820302_INSPECTIONS_20171231

Z V
NUH I H UAHULINA
Department of Environmental Quai

I I
Division of Water Resources
Facility Number C - O Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 4D 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 0 Denied Access
If i
Date of Visit:Arrival Time: Departure Time: —County: SQY Region:
Farm Name: V e /V AZi"
Owner Name: Lev,
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: rvQf-j-i, N et!/ _ Title: Phone:
Onsite Representative: Il Integrator:
Certified Operator: Certification Number: / 90
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Deli n °Current
_
Design
Current
Design Current
Swine
Capactty `Pop
_ Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
(�IJ
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , P,ouI
Ca aci
.P,o .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Pullets
Turkeys
Beef Feeder
Boars
Beef Brood Cow
-P sml—
Other:=
�a
Turkey Poults
Other
Other
Discharees and Stream Impacts
1, Is any discharge observed from any part of the operation? ❑ Yes ® No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: T'
a. Was the conveyance man-made? ❑ Yes ❑ No NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No to NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes [:]No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [] Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No 0 NA 0 NE
of the State other than from a discharge?
Page l of 3 21412015 Continued

f Faci14 Number: jDateof Inspection:
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
Structlur Strucrure6 Structure 3 Structure 4 Structure 5
Identifier: [[+
Spillway?:
No ❑ NA ❑ NE
No {O NA ❑ NE
Structure 6
Designed Freeboard (in):
cr
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 DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc )
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Cropj Window Evidence Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): A 1 Ll-A , tic
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
� No
❑ NA
❑ NE
15_ Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[$T No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
CpNo
❑ 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 9 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 [W No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [5j No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ONE
❑ NA ❑ NE
Page 2 of 3 2/4/201 S Continued

O' Facifi 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 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA
R,
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA .
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No ❑ NA
❑ NE
33_ Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No 0 NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any o her cornments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature: il�
Date:
—70 1?
Page 3 of 3
21412015

i ypC Ui V LSlL: ® %-Umpuaace Lusprcuon v vperauvu iceVLCw V JLCullurC r VU1UX9 UU v ■ MU RI 211 naaLaLniLCC
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: L�County: Region:
Farm Name: (r�Q �611 Owner Email:
Owner Name: �ei`f ��ZI �/' Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
kI
Lt
Certified Operator -
Back -up Operator:
Location of Farm:
&-I/' Title: Phone:
Latitude:
Integrator:
Certification Number: ! 7
Certification Number:
Longitude:
W�,Dgn
elie Current�
Carrent�
t Desgn Current
Wet Poul �Design
P achy Pop �: 3 try
Capacity
Pop'Q
Cattle Capacity Pop
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Y'
DairyHeifer
Farrow to Wean
_
Design
Current
D Cow
Farrow to Feeder
D :'P,oul
Ga aci
r
P,o .;
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Itil
Turkeys
her
'_ Turkey Poults
Other
ja Other
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Ley No ❑ NA ❑ NE
[] Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
[� NA
❑ NE
❑ Yes
❑ No
0 NA
❑ NE
❑ Yes
Qq No
❑ NA
❑ NE
❑ Yes
tp No
❑ NA
❑ NE
a
Page 1 of 3 21412011 Continued

FacHity Number: Date of Ins ection: 23
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[� No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
rU NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: d SM
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
E] Yes
M 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
(A No
[] NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
�.No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 03 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 of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): CoalMJ'Evidence
i7`►'LL� ! �I"`' �4 D
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes N No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Co 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
f�g No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes []p No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E�No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

FIGility Number: Date Of lns ectioa: 4
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 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 to No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
TT
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA ❑ NE
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 paSes as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q10- 453-3 306
Date: 6
1M /1 -7
214/2 J7S

type of visit: ! Compliance inspection V Operation Review U Structure Evaluation V "Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: /,� Arrival Time: Qyt Departure Time: fl.. County: S4r.'rS0 Region:
Farm Name:I" Owner Email:
Owner Name: 4-': Phone:
Mailing Address:
Physical Address:
Facility Contact: jT`ti �� jlq+r' Title:
k
Onsite Representative:
94
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Integrator: �Lpj�.�+r`���✓
Certification Number: 1 g�
Certification Number:
Longitude:
Design Current
ROOM,
Design Current
Swine ;@aacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Gagacity Pop.
Wean to Finish
[Layer
Dairy Cow
Wean to Feeder
]Non -Layer
Daig Calf
Feeder to Finish Aw
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D :` Pout
Ca aci
P.o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other W.-. ;y..:
TurkeX Points
Other
Other
Discharges and Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b, Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes LpLNo ❑ NA ❑ NE
❑ Yes
❑ No
g NA
❑ NE
[] Yes
[:]No
WNA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes No
❑ Yes No
® NA
TDNA
❑ NE
❑ NE
❑ NA
❑ NE
Page I of 3 21412015 Continued

