820286_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Quai

Date of Visit: Arrival Time: oe Departure Time:1 777 ; Ep ounty: M
Farm Name D �� i,�1�� a_ ,,t Owner Email:
Owner Name: (4) , 1' ct -e V Phone:
Mailing Address:
Region:
Physical Address: i
Facility Contact: L�} t y� 1`4.-L l Lf-cv rxt' Title: Phone:
Onsite Representative: i 1 Integrator: 14(rf—S
Certified Operator: Certification Number: I kq �2` d
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Des�ga Current
Capacity' Pop.
ar,do
WetPoulfry
Design Current
Capacity Pop
Design Cnrrent
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Dairy Calf
Wean to Feeder
Non -La er
Feeder to Finish
Farrow to Wean
Farrow to Feeder
{1
t{ 0
D , P,oul
Design ; Current
Ca aci Po
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
,
Pullets
Turkeys
Turkey Poults
Other
Beef Brood Cow
t ;
father
Other
Discharges and Stream Impacts
l . Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated aI: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
fA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑Yes
❑ No
[A
❑ 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
[TNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
E:�No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili umber: X jDate of Ins ection: 3J ►�
L
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[a l�j)_� NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No [3-NA—
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
�T
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[444a ❑ 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
[�-❑ 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
64w- ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑'lqo---❑ 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
E3-W— ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[]rNo ❑ NA
❑ NE
maintenance or improvement?
1 I. Is there evidence of incorrect land application? if yes, check the appropriate box below.
❑ Yes
E P-M—❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l 0% 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): -eiA 14
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑i' o ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E l'o ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Er N ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�io ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o
r
❑ 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 ff No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Fj"No
❑- ❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
[DNA ❑ NE
Page 2 of 3 21412015 Continued

FaciliNumber: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[Zle�— ❑ NA
❑ NE
25.'Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
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?
❑ Yeses
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
©'lao ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [❑ 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 [ o ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes []r?To-- ❑ 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
❑ >4v - ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
J
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ate% ❑ NA
❑ NE
33. Did the Reviewerlinspector fail to discuss review/inspection with an on -site representative?
[:]Yes
D-No ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E:rNo ❑ NA
❑ NE
Comments (refer to question f: 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).
Slvq�
& - y. 3 1°- 3. & -y 77,
C0--3 og- BSI1
Reviewer/Inspector Name: _ 1c, t L1 U Phone?/#
Reviewer/Inspector Signature: Date:"?
Page 3 of 3 21412015

f
ivisio'Tot Water: Resources _ —
Facility Number L� - ® fl Div�effig
t Soil and Water Conservation
Q ency
Type of Visit: Compliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency ther 0 Denied Access
Date of Visit: Arrival Time:[� Departure Time: County: . Region:(
Farm Name: �� K_ !" lre. Owner Email:
Owner Name: Ffer Phone:
Mailing Address:
Physical Address: 7
Facility Contact: Title: _ QCli/1�/� Phone:
Onsite Representative:
Certified Operator:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
=ii 1Ei
D Current
Swine Capacity Pop.
Design Current Design Cuirrent
Wet Poultry Capacity ''Pop. = Cattle Capacity Pop.
Finish
III
La er
Dai Cow
Dai Calf
Dai Fieifer
Feeder
Non -La er
FFeedertto,Finish
o Wean
Feeder
Farrow to Finish
Design
D ; P,oult Ca ac'
Lavers
-Current'
Po
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
Boars
Other
Other
;q: Wkfa6v.uun-.y�ui:i�;-
Turke s
Turke Poults
Other
.iMwI;R.'�.,A/!liY6
!!_•__:fN.gm....uBtitEpL
Discharges and Stream Impacts
1. Is
NE
any discharge observed from any part of the operation?
❑ Yes
❑ No
❑ NA
E�
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
[2--NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
BNE
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
[ E
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
❑ NA
ED-N-E
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
❑ No
❑ NA
[E
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: - Date of Ims ection: —/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes B<o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5_ Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA
Q E
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑ No
❑ NA
[D"IGE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
[:]No
❑ NA
D-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
EJI�E
maintenance or improvement?
Waste Ammlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[] No
❑ NA
maintenance or improvement?
11 _ Is there evidence of incorrect land application? If yes, check the appropriate box below_
❑ Yes
❑ No
❑ NA'
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, 7_n, etc_)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[:]No
❑ NA
e--NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
[J-NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
[3-NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
D NA
[3-N-E
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
[3-NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
[] NA
[5-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 D No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [:]No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA DNE
❑ Weather Code
❑ Sludge Survey
❑ NA [3-NV
[] NA D-#3✓
Page 2 of 3 21412015 Continued

