820316_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Quai
II

Type of Visit: k::Mompliance Inspection V Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: 91 outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: —1] Arrival Time: "a (Departure Time: � County: Region:
Farm Name: p� s ; tee- tt iC �T /1 �i%5f� owner Email:
Owner Name: �1�}�yyta,� �a'yC �� Phone:
Mailing Address:
Physical Address:
Facility Contact a /� Title: 4eOV Phone:
Onsite Representative: Integrator: 11, ,/�
Certified Operator: Certification Number: Azo3
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
1 II'
Swine
Design
Capacity
Itulll{J!
Current
Pop. `
Wet Poultry'"E
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Farrow to Wean
D , P,oult , Ca ac" ,. Po �,,,
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
Eg-1,10
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
RNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Faci I ity Number: 3 4, Ds ection: :S
J Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
Eig-No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes
[] No
❑ NA
[] NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): -
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? [—]Yes
F�&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
allo
❑ 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
gNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes
ELNo
❑ 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
09No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
W. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
M_No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes
fo-No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, 7n, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop ❑/Evidence of Wind Drift ❑ Application Outside of Approved Area
Window
12. Crop Type(s): �'�lz �ltijf�/6Y� 7-
13. Soil Type(s).
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes L?FNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ®No 0 NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
En -No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E�LNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
gNo
❑ NA
❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
gNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? Ifyes, check the appropriate box below. ❑ Yes Callo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 ° Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [&No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - 4- = I Date of Inspection: /
i 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ;�No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [:]Yes Callo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes allo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
CFg] 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
[allo
[] NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
(2,No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[gNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[RNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[RNo
[] NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ONo
❑ NA
❑ NE
Comments {refer to question.# �Expfain any.YES;answers and/or, any. additional. recommendations orjany other comrndhts.ki' �,
Lise'drawings of'facility to better t;zpla�ri situati6nse55ary).`(use additional pages as nec t F „ i, � ! ry
i �� ue� ,i �'IL� i! ,
Reviewer/Inspector Name: J �_i-�� Phone:
Reviewer/Inspector Signature: � �� Date: Z2
Page 3 of 3 21412015

Type of Visit: ,mommpliance Inspection Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: t�1 Routine 0 Complaint 0 Follow-up Q Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: % / County: Region.
Farm Name: _%"�7 p/` �J�j� �p�`S avt Owne mail:
Owner Name: %V� r/rlQa rq /D/`' Phone:
Mailing Address:
Physical Address:
Facility Contact: S�Gz�Ji'! tfij'�— J�'/�h/ Title: Phone:
Q
Onsite Representative: Ste— Integrator:
Certified Operator: Certification Number: Azy'O�
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Gurrentr Design Current99211111116esign
SvrtneF Capacity Vet Poultry Capacity Pop.
Current
CattlAl Capacity Pop.
=
Popes'.
e
_
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
O9} -
Dairy Heifer
1
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
£ •46a'o Itr
Ca act = Po
Non -Dairy
Farrow to Finish
M:4 Layers
Beef Stocker
Gilts;`
Non -Layers
Beef Feeder
Boars
M
Pullets
Turkeys.'
Beef Brood Cow
:s
T,
>Other
r �;
Turke Poults
Other
Pther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
[] NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR) []Yes [:]No ❑ NA ❑ NE
2_ Is there evidence of a past discharge from any part of the operation'? ❑ Yes E. No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ZLNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

'Facility'IFacility Number: - 3jj, jDate of Inspection: / —
�- Waste Collection & Treatment
" 4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[SNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Q
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E 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
allo
❑ 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
J&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
[gNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required butlers, setbacks, or compliance alternatives that need
❑ Yes
In No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application`? If yes, check the appropriate box below. ❑ Yes 2] 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): -,q--
13. Soil Type(s): A-lb13 GL
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
[a 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.
❑ W UP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21 _ Does record keeping need improvement'? If yes, check the appropriate box below. ❑ Yes [�j No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes MNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection: —
— b
124. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EZ No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
0 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
gNo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
allo
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�.No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
® No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
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
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone:
Date: j
21412015

f
c
1
/L7
Type of Visit: <D<ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: tine O Complaint Q Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: Arrival Time: Departure Time: v County: ,s y]@I-- Region:
Farm Name:fr Owner Email:
Owner Name: J�/?d`�iJ�ry,-�asy�r Phone:
Mailing Address:
Physical Address:
Facility Contact: a D.y--- jVC �i�' Title: Phone:
Onsite Representative: Integrator: '�� &
Certified Operator: Ste _ Certification Number: A;2 �1,93
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine jWZGpacity
Wean to Finish
Design Current Design krreit
Pop. Wet Poultry Capacityop. Cattle
La er DairyCow
Design Current
Capacity Pop.
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Dr. Pouf
Layers
Non -Layers
Design Current
Ca aeit P,o
DairyHeifer
Farrow to Wean
D Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Beef Brood Cow
Other M
.., _.
Turkeys
Turke I'oults
Other
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes JZ No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DW R) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes SLNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes allo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