F;cility Number: KdZ7 Date of inspection:
Waste Coilection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4
Identifier: 6 10-
Spillway?:
Designed Freeboard (in): 41
Observed Freeboard (in):
tsc7
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Structure 5
No ❑ NA ❑ NE
No 1ANA ❑ NE
Structure 6
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ()) No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes UU No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement? T'
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes R 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 ❑ A plication Outside of Approved Area
12. Crop Type(s): �.�-+s�cdq S SS
13. Soil Type(s): —A 1"t IOva .
14_ Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
P No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
*No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
CP No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [�SNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes P No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists 10 Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: Q 2 Date of Inspection: q
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 provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
(refer to question #f): Explain any YES answers and/or any addi
gs of facility to better explain situations (use additional pages as
Reviewer/Inspector Name:
Reviewer/Inspector Signatw
Page 3 of 3
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑Yes
�No
❑NA
❑NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes �3 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
ons or any other comments.
Phone: 9�O�y33 -33�
Date: 4
21412015

$ fJ
Division of Water Resources
Facility Number��� 3 0 '0 Division of Sail and Water Conservation
Other Agency
IType of Visit: 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access Il
Date of Visit: Arrival Time: Departure Time: ounty: E)�V S&v( Region:
Farm Name: �C' j 1-C)'0_ Al lWm Owner Email:
Owner Name: I �&-V" _ Phone:
T�
Mailing Address:
Physical Address:
Facility Contact: Ke-19 446,1- Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
k
Latitude:
Phone:
Integrator:
Certification Number: % '?0 /,6
Certification Number:
Longitude:
Design
Swine Capacity
Gurrent Design Current Design Current
Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
Layer
lDairvCow
Wean to Feeder
-
I
INon-Layer
I
Dairy Calf
Feeder to Finish
ca Design Currnt
D . P=oul Ca aci Pao
La ers
Dairy Heifer
Farrow to Wean
Dry Cow
_
Farrow to Feeder
Farrow to Finish
Non-Da'iry
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
jBeef Brood Cow
_
= �" gg
Other
Turke s
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
R71 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
f� NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
[] No
GINA
❑ 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
nq No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
fig No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

IFae—W Number: y- 5 p Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �D 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: 9X& 5M 4--
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
3 Z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes MNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 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? T
Waste ADDUCatioD
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [?g No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [P 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): k I L-jr A 5 11S
iN - U'Vi-b-
fe
13. Soil Typc(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[M No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
� No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[P No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
MNo
❑ NA
❑ NE
IS. 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
M No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design [:]Maps [:]Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below_
❑ Yes
E4 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
5 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[4 No
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

'Facility umber: y - oZ Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes N 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 Duality 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
ip No
❑ NA
❑ NE
❑ Yes
[V No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes M No ❑ NA ❑ NE
[] Yes Q No ❑ NA ❑ NE
❑ Yes 1P No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
EP No
❑ NA
❑ NE
33. Did the Reviewerfinspector fail to discuss review/inspection with an on -site representative? ❑ Yes
EP No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? [] Yes [W No ❑ NA ❑ NE
Comments (refer to. question #)-.,.Eaglain any YES answers and/or any additionalrecommendations or*anytothor comments. x w
Use drawings of.facility to better explain situations (use additional pages as.necessary). h
Reviewer/Inspector Name:
Reviewer/Inspector Signature: f
Page 3 of 3
Phone: ` fQ -33OD
Date:
4120 4

Type of Visit: WCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ® Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: � Arrival Time: O '�j0a.v Departure Time: "//r D County: f6� Region:
Farm Name: �� d c , V rN Owner Email:
Owner Name: e, A Phone:
Mailing Address:
Physical Address:
Facility Contact: i'��t`t'^ (9+� Title: Phone:
it
Onsite Representative: Integrator:
Certified Operator: Certification Number: '6
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Curren#.
Design Current
Swine
Camp ity Pop nW�et l?ouIt Capacity Pop
=Cattle Capacity Pop.
Finish
- La er
DairyCow
Feeder
Non -La er
DairyCalf
o Finish
rFao
�� ?'
DairyHeifer
Wean
�� Design Current
D Cow
o Feeder
=, D PoW Ca aci i'o P.. _
Non -Dairy
Farrow to Finish
Layers
Non -Layers
Beef Stocker
Beef Feeder
Gilts
Soars
Pullets
Beef Brood Cow
n
Turkeys
Other
urkey Poults
Other
-
Other
Dischar es and Stream Im acts
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 P No ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes [—]No
E?3NA ❑NE
NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No V NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes '[ No E] 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? 10
Page 1 of 3 21412011 Continued