Facility Number: jDate of inspection: ! -
3—;5r-
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No ❑ NA
�iE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[] Yes
❑ No ❑ NA
Q-5
the appropriate box(es) below.
Failure to complete annual sludge survey ❑Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
❑ No ❑ NA
E� <E
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No ❑ NA
[aKE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes [—]No
❑ NA
[JNE
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?
D Yes ❑ No
❑ NA
NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes ❑ No
❑ NA
[21qE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ NA
e'V_E
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA QNE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 0 No ❑ NA [3-NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ No ❑ NA [3'IgE
(refer to question,#) -.:Explain any YES answers and/or) es di ionkssa
t �mments (re_ ty � ( any �addtt�©nal recoi.nmendat,00s or aoy other co , r mments.
drawings of,facili to better, explain situations use additions 1
Pag r3')-
Reviewer/Inspector Name:
1 Tif Phone: --0(15-1
Reviewer/inspector Signature:
Page 3 of 3
Date: d—/'a—i %�
21412015

ype or visit: ulcomptnance inspection V Uperation Review V structure r:vatuatton U i ecnmcal Assistance
Reason for Visit: GKoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: by Departure Time: County:
4)lt
Farm Name: c7 Yl 11 4i% Owner Email:
Owner Name: �! ��-Lw & i,) 641 Phone:
Mailing Address:
Physical Address:
Facility Contact: %t 2 I I # i Q�, e7�j�. Title:
Onsite Representative:
Certified Operator: 1, (
Sack -up Operator:
Location of Farm: Latitude:
Wean to Finish I I I I Layer
11 Wean to Feeder Non -La er
Feeder to Finish
Farrow to Wean
Farrow to Feeder D : IP5
Farrow to Finish Layers
Gilts Non-L
Boars Pullets
Poults
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?
Integrator:
Phone:
Region
wt3 -s'
Certification Number: / U Lf;z_"f
Certification Number:
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes. notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Dai Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes MWft— ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
[:]Yes ❑ No
❑ Yes ❑iNo
❑ Yes Q No
❑ NE
.LNA ❑ NE
� NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 21412015 Continued

Faci[it Number: - Date of Ins ection:12
Waste Collection & Treatment
4, fs storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes LEK �❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No Ej<A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ,L
5. Are there any immediate threats to the the integrity of any of the structures observed? ❑ Yes No D 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
Ea"N�o
❑ NA
❑ NE
8_ Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[�'No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
to
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application`? If yes. check the appropriate box below.
❑ Yes
[!fNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s): &I'rt44 _,.5&
13. Soil Type(s): W t~.,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
2 N
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[] No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes [�No ❑ NA ❑ NE
❑ Yes [a' —No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [ENo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? if yes, check ❑ Yes [D—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. D Yes [3No D NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers D Weather Code
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [f'No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [E!j No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili umber: jrDate of Inspection: ;K3 g;;�V7
24.,f id the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [a<o ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3'1qo ❑ 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 [E No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[3 o
❑ 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
❑
[] NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[3 o
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[�
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[] Yes
[a o
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
B`Ko
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
0<0
❑ 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);
�1
Reviewer/Inspector Name:
k ct 10­3A-6K S I
Phone:
Reviewer/Inspector Signature:
Date:
Page 3 of 3 11 2/4/2015

i ype of r isu: )Lyeo uance inspection U vperanon xevrew U structure r va[uanon U i ecomcm tLssibLance
Reason for Visit: _ outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit' JILArrival Time: Departure Time: unty:-
Farm Name: J� '� �'L pi� �� Owner Email:
Owner Name: I w_ C ! �G1 ft! •e 6l Phone:
Mailing Address:
Physical Address:
Region
Facility Contact: 4) I- U I�OLy�, y Title: Phone:
Onsite Representative: Integrator:
Certified Operator: VCertification Number: I �{
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Desi n Current ' . - Design Current
g
Swine Capacity : Prop. Wef. Poultry Capacity Pop.
Cattle
Design Current
Capacity Pop.
Wean to Finish
Wean to Feeder
La er
Non -La er
Da Cow
Da Calf
Feeder to Finish
ti
-
j: Desi Current
D . Poul Caae Po
Da Heifer
Farrow to Wean
D Cow
Farrow to Feeder
Non -Da'
Farrow to Finish
Layers
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
113eef Brood Cow
-'
Other '4
Turkeys
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Ea�N� ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[:]No
E3-NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[_*A
❑ 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
[t]"NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[ 3'Ro
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
EEf No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facilit Number: -
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Identifier:
[�❑NA ❑NE
[:]No E�J-<A ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): r
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes [t], .?fib ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [3Ko ❑ 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 ❑,?do ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes [o�-<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 [fNo ❑ NA [] NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes <o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [!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 Cro Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):4(.Gt -4; '' 0
13. Soil Type(s): ✓%
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[DbIo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
QN6
❑ 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
[2'iglo
❑ NA
[] NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[DND
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[2-No
❑ NA
❑ NE
the appropriate box.
❑1AIUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes [ o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes L�fNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes 9440
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

