... !. .._ MIS ?�2.....� _. !Psi 6�Pl .-.-.-�!�
IlQre r S le
Facility Contact: ...... 16l[x,-....... Title PhoneNo: J qD: L L,7_� ........
Onsite Representative: ........ K�!'.rG,ri -- – WiEttlf~�J................... .......... Integrator: _, / iv-4aX ------ ------ ,------ ------
Certified Operator:._...._._.AeAr e. 3. Operator Certification Number: _ &'�
Location of Farm:
GKwine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• ��« Longitude �• ��"
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation? [:]Yes 94401
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other /
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑40
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ......... _.1 ...... _.. _. _... _.
Freeboard (inches): 1-a
❑ Yes
❑ Yes
o
❑ Yeso
❑ Yes
❑'1 F�a
❑ Yes To
Structure 6
12/12103 Continued

Facility Number: 5.2 — 7SQ Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes 214
seepage, etc.) f
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or ❑ Yes [1No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ) � �
7. Do any of the structures need maintenance/improvement? ❑ Yes LHNo
S. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 911'o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes [moo
elevation markings?
Waste Application
10. Are there any buffers that need maintenancefimprovement? ❑ Yes 40
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes 2N0
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type t 4ass 0""A.4 -eel, .,!
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 211o' -,el-x
14. a) Does the facility lack adequate acreage for land application? ❑ Yes EH<o
b) Does the facility need a wettable acre determination? ❑ Yes UNo
c) This facility is pended for a wettable acre determination? ❑ Yes [wo
15. Does the receiving crop need improvement? ©-les ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes 91 -Ko
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below [] Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes U -No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes two
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes D -N6_
Air Quality representative immediately.
Cvts {iefer to questeon:#) Edam nay YF� answers and/or any ireoommeadatzoas or any oticr comments.- P,=�
:U drawtags of €a�tty tv better explain sttuanosts. {nge'av�I pages as aec`essary) ®field Copy Final Notes
m
GA
Ts P la n TO c h wu t' lye 1Ca.��
�j ong s C �+M �PSLve cre`r �.i 44 dd
,
Ae L'oe, �, k/ae�1;�9 wf f� fan actflP�, �v IGw�fle pir", �V rnclvc%
S O h1 71 f!` ! �� ,,T er Ar1r� va �S a ry� Vken T
Reviewer/Inspector Namedr
'-o
Reviewer/Inspector Signature: Date: 7
12112/03 Continued

Facility Number: 8 —� Date of Inspection /7 G
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel}'�stS�asigfi,s etc.) ❑ Yes 92'11'o"
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q.No
❑ err ❑ -❑ Waste 8 —
zf-/k-A5 a -.�v -).7.
24. Is facility not in compliance with any Applicable setback criteria in effect at the time of design? ❑ Yes 0 -No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes E3-90
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application) ❑ Yes ❑ 0
27. Did Reviewerl nspector fail to discuss reviewlinspection with on-site representative? ❑ Yes ®WO,
28. Does facility require a follow-up visit by same agency? ❑ Yes
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 3I-35) ❑ Yes 94TC
31- If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
Q No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
dditi6ttal Comments and/or Drawrngs A � "
Has Plons Ido mets tire,dl /cyan.
12112103

Site Requires Immediate Attention:
Facility No. 02 - z f
DIVISION OF ENVMONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE. S ` / , 1995
Time: I=ob /•'13
M ns -r z 9/r
Farm Name/Owner:A4RFV Ir? iNT7- ,AJVksE2lr
Mailing Address: Z30X .3-//-- ps�e3�Ra A��. X38 z=
County: >Fi- p sn rJ
Integrator: (11 LMP4y, _ ' Phone: O -z1/I
On Site Representative: ¢p /%' /� 1,64' e&AJ lgJ�A✓ Phone; 91 D
Physical Address/Location: d s S 1 a is r bee -
Alamo r* 0-4 _ #,, y 411 _
Type of Operation: Swine Poultry battle
Design Capacity:2�vA0 dAs;v Number of Animals on Site: - -SSD
DEINI Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ,� Longitude: ,
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately l Foot + 7 inches) dis or No Actual Freeboard: _ ' Zit. Inches
Was any seepage observed from the lagoon(s)? Yes o No Was any erosion observed? Yes oqo
Is adequate land available for spray? (v7e�or No is the cover crop adequate? es or No
Crop(s) being utilized:
/ -t E 7-42�") or -4
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings es or No
100 Feet from Wells? Fs pr No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or6�)
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? YesNo If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes
Additional Comments_ / ldfA9A) =� z /f c
Inspector Nante
cc: Facility Assessment Unit
Signature
Use Attachments if Needed.