820262_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual
2 V

r�
(Type of Visit: EDF -Compliance inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral O Emergency 0 Other O Denied Access
Date of Visit:
Arrival Time:; pc7
Departure Time:
County: ,7,2gsB�
`—
�`
Region:
Farm Name: ,.y�� d K
TGt �'ri p2
rf� Owner Email:
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Owner Name: "2� • Phone:
Mailing Address:
Physical Address:
Facility Contact: 12Title: Phone:
Onsite Representative: Integrator: sm i
Certified Operator: Certification Number:.�t5
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
[] No
0 Yes
Q No
❑ Yes
to
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Caparity Pop.
Wean to Finish
La er
Cow
Wean to Feeder
Non -La er
—.Dairy
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
P,ault ,
Ga ad
P,o ,
Non -Dairy
Farrow to Finish
Layers
I I
113eef Stocker
Gilts
Non -Layers
113eef Feeder
Boars
Pullets
113eef Brood Cow
Turkeys
Uther
Turkey Poults
Other
LJ2Lher
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?
Page 1 of 3
❑ Yes ENo ❑ NA ❑ NE
❑ Yes [—]No
❑ Yes ❑ No
❑ Yes
[] No
0 Yes
Q No
❑ Yes
to
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA [] NE
❑ NA ❑ NE
21412015 Continued

Facility Number: _ I jDate of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ff-go ❑ 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 �o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes [jNo ❑ 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 [r]`TVo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E] -No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes B ]l�o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [ o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window' ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): s l/J7 /�y �dSrrd
13. Soil Type(s):/`i1Yi
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes B -go ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes �o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes 0`No ❑ NA ❑ NE
acres determination?
l7. Does the facility lack adequate acreage for land application?
❑ Yes
Callo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
[D--N"b
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[D -No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[3 -No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists []Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[J`T; o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[]'No
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
10
❑ NA
❑ NE
Page 2 of 3
2/412015 Continued

e
Facili Number: � _ Date of Inspection: — /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Ergo
o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Ej-'No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a AOA 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 El 1"°
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes r7l�O
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately -
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
0 N ❑NE
❑ NA ❑ NE
❑NA ❑NE
0 Yes ED -14o ❑ NA ❑ NE
❑ Yes [D" Mo ❑ NA ❑ NE
❑ Yes [3'fio [] NA ❑ NE
❑ Yes [no ❑ NA ❑ NE
❑ Yes ErNo
❑ Yes ZNo
[:]Yes D%o
DNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Commentsrefer�to oe""st<on #}:. Explain. any YES answers and/or any additional recommendations or any other commeutsi
( 4
drawau
ings of faBE to tieLter exp lain situatio s use,additianal a es as necessary).
g 1]'�� ( P 2
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: ` v--3 0-3
Date:
2/4/2015

Type of Visit: eMomplia ce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral_ 0 Emergency 0 Other 0 Denied Access
Date oI Arrival Time: JS Departure Time: �D� County: Region:
Farm Name: cervi IQ 1 Z,2 Owner Email:
Owner Name: C . Phone:
Mailing Address:
Physical Address:
Facility Contact: L{J elf Title: QLU4 Phone:
Onsite Representative: Integrator:
Certified Operator: �j� Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (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 MNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
[] Yes 3 No
[:]Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/2015 Continued
Design Current+
Design
Current
Design Current
Swine
CapacityaPop
Wet Poultry
Capacity
Pdp:
C►attle Capacity Pap.
Wean to Finish
[Layer
airy Cow
Wean to Feeder n
Non -La er I
ai Calf
I
Design
" _
Cprrent,.
Dai Heifer
Dry Cow
Feeder to Finish
Farrow to Wean
Farrow to Feeder
,.
D . P,oult .
Ca aci
P,o .
Non -Dairy
Farrow to Finish
r
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turke s
Beef Brood Cow
* "��
3
Other`,
kT *
TurkeyPoints
Other
Others
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (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 MNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
[] Yes 3 No
[:]Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/2015 Continued

' Facility Number: jDate of Inspection7
—/
J,No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
allo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�No
❑ NA
Spillway?:
❑ Rainfall ❑ Stocking [-I Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
Designed Freeboard (in):
j,No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Observed Freeboard (in):
[3 -No
❑ NA
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0,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
E![No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
0 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
[a No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
allo
❑ NA
❑ NE
maintenance or improvement?
I 1. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Jallo ❑ 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): �/ 0 U--
13. Soil Type(s): A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
J,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
JR No
❑ NA
0 NE
acres determination?
❑Other:
17. Does the facility lack adequate acreage for land application?
❑ Yes
P 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
[ a 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.
JR Yes
o�
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard a Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking [-I Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
j,No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[3 -No
❑ NA
❑ NE
Page 2 of 3 2/412015 Continued

+ Facility Number: - Date of Inspection: 7r 12
` 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes P!�No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 0 Yes Jallo
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 M No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes MNo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ Yes [&No ❑ NA ❑ NE
❑ Yes [ZI-No ❑ NA ❑ NE
❑ Yes 5INo ❑ NA ❑ NE
❑ Yes fEj No 0 NA ❑ NE
❑ Yes ,� No
❑ Yes rk No
❑ Yes gNo
DNA ❑NE
❑NA ❑NE
❑ NA ❑ NE
ralrj,7 /�� "/ -r- V .74A 110 e-ve 9t__ 'Xi'D T-? a v "?-W ld�x
PJ �
� %ii'� u/: l� pC /..S.S�I r� Q /�G'r ' C i✓
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone:
Date:
2/4/2015