Facility Number: Date of ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ -Ko" ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3'110 ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [5'i�o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes C3<o ❑ NA ❑ NE
❑ Yes to ❑ NA ❑ NE
❑ Yes 2] o [DNA ❑ NE
[—]Yes ` No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [:]Yes [3No ❑ NA ❑ NE
33. Did the ReviewerlInspector fail to discuss review/inspection with an on -site representative? ❑ Yes G311qo E] NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes Q'No [] NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
CAILI r-t,41 '%9.1
S(u,k9,,Skv, �- 69,2 I5
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: ti
2/4 014

s g` -�rU Ly is
Type of Visit: Q'C.�ommpliance Inspection O Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral 0 Emergency O Other O Denied Access
Date of Visit: Arrival T1 1 ,7 Departure Time: -county: Region:
1
Farm Name U-s Y - L `t(V `Lk �'� _ Owner Email:
Owner Name: _ 12t) l (t t "PA w CIO Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: l
Title:
Phone:
Integrator:
Certification Number: r?q51-6 _
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
SwineM'Dje
Wean to Finish
sign Current
acity Pop.
Wet Poultry
Design
Capacity
Current
Pop.
Caine
Da' Cow
Design Current
Capacity Pop.
Wean to Feeder
�Non-La
Da' Calf
Feeder to Finish
;il
D . P.oul , Ca spallon-Dairy
Layers
Da Heifer
Cow
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Pullets
Turke s
Turkey Poults
Other
Beef Feeder
Beef Brood Cow
Boars
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)?
❑ Yes (3-io❑ NA ❑ NE
❑ Yes ❑ No [3-tM ❑ NE
❑ Yes ❑ No [D-11A ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes [:]No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑-lqo� ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No �NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[D-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
[J- D 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
EEI<o ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
L 3 ""' ❑ 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
io ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes D<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): r
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E 1Vo'❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes g�No
o NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes�:O�o
NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
NA
❑ NE
Required Records & Documents
19. Did the facility fait to have the Certificate of Coverage & Permit readily available?
❑ Yes
�I ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No ❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[—]Yes
No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers ❑ Weather Code
❑ Sludge Survey
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspectioj��N
22. Did the facility fail to install and maintain a rain gauge?
❑Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Factli Number: jDate of Inspection:
24_ Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes l3-"'o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ kKb ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 011ow❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes DIG ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ❑'No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes [D-IQo ❑ 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 [a o ❑ 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 0 No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ENo ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
yve G - qt3�
Reviewer/Inspector Name
Phone:''A .') -)
Reviewer/Inspector Signature:
Page 3 of 3
Date: i
21412014

I
Type of Visit: (fCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: ET-1 County: Region:
Farm Name: 19-kr, Arrl y i K. rar w4, _ Owner Email:
Owner Name: LAO' i 1 k i I.— A 1fow, I Phone:
Mailing Address:
Physical Address: F
Facility Contact: &{ i TO W w i Title: &tom h ,r- Phone: /
Onsite Representative: _ Siz, Integrator: /jZur,;►F,
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
DesignCur r of� # , • ` ;Design C rrent` Design Current
ykyY_w'� -. s Vf'I a .; 1 i .wise
Swine �CspacgtyPop _Wet Poultry CapacttyPOp�: Cattle Capacity Pop.
Wean to Finish La er Dairy Cow
Wean to Feeder -Layer Dairy Calf
Feeder to Finish w0 42q00 `. ` Dairy Heifer
Farrow to Wean DesigDry Cow
Farrow to Feeder D • Point . , �Ca ac'i _ Po {. Non-Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non -Layers Beef Feeder
Boars Pullets Beef Brood Cow
.:. Turkeys
Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 5LNo ❑ NA ❑ NE
❑ Yes ❑ No
[-]Yes ❑ No
❑ Yes ❑ No
❑ Yes S No
❑ Yes 54 No
❑NA ❑NE
❑NA ❑NE
[DNA ❑NE
❑NA ❑NE
❑NA ❑NE
Page I of 3 21412011 Continued

Facility ?Number: C� I Date of Inspection - —E—
Waste Collection & Treatment
t 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a 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): L�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
®, No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes
5�No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
[.t� No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit'? ❑ Yes
RNo
❑ 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
f No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
RNo
❑ NA
❑ NE
maintenance or improvement'?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes
® No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Y/»tic� rsz- r
13. Soil Type(s):�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [KNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [a 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
[A -No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
M No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
®..No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check
❑ Yes
DF[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 5jNo
❑ 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 H,No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes allo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: 13
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
0 No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
® o
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
C,No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
[]NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question # ): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/inspector Name: '> /Yy`C
011
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