Facffi Number: - D Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[�3 No ❑ NA
❑ NE
a. If yes, is waste level into the ctural freeboard?
❑ Yes
❑ No WNA
❑ NE
,// Struc
Structure 3 Structure 4
Structure 5
Structure 6
Identlef:G J7 S
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
M 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?
TT
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes WNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes PNo ❑ 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 f ❑ Eviden of Wind Drift ❑ ApplicationOutsideof Approved Area
12. Crop Type(s): � � 4di Cam, s 41.�S-, _ ��� Limos �� 5", Wt s
13. Soil Type(s): l.T'61kb#--0 — 6-VA. &' . N Y4
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & _Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
-N&4, V_Q1k14 5
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
� No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. [:]Yes [?q 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 �j No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes M No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: jDateof Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No ❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
Ep No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA
❑ NE
and report mortality rates that were higher than normal?
24. 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
Qn No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
V No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWNT?
❑ Yes
No ❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA
❑ NE
Comments (refeir to=que"st�on #) !Explain any YES answcrsandlor anyaddit�o>1alrecaminendatigns or any other comments.
Use in of(faclty toabetterexp�ain sitnati 'on usedonal pages as necessary).
_ o {_
Reviewer/Inspector Name:
Phone: ?(1P -yU-
Reviewer/Inspector Signature: l
Date: 6 &�(
Page 3 of 3
2/4/2011

i ype of visit: q-ompuance inspecuon v vperanon xeview u btrucrure r vatuanon V i ecamcat Assistance
Reason for Visit: 49 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: C-1-71.4 Arrival Time: ,'� Departure Time: fI County: _rp�Jo., Region:
Farm Name: Owner Email:
Owner Name: �P,r �'�t �f2,r, �Y Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
i
Certified Operator: 4
Title:
Phone: /
integrator:��[t.�
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
WzM7A-���� Dsi Curent
Dn Current; K gn CapacitykPop "k ;;rWetPoultry�. Capacity Pop.
Wean to Finish La er
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Wean to Feeder
Non -La er
Feeder to Finish;
-
; Design Current
D '.;'Pool Ca aci - P.o
Layers
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Other -
Turkeys
Turkey Poults
Other
ter
Discharees and Stream Imnacts
1. Is any discharge observed from any part of the operation? ❑ Yes r No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made? ❑ Yes ❑ No [P NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) [:]Yes [:]No 1P NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [:]No
❑ Yes No
❑ Yes No
RNA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

facdi Number: Z - O IDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [X] 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: /4/ ozp
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 33 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 No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes J� No ❑ NA ❑ NE
waste management or closure plan? 1 j
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 QgNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 5d No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or W lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window
%� ❑ vidence of Wind Drift ❑ Application Outside offApproved Area
12. Crop Type(s): GaS� " 6'- ,, � SS �, ,�+Ql . Fec,o t RSA) f Sig • 9,t �
13. Soil Type(s): & R5b6vv —6i> i .I, "Ly_ J 7114-- I Oki_1 4,6543
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
Ip No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
[] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements [—]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ga No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [: Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes P] No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Pa No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility -'Number: a- - OZ Date of Ins ection: 8
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes RD No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes W No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ®No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Yes [5a No ❑ NA ❑ NE
❑ Yes [A No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: g /
21412011

Type of Visit: JR 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 0 Denied Access
Date of Visit: 7/Pf - 1 12, Arrival Time: % Departure Time:® County:_Sy4;fW,0i✓Region: )CWD
Farm Name: e Owner Email:
t
Owner Name: kJY,
/al s Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
H
H
Title:
Phone:
Integrator: _Ay""./i~` -
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
st DeGurrent - Desi Current
Desi Current
1� _ g n
g n
Swine Caactty Pap. WettiPoitltry Capacity Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
, x' I
� �" � �" .r Current
k" Design ^ e
Dai Heifer
Farrow to Wean
Dry Cow
_D f 4I'oultry "' Ca aci P,o
Farrow to Feeder
Non -Da'
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 P No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes Pj No
❑ Yes O No
NA ❑ NE
NA ❑ NE
rvi NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Hacili Number: jDate of Inspection: 1 -2-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑Yes t� No [DNA ❑ 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 Struc re 6
Identifier: N�✓ Qu
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 333
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
P No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
0 Yes
WNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes P;MNo ❑ 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): Gw 6,w S
13. Soil Type(s): b d�-{y p�
1` aj}`
14. Do the receiving crops differ from those designated in t e CAWMP?
❑ Yes
® No
TF
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
P
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0 No
❑ NA
[] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
IV] No
❑ NA
E] 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
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22_ Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of
21412011 Continued

aciii Number: - p Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ;K No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes �O No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
CK No
❑ NA
❑ NE
❑ Yes
No
❑ NA
[] NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes IP No ❑ NA ❑ NE
❑ Yes [ANo ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
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 JR No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 53 No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations: or any other comments7
se drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspeetor Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 149 —(,73^33 )0
Date: ! f ,Z
21412011