r
Facility Number: _4r - - 3/[r J Date of Inspection_: f
jWaste Collection & Treatment
l
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? []Yes E3Yo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): - Z
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes P 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
M-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
ELNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[-]Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance a]ternatives that need
❑ Yes
J�2 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Cp eri �f✓�z��jl'a�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
jNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑Yes
M No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
allo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
O No
❑ NA
❑ NE
18. Is there a lack of property operating waste application equipment?
❑ Yes
5a No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[a -No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
E�gNo
❑ 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
F2�jNo
❑ 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
jo No
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Tj
Facility Number: jDate of ins ection: --/
1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes MNo
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3,No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes E[ No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [] Yes RNo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[DNA ❑ NE
[—]Yes C&No ❑ NA ❑ NE
❑ Yes E@�No ❑ NA ❑ NE
❑ Yes V,No ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
[:]Yes
2KNo
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Comments.(refer to question #)Explainlany�YES answers; and/or any. additional; recommendations or4gny atlier comments. f.
Use drawings of facility to.better ex pia!nusituataons (use,additional pages as.necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: FAO3�
Date:
21412014

E2QJ:=i
f Water Resoacility Number ®- 'tj f j, on of Soil and Water Conservation
[ii Other Aaaary
Type of Visit: {-7Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ' O O Departure Time: ® County:.;�r7 ..-. Region:
Farm Name: j 20�j " s' f �-Y 1 �� Owner Email: ��
Owner Name: /min Az4e/p1' Phone:
Mailing Address:
Physical Address:
Facility Contact: / Title: &'Co f? Phone:
Onsite Representative: Integrator: eiLll �ti�
Certified Operator: Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design
Current
Design Current
Design Current
Swine
Capacity".
Pap.
Wet Poultry Capacity Pop. Cattle .
Capacity Pop.
Wean to Finish
Layer Dairy Cow
Wean to Feeder
I
INon-Layer_lDairy
Calf
eeder to Finish
-` Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D , P.pultr Ca aci P,o , Non -Dairy
Farrow to Finish
Layers Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
"An kfaum � s
Turkeys
Other : ...
Turkey Poults
Other
Other
Discharges 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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [Eq No ❑ NA ❑ NE
[-]Yes
[:]No
[:]NA
[:]NE
[]Yes
[]No
[:]NA
❑ 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 ,KNo
❑ Yes �No
❑ NA ❑ NE
[DNA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Facili Number: 97 jDate of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
allo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): [ g
Observed Freeboard (in): 1;2 ( r
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
[0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[—]Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Aaolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
[]Yes
(Z No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus [] Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop/Window `❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �, l!'j'L
13. Soil Type(s): Ij19
14. Do the receiving crops differ from those designated in the CAWW? ❑ 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 Q No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes Z[ 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 [a No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes � No
❑ Waste Application [] Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 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 [& No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

Facility Number: jDate of Ins ection: /
1; 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes MNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3-No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes rNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [R No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes [Ra4o ❑ NA ❑ NE
C] Yes ONo ❑ NA ❑ NE
I'CM
.Yes [No ❑ NA ❑ NE
❑ Yes ® No
[:]Yes RNo
❑ Yes Jallo
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or-: any additional recommendations or any other comments
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
214/2014

WK W Slror V3
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: E) Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Os� Region: mo
Farm Name: NQa Sha„ J WII!-p 14'
Owner Name:rylq� �Qy jr�r
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Shanam InyIrI' Title: Hey 4I/ Phone:
Onsite Representative: S '161 N11yt'n ' Integrator: I 0
Certified Operator: SI9('n _ NQ,��vr Certification Number:
Sack -up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Desr Current
r .:. ...
Desi n Current Design Current
Swine Capacrry Pop.
VVetjr Itry pacity Pop. C*attle Capacity Pop.
_-
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Feeder to Finish Q449282
I TN-Va-Layer
Dairy Calf
airy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Farrow to Finish
D . P■oul Ca aci P,o
Layers
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars Pullets
Beef Brood Cow
OtherF—ITurkey Poults
NJ
Other I 10ther
Discharees and Stream IMD3Cts
1. Is any discharge observed from any part of the operation?
❑ Yes
Er No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[] Yes
[] No
❑ NA
[] NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ER No
[] NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
® No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

' Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
5dNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): Iq 12_
Observed Freeboard (in): 29 _ a�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E� 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
15� No
[] NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[W No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
1Z No
❑ NA
❑ NE
j maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
CR No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
l
12. Crop Type(s): M C. r p a n �
J
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
I" No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
t@ No
0 NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E[ No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
{gNo
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes (9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes �allo [] NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes CVNo C] NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
® Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ MonthI and V infall Inspecti ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?�s) LwG -Wves Now] NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreaker?on irrigatiot equipme I? ❑ Yes ❑ No 0 NA ❑ NE
Page 2 of 3 21412011 CondAmed