Type of Visit: ompliance 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: 1/ � / Arrival Time: r D a Departure Time: ; 3 i) County: r
v=-- Region:
Farm Name: �k� r•![�� �. ria /on— Owner Email:
Owner Name: ,(/�; % i �.---- TO tug f { Phone:
Mailing Address:
Physical Address:
Facility Contact: G[/;-C�� ��- PO ru,c Title: ,t7 GU r� r- ✓ Phone:
Onsite Representative: �j u-�� Integrator:
Certified Operator: .51 Certification Number: /S/_11;2_k�
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design1Current= Design Current Design Current
_"
- _ _
Swine CapacEtyPop. uWefim
Poultry Capacity Pop. Catffe Capacity Pop.
Wean to Finish Layer Dai Cow
Wean to Feeder
Non -La er
Dai Calf
eeder to Finish
G a
/ p a
.. " i"
DairyHeifer
Farrow to Wean
Desi Current
-
D `, P,oult , Ca`aei�Po
D Cow
Farrow to Feeder
Non-DaiKL
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
oars
Pullets
Beef Brood Cow
Turkeys
r_..Turke
100t!her
Puults
Other
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation? ❑ Yes allo ❑ 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)
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 C&No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection: --/9—/
Waste Collection &Treatment
• 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
fS 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): f
Observed Freeboard (in):
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
I, 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
WX 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
�o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ 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): 440&
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �jNo ❑ 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 [M-No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[:]Yes
[S No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
®.No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
[RNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes ®,No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
[:]Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes C&No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ANo
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
` 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ ! No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other 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?
Reviewer/Inspector Name:
Reviewer/Inspector Signature.
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes Co No ❑ NA ❑ NE
❑ Yes ®, No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
[:]Yes [ No
[:]Yes CR No
D Yes Z_No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: q/0-_4/J3-33WP
Date:
21412011

A
�r 0,0 y re- o►a7
. ype ui v isit: t,�-compnanec inspection V uperatton meview V btructure r.vamanon V i ecnnicai Assistance I
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: —j rrival Time: ; oD Departure Time: ,`3i7 County:����5��
Farm Names Owner Email:
Owner Name: lj`; /li u•A,L A- q�'DGLI rl/ Phone:
Mailing Address:
Region: _�)
Physical Address:
Facility Contact: 9eus7 Phone:
Onsite Representative: ,$�.� Integrator:
Certified Operator: �� Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current Design Current
Swine Capacity : 1'op. Wetjl?oultry Capacity Pop. Cattle Capacity Pop.
101
Wean to Finish
La er
Non -La er
Da Cow
Dai Calf
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Dai Heifer
Design Current Dry Cow
D . P,oult : Ca ace P,o , Non -Dairy
Layers Beef Stocker
Non -Layers Beef Feeder
Pullets Beef Brood Cow
Farrow to Finish
Gilts
Boars
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes
R1 No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes ❑ No 0 NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [0 No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [5j No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[g[ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
S. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[LNo
❑ 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
El 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
C,No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[A No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes � No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN 0 PAN > i 0% 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): _y�JGrnv .
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 5jLNo ❑ NA ONE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes M No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA 0 NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes ® No ❑ NA ❑ NE
❑ Yes E[ No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[-]Yes
RNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
®,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
XNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[S No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes allo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

1,1
Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34, Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
[:]Yes
[ No
❑ NA
❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes [2 No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes CR No
❑ Yes Eg No
❑ Yes 2 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: CT Phone: o
Reviewer/lnspector Signature:
Page 3 of 3
Date: 6
21412011

Type of Visit: O'Compliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:� Arrival Time: ® Departure Timc: [� County: Region: j5
Farm Name: 7,0—j/_y4 %Np !j% IyU Fa rim Owner Email:
Owner Name: U) ! Jj Y.... /f PpAlto%% Phone:
Mailing Address:
Physical Address:
Facility Contact: a4..� /f Title: ene2&C✓f
Integrator: OWJ e!�2
Certification Number:
Onsite Representative: �: e
Certified Operator: -1c1�
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Longitude:
MM
e I@a actty Po WettPoult Desii n Cif Design Ca� t rt g'trrenty Design C*urrent
Swin p p ry Capacity tPo Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
eeder to Finish
Non -La er
° Desig�hCurrent :
aD , Poult . Ca act 1Po P.--
Dairy Calf
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
Non -Dairy
Beef Stocker
Farrow to Finish
Layers
Gilts
Boars
'
Other -._:
Other
Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
Turkeys
=
-Turkey Poults
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c_ What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ® No ❑ NA ❑ NE
[-]Yes [:]No
[:]Yes [—]No
❑ NA ❑ NE
❑ 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 [S No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes r%71 No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: Date of inspection:
Waste Collection & Treatment
• 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
P3,No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):��
5_ Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�No
❑ NA
❑ NE
(i_e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
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
[a 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
E[No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
is No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [g-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [] Application Outside of Approved Area
12. Crop Type(s): Z'9�,�y�r-�/
13. Soil Type(s):-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Rj No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes �Z No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes jSC:;AM No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21 _ Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes P No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes allo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
25_ Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i_e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
,!,No
❑ NA
❑ NE
❑ Yes [No ❑ NA ❑ NE
❑ Yes [&No ❑ NA ❑ NE
[:]Yes allo ❑ NA ❑ NE
❑ Yes jo No
❑ Yes rVI No
❑ Yes RNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ff): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional Daees as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: `30"�s-'0
Date:�� _
21412011