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral O Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: N Departure Time: eat County: �� Region:-�
Farm Name: li
Owner Email:
Owner Name: 44, /Jq jg{ _ Phone:
Mailing Address:
Physical Address:
Facility Contact: JLgj&_'r_ Title: Phone:
It
Onsite Representative:
Certified Operator: q
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
-
kWesignn " Current
Desi CPcrent
Design Current
Swine
Ca a� 1.0 ,
P:. h` P
Wet Poult ,
ry
Ca ac�ty� oA,
P
Cattle Capacity Pop.
Wean to Finish
Layer
Dai Cow
Dai Calf
Wean to Feeder Non -La er
Feeder to Finish
Dai Heifer
Farrow to Wean
Design Current
D Cow
Non -Dairy
Farrow to Feeder Dr Pbui Ca acitvPo
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
111111111,1111111=E
M�
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 Callo [DNA ❑ NE
[::]Yes
[:]No
y� NA
T
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes ❑ No ® NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

r
Facili Number: - Date of Inspection: 8 /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[] No
§a NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
2
Observed Freeboard (in): �� ✓�tt
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
n 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 EP No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [P No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Appli tion Outside of Approved
11 Area
12.Cro T es:N
P YIt () s�Jass �, G,)� 7P , �aV.�Q.J_
13. Soil Type(s): o ►-fak Pal 41
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 T No ❑ NA [] NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes �iV No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbrcakcrs on irrigation equipment?
❑ Yes
1PNo
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

- _ -
'aciii 'Number: - Date of'Inspection: g 1
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 provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [� No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes No ❑ NA ❑ NE
❑ Yes 1�1 No ❑ NA ❑ NE
❑ Yes [g No ❑ NA ❑ NE
❑ Yes [�a No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: qlD—q33-3300
Date: I Y 1
1/4/1011

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: /07County: _f Region:
Farm Name: Cil GI /—grP►'t Owner Email:
L
14
Owner Name:Phone:
11
Mailing Address:
Physical Address:
Facility Contact: NAL Nil l0'1- Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number: 9 094
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: =o �, �„ Longitude: =°
Design Current
Swute ` Capacity Population
Design Curr:.ent
Wet Poultry Capacity .P hon
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ Wean to Feeder
❑Non -La er
❑ Da" Calf
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder.
D . Poult r _ �^��_���m"
El Dairy Heifer
❑ Dry Cow
El Non -Dairy
❑ Layers
El Farrow to Finish
❑ Beef Stocker
❑ Non -Layers
❑ Pullets
❑ Gilts
❑Beef Feeder
❑ Boars
❑Beef Brood Co
❑ Turkeys
Other
Number of Structures:
❑ Turkey Poults
❑ Other
❑Other
NIMENIN
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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 9No ❑ NA ❑ NE
❑ Yes
❑ No
P NA
❑ NE
❑ Yes
❑ No
[�?NA
❑ NE
❑ Yes
❑ No
PNA
❑ NE
❑ Yes
�!?No
❑ NA
❑ NE
❑ Yes
[�iNo
❑ NA
❑ NE
Page I of 3 12128104 Continued

` Facility Number: Q�
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus "storm storage plus heavy rainfall) less than adequate? ❑ Yes [�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ONA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: OLD
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2a
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
91 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
9No ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
4&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
f)-J:No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
29 No ❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
(jjNo ❑ 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 ❑ vidence of Wind Drift El Application of Area
�JOutside
12. Crop type(s) � l��Ce,�Q !Q f-f�
13. Soil type(s) lY&4 11�. �IASF� O' .t^ S. L,/h4 b.":7
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
DINo ❑ NA ❑ NE
No ❑ NA ❑ NE
W No ❑ NA ❑ NE
1P No ❑ NA ❑ NE
® No ❑ NA ❑ NE
S answers and/or any recommendations or any other comruents.
Comm�en gr"efer to quest' b t j taut s tuatio
Use drawn s of facility _ p ns. (use additional pages as necessary);
err
Reviewer/Inspector Name 1 1 , _ Phone: /0.- -3m
ReviewerAnspector Signature: Date: ZZ
Page 2 of 3 12128104 Continued