ivision f Water Resources
Facility Number ®- ��- O Division of Sail and Water Conservation
Q Other Agency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 01Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ® Arrival Time:,'O c7 Departure Time: /3 d County: jAtoffg—Region:(
Farm Name: A&/ya c -L r �Q/rtt� d"3 Owner Email:
Owner Name: T Farms Phone:
Mailing Address:
Physical Address:
Facility Contact: VQ� Title: Awn r/" Phone:
Onsite Representative: Integrator:
Certified Operator: J��.•— Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design
Current
❑ Yes
Design
Current
Design Current
Swine Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder]
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D . P,oult .
Ca ac't
Pia
Non -Dai
Farrow to Finish
Layers
I
Beef Stocker
Gilts
Non -Layers
Beef Feeder
I
Boars
Pullets
Beef Brood Cow
Turkeys
Outer
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 10 No ❑ NA ❑ NE
❑ Yes ❑ No
[::]Yes ❑No
❑ Yes
❑ No
❑ Yes
JRL No
Ej Yes
® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: _ b ;Z— Date of Inspection: 7,,77—/1,
❑ Yes
'No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
5 No
❑ NA
❑ NE
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
❑ NA
Identifier:
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
Spillway?:
Re aired Records & Documents
Designed Freeboard (in):
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
C9 No
❑ NA
Observed Freeboard (in):
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
0 No
❑ NA
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
E3,No
[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 DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
E23 -No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Uallo
❑ 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
Callo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): ff-j,-r V VI j j lr_-
14. Do the receiving crops differ frbm those designated in the CAWMP?
❑ Yes
'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
5 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
9No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
CaNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
Re aired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
C9 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
0 No
❑ NA
❑ NE
the appropriate box.
❑ WUP El Checklists [—]Design ❑Maps [—]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E&No
23, if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ;Z -No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ONE
❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

'[Facility Number: jDate of Inspection: -- 6;
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M No
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a 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 C&No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [S No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[-]Yes No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes [allo
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes ®.No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes C.No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes L! No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
DNA C] NE
❑NA ❑NE
❑ NA ❑ NE
[] NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question#) #Eaplaxn any .YES answers. and/orany additional recon mendations or any o.tMrIinments.,
Uses drawings, of. faeilrty I explau situations (useadd�tronal pales :as necessary,) -
Wi'/ �d'—' J I-V cy.0 �I�tic r`5 �-�'
O
7x_ -4-Y W-.fJ�r Ag41—1,/f;. 60
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: Z�D"/�.3.j-3.3&O
Date: 2 27— ZaA
2/4/2015

type of Visit: ompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
treason for Visit: outine O Complaint C) Follow-up O Referral Q Emergency O Other 0 Denied Access
Date of Visit: 1) Arrival Time: ' Q Departure Time: ! County:L d*-- Region: y (�
Farm Name _ lir ,,,r F -e r rrn f I
Owner Name: ; w F6te t"J
Mailing Address:
Owner Email:
Phone:
Physical Address:
Facility Contact: Da -y G A2e Il s Title:—/9TI}h �/" Phone:
Onsite Representative: S�c.L1 Integrator: /77 T'
Certified Operator: Certification Number: 4�AQQL�
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?
❑ Yes C5No ❑ NA ❑ NE
[—]Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
Design Current
Design
Current
Design Current
Swine
Capacity Pap. Wet Poultry
CF p city
Pap.
Cattle Capacity Pop.
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
Wean to FinishLa
er
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
airy Cow
. �No
Wean to Feeder
ADDI jNon-Layer
I
[] Yes
[Z�No
a" Calf
❑ NE
Feeder to Finish
''
Dairy Heifer
Farrow to Wean
4:�
Design
Current
Cow
Farrow to Feeder
Dr P,.ot
Ca` aci
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
_
Turkeys
t .g
he
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?
❑ Yes C5No ❑ NA ❑ NE
[—]Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[:]Yes
❑No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
. �No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
[Z�No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/412014 Continued

Facili Number: _ Date of Inspection: (-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [!�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): T_
Observed Freeboard (in): ;2 7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EJ ' o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
DEf-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
ONo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
03 --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
't"' No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
C&No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes
0 -No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload 0 Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence ofWind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): ! r -r",3 -c-/
13. Soil Type(s): r U %
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
Callo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[�J_No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Ef No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
E2No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E3 -No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
(a No
❑ NA
❑ NE
the appropriate box_
❑WUP ❑Checklists E] Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes r -No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes fo No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 25 -No ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

a
Facility Number: - �— Date of Inspection: ZEI75
—
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o
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 RNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [a No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
JS -No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes
N�No
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[ff.No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
UNo
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[!� No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
S No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
[:INA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
0 N ❑NE
DNA ❑NE
❑NA ❑NE
Reviewer/Inspector Name:
Reviewer/]nspector Signature:
Page 3 of 3
Phone:
Date: ly )
2/412011

Type of Visit: O'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 0 Denied Access
Date of Visit: Arrival Time: ! o Departure Time: 3,'o a County:..�stp�
Farm Name: %7 Civ i f1 /' i rc 5 1. r 2 4-,3 Owner Email: '� T
Owner Name: J=fotjrrrt 4 _-F_7,n G. Phone:
Mailing Address:
Physical Address:
Facility Contact: ZD,2t.ar Title: Phone:
Onsite Representative:f'p�� Integrator:
Region:
Certified Operator: 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)?
❑ Yes JER-No [:]NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes F] No ❑NA ❑NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes C�_No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes 5�g_No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued
DesignCurrent
DesEgn Current _ Design Current
Swine
CapacItyPop.
Wet Poultry
C pactyPop,
Cattle Capacity Pop.
Wean to Finish
I
I Layer
Dairy Cow
Wean to Feeder
dq
iNon-Layer
I I
Dairy Calf
Feeder to Finish
_ �= a
Dairy Heifer
Farrow to
gn' Current,
D Cow
Farrow to Feeder
D , 1',oul
.,.
,Cae atce .y l?o `..: . -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
* u.
Turkeys
-
Other
Turkey Poults
Other
Other
904
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c_ What is the estimated volume that reached waters of the State (gallons)?
❑ Yes JER-No [:]NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes F] No ❑NA ❑NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes C�_No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes 5�g_No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