IType of Visit O Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine O Complaint O Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: r 3 County: Region: L4��
Farm Name: `K- Q��+'�- Owner Email:
Owner Name: _a/i /`" a7. Phone:
Mailing Address:
Physical Address:
Facility Contact: _ f f �ia - �DWr/./ Title: Phone No:
Onsite Representative: _:�2 e,-, - Integrator: a✓
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e = 4 = Longitude: [=1 ° = ' = u
Design -' . Current
Swine CPacity Population
Design Current Design Curre41 nt
Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
eeder to Finish
&'q
Dry Poultry
❑ Layers
❑ Dairy Heifer
❑ Dry Cow
❑ Non-Dai
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Beef Stocker
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Gilts
El Beef Feeder
❑ Boars
Be Brood Co
Number of Structures:
,,.
Other
❑ Other
❑ Turkey Poults
❑ Other
4
Discharges & Stream Impacts
I _ Is any discharge observed from any part of the operation?
❑ Yes
[&No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
JKNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
QNo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

y Facility Number: — Date of Inspection
f Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes IN No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): / }
Observed Freeboard (in): 3
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.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes KNo ❑ 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 en-dronmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ,qNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
U No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0,No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
,M No
❑ NA ❑ NE
maintenance/improvement?
1. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
0,No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_)
❑ PAN ❑ PAN > 10% or lO 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
RNo
❑ 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
KNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
UNo
❑ NA ❑ NI,
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facitity to better explain situations. (use additional pages as necessary):
ReAewer/Inspector Name I Phone: [:p
ReviewerlInspector Signature: 011Date: 1";Zo/D
Page 2 of 3 12128104 Continued

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

type of Visit t9'Compliance Inspection Q Operation Review O Structure Evaluation U Technical Assistance
Reason for Visit outine 0 Complaint Q Follow up 0 Referral 0 Emergency 0 Other El Denied Access
Date of Visit: / rrival Time: r D Departure Time: ; County" ��1 Region:
Farm Name: ``,,�L te_&i � Owner Email:
Owner Name: W-1-IfI Gl� /f— POW a° ! J Phone:
Mailing Address:
Physical Address:
Facility Contact:/ f ld/TitlePhone No:
Onsite Representative: S' Integrator: �r
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 01 = Longitude: = e = 4 = «
Design Current
Swine Capity Population
Desigu Current Design Current
Wet Poultry Capacity Population CattleWC5pactryngopuiation
Layer ia Cow
❑ Wean to Finish
= IEJ
❑ Wean to Feeder
❑Non -Layer
Dry Poultry
❑
❑Dai Calf
❑Daily Heifer
Feeder to Finish
bD
Discharges &Stream Impacts
I. Is any discharge observed from any part of the operation?
❑Yes
CR�Uo
❑ NA
❑ NE
Discharge originated at: El Structure ❑Application Field El Other
a. Was the conveyance man-made?
El Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
El Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[I Yes
C&No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑Yes
RNo
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

` Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 53No ❑ 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): g`
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ,&No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 0,No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [�io ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 6_TNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0,No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers. setbacks, or compliance alternatives that need ❑ Yes M-No ❑ NA ❑ NE
maintenance/improvement?
l . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ®-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind 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 FZ�No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ❑.No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes [R No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [ENO ❑ NA ❑ NE
❑ Yes 0q10 ❑ NA ❑ NE
Reviewerllnspector Name Phone: �1Q Z133����
Reviewerllnspector Signature: Date: /p p2 0-6-A001:4
17/lRIfid Continued

Facility Number: Date of Inspection O—
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P3-No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[HNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® 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
[%ENO
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
I.No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
allo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E3 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
EaNo
❑ 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
15No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
10 No
❑ NA
❑ NE
12128104