Faeility Number: YIA-
e)— Date of Inspection
Reouired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [4 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA El NE
the appropriate box_ 0 WUP El Checklists ❑ Design El Maps ❑ Other `
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No El NA ❑ NE
El Waste Application El Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis El Waste Transfers ff ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
1�No
❑ NA
❑ NE
23.
1f selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ERNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
F3 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
tR No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
q?No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
;� No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
1p 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
EP 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
[�1No
[I NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
f(
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
IR No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
N)No
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit Ir Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint o Follow up o Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: Gl D 09 Arrival Time: Q Departure Time: ��.r3 County: S64'hoSotj Region: T lw
Farm Name: n\r- e Af,1�� Owner Email:
Owner Name: w,1 f`►61" g L4 44L jo, Phone:
Mailing Address:
Physical Address: I
Facility Contact:Title: Phone No: LCC
u
Onsite Representative: Integrator: ALUA-62 wrt0
Certified Operator: Operator Certification Number: 19,094
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: ❑ o = ❑ Longitude: I=] ° = = u
Design Current
DesignWrrent
Design Current
Capacity Popnladon
Wet Poultry Capacity Population
Cattle Capacity Populaton
inish
ram
❑ La er
❑ Dai Cow
eeder
❑ Non -La er
❑ Dai Calf
Finish
�O
❑ DairyHeifer
Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
El Beef Stocker
Gilts
Non -Layers
ElBeef Feeder
EBoars
❑ Pullets
ElBeef Brood Cowl
El Turkeys
Other
❑ Turkey Poults
❑Other
Number of Structures:Ni I
EET Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 1� No ❑ NA ❑ NE
❑ Yes
EpNo
❑ NA
❑ NE
❑ Yes
1� No
❑ NA
❑ NE
❑ Yes ( No ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
❑ Yes 1�0 ❑ NA ❑ NE
12128104 Continued

L�
F.A_
Facility Number: Z— 02 IDate of Inspection D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes K No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [54NA ❑ NE
Stnrcture I Stnicture 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: e4 N1 _ e_Z 2
Spillway?:
Designed Freeboard (in):
Obsmed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
QPNo
❑ NA ❑ NE
Oe/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
FNo
❑ 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
[M No
El NA 1-1NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
N 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
EPNo
ElNA ElNE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) `cns`irt,l bev-m" Ma v. ,154.,e), �w-e,.v CASAj,, )r Sn+.
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Fallo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[S�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'
❑ Yes
[5�`No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
C* o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ 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):
L
Reviewer/Inspector Name N(cL, i Phone: Wo-tf.3.3- 33ov
Reviewer/Inspector Signature Date: 9 D
12128104 Continued

LAIL 9-
Facility Number: Q Date of Inspection 9
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes PNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes P No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
[ No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
§a No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
T No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[0 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[P No
❑ NA ❑ NE
Other Issues
28_ Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
09 No
❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
(9 No
❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
ElNA ElNE
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
CA No
❑ NA ❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
§4 No
❑ NA ❑ NE
Page 3 of 3 12128104

' _ I
Division of Water Quality
Facility Number `� ('� Division of Soil and WitieiriErn-servationIMIM
Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ®Routine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: + Departure Time: County: Region:
Farm Name:
� ff Owner Email:
Owner Name: A)i ihit e4` 9Y Phone:
Mailing Address:
Physical Address: �!
Facility Contact: Y--�-t�i"�l AL4 0-el" Title:
Onsite Representative: C4
Certified Operator: N
Back-up Operator:
Phone No:
Integrator: �LI�FJ�Z.-rryV�
Operator Certification Number: 1 / q O /6
Back-up Certification Number:
Location of Farm: Latitude: = o =1 El I, Longitude: = ° = f = "
Design
Current' _�
Design Current Design Current
Swine
Capacity
Population W,et�Poultry Capa ty ptjir iori Cattle Capacity Population
❑ La er ❑Dai Co
[ Non -La er ❑ Dai Calf
to Finish
to Feeder
r
r to Finish
v Dry Pou_ ltry -
`* Ff❑Dairy Heifer
_.
- ❑ Dry Cow
Farrow to Wean
❑ Farrow to Feeder
'LL
ElLayers
❑ Non-Dai
❑ Farrow to Finish
❑ Non -Layers
El Pullets;
❑ Beef Stocker
❑ Beef Feeder
❑Beef Brood Co
Gilts
P101 Boars
-;..
El Turkeys
Other
_e
❑ Turkey Poults
❑Other
--
Number of Structures:
❑ Other
022
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 than -made?
❑ Yes
❑ No
[ANA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
WNA
❑ 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
❑ NoNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
FNo
[:3NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
Yes
Eli
t No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