Facili Number: -Date of Inspection: r/ — /'�b7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[-]Yes
0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?;
Designed Freeboard (in): ` / g0 Pit
Observed Freeboard (in): -- �L( ,3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
I 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
C.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
Callo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ja No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes C.No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 3*-"U/v b7norr-�e�.Jf
13. Soil Types):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes fZ[ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes � No ❑ NA F-1NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E, 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 S No ❑ NA ❑ NE
❑ Yes B No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes O..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 p Weekly Freeboard CElWaste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes n No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [S -No
DNA ❑NE
❑ Weather Code
❑ Sludge Survey
[DNA ❑NE
❑ NA ❑ NE
Page 2 of 3 2/412011 Continued

[Facility Number: _ Date of Inspection: /" /
■
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes PSNo
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 Jallo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[a No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
J, No
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
2!�No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[&No
❑ Application Field ❑ Lagoon/Storage Pond p Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[nNo
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
r'--' No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
gLNo
❑ NA ❑ NE
0 N ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
0 NA ❑ NE
0 NA ❑ NE
[DNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA 0 NE
❑ NA ❑ NE
Comments (refer to gdestion #) ,Explain any YES answers and/or any additional recommendations or any other Cotnments. - +
U 'drawings of facilty:to, betterexplain situations (use additional pages as necessary).
zz_ e V I,, e _-J-
Reviewer/Inspector Name:
ReviewerAnspector Signature:
Page 3 of 3
Phone: �J6_
Date:
214/2011

I M 004
Division of Water Q�fS' B�'L�►
Facility Number a - ® ®Divisio%fSUil15­nd1W__ORthConservation
er
type of visit: Q$Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Zeason for Visit: 15Moutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 3;8 Departure Time: Kao County: SA psp�
Farm Name_ M Ian T F&- m -rtr— Owner Email:
rT
Owner Name: &Vy l r hQ�,"5 jky-_ Phone:
Mailing Address:
Physical Address: Jy1 F dear B Well Lh Tc,✓�.pv
Facility Contact: ba" Wei is Title: �n
Phone:
Onsite Representative: DAYe,YVP—ljf Integrator: M-1
Certified Operator: 12POCle— D Wel Certification Number: a
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Region: FAD
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
•
Design CurrentY
k R
�gn
•
Cu nt
Design C•nrrent
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Swine
Capacity Pop.
DAIM
Wet Poultry{* Ca achy
p
Po
P
F
Cattle Capacity Pop.
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
Wean to Finish
c. What is the estimated volume that reached waters of the State (gallons)?
Layer
Dai Cow
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
Wean to Feeder ® Non -Layer
Feeder to Finish " "" ''_
Dai Calf
Dai Heifer
❑ NA
❑ NE
Farrow to Wean
Farrow to Feeder
[] Yes
Design
D iPoult Caaei
Current
P -.o .
D Cow
Non -Dairy
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
Q No
Farrow to Finish
❑ NE
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Outer
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[-]Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[] Yes
R] No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
Q No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 214/2011 Continued

Facility Number. _ a6 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E:q 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
® No
Identifier:
❑ NE
Spillway?:
CR No
Designed Freeboard (in): 1— �^ � q�,l _
❑ NE
Observed Freeboard (in): '33 HJT
E] No
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes CR No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
U No
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes f' 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 1�2 No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes fo 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
E] NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes f,;j No [DNA
❑ NE
maintenance or improvement?
I I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes CR 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): Caxidal / ' S m'.i
13. Soil Type(s):_A*Vvillp
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes R No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design [-]maps ❑ Lease Agreements
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
CR No
❑ NA
❑ NE
C] Yes
E] No
❑ NA
❑ NE
❑ Yes
U No
❑ NA
❑ NE
[]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard gWaste 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? ❑ Yeso E] NA E] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® o NA ❑ NE
Page 2 of 3 21412011 Continued

• Facifi Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [R No [DNA ❑ 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 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?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
❑ Yes
1,�RrNo
❑ NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
ER No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes U No ❑ NA ❑ NE
❑ Yes [2 No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? [:]Yes E] No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [—]Yes 15ZNo ❑ 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).
Way, somfli I ore, ©otyp%L -(br 6o dap �6t� aik cher SA, pOn ty 07e_
VVoks j le_ w a r-5vAd . -Por x013 , w n LIM&M 6`f rar e �IJ �ir�9
;s series of a W(e- e nefldeA I , if no mdfe. Www-saweb grf_�4d &)
PALS, gear.g4a v�a�e s0,h_ pre ysorm.-fbr rem+sera, e_veni,
eo&,L records excq7f- armaboue, CNoo-ao19- Pc -00)43
-� orrorf �
Not a, -Pam due, +Q hole s ver ��In C�twi°d by � r WV_Q
f (�J i -6y cais�NvttJ
a5�s���9e° sc�rY� hvas� j�
d �e_"4 ar nod ea rv�:u
Wa+ Pla) wits- mod l Pek i011dLc1e_gw l� &I Ae -Oed-,yon[ 1P64 !
C AJJII 61QI �0�ej abov n Of 0) � ted vcfr rorl),
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9w
Date: a 1
214/2011