S
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit alioutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /` Arrival Time: Departure Time: �County: 9= Region:/ K-
Farm Name: Owner Email:
Owner Name: !N! ll ; o�,= _ 14- Pp W ,--l/ Phone:
Mailing Address:
Physical Address:
Facility Contact: w% �%- >wt'l/ Title: Phone No:
Onsite Representative: _ �— Integrator:
Certified Operator: - %��— Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: E__1a =' =., Longitude: =° =, ❑ G
��
NOW Design Des' n Current
n
Current
Swine Cap c�4'i" PopulatOon W*et P oultry Capacity Po elation
C ty
•at#le Capac
Population
t � �p
❑ Wean to Finish
❑ La er
❑ Non -Layer
r -
iry Cow
❑ Wean to Feeder
iry Calf
Feeder to Finish
(�O
DtyPoultry
❑ La ers
LaEl
❑ Non-Laye
❑ Pullets
❑Turke s
Dairy Heifer
❑ Farrow to Wean
❑ Da Cow
❑ Farrow to Feeder
El
Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑ Beef Feeder
❑ Boars
❑ Beef Brood Co
-
a
_- _ Turkey Poults
❑ Other
❑Other
Number of Structures: j
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
JF2�[No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes.. notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
J4 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
RNo
❑ NA
❑ NE
other than from a discharge'?
Page 1 of 3
12128104
Continued

f Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 9 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): -33
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes IRNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes RNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ®, No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
K No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
&No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
&No
❑ NA [_1 NE
maintenance/improvement?
] I. Is there evidence of incorrect application'? If yes, check the appropriate box below. ❑ Yes
[.No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) oer/xkdeL
13. Soil type(s)
14, Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
RNo
[:1 NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
Fk] No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
RNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
RNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
® No
❑ NA ❑ NE
Reviewer/Inspector Name Phone: /D— ,... --T 6rJ
Reviewer/Inspector Signature: Date: /D—,57- per( ��
_b " J

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes B.No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes JZ[No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Sj4o ❑ 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
IS No
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
N No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ER No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
ERNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
14 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
10 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[3No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Page 3 of 3 12128104

r
q Division of Water Quality
Facility Number O Division of Soil and Water Conservation /41—,;700%
O Other Agency
Type of Visit If9 ompliance Inspection 0 Operation review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint Q Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
e (�
Date of Visit: Arrival Time: J, D Departure Time: .�yJr County: Region:
Farm Name,-rz "Ls✓ L/li ._ _.�.y� Owner Email:
Owner Name: �� - D t.[l a Phone:
Mailing Address:
Physical Address:
Facility Contact: 4V1 160— PO We Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:1
Operator Certification Number:
Back-up Certification Number:
Latitude: =0 = � Longitude: =° =' =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish 1v0 O
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -Layer
Dry Poultry
Layers
Non-L
Pullets
Ulurkey Poults
❑ Other
Discharges & Stream Impacts
. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ 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 [9 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[0 No
❑ NA
❑ NE
❑ Yes
4 No
❑ NA
❑ NE
12128104 Continued

Facility Number: —
i
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 4 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes [(No ❑ NA ❑ NE
❑ Yes O No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [A Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [ZNo ❑ 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 rg No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ®.No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes MNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)�--- ^
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes r'21No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes ® No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ® No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes EZ No ❑ NA ❑ NE
Comments (refer to question #): 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 Phone: �Dc7
Reviewer/Inspector Signature: Date: 0
121-661 4 c.annnuea

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes ® No ❑ NA ❑ NE
the appropiate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes WNo ❑ 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
R3 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
9No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
t' No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
EgNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
i@ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P, No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[9No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
13No
❑ 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
[NNo
❑ 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
R 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
KNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Wo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

,}
type of Visit Q�C6mpllance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ta�'futine O Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: 1 05 County!,� O Region:
//-
Farm Name: �hrr_/fe L V,' n Aar./rr, Owner Email:
Owner Name: W; l II r --- Fie) W e I I _ Phone:
Mailing Address:
Physical Address:
Facility Contact: W ` �! 0 uJ �'� Title: Phone No:
Onsite Representative:
Certified Operator: �-
Back-up Operator:
Integrator: /We",
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [� o [� L [� Ii Longitude: 0 o ❑ 1 ❑ u
Design
Current
Design Current
Design Current
Swine
Capacity
Population
Wet Poultry
Capes- ty Population
Cattie Capacity Population
❑ Wean to Finish
❑ Layer
❑Dai Cow
❑ Wean to Feeder
❑Non -La er
❑Dai Calf
Feeder to Finish
D Sa
"' ��'' "
❑ DairyHeifer
❑ Farrow to Wean
Dny Poultry'
�°
❑ D Cow
❑ Farrow to Feeder
Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowl
❑ Turkeys
tr. .
Other
❑ Turke Poults
t `
❑ Other
❑Other
Number.of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
®-No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
RNo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
® No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes. notify DWQ)
❑ Yes
9) No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
® No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — Date of Inspection G
L Waste Collection & Treatment
s —
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): C9
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc_)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes [XNo ❑ NA ❑ NE
❑ Yes [RNo ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes Z No ❑ NA ❑ NE
❑ Yes 9 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? 0 Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes tZ 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 Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [K No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [--IPAN > ] 0% or ] 0 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. CroptyPe(s) rIKV(3rsc.
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes IKNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ® Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes [9 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes to No ❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment? ❑ Yes 9LNo ❑ NA ❑ NE
Comments (refer to question # ): 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):
CaPn_7t)_4Uy_ UJD1 k'( -1
Reviewer/Inspector Name 1 Yv - _ j Phone: g/O—
ReviewerlInspector Signature: Date: /O - & aD06
Page 2 of-3 12128104 Continued