E
Facility Number: 3 Date of Inspection / O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes t No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No J?9NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: OLD
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �l�q3/0
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 29 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 LJ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? [:]Yes 'PNo ❑ 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 29No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ElNA ElNE
maintenance/improvement? 19
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes PNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ 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)GJs&v.Lvun�k&-4 ,1J"1 L. &S C61r-.X
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
nNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
1`No
❑ NA
❑ NE
1,6. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
$1 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
EDNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
PNo
❑ NA
❑ NE
Reviewer/Inspector Name:'" D
Reviewer/Inspector Signature: Date:
Page 2 of J I21251!4 Uonttnuea

Facility Number: Date Date of Inspection L7/116
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes I No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes BNo ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design ❑Maps El Other
21 _ Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22_ Did the facility fail to install and maintain a rain gauge? ❑ Yes rpNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes ERNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ip No
❑ NA
❑ NE
25. Did the facility fai I to conduct a sludge survey as required by the permit?
❑ Yes
$3 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
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
fpNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
-PNo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
MNo
[INA
ElNE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[KNo
❑ NA
❑ NE
Page 3 of 3 12128104

Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: tb 2 O Arrival Time: rr J M Departure Time: a - M County: S [SON Region: FRO
Farm Name: tj I _] Owner Email:
Owner Name: k��l�4rr,,J�]w Phone:
Mailing Address:
Physical Address:
Facility Contact: RA 41k /�, 10`e� Title: Phone No:
q 1
Onsite Representative: Integrator: U411)64
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [� o ❑ , r] Longitude: [= o = ` =
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
I 33
0d
El Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharces & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Daia Cow
❑ Dai Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non-Dai
❑ 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 P No ❑ NA ❑ NE
❑ Yes
❑ No
C&NA
❑ NE
[:]Yes
[--]No
$1 NA
❑ NE
%NA
❑ NE
❑ Yes
❑ No
El Yes
ANo
El NA
El NE
❑ Yes ),No ❑ NA ❑ NE
12128104 Continued

,
IFacilityNumber:eoa, Date of Inspection fa Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes tpNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 1p NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: New O �A
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �jNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes q�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 P No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes CNo ❑ 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 JP No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 14 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes D4 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 ofWindDrift/ ❑ )Applicatioon Outside of Area Co,.,�^� � �j,,
12. Crop types)�4J Nm�a 4a, Pos-�we), �cuk �s�), �.6N'QEn Over, C o,` K k"�'';
13.
Soil type(s) lroA, Ln tl v A-, KA
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
tgNo
❑ 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
SDNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary): V
Reviewer/inspector Name
Phone:
Reviewer/Inspector Signature:
Date:
12128104 Continued

t
Facility Number: Date of Inspection o a
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes LpNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 03 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 Q�No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes P No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes U9 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
09 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
19 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�d No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[:]Yes
IgNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
PNo
❑ 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
MNo
❑ 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
P No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
V] No
❑ NA
❑ NE
nal Comments and/or Drawings:
12128104

Type of Visit 49 Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine Q Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: /a'i*3 _j Arrival Time: D j Q Departure Time: o fVl a County: ���'�P�� Region:
Farm Name: � i f U- &;tti(.r m_ Owner Email:
Owner Name: KP�t' �� '' Phone:
Mailing Address:
Physical Address:
Facility Contact: fYr Title:
11
Onsite Representative:
tT
Certified Operator -
Back -up Operator:
Location of Farm:
Phone No:
integrator: A1,1 I2 gryu-) v►
Operator Certification Number:
Back-up Certification Number:
Latitude: o E:::] " Longitude: E�] o
Design x Current
Design. Current
Design Current
Mae
Swine""
Ca aci` Po ulation
P h P
Wet Poultr YCapacity Population
Cti Capacity Population
`'' ❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La cr
Dairy
❑
El Non -La ers
El Pullets
El Turkeys
❑ Turke Other Poults
❑
Discharges & Stream Impacts
Discharges & Stream Impacts
Calf
1. Is any discharge observed from any part of the operation`? ❑ Yes W No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field El Other
a. Was the conveyance man-made? ❑ Yes El No MNA ❑ NE
b. Did the discharge reach waters of the State'? (if yes, notify DWQ) ❑ Yes El No 7NA ❑ 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 M 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 El Yes P No El NA ❑ NE
other than from a discharge?
Page I of 3 12128104 Continued