• Facility No.'3a:VeAFarm Name NX'M.l_ Date
Permit ✓� COC c - I OIC ✓ NPDES (Rainbreaker PLAT
FB props
i
Annual Cert Daily Pipe)
..�.- res irr.,■,� ityr ns�:
tw N
E���►�,� ��1.:■�r■�1.�-:ter ■�
Lagoon Name, S forspillway 1 2 3 4 5 6 1 7
Design Freeboard 1 Last Recorded in
Observed freeboard
Sludge Survey Date 9013
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA?
Calibration Date
Aing -
3ID
Soil Test Date D_ l� asDoreaml3 - to � 3 Crop Yield `� Transfer Sheets
pH Fields Wettable Acres ✓ RAIN GAUGE
Lime Needed Old WUP Dead box or incinerator
Lime Applied Weekly Freeboard Mortality Records
Cu -1 ✓ Zn -1 / 614L 1 in Inspections ✓ Check Lists
Needs S (S -I<25)120 min Insp. ^ ✓ Storm Water
Needs P 8�`tii7 K �� WPathPr rndp-.
Pull/Field Soil Crop Acres PAN Window Max Rate Max Amt
—S I
All
v of
Verify PHONE NUMBERS and affiliations
Date last WUP FRO 143/Ll, FRO or Farm Records
Date last WUP at farm Lagoon # 1 150no ��'3K1a1�3
App. Hardware Top Dike qL $� 3
Stop Pump
Start Pump
-� 0-7
Conversion- Cu -I 3000= 108 Ib/ac; Zn -I 3000= 213 lblac

i ype or visa. uy %_ompnance inspecnon V uperanon Kevtew V nitructure Evatuanon V t ecnntcal Assistance
Reason for Visit: ®'Routine O Complaint O Follow-up O Referral Q Emergency O Other 0 Denied Access
Date of Visit: Arrival Timer Departure Time: County:jrylrjf �r
Farm Name: t/I/) �, Roms ylw_ — 13 Owner Email:
Owner Name: P' &VIll Phone:
Mailing Address:
Physical Address: 6 f fGntY 13, JrRj 0 tatp IV
Facility Contact: Da ✓ 4d 1w 1k Title: © wn-& - Phone:
Region: FA
Onsite Representative: �JkuP _ 642j � Integrator: HI -13
Certified Operator: 6e(y, i A yyeli( - Certification Number: DQQ$
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 ❑ NA ❑ NE
❑ Yes ❑ No [] NA ❑ NE
[:]Yes ❑No
❑ Yes ® No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/412011 Continued
NIEL
'.Current
= - Design Current
Swine
Capacity Pop.
WefPoultry-Y
Capc Pop.
Cattle '- Capacity Pop.
Wean to Finish
La er
Da Cow
Wean to Feeder
Q
on -Layer
Da Calf
Feeder to Finish
Da Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder.
D , P,oult ,
Ca aci Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
jPullets
111eef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 ❑ NA ❑ NE
❑ Yes ❑ No [] NA ❑ NE
[:]Yes ❑No
❑ Yes ® No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/412011 Continued

Facili Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
acres determination?
Spillway?:
17. Does the facility lack adequate acreage for land application'?
[] Yes
[RNo
❑ NA
Designed Freeboard (in): �q Ig Ll5—
I & Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
Observed Freeboard (in): 3 H3� s157
Required Records & Documents
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Eig No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
Ca No
❑ NA
[] NE
waste management or closure plan?
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
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
CZ No
[] NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[3 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�j No
❑ NA
❑ NE
maintenance or improvement?
2/4/2011 Continued
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
C�`No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes CyNo ❑ 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 �" a�Njdence of Wind Drift 1- ❑ Application Outside of Approved Area
12. Crop Type(s): (26aj4 _�4yr �t�r I tll:v f� Small aal�l &UjP4_
13. Soil Type(s):
14. Do the receiving crops liffer from those designated in the CAWMP?
❑ Yes
U 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
U No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application'?
[] Yes
[RNo
❑ NA
❑ NE
I & Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ N
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
E4 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
t5j No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
&Ef'NA
❑ NE
Page 2 of 3
2/4/2011 Continued

Facil ity dumber: a` - a
Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes U No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes F%f No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey C1 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
[RNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
Eg-NA
❑ NE
Other Issues
❑ Yes
5 ' No
❑ NA
❑ NE
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[5] -No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
❑ Yes
® No
❑ NA
❑ NE
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
n No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
❑ Yes
(53'No
❑ NA
❑ NE
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
allo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
5 ' No
❑ NA
❑ NE
❑ Application Field D 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
(53'No
❑ NA
❑ NE
Comments (refer to question .) ,Explain:any YES answers andlor,;any additional recommendations or; any other ediii—m—
ILlse;drawings of:facility to better., explain.situations.4 additional uaQes as necessary):
Plene. Glu` -a 1Or�SDr 030-e Of I ay0on ha 16 -e-r iaVe;
a �remal•e_ f bkph,�,
a La 1 '1 .511f 0d d - L�c� teas' hoc. Q o o,� � S e�Ct�. Q ��i aa.l a
)q► U40(60 l ocakcuriat CC S pelyn -, aoa., wl mo d &I Omf -eo�y , 1 g(
�Li�f i?aaehavv gas e�la1 modfl 'eL loco ��xz1� or) ojpfi'eld. [-7com ret-�vir"-a
y, please CaII bra a,1d haves slwd s��ve d o-l� b hofy ow, : NJ, -esv ��,�
Ql�a v a Si � iQ cm a Cr
,e. have so �� l r iug,�( ��y yam,
u. Morea,ay �I�Z 4if ayfle�, �a fi. �� flares I
VV41 M6 hf V Ales. )'aW&7 an d y oa t re(a�dJ� pcq AOkW a hat, ,
C dh, noi&above n-ai fldllce CLIO,
Reviewer/Inspector Name: S Phone:910-g33 33001s5s ri
Reviewer/lnspector Signature: %Date:
Page 3 of 3 0 /4/2011

~ Facility No. '�LFarm Name �l ? Date )(0
Permit COC OIC NPDES (Rainbreaker PLAT Annual Cert Daily Pipe)
2
�&711 Eli
VIM
w�■r�
Lagoon Name, S forspillway 1 2 3 4 5 6 7
Design Freeboard 1 Last Recorded in
Observed freeboard
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA? TIE]
I I:Ud17r!qWAff1."dN1q- War
Calibration Date
Ring Size (in)
iAl�lR��©-L�ililf�3`����I•�
Soil Test Date ! v
Crop Yield ✓
Transfer Sheets
pH Fields
Wettable Acres
RAIN GAUGE
Lime Needed
WUP
Dead box or incinerator
Lime Applied
Weekly Freeboard
Mortality Records
Cu -I Zn -I Plfm'
1 in Inspections
Check Lists
Needs S (S-1<25)
120 min Insp.
Storm Water
Needs P
Weather Codes
Iffix-M��Piz
�������
Pull/Field Soil Crop Acres PAN Window Max Rate Max Amt
-fcu5 a �� Dr
Verify PHONE NUMBERS and affiliations
Date last WUP FRO �NttFRO or Farm Records
Date last WUP at farm(vi� Lagoon #
App. Hardware Top Dike
Stop Pump
Start Pump
Conversion- Cu -I 3000= 108 lb/ac; Zn -I 3000= 213 lb/ac

I
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
a�sa K
Date of Visit:.J Arrival Time: Departure Time: County: Region:
Farm Name: md(VIl -r rQ/lm 3
Owner Name: HofVt) Inc,
Mailing Address:
Physical Add ess:
Facility Contact:
v
Onsite Representative: 0jvi' wetu
Certified Operator: dry Vve l�
Owner Email:
Title: 01vi `er
Phone:
Phone:
Integrator:
Certification Number: 000
Sack-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
-• Design Current
`� �.-- -
Design
C+urrent
- Design Current
Swine C•aparity Pop..
Vet PoultrS
Capacity
Pop.
Cattle Capacity Pop.
Finish
Layer
Dai Cow
Feeder $'d
Non -La er
Dai Calf
o Finish
`" ` =_.
-
Dai Heifer
to Wean
FGi
Design
Current
D Cow
to Feeder
Dr �Poultr,V_.:_ -.
II Ca acity
Po
Non -Dairy
to Finish
Layers
Beef Stocker
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
U_ther
Turke 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?
❑ Yes H No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes E:]No [:]NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
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
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/2011 Continued

Facility Number: 1 'a. = Date of Ins ection:
❑ Yes
�' No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:-- a.AILL
18. is there a lack of properly operating waste application equipment?
❑ Yes
t'No
❑ NA
Spillway?:
Required Records & Documents
Designed Freeboard (in): 19 5 -
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
25 Yes
❑ No
❑ NA
Observed Freeboard (in): DQ_
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
f�;FNo
0 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?
tR Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
t' 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
12 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
CR No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes W No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, 7n, etc.)
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window E]Evidence of Wind Drift [3Application Outside of Approved Area
12. Crop Type(s): 16Eamyda iqzo a , {yeljfd — -
13. Soil Type(s): &% b I& I, I ),p _
14. Do the receiving crops differ from those designated in the CA WMP?
❑ 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
t'No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
25 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 E] Other:
21. Does record keeping need improvement? If yes. check the appropriate box below. ❑Yes NNo ❑ NA ❑ NE
El Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge'? ❑ Yes No ❑ NA El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ® NA ❑ NE
Page 2 of 3 2/4/2011 Confirmed

. Facility Number: <6a, - a Date of Inspection: 11103
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes R] No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes K 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 F] 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
❑ 14E
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 H 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 12 -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 3 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes CK No
❑ NA
❑ NE
Couiinents (refer to question_ #) ExpIAh any YES answersiand/or any additional, recommendations or any other,eomiderits.
Use-.drawings.of facility to better explatms tttations:(useAdditional pages as necessary)
7r lea-k�► Z,,,Cover ©n a43, yi�� � pd (7'! Gqn aT^ Is c tAtab Twa- n s o Ia1�- � �- dr�-'�� o � � � 9�0'' a , � lso ref r0jvbe1,-r �� �f �
Sfofp_ L49joal �.
i5, ane iyh L nc, read raj of r� , SP�e �Qj h, y z,3�c readib 1`1 1011 f-ra" cM 4io'k1n
CQvie,
of
Q1, pleo'e, b0ch'9y9'C- 5f fecordl dor klove44-er wr h Koss 0-:d�sem, La,t woe_
Gnq si3 lr+pvf1�1 �Q� bar � �v nl s�� e su vv bele
�� r � in a ao � � y�-
Dq, I [t nf4_ ca I a*o1 iP I�
Excert �a ho�e0L abae .9 od `Qvr„ � 0,1O_ re (oras,
;ititL coo rtvi V)I117
CML�jl�fll�:�
Reviewer/lnspectorName- OOOA ��Ljn.ejQr Phone:
Reviewer/Inspector Signature: Date: �ny 3 �Q j
Page 3 of 3 2/4/2011

Facility No. �� Farm Name �, : Fa f Date III 31 /1
Permit COC OIC NPDES (Rainbreaker PLAT Annual Cert)
--L--�- ire, t a`- l L,-3
��� F�T1l�Ir�"11�L�1A
T!7`! -E f, W.017.1
Lagoon 1 2 3 4 5 6 7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date id !
Sludge Depth ft
Liquid Trt. Zone (ft)K7�)L(0
Ratio Slud a to Treatment Volume 3
WE
, � ,meq 0wo orasrl l 33 rou -� t ��-uQ M (IT)''40j?
Soil Test Date I_ia (J7�fj0 Wettable Acres L. RAIN GAUGE
pH Fields G 1 WUP Dead box or incinerator
Lime Needed Weekly Freeboard � Mortality Records
Lime Applied 1 in Inspections L/
Cu -I __jZ' Zn-I�� 120 min Insp.
Needs P ii D ✓
,� � Weather Codes
Croa Yield / ca, KA-, Transfer gheets n", .0^4.
.1 t.
N Amt (Ib11000 Gal) ( i� �r,� r
Pull/Field Soil
Crop Acres PAN Window Max Rate Max Arta
a Na= - r,
17
Design Width
Actual Width
, � ,meq 0wo orasrl l 33 rou -� t ��-uQ M (IT)''40j?
Soil Test Date I_ia (J7�fj0 Wettable Acres L. RAIN GAUGE
pH Fields G 1 WUP Dead box or incinerator
Lime Needed Weekly Freeboard � Mortality Records
Lime Applied 1 in Inspections L/
Cu -I __jZ' Zn-I�� 120 min Insp.
Needs P ii D ✓
,� � Weather Codes
Croa Yield / ca, KA-, Transfer gheets n", .0^4.
.1 t.
N Amt (Ib11000 Gal) ( i� �r,� r
Pull/Field Soil
Crop Acres PAN Window Max Rate Max Arta
a Na= - r,
17
3
r
5C
S
3;
Jay PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm
FRO or Farm Records�151b-)
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu -I 3000= 108 Iblac; Zn -I 3000= 213 lb/ac
1) ✓.
'X,I I
App. Hardware

J
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 9 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: (Arrival Time: �� �Q /6{ Departure Time: 4�OfJ IH County: S Lq� "Hegion: Lgeg
Farm Name: 6VV/k tvg Cr a 3 Owner Email:
Owner Name: _ � ✓t �' 1 / m j A e. , Phone:
Mailing Address:
Physical Address:
Facility Contact: IlUl1C/ Title: Phone No: ,p
Onsite Representative: Integrator: ^/' fl l.•�� =p �l-�1 t'1 r QC_
Certified Operator: -s _ Operator Certification Number: �a1:�3
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o ❑ I = Longitude: ❑ o ❑ , ❑ «
n_.
DesiMaid
g
Current
Desegn Current
fDes
ign CurrenCapacity
Pop on
Wet Poultry
;Capacity+�Populatmn
Cattle . �apacity Population
❑ Layer
❑ Dai Cow
❑ Non -Layer
❑ Dai Calf
-`
❑ Dai Heifer
Dry Poultry
{.
Y
❑ D Cow
;° _ :�..
❑Non -Dairy
Layers
El Beef Stocker
om a discharge?
Non -Layers
FEputlets
❑ Beef Feeder
Page 1 of 3
12/28/04
Continued
❑Beef Brood Co
M;.' ►'
._
❑ Turkeys
❑ TurkeyPoults
y 9
JE==L:11nOthe=r
❑ Other
Number of'Stm ures:
❑ Wean to Finish
Wean to Feeder
Feeder to Finish
❑Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ GiIts
❑ Boars
Discharees &Stream impacts
1. Is any discharge observed from any part of the operation? ❑Yes GM No ❑ NA ❑ NE
Discharge originated at: El Structure El Application Field ❑Other
a. Was the conveyance man-made? El Yes ❑ No Q9 NA ❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ) El Yes ❑ No [ANA ❑ 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 SM NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑Yes f�d)No ❑ NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes �No ❑ NA ❑ NE
other than fr
om a discharge?
Page 1 of 3
12/28/04
Continued

Facility Number: Date of Inspection
❑ Yes
JpNo
❑ NA
Waste Collection & Treatment
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
RNo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
1P No
[INA ❑NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
LTA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
No
❑ NA
❑ NE
Spillway?:
Designed Freeboard (in):
7 36
Observed Freeboard (in): y 3J7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
UjNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
VNo
❑ 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
PNo
❑ NA EINE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
P No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
?;No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
tpNo
❑ NA ❑ NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
1�71No
❑ 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 ofAcceptableWindow ❑ Evidence of Wind Drift ❑ Application Outside of Area
�c�c�ept_a fbleCr�op
12. Crop type(s) '-O[5TZU Fes' �'�WJtGt S'V l� ) f � • C"a' :. 0 (l n:$
13. Soil type(s)
J
J
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
JpNo
❑ 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
P No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Reviewer/inspector Name U Phone:
Reviewer/inspector Signature: Date:
Page 2 of 3 12128/04
Continued

Facility Number: —a Date of Inspection l
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 14 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 p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 11 Yes MNo ❑ NA ❑ NE
❑ Waste Application [:]Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" 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 IP No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ft o
N NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ONo
[-I NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
bNo
❑ 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
F]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
10No
❑ 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
�QNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo
❑ NA
❑ NE
Additional Comments and/or Drawings;;
AL
Page 3 of 3 12128104

Type of Visit * Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit • Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: :Q County: S42n_^96"J Region:
Farm Name: Owner Email:
Owner Name: Da vkt Phone -
Mailing Address:
Physical Address: '' rr
Facility Contact: 1--eL)et/ 5 Title:
Onsite Representative: lI
V
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
+a
Operator Certification Number: a o o S3
Back-up Certification Number:
Latitude: = o =I = Longitude: = ° = =
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Design Current
Design Current
Design Current
Swine Ec,yPopulation
Wet Poultry Cap�ty Pop�itation
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dai Cow
❑ Yes
Wean to Feeder `� D
❑ Non -Layer
❑ NE
❑ Dai Calf
❑ Yes
❑ Feeder to Finish
I NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Dai Heifer
❑ Farrow to Wean
Dry
Poultry
❑ D Cow
'18 NA
❑ Farrow to Feeder
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑Non -Dai
❑ NA
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
No
❑ Gilts
❑ Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
Page 1 of 3
- - - -
❑ Turke s
-
Other
❑ Turke poults
Number of Structures:
❑ Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes]
No
I
❑ 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
I 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
'18 NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128/04
Continued

Facility -Number: 8 A b Date of Inspection �a-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
F No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No 1�NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): U 3 41 a �
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
f No [ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
11 r
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
No 0 NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�No El NA El NE
maintenance/improvement?
//
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
Ed 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) 641 , 00-eexi
13. Soil type(s) 44
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility tail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
1PNo [:1 NA 0 N
(ANo 0 N El NE
09 No ❑ NA ❑ NE
[P No ❑ NA ❑ NE
qNo [j NA El NE
_Comments. (refer to question 9): Explain any.YES answers and/or any recommendations or any other.. comments
.Use drawings 'of facility to better explain situations. (use. additional pages as necessary):
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 2 of 3
j Phone. `IID 1i3;
Date: / 2-1q'0
12/28/04 Continued

Facility Number: a, Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [�)No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design El Maps El other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes FNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [!&No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No QK�NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes W No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes [j] No ❑ NA ❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
P No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PEAT) certification?
❑ Yes ATO
EgNA
❑ NE
Other Issues
(]RSy�/
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
QPNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ER 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
fp 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
Q9 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
VNo
❑ NA
❑ NE
Additional Comments and/or Drawings:. tr.:;
Page 3 of 3 12128104
Page 3 of 3 12128104

6i"A 8 1q 31TID� 3+r5
B Division of Water Quality
Facility Number $ Z_ 5-11 0 Division of Soil and Water Conservation
—� Other Agency
Type of Visit Q Compliance Inspection Q Operation Review *Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint 0 Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 3 ` g- Arrival Time: /Z:Q g Departure Time: Z : / S� County:Region:
Farm Name: _.. __>� 1` #Z __ Owner Email:
Owner Name: 0 -':Io 4C Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Title:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: E] e Longitude: =
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Wean to Feeder
❑ No
ElFeeder to Finish
[W�NE
❑ Farrow to Wean
I❑
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
E] Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ No
❑ NA
[W�NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
[WNE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
CjNE
e. 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
[A NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
❑ NA
®'NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No
❑ NA
E�NE
other than from a discharge?
Page l of 3
12128/04
Continued

•Faeility Number: Sz —2(ps Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes % No [INA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [1 No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 30 J
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
[A No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ NA
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
[29 No ❑ NA ❑ NE
through a waste management or closure plan?
❑ No
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 W NE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes
NA LS NE
❑ No ElI
(Not applicable to roofed pits, dry stacks and/or wet stacks)
UP NE
9_ Does any part of the waste management system other than the waste structures require ❑ Yes
❑ No ❑ NA tfl NE
maintenance or improvement?
❑ NA
Waste Application
18. Is there a lack of properly operating waste application equipment?
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
❑ No ❑ NA [A NE
maintenance/improvement?
EA NE
11. Is there evidence of incorrect application? I f yes, check the appropriate box below. ❑ Yes
❑ No ❑ NA [A NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
[A 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
UP NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
® NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
EA NE
Reviewer/inspector Name ' � is F, ;�L► Q``t S `' Phone: (9101J#33- 330
Reviewer/Inspector SignatuDate:
Page 2 of 3 12/28/04 Continued

Facility Number: 9.2 —2 Date of Inspection FS'D 7-1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA *E
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes ❑ No ❑ NA VINE
the appropriate box.
❑ WUP El Checklists [I Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No [INA 4 NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No [INA rNE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA PiNE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA VPNE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA ONE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA /PNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No ❑ NA
PNE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No ❑ NA
19 NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No ❑ NA
NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No ❑ NA
� NE
If yes, contact a regional Air Quality representative immediately
31 .
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No ❑ NA
P 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
W NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No ❑ NA
F'NE
Additional Commentswsnd/or Drawings:
f
Page 3 of 3 12/28/04

Division of Water Quality
:Facility Number �'—E ,2G,x Q DivLseon o[ Soil and Rater Conservation
Other Agency
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint 0 Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: (. ' O OS Arrival Time: 8.'SD Departure Time: County: _i2gA994 Region: ,RO
Farm Name: —&ar v.n T a-fl,5nC, 4 2� Owner Email:
Owner Name: A. FGe Z , Phone: '1/0- ,S`9.7 -S 70S- S9 G - 9,9,f
Maiting Address: Ap, 0. _ Aar __ 131 _ yr N6 '83 93
Physical Address:
Facility Contact: _ Delve i.✓d& Title: Phone No:
Onsite Representative: Qq.e_ We& Integrator:M-rel.-AA �'r___�102yo
Certified Operator: 40 aice k/e6 Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
65
Latitude: = o =A
F --I Longitude: = ° ❑ J = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
DArkean to Feeder �7 ROO 7aio k I ❑ Non -La er EEI
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
Layers
Non -Layers_
Pullets
Turkeys
Turkey Poults
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: - ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
Design Current'..,,
Cattle Capacity , Population,—
❑ Dairy Cow
❑ Dairy Calf
❑
Dairy Heife,
❑
Dry Cow
❑
Non -Dairy
❑ Beef Stocker
❑ 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 [jj o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:1 NA
0 N
El Yes
El No
Cl Yes
Q-,.�f10
E1 NA
[INE
[__1 Yes
❑'Ko
❑ NA
❑ NE
12/28104 Continued

8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
e<o
fFacility Number: Date of Inspection o-o
(Not applicable to roofed pits, dry stacks and/or wet stacks)
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes Levo ❑ NA EINE
EK
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: ;af , �A -} _ 3 1
Spillway?: 1710 4n /710ni ,
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
Designed Freeboard (in): _12� i
❑ NA ❑ NE
_ 61�
Observed Freeboard (in): 'tfr4www 3 p r 3 ''
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes E]-No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes D-f4o ❑ NA ❑ NE
through a waste management or closure plan?
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
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 ®bio ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
e<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
Q+ -10
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
O'lqo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
EKo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
? 7s,
,SO
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
['Ko
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement'? ❑ Yes
EE No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
❑ No
❑ NA B<E
17. Does the facility lack adequate acreage for land application? ❑ Yes
❑ No
❑ NA U -NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
OX
❑ NA ❑ NE
Reviewer/Inspector Name n7aa11 Qum f�py Phone: 91D'1& -/S41/ e.1 Z3
Reviewer/Inspector Signature: Date:
12/28104 Continued

Facility Number: S� Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
h'J Yes ❑ No ❑ NA ❑ NE
20- Does the facility fail to have all com onents of the CAWMP readily available? If yes, check
�es
❑ No
❑ NA
[:1 NE
the appropirate box.
❑ P ❑ Cts 0*6esign 0>2K ❑ O�
OOL91e 4s e, Ile
ye, hl '"9 Q if'pr
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
21. Does record keeping need improvement? If yes, check the appropriate box below.'
9�s
El No
[:1 NA
❑ NE
ti -13111 Ly `JPO 11 C,"�idyo,uyy
ElWa to lication El Weekly Freeboard ❑ ❑
❑
❑ Yes
04o
❑ Rainfall ❑ Stock ❑ Crop Yr ❑ 120 Minute Ins ep ctioys ❑ Monthly and I"
Rain Inspections ❑
Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[gWo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
[9-1
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
CSE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
R'11E
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
D -go
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
Eg-KE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ERNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E: No
❑ NA ❑ NE
and report the mortality rates that were higher than normal?
OOL91e 4s e, Ile
ye, hl '"9 Q if'pr
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Elo
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
S. /'?r. we//s
3
r'et7&,reol
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
04o
❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
/P r01'ed
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
2<o
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
EKo
❑ NA ❑ NE
AddiEialrCom_ments'an�i%vr Drawings �_'* `� �`` t I � x � i I
!9� / W I lir. e/l otos 'a/- recf,w� Ne nuc., Cer�;f,'eAle of eovu-age 4AJ
� fit. G c•,ex, / �"e/'ni : T , .� J
OOL91e 4s e, Ile
ye, hl '"9 Q if'pr
�aj o��s • 4 Q ., �
l' r]eviewf l
,S {
Some v ��% lek, �O�i^t.+i� ca�,�)<:o�c3//
S. /'?r. we//s
3
r'et7&,reol
eeeoeaIj 6v7� P4'se
/P r01'ed
12/28/04

Type of Visit • Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit • Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number "ate of Visit: 8 -/ Time:
O Not Operational O Below Threshold
Mliermitted CKertified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: tu.l. a LA - a^w /- County:
6o--/
Owner Name: �a!'rw�.. �.�� ..... ar.n �._��.�._................ .......... ........ Phone No: ....g� � .. .q�a.-...� `� ..._...........
Mailing Address:aX..........f-------- ------... -................ ......... ...----
Facility Contact: ......... Title: Phone No:
Onsite Representative:........ Integrator, t�46I!..... �1"r ... .WW___W_---
.
Certified Operator:. ......�__ cc ,t. �.._ /5�—------------ Operator Certification Number:._. F90 Si
Location of Farm:
!:>vos3
[{•Swine ❑ Poultry ❑ Cattle ❑ horse Latitude • 4 && Longitude • 1 "
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes ago
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes [Tf�o
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑yes GrNo
c. If discharge is observed, what is the estimated flow in gal/min-?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 0 No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 01 o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [bio
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ETNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...... �- - _.....--......... W. -. _--•
Freeboard (inches):
12112103 Continued

Facility Number:
Date of Inspection / O
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 0 -140 -
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or ❑ Yes E'lqo-
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 maintenancerimprovement? ❑ Yes 04'ro
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 0110
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes Llf�o
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ONO
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes EINo
❑ Excessive Ponding ❑ PAN [IHydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type ArmudIA . 4✓erseed
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [Ala
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
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
Air Quality representative immediately.
❑ Yes 9-#o
❑ Yes B -No
❑ Yes 13 -No
❑ Yes Blgo
❑ Yes [3 -No
❑ Yes ❑ No
❑ Yes gNa_
❑ Yes ❑ No
❑ Yes ER4-6
.Comments {rimer to gnesbon 1#) tany., answers and/or ,recommendations or any otl4er commis
Use d--,Y
rawings of facility to better expisia sitaatioas. {ase t�o>aal z as necessa )' ;
x j Y -- � pa$ Leg 4 [}Pi-eld Copy ❑ Final Notes
=- W x.ro_w. _
��^
TA,ArL GtrC a frW weeplS rit 49$7C Cf %1:s !py 7rP1Ps. 7h'5 rr a „tw 7✓1P.
a
Glfp gtil
W[115 :s PS�ash%n� CO[rl�Q' 'O/CdSP MChrtCr Cr"', ,Spy"% A0r -edg lt3 !'�`Pc�P�
1
r
Reviewer/InspectorName-
:�x:.
Reviewer/Inspector Signature: Date:
1.2112103 Continued

I.
Facility Number: Z — 7G Date of Inspection
Required Records & Documents
2I . Pail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
g1lo,
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
•
(ie/p
❑Yes
� ow_Ws,
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[Q -No
0,Waste'A'ppfica6en ❑ Waste Analysis ❑
y -8";P j `1, I.3 0,87
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design.
❑ Y es
0 -No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
allo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
E}Nb
28. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
O -W
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 1" 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.
ddttranal Ctmntnents°and/or Drawings -_
T.=-:.-�`..•«"�.'.^..:.-..n.c
� / �fI.Y�S e-
•
12112103
12112103

Site Requires Immediate Attention:
Facility No. A z 7-C-4
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: •} 9 , 1995
Time: 12'• 4R
Farm Name/Owner:- MC_ .� . �r z w � tt� 3 C s
-Mailing Address: k t4c. Z$ Ak
County:-
Integrator: F� . -F_ .... Phone: 9a - 7.81% - 2-
t
,On Site Representative: _-- Gv�„ D"._ w u-. Phone: '4 10 - 5�� - S-tc,.
Physical Address/Location: __ �� tq CQr�•`��s �-� —
Rtwr LLTa. + S awe)
Type of Operation: Swine Poultry Cattle
Design Capacity: 7_64na Number of Animals on Site: Z6o 0
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ° Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches)t'Yed or No Freeboard: K Ft. (_Inches
Was any seepage observed from the
Is adequate land available for spray?
Crop(s) being utilized: Go
I? Yes o N� as any erosion o ed? Yes 0423)
No Is the cover crop adequate? Ye or No
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwel' Yes r No
100 Feet from Wells? Yes
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes ot No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue ine: Yes 8 oNo
Is animal waste discharged into water o state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
;ly o.4r� ld+�oe�
Ms,_�%&c1 W.&k�r
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.