•
Facility Number: — Date of Inspection `D6
Required Records & Documents
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes allo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [K No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [9 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28_ Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30_ At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or
❑ Yes
12 No
❑ NA
❑ NE
❑ Yes
5d No
❑ NA
❑ NE
❑ Yes
C9.No
❑ NA
❑ NE
❑ Yes
19 No
❑ NA
❑ NE
❑ Yes
J9 No
❑ NA
❑ NE
❑ Yes
O No
❑ NA
❑ NE
❑ Yes
fig No
❑ NA
❑ NE
❑ Yes
[9 No
❑ NA
❑ NE
❑ Yes
NJ No
❑ NA
❑ NE
❑ Yes
['No
❑ NA
❑ NE
❑ Yes
19 No
❑ NA
❑ NE
❑ Yes Z No ❑ NA ❑ NE
Page 3 of 3 12128104

S
olk9 4, f4C
idlrty;N iiiW W.
�
® Division of Water tr
0 Division of Soil and
0 Other, Agency
Type of Visit OF Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: dS I Arri,-,[ 1-ime: !j Departure'rime: of C: p ,K, County: Region: O
Farm Name: ��ia_.�/v �,��� �a,� �7 Owner Email:
Owner Name:•/lL�t •_ v ���� Phone:
Mailing Address:
Physical Address: / ll
Facility Contact: _(/� (i4 w +-l� Title:
Onsite Representative:
Certified Operator: _ /�Jja'u- XOw@lr
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator:
Operator Certification Number: /�. � -
Back-up Certification Number:
Latitude: 1=1 o= 1= Longitude: = o= 1 ❑ u
Design Current Design Current
Capacity Population 'Vet Poultry Capacity Population
ED La er
Non -Laver
❑
Wean to Finish
❑
Wean to Feeder
eeder to Finisho
U
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
❑
Lavers
❑
Non -Layers
❑
Pullets
❑
Turkeys
❑
Turkev Poults
❑
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation"
Discharge originated at: ❑ Structure ❑ Application Ficld ❑ Other
a. Was the conveyance ratan -made'?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dai Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Cow
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)?
Number of Structures:
d. Does discharge bypass the waste management systein? (If yes_ noti1} 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 [jtNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
53 No
❑ NA
❑ NE
❑ Yes
[jallo
❑ NA
❑ NE
12128104 Continued

Facility Number: g — f Date of Inspection FF-/-0
Required Records & Documents ,�,/ ElEl19. Did the facility fail to have Certificate of Coverage & Permit readily available? [I[2
Yes No NA NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes IJ-dNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [RI No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
B No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
VNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[rNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
9 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
QrNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[gNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
&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
IrNo
El 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
El NA
❑ NE
33. Does facility require a follow-up visit by same agency?
El Yes
,[;�No
53No
❑ NA
❑ NE
asle.t re lzdv a slaf�.� Sa.rc �lN :rc:� .4s�F� Ki,/•%r.•• 1°ae.tl/ do•wjLt7'�.`s
12128104

Facility lumber: Y' —.2
Date of Inspection -�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: l
Spillway?:
Designed Freeboard (in): 1 q
Observed Freeboard (in): 2 7
5_ Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 9No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes Eg/No ❑ NA ❑ NE
❑ Yes U/No ❑ NA ❑ NE
if any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures 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 EtNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [(No ❑ NA ❑ NE
maintenance/improvement? --
]1. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes OX0 ❑ 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 ❑ �Elvidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) '&v k,�Q, �., �twa U t VA; 'X ---
13. Soil type(s) �&LZ
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [9/No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [;j"No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
determination`❑ Yes
[2No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
9
❑ NA
El NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers.andlor any recommendations or any other comments. o
Use drawings of facility to betier explain situations. (use additional pages as necessary)17 :�
r
V4 re rV Sew a Qr ;oold 27 mst, 71- K�OOh fe, 4 lr.
Reviewer/Inspector Name. { Phone:
Reviewer/Inspector Signature: ,�, �ia[ r�G �g, A� Date: / —0s'
12128104 Continued

Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint Q Follow up Q Emergency Notification O Other ❑ Denied Access
Datc of Visit: Time:
Facilit} lumber
Apt Operational 0 Below Threshold
O'germitted 2Certified 0 Conditionally Certified ❑ Retiistered Date East Operated or Above Threshold:
Farm Name: /he Count.: S4mdso n
Owner Name: /%��C Phone .No:
Aiailinr Address: to, ti o" p_ V3 Heir& &&
Facility Contact:
Onsite Rep rest ntative:
Title:
Integrator:
Phone No:
Certified Operator: 1. f �, a w, _ %,o,., t; �� Operator Certification Number:
Location of Farm:
EBI�wene ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 6 `` Longitude • •
Design Current Design Current Design Current
Swine Ca acitt Population Poultry Ca acitV Population Cattle Ca aciri• Population
❑ Wean to Feeder I 1 10 Laver I I I0 Dairy I
O'Feeder to Finish I PL14eA IEJNon-LaverL_❑ Non -Dairy
❑ Farrow to «"ean
❑ Farro.�- to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons IU Subsurface Drains Present -AU Lzg"n Area jU Spray Field Area
Holding Ponds I Solid Traps [] No Liquid Waste Management System
Dischar-es & Stream impacts
1 _ Is anv discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharee is observed, did it reach Water of the State? (If yes, notifi, DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes. notify DWQ)
1 Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure ? Structure 3 Structure 4 Structure 5
Identifier:
❑ Yes ®No
❑ Yes ❑ No
El Yes El No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes 4 No
Structure 5
I�
Freeboard (inches):
05103101 Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, [g] Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes Qi No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? m Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes] No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ��yy
elevation markings? ❑ Yes L_`� No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [0 No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
❑ No
12.
Crop type r r
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
PNO
14_
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑-W
b) Does the facility need a wettable acre determination?
V'ad BYeY es
@#Mo
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
0<0
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
QN-o
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
[3>No
20,
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
131TO
21 _
Did the facility fail to have a actively certified operator in charge?
❑ Yes
L'-ff ivo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[; No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑l No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
El Yes
L�-
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
@omments++(refer ta{quesdon�#Eipiasn any�YES"answers and/or any�recommendations or�anther comments.
'. ':^t 's `
w� �-;u�mT" -.f a a - .# � a = y ate- , a IS
Use drawtngsaof�faciitty to Watertezplata situations (use additional,pages as necessary}
- Iy� _ hi f . °w Pield Copy ❑ Final. Notes
W' W J. r... 1� HC1�411t'�'4Y F' �"�`Tn., .,�.�: -ti: _. :�. .e,. =. a" '�.�#gajn`..,Ei r,`II .�' a�Y
�- ��m D ✓G cvoo�Y s.�'o � 7 � s oj„ Gl ; � � a(f f-o
{ I�.�S/1�ri�
clyoot. 7— LC[700sj GL t(JRjF� iR1. '7C/OPi1� r� T1 11 Qt(W1
t
C.woC co�loacrt� tJa�k on bcv� S�adt3.
Ivr 6Cr,,�u�� �fcwaQ r.e_o �r�.� }.L�o�L. rncR+-fi:'Cav Q 5pv.ocl,
lijac��
Reviewer/InspectorName
Reviewer/Inspector Signature: Date:
05103101 V Continued

Site Requires Immediate Attention:
Facility No. B Z - z T
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 7-Z 7 , 1995
Time: 3'
Farm Name/Owner:
Mailing Address:_- / Bax /7 .%5►e.Pe //S 41 C
County: �.¢ZO-soy✓
Integrator: -' -b fC Phone: P/n -.0-3z -47ZY
On Site Representative: S Nla 101 x) Phone:. .5-3z - z- /10 y
Physical Address/Location: s-d .3 -0y
K3
Type of Operation: Swine Poultry Cattle
Design Capacity: ,r?SP a Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 0Longitude:
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or& Actual Freeboard: Ft. f 1 S Inches
Was any seepage observed from the la oon(s)? Yes or� Was any erosion observed? Yes o�
Is adequate land available for spray? es r No Is the cover cr p adequate? Yes r�
Crop(s) being utilized: 1 .�/ s ia✓ -
Does the facility meet 5CS minimum setback criteria? 200 Feet from Dwellings? e r No
100 Feet from Wells? es r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes ordp
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or o
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or(g) If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes o(manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes ore!!ZDC?) /
Additional Comments:
SC S E f OS 1, o ryas r�Rc IK- 5 L_
—�� Ili tTT"�
Inspector Name
Signature
M
cc: Facility Assessment Unit Use Attachments if Needed.