1I '-
Facility Number: _g2LJOg Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a- If yes, is waste level into the structural freeboard?
Structure 1 Structur 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?
(iel 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 qNo ❑ NA ❑ NE
❑ Yes ❑ No ONA ❑ NE
Structure 5 Structure 6
❑ Yes F No ❑ NA ❑ NE
❑ Yes WNo ❑ 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 P No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes !] No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes P No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 19 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P;j 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
E] 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
P No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[54 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
C&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):
AL
�
ff �A 2
Reviewer/Inspector Name I 1'rLQ�✓ Y -- Y 'Y �� Phone: �) 37 3 00
Reviewer/Inspector Signature: Date: Q-13 __04�
Page 2 of 3 I2128104 Continued

1 - .
Facility Number: — 3p Date of Inspection /
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes V;No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [--]Yes *0 JA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below, ❑ Yes [51No ❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
P6No
❑ NA
❑ NE
❑ Yes
0jgo
❑ NA
❑ NE
❑Yes
C5No
El NA
El NE
❑ Yes
PNo
❑ NA
❑ NE
❑ Yes
❑ No
5MNA
❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 29 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
W No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
w
Page 3 of 3 12/2&104

r
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: %S Departure Time: County: 454fysL..
Farm Name: �e r L '41 6t6ft Owner Email:
Owner Name:. r�ln /Y� �i �a r Phone:
Mailing Address:
Physical Address: ���� �
Facility Contact: K,v.l4 /Utt y to v Title:
Onsite Representative:
Certified Operator: ���/ R 0!/.� r
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Integrator:
Region:�
Operator Certification Number: f f e 9_10__
Back-up Certification Number:
�o[��� g �
Latitude: Longitude: =o=�
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
1; ❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current.
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
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 N(No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes B h4o ❑ NA ❑ NE
❑ Yes U4 ❑ NA ❑ NE
12128104 Continued

Facility Number: 3Qt Date of Inspection
Waste Collection & Treatment
, .,�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[I Yes
i1G 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: I
Spillway?:
Designed Freeboard (in): I.Ci li
Observed Freeboard (in): ,3 2— _r�2
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
P 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
Gfio
❑ 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
enNironmentall threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ YesW'No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
Lief 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
E] Yes
[U90
❑ NA
❑ NE
maintenance or improvement?
Waste Apnlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
OdNo
❑ NA
❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
,/
B No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifi ❑ Application Outside of Area
12.
Crop types) Fr�s !`� 6MO ape Z IXt fie! d`i-A s. -t- 6f' & d r c - .. toes k /-k� got
sahf zed
r&s_
13.
Soil type(s) %l!n ,�t Is ,� is a eg,-
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
LSefNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
[YoNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination` ❑ Yes
B No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
EYNo
❑ NA
❑ NE
18.
is there a lack of properly operating waste application equipment? ❑ Yes
dNo
❑ NA
❑ NE
Reviewer/Inspector Name Phone:two
Reviewer/Inspector Signature: Date: —22— 6
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [91"No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0�rNo ❑ NA ❑ NE
the appropirate box. ❑ wUP ❑ Checklists ❑ Design ❑ Maps
p ❑Other
21. Does record keeping need improvement'? If yes, check the appropriate box below. ElYes EiK ❑ NA ❑ NE
❑ ❑ Weekip-Eree"rd ❑- na ysis• ❑ SoiFAnalr- ❑ . ❑ n
❑ PMftf M-`❑ SteeLa& ❑ CIp-Y..ield ❑ ns ❑ Nf mimy „ Rai2 fnzprx4ojn ❑ Vi"hc&Gede
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
El NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElLy Yes
,ER
No
❑ NA
❑ NE
24_
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
91N '
❑ NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
No
❑ NA
❑ NE
26_
Did the facility fail to have an actively certified operator in charge?
❑ Yes
L1A
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[VVo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[2fNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
QNo
❑ 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
EYNo
❑ 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
[i�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?
Ell5a Yes
,� ,r
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
9No
❑ NA
❑ NE
dditioual Comments and/or Drawings:
12128104

IL
Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facilin Number Dau of\ isit: S '� v yTime:
: D�
Not Operational 0 Below Threshold
I1rermitted OC"ertified [3 Conditionally Certified Q Re; istered Date Last Operated or Above Threshold:
Farm Name: 'Cfeld Al 67,rm Count-: -�a+.Py
Owner Name: me; /A NJer
/ Phone No: __2/0 - SG R/-
Mailinc Address: 7g/_ Hon �x c,7`% C Ln&i
Facility Contact: i�. T`i _ AlnV 14 Title: Phone No:
Onsite Representative: ��� Na';' _ Integrator: &vQlkl
Certified Operator: uE tie �� �ar Operator Certification Number:
Location of Farm:
❑wine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �•
Design Current
Swine ranaritc Pnnnlatinn
❑ Wean to Feeder
eeder to Finish
3 3 LtSq�
❑ Farrow to vvean
❑ Farrou- to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultsv Capacity Population Cattle Capacity Population
❑ Laver I ❑ Dairy
❑ Non -Laver I I ❑ Non -Dairy
10 Other
Total Design Capacity
Total SSLW
Number of Lagoons JE1 Subsurface Drains Present ❑ Lagoor Area S rav Field Area
Holding Ponds / Solid Traps 0 IQ No Liquid waste Management System
Discharges & Stream Impacts
1. Is anv discharge observed from any pan of the operation?
Discharge originated at: ❑ Lagoon ❑ Sprav Field ❑ Other
a. If dischame is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed. what is the estimated flow in Ral/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any pan 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 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 1
Freeboard (inches): Y i 7
❑ Yes 0-14-
❑ Yes ago-
El,
L� Yes No
❑ Yes aIio
❑Yes ,Otr�o�
❑ Yes Ll No
❑ Yes ❑1q-o—
Structure 6
05103107
Continued

Facility Number: Date of Inspection 3 0
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.) /
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes afi
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes [11 o
S. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes [314o
elevation markings?
Waste Application
10_
Are there any buffers that need maintenance/improvement?
❑ Yes
ONO
11.
Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
Leo
❑ Excessive Pondin � PAN ❑ Hydraulic Overload ❑ Frozen GroundCopper and/or Zinc
12.
J[1]
Crop type Be"MvAk Sm Il e,'J cci-" l✓%! .i.f 949an5
13-
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
[ -No
14,
a) Does the facility lack adequate acreage for land application?
❑ Yes
D-Ko
b) Does the facility need a wettable acre determination?
❑ Yes
ONo
c) This facility is pended for a wettable acre determination?
❑ Yes
0Ao
15.
Does the receiving crop need improvement?
❑ Yes
01 io
16. Is there a lack of adequate waste application equipment? ❑ Yes Leo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes D No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, El Yes �"S
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes MN6--
Air Quality representative immediately.
rgnrem-other.Comments {fnon nYES answers maycomments. -
;Use drawings of.facih to better sttuabans. {use nddtbonai . es as necessa
r3' )
I ._ = [ Field Copy ❑Final Notes
- d _ - -
Reviewer/Inspector Name Gr ( r z_ t-
Reviewer/Inspector Signature: Date: �,7 - 0
1 Z111/UJ t.onanuea

k Facility Number: Date of Inspection �• -v
Revuired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
22. Does the facifitv fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
{ielP,, klists,si'gn,3napsretc.)
❑
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ Waste App ❑+=bumzl• ❑ OV ❑ Seillir►gr
!� >l 3.8 3s 2 -'2 o '-7 /
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
O#tf
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
CKo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
�o
(ie/ discharge, freeboard problems, over application)
❑
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
e-N-O
28. Does facility require a follow-up visit by same agency?
❑ Yes
O-No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
O-No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) es ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �o
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes Elm
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes �o
34. Did the facility fail to calibrate waste application equipment? ❑ Yes [}NS
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes 0"N' o
❑ SEeeltiug ern ❑ GmpX4e1dZom ❑fcsir a}i— ❑ n
❑ ❑ ca
12112103

Site Requires Immediate Attention: A) 0
Facility No. Z- 14$ o
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 14 N () 0 , 1995
Time: b 3 7 7.
Farm NamelOwner. _ MYA D vn
Mailing Address: '--
County:_
Integrator: _Mv ti Phone:
On Site Representative: ovt Phone:
Physical Address/Location: 2_1 k o Go 7- m 1 S u 1'e t o
t Z)25 1 `YY\*11'Z-V pa w, o.►n • le��, .
Type of Operation: Swine Poultry Cattle
Design Capacity: Svc) Number of Animals on Site: q fl
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: w Longitude: w
Circle Yes or No
Does the Animal Waste Lagoon sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) � No tual Freeboard: 3 Ft. � Inches
Was any seepage observed from the l n(s)? Yes or No Was any erosion observed? Yes or
Is adequate land available for Spray ? Y or No Is the cover crop adequate? Yes or No
eq sP . Y P �
Crop(s) being utilized: S a 1 &' W
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin ? or No
100 Feet from Wells? r o
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o No
1s animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue ne: Yes o*No
Is animal waste discharged into water of a state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (vqkmes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:_
-Inspector Name
cc: Facility Assessment Unit Use Attachments if Needed.