Facili. Number: $ Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes [3 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes M No [] NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
23 Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
❑ No
aNA
❑ NE
❑ Yes
W No
❑ NA
❑ NE
❑ Yes [a No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Yes ❑ No ❑ NA ❑ NE
[:]Yes No
[:]Yes No
[-]Yes No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Comments .(refer to question ft Explain any YES answers and/or -any additional recommendations or;any other corn" t�s d
Use drawings of facility to better explain situations (use additional pages as necessary)..d:.
pieo,� el�ec ^tia h h L4yov, a aAk mow"64 Jvi k
31� tf des oY� u be-�ie o�[ �-bvo da s af�s�raf
` ail �r # r� e ,s `� sal c re >�ar�+fa�1141;g horb�daie).
Please- i9 {n � - ` 9
Nai mvch s jrQr�j ho, bP dMe_ 6-ore IAf iPy E on., old -'a!/
IroccA -0e(d r and tecQ-dfi
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
Phone: '7
Date:
4/Z011

I. 1w
ur
Dat(
Fat n Narne', 11-3
Permit
eYrO NPOES (Rainbreaker-1 PLATAnnual Cert,136ilyPipe)
A,
FB Di
ro
Elm-TIM
OMMEM,
al
Lago6ri NAM'
-'s.f6io,
i0w
a
2
3-
4
5
.DesighT reeb
aril.
1A R666rd-
Regarded in
ZI)
Observed'---jlreeboar
!zo
Liquid Trt.-,Zon6*
> -45 Ratio Slu'dje':fb;'Tfeatii�eM, Wldi� 6. if- D.
Date -6 u V q
I id hai/.
FOA?
wen- namgmpm
Kim
Soil Test
-.'Crop Yield Transfer'Sheets,
.Da.
pH Fields
l
NIj
Wettable Acres RAIN GAUGE
Lime Nee'de'd!;::
AppliedWeekly
I
l
WUP Dead box or incineraor
Freeboard
Lime
V� Mortality Records
Cu-I
Needs S-1 <25
z
11 A
0
I in Inspections! ✓ Check Lists
1 12 0 min Insp. Storm Water
O
Npprfiq P:
wil
%
6i4li: .,WP;AhPr (nrfp-q
W-01 I
MUMMER
Verify PHONI�:N
M
land:afflli
r altions
: I ..
Date last-W U1
F
0
'FRO or Farm Records
Date Iasi WO
a
Lagoon #
App. Hard w` a'i
Top Dike
Stop Pump 4-10
9111 J` Start Pump 44,3�
1
k
Conversi0
lb/.,.P; Zn-1 3000= 213 lb/ac

. a
ivi-O of Water Quality —
Facility Number a- - 3 ® Division of soil and Water Conservation
0 Other Agency
Type of Visit: 15 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: � Arrival Time:115,tiaM ] Departure Time: f County-SOFM
Farm Name: I4a Ri Lh b. Owner Email:
Owner Name: 04 N'19X Phone:
Mailing Address:
Physical Address:
Region:
—
Facility Contact: a alinj oy N yc/01- Title: Harao Phone:
Onsite Representative:Integrator: M _P
Certified Operator: .shaA/j/n Certification Number: ca?o) $03
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
� esgn� Current
_Design' Current,;
Design Current
swine -.F CaPacttyq Pop:
Wet`P61 l y ..pac �ty Pop
'Y+Yf
Cattle
Capacity Pap.
'�.'M_.:....?:�si .���.',r�".if0.6.i�`i:h..._.
.. �4.- it .
Non -La er
�Deslgn Current
., �9`•_ '.
airy Cow
airy Calf
Da Heifer
Dry Cow
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
D , P,ouIt , Ca aci Po
La ers
Non -Dairy
Beef Stocker
Farrow to Finish
Gilts
Nan -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
-- - z
Turkeys
-
Other -
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes Eg No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[] No
[] NA
❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) [] Yes [] No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [—]Yes 5g No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [—]Yes allo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facilit Number: - ?y Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_%�
5. Are there any immediate threats to the integrity offaany �of the structures observed? ❑ Yes S 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 tg 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 10 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes D�t No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes'P No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �R No ❑ NA ❑ NE
maintenance or improvement?
11. 1s there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes DR 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,o,[Winil Drift ❑ Application Outside of Approved Area
12. Crop Type(s): ' '
,
l!
13. Soil Type(s): N `
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ER7No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application'?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
N No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Callo
❑ 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
'Q No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
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
21412011 Continued

Facility Number: 13a jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [2j No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes P No DNA ❑ 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 JR) No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No mC NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes C3 No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
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.
JX Application Field ❑ Lagoon/Storage Pond ❑ Other:
32_ Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fait to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes R No ❑ NA ❑ NE
❑ Yes tR'No ❑ NA ❑ NE
'Yes []No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
[:]Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #!): Explain any YES answers and/or any additional recommendations orianv other�,coiMiments
" w�
Use drawings.,of facility to better explain situations (use additional pages as necessary). _ . �
-7, RtDOJ -(br ann 1a) }d tho�yl� -- ins "a�� o��, ��� mU(ch b 'e qq
[ r d ha Nolf 0 1 d cr s awe cd�
�9 � Y✓l�'j old- �.,
b�-, Ofi4 44o her )Oil,
�[. vvi f( nfel4o Cafi bra�-_ +41l{r- y194-
r� U/� / QDI y�
a o© _
I, �l vj+ * a 4,y da 1 a Pr L �0
1 naval S �r c ���s Fill r - l Qj-t— dry -PdII and jt-i� I&,
60a -(mds aad Oco-/i
Reviewer/Inspector Name: � -(ijS 'ia `
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: TLAQ Q1) 1
21412011

Facility No. Sc) 3( Farm Name Date b6do
Permit COC OIC NPDES(Rainbreaker PLAT Annual Cert Daily Pipe)
Lagoon Name, S forspillway
1
21W
3
4
5
6
7
Design Freeboard / Last Recorded in
Observed freeboard
Sludge Survey Date
Sludge Depth_ ft
75,
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA?
M,r:_�;rr.4.w,-IM"Ai MA r_lI.-rrr�=;;r_.r0.9401�ra "S L1rrrii1wJ
tSM;.120.MWActual
Flow
Soil Test Date Crop Yield ✓ Transfer Sheets
pH Fields Wettable Acres 7— RAIN GAUGE
Lime Needed U WUP Dead box or incinerator
Lime Applied j� Weekly Freeboard ✓ Mortality Records
Cu-1 �Zn-1 1 in Inspections Check Lists
Needs S. (S-1<25) 120 min Insp. Storm Water
Needs P nmxr i-, - t0O Iy// Weather Codes
J
Verify PHONE NUMBERS and affiliations
Date last WUP FRO FRO or Farm Records
Date last WUP at farm Lagoon #
App. Hardware Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 lb/ac; Zn-I 3000= 213 lb/ac

Type of Visit: e Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: ® Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: © Departure Time: County: Region:
Farm Name: n er gh& , 10,a N00 �,11�Owner Email:
Owner Name: u� (XV �Q/ Phone:
Mailing Address:
Physical Address:
Facility Contact: shoIng, WIVIor Title: y�,Qd�/, Phone:
Onsite Representative: f j is na, n a- _ Integrator:
Certified Operator: NQ Certification Number: ova qb3
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
"
-Design
Current
Design Current
Swine
C•apacit� Pop.
Vet Poultry
Capacity
Pop.
Cattle Capacity Pap.
anto Finish
La er
Dai Cow
ean to Feeder
f
Non -La er
Dai Calf
eder to Finish
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
1l . P,�ultt:�
Ca petty
P,o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
1.
Boars
Pullets
Beef Brood Cow
Turkeys
Wither
Turkey Pouets
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 CEI-No D NA ❑ NE
❑ Yes ❑ No
[] Yes [:]No
❑ Yes ❑ No
❑ Yes ` No
❑ Yes §allo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA [:IN E
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

10~ao-Irr
Facili Number: '6a - 3 Date of Ins ection: (Cf
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?: _
Designed Freeboard (in): C(_
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
allo ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 6
❑ Yes 1K No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes Q-No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes B No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes t@ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13, Soil Type(s):
14_ Do the receiving crops differ from those designated in the CAWMP?
U Yes
KA No
U NA
U 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
❑ Yes
tR No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
tR No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
CR 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_
'lam 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
E;3'NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: jDate of Inspection: 10
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 12 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 RNA ❑ 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 ER No ❑ NA ❑ NE
❑ Yes Ca No ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
Q 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
0 No
❑ NA
❑ NE
Comments (refer to question ff): Explain any YES answers :and/or any additional recommendations or, auyjother c mom nents.
—:
Use drawings of facility to better explain situations (use additional -pages as nece§sary)., , n
pul k (5 7�So Rod(Ice, capf 06,juj+b2�ie old a�sfvo
Nose_ W Cr k a) bcr-P_go j 61 10 joa,, Ms ide h9, i s a)o( I'O f Re,#,-e mow Ohde.
arks ba-,hh.°' , S
s, Melds n back (J-ec5tV)ar,° wtydr old urn oaNe- Pa, - yol r'� � �`�� e h a..��o� bP�
S f"'014 in {gars, Th>a"e ,�iro�a� b-e /,mold✓ed� -Prop p1�
y
Pfeae chA,l e- Pin/ M4ej why �9e* Cr new wo-ie ,sue, te, Sa„ r�
-fidayS, �� I f H l� ✓rr► j � do,� - Usan�,�o Y P �
S, La C i I I be �so-,� � -for a o [I nee`#- wte k r Yule d 1 sr,�js e t s (cdye� cj o
Lo 00, is I!1 COMP11017(e,
Goal -Ge ld1 al_ re colcb
�� id Dial node Qbo,,e, n4� �odt,eer cofr]
Reviewer/Inspector Name
1
Phone: q(2—I 33 ,%00Ll
Reviewer/Inspector Signature:
Page 3 of 3
Date: Qrta-Q_-aQ t
21412011

142
• . . 3l�
Facility No Farm Name N 5 L� i 11 Date lolaokf
Permit COC ✓ OIC_ NPDES (Rain breaker PLAT Annual Cert Daily Pipe )
FB Dro s
56 r
Lagoon Name, S for so Iwa
1
2
3
4
5
6
7
Design Freeboard 1 Last Recorded in
Observed freeboard
a
Sludge Survey Date
5
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA?
Calibration Date
i - s -
----
---
- ` _ ,
--------
Soil Test Date 1).1�•1p
Crop Yield ✓
Transfer Sheets
pH Fields
Wettable Acres
RAIN GAUGE
Lime Needed
WUP
Dead box or incinerator
Lime Applied
Weekly Freeboard ✓
Mortality Records
Cu-1 �,/Zn-I
1 in Inspections
Check Lists
Needs S (S-1<25)
120 min Insp. ✓
Storm Water
Needs P
Weather Codes
J
=01
►
�7IJILILI�
Ii:l��
��-�
��
�S'11i1
:rallrf�,s,
(P
Verify PHONE NUM7RP and affiliations
Date last WUP FRO$��'� FRO or Farm Records' �a f
Date last WUP at farm Lagoon #
App. Hardware Top Dike
Vk Stop Pump
Start Pump
kip
Conversion- Cu-I 3000= 108 Ib/ac; Zn-I 3000= 213 lblac
Can - fah (T-7-r7e__

Type of Visit aCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit gRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: ar o J County: Sam 5
Farm Name:yayl o-'Sh pe I4a. Wouloh iF+Yrkm�t Owner Email:
!\�r llwnnr Ai�mn• O/ Ath I nVlar PhnnP-
Mailing Address:
Region:
Physical Address:
Facility Contact: S hana m No V I Cr Title: M&aa PT'_ _ Phone No:
Onsite Representative: �� I Integrator: > �-
Certified Operator: .5hayi h oyla- Operator Certification Number: as `403
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ e E::] ' = « Longitude: = o = I =
-> -- Design Currezet d� De Current iM5paci!y
esign Current
Swine CaPopulation ' wetWPoultry ap city 1?opul h n Capacity Population
❑ Wean to Finish ❑.La er ❑ Dairy Cow
❑ Wean to Feeder ❑ Non -Layer I I Dairy Calf
Feeder to Finish Q ❑ Dairy Heifer
❑ Farrow to Wean
} Dry Poultry,";" °��t�,' -. "' � -� ❑ D Cow
❑ Farrow to Feeder °'"Layers � � ❑ Non -Dairy
❑ Farrow to Finish ❑ Layers
❑ Beef Stocker
❑ Gilts ❑ Non -Lavers
Pullets El Beef Feeder
❑ Boars ❑ Beef Brood Co
ElTurkeys
Other; ❑ Turkey Poults
❑ Other ❑Other Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes RNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes CR No ❑ NA ❑ NE
V
3- Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes J�RNo ❑ NA ❑ NE
other than from a discharge?
Page I of 3 12128104 Continued

Facility Number: Date of Inspection
• Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P-No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): q
Observed Freeboard (in : _0 _
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes RNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes UNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4fi were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? rayes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
CRNo
❑ 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
Wo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
N7No
❑ NA ❑ NE
maintenance/improvement?
1. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[�kNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ElEvidence of Wind Drift ElApplication Outside of Area
-��
12. Crop type(s) rekeye- Pnflo am , kht Joy Beim f
13. Soil type(s) Coidibm !-ynCA S ) Na KQhS
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
C&No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement'? ❑ Yes
RNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
tRNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
[`No
❑ NA ❑ NE
I & Is there a lack of properly operating waste application equipment? ❑ Yes
2!�No
❑ NA ❑ NE
Reviewer/Inspector Name (. ) Phone(cf)V Y33- 3920K33V
Reviewer/Inspector Signature: Date: s QP L_ j
Page 2 of 3 121204 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? []Yes [�JNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ERNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E"No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
®-NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
15No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
97No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
allo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification'?
❑ Yes
❑ No
UNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
9No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® 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
K 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
[237"No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
09 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
rLrrNo
❑ NA
❑ NE
Additional Comments and/or Drawings: '
N VOPrn rr'lf _TV, bcf� qm , -ge(ds , Arm p1tVpot fLAp 4 cr6aL7�-
a d ars af-ern,a-li ) a cc0V/ t7 * y /awl
-7, 9V6e Ofs o� l a �l , �u��� frof
`'
A
bock h, free- 14711br.
��✓s s-�r� tk S �i y9� . Also c�� -
�9�
e
m 0 I-,-o v -s►Cfe r -F ba+ r. 1�aj -� o 1 �c�-, h �s ood co
Cooad_ record ,
Page 3 of 3 12128104

)jWi.ecodle 'es-1 B}8 r
t' ¢ �u��rfi �P�
Facility No.q ".3 i Farm Name N[�S 1�� 1 41� }��g Date �
Permit COC OIC_ NPDES Rainbreaker PLAT Annual Cert
i
1 r ' MYM.1
Desig' ' / ■ . •
Sludge Survey Date
'WE, imp
ff, MA�Wnw
• • - r ' /
---
Liquid Trt. Zone (ft)
Ratio Sludge to Treatment Volume
;n r„ F�lo++t^ir r t1a, nS A14nkIa1)1n .F�Mo!,d , 0gnnht-,/71 ran,nf
Design Flow
Soil Test Date lti I la�`i f'�
Wettable Acres RAIN GAUGE
pH Fields
WUP Dead box or incinerator
Lime Needed
Weekly Freeboar� Mortality Records
Lime Applied
1 in Inspections
Cu-1 Zn-I ✓
120 min Insp.
Needs P
Weather Codes
Cann Yield
Transfer Sheets
WIN �Omm
.1 r.
.1 r.
i Z
Pull/Field
Soil
Crop
Acres
PAN
Window
Max Rate
Max Amt
-w
1 / D
IS
tiROIL
For
Verify PHONE NUMBER§ and affiliations
Date last WUP FRO q13f 01 Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Ib/ac; Zn-I 3000= 213 Ib/ac
App. Hardware
x

j�e, -(IIL
bye
)OV
Qj
-e - -�c Ja H
3P�,c /1Qq

r
11
S'�L' M. owl
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine O Complaint 0 Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
. I
Date of Visit: / O Arrival Time: Departure Time: r County: ^ti Region:
If
Farm Name: /` o2.i Owner Email:
Owner Name: /VD!`M4h/ _ . Ldr Phone:
Mailing Address:
Physical Address: ``,,
Facility Contact: c�aL Zv _ Title: /i&rdt er' _ Phone No:
Onsite Representative: [ Integrator: IV-6
Certified Operator: ��� U Ar Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = 1 ET
Longitude: = ° 0 I [=1 N
Design Current
Design
Current Design Current
Swine Capacity Population
Wet Poultry Capacity
Population Cattle Capacity Population
El Dairy
❑ Wean to Finish
10 Layer
Cow
Calf
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure [IApplication Field [IOther
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?
ElYes Ly'No ElNA ❑ NE
❑ Yes ❑ A ❑ No 2 NE
❑ Yes ❑ No L'lrA ElNE
❑ Yes [I No UNA [I NE
❑ Yes lfd'No [INA ElNE
ElYes UKo ❑ NA ❑ NE
12128104 Continued
ElYes UKo ❑ NA ❑ NE
12128104 Continued

r
l
Facility Number: 8, 1_ Q3/ Date of Inspection
Waste Collection & Treatment ,.,/
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes 0 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / 9-
-Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
ErNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
�
B 1Vo ❑ 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 environmentalthreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes
�L7,�No
IJ �vo ❑ 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
9lo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
,--,
ffli< ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
,�,
L1 0 ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop ❑ Evidence of Wind Drift ❑ Application Outside of Area
%Window
12. Crop type(s)�5cr�� r �Gy , CtJ1l,�-sa/
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
L'SNo'
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
2 o
ElNA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
Yes
El2
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes
�"No
2<0
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
@<
❑ NA
❑ NE
y endat� ns orb y other`fcomments. Comments (refer to question #): Egplain� any YES answers and/or an recomm 4
Use drawings of facihty to better explain. situations. (use additional pages as pceSSary e r fi-
ReviewerlInspector Name€ Phone:
Reviewer/Inspector ' nature: Date: l 4
1218104 Continued

{
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps
p El Other
❑ Yes 2hio ❑ NA ❑ NE
❑ Yes 21 o ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
To
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
Yes
El/
,❑
I� No
NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
❑ NoE
,❑l S
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
R <o
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
B<o
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
ElM Yes
o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
EWA
❑ NE
Other Issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 011 o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2 o
❑ 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
_,
M1 o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
a<o
❑ 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
9Xo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
gd'No
❑ NA
❑ NE
A`d�honal�Cou;ments audlar�Drav lugs:
61n
12128104

L,
Type of Visit i$Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit aRoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: ® Arrival Time: Departure Time: County: anjual Region: t
po
Farm Name: �Eswhp j4a.10wha F Ab aI Owner Email:
Owner Name: Na rn a, Or __ Phone: Q QD "D 5 Lf-7 (�
Mailing Address:
Physical Address: _%l L
Facility Contact: _Sbannon Naylor Title: t7am Na r Phone No:
Onsite Representative: ,, rr Integrator: V A l0"
Certified Operator: f Ag-orlon _ NQdor Operator Certification Number: Awa)qm-
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = ` = ' Longitude: = o = 6 0 fl
I
Des n
airy
C ° " y ' gn rent
ur
�` 4
Design Current
ine _ Cap
rPFE3
Pao pulahon Wet Poult ry
_ .,�:.. wnp..^.,
Ca •a-c► Po Mahon "
p'a''ty
Cattle Ca pacify Population
Wean to Finish
Wean to Feeder
❑ La er
JE1 Non -Layer 1
D "Point
❑ Dai Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
Feeder to Finish
ZjbQ
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Non-Dai
❑ Farrow to Finish
❑ La ers
❑Non -La ers
❑ Beef Stocker
El Beef Feeder
❑ Gilts
❑ Boars
El Pullets
❑ Beef Brood Co
Other
❑ Turkeys
, y ❑ Turkey Poults
❑ Other
Number of Structures:
❑ Other
Discharges & Stream Impacts
1 _ Is any discharge observed from any part of the operation?
❑ Yes
['No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
V"No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
El NA
ElNE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
,9No
CgrNo
❑ NA
❑ NE
other than from a discharge'?
Page I of 3
12128104
Continued

Facility Number: aZ —3r Date of Inspection d 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes CRNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): q q
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes W 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 D@ 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 ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes IR 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 R No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes IR No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Cnfh VhPoi sfi * bolviS ` �_Cr va {
13.
Soil type(s) lr 0 A Is,. L r) S I , No B is s [
a —
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Pa 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
12 No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
CR No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
N No
❑ NA
❑ NE
Reviewer/Inspector Name ' A/ $C Phone: 9 Q-c�3L�X33a��
Reviewer/Inspector Signature: Date: Aft="Q
Pape 2 of 3 12128104 Continued

Facility -Number:$ a -3 Date of Inspection Eaufl
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? N Yes ❑ No ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 5 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 5JNo ❑ 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 [3jNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No CR 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
O No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ERNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
CRNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
allo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E�k`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
R1 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
9INo
❑ 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
NNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
NTlo
❑ NA
❑ NE
Additional Commedts and/or Drawings:47
:k`Aid.
•}
-7, Pfehe_ mot~ 04side of I ,!j0 1, a
P1 adcCclaj �1foo�l v .se�J cad �r do P� h o��- odd �cr�'� h�1�1:
boon 1 WS14e_'g4-r'0'0"dT�Se'r'q,
Ta,i ,y is rvWk j6� stPdje mr79,%„1--r 1ftV OJI*7a ---IVledMe
1 �C�arn�shs�P` I2G
R r rn�sle�
Page 3 of 3 12128104

Facility No.`6331t ---Farm Name [�-�+�t�� `�� Date [(0Ax _
Permit COC OIC NPDES (Rainbreaker PLAT Annual Cert)
Pop -Type Desi n Current
FB Drops
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
a?
Sludge Survey Date
Sludge Depth ft& %
Liquid Trt. Zone ft
����''*•T1/: Diu �'�^N_
Calibration Date
1
2
3
4
5
6
7
8
Design Flow
Actual Flow
Design Width
Actual Width
Soil Test Date�2
pH Fields ✓
Lime Needed
Lime Applied joy-
Cu Zn
Needs P
Crop Yield ✓ `C, j'y
Wettable Acres /
WUP
Weekly Freeboard �G
Rainfall >1"
1 in Inspections ✓
120 min Inspections
Weather Codes
Transfer Sheets
RAIN GAUGE
ail!
�
I �
s •�
c
itI/1�
I
1
�
Verify PHONE NUMBERS and affiliations
Date last WUP FRO 10f0s' Date last WUP at farm App. Hardware
41 - tad ram# hod
FRO or Farm Records siq r r 4� 1
Lagoon # I Asa; ( �( i �e
Top Dike 51.0 tb
Stop Pump 41') J *1 �
Start Pump 4rf3

t
P I K5 'UVS
11, SP pi-s-. X09
Type of Visit XrCompliance Inspection U Operation Review U Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine 0 Complaint Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: i� y�� Arrival Time: r 3 a Departure Time: County: SAPS61 Region: ` #QQ
Farm Name: ��'s' I� ( Owner Email:
Owner Name: _ IUtmdlrS�IG►z Phone:
Mailing Address:
Physical Address:
Facility Contact: „ ShAnM . Ala y l &7' Title:
Phone No:
Onsite Representative: h��,,,� �/ Integrator: �J
Certified Operator: Sh§n fv a k Operator Certification Number: �� r0.
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: [= 4 [= ` =" Longitude: 0001 = 9
Design Current
Desgn Current
Design Current
Swine Capacity Population
Wet PoultryCapacityP-�op�ulat�on
C$e Capacity Population
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ Wean to Feeder
❑Non -La er
❑Dai Calf
❑ Feeder to Finish
❑Dai Heifer
❑ Farrow to Wean
DryPoaltry r.�-
❑ D Cow
❑ Farrow to Feeder ...:.`` 4..:, •: ;�. :,
El Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Co
El Turke s
Other
❑ Turkey Poults
�"
❑ Other
❑Other
°, Number of Structures:
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?
Page 1 of 3
❑ Yes ❑ No ❑ NA 9NE
❑ Yes
❑ No
❑ NA
t�rNE
❑ Yes
❑ No
❑ NA
RNE
❑ NA
RNE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
SL14E
❑ Yes
❑ No
❑ NA
D�NE
12128104 Continued

V
Facility Number: 5aL— 3! Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a __
5_ Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes VNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes CgNo ❑ 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 DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA tia'NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes CgNo ❑ NA ENE
(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 ❑ No ❑ NA RNE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA [ErNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA A NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
RNE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
aNE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
R NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
RNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
RNE
Comments (refer to question #): Explain an} YES answers and/or any recommendations or any other comments (q.
Use drawings of facility to better explain.situations. (use additional pages as necessary).
ro
•
Reviewer/Inspector Name �s'�,�j�1
Phone:- 433-330P
Reviewer/Inspector Signature:
Date: 413 (0 $
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection I q 1310 y
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑,No ❑ NA JR NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check [:]Yes [--]No ❑ NA E9:1VE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El 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 Cade
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
laNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
RN
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
®'NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
U'NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
W No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
WNE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
91 NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
aNE
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
kNE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
)a NE
General Permit? (ie/ discharge, freeboard problems, over application)
32,
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
C&No
❑ NA
*NE
33.
Does facility require a follow-up visit by same agency'?
❑ Yes
RNo
❑ NA
WRE
Additional Comments and/or Drawings f.�.
�Mr ��1� 0 �` S'�+��e D'1 � �1�� 1 , r YV� � (� ✓m� � ��f� � 1 � n �f" ��e
V'sid--' P revs e► r h r" h Ate— hp� ,�r� Febnw ,
� � y
Page 3 of 3 12128104

r.]
F-n �I�ts 0101o� �S
Facility Number $a 31
OF Division of Water Quality
Q Division of Soil and Water Conservation
O Other Agency
Type of Visit EE Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit'& Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: 1,00 P County: S
Farm Name: NQyl&- 2 4a Owner Email:
Owner Name: A dCt1_'I GEC May Lor Phone:
Mailing Address: 3t'v c[ Nca Sag
Physical Address:
Facility Contact: ghannm A/Qv 1W Title:
Onsite Representative: L ,,
Certified Operator: S hhknai Pax[*,
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
10 Wean to Finish
❑ Wean to Feeder
IR Feeder to Finish �"�A
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Cilts
❑ Boars
Other
❑ Other
Region:
Phone No: II/0-9q0-asy7�e 1
Integrator: _P vf&-syoy/7
r I
Operator Certification Number: Z)i q03
Back-up Certification Number:
Latitude: 00 0 4 = « Longitude: F-1 0 0 ` = u
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ urkey 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?
Cattle Capacity
❑ Dair
y Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures.ET I . I
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 ®'No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
A No
❑ NA
❑ NE
❑ Yes
OR No
❑ NA
❑ NE
12128104 Continued

Facility Number: Q — 3 ] Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 52 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): tiq �q
Observed Freeboard (in): of !R 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes CRNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes RrNo ❑ 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? I&Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
EZNo
❑ 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
CR 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
KNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift ❑ Application Outside of Area
W 12. Croptype(s) rn Wh*­�.So►ibeals VM3Y'_ -
T
j f
13. Soil type(s) GaA Ln, PoB P-0.,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
CKNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
NrNo
❑ NA ❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
U No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
Y No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
QTNo
❑ 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):
Reviewer/Inspector Name 7041v3dintl Phone: In L133-3360
Reviewer/inspector Signature: Date:
I2/2R/Ad Continued

Facility Number: g a — 3)bj Date of Inspection d Q
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Wo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes CRNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
❑ No
iR NA
❑ NE
❑ Yes
[5j No
❑ NA
❑ NE
❑ Yes
ff No
❑ NA
❑ NE
❑ Yes
[2fNo
❑ NA
❑ NE
❑ Yes ❑ No RNA ❑ NE
❑ Yes 5'No ❑ NA ❑ NE
❑ Yes BNo ❑ NA ❑ NE
❑ Yes [KNo
❑ Yes 54No
❑ Yes 9No
❑ Yes 5rNo
aSr SltJje Sv rye -to be dot -e e- ry 4 r
SI�� �.a►as fi�� ler"9h i�t aa�� ex�r,(� Fvrm�++�'-
�`etd ooJ h A e ld- r,
� h �sm iW .
S 1 mac(,, M b� be Snead
a#, Uvne. O- witle AW ys,s- IW- q` 1qb, Yeas aw-ao4 kit 4--r al IP" W�
Li6it was apr1lied rn a 4o7) grfe(anm,dea , �sall
Retreauati).e, rewdr bed iv home- -�e� loose pT CW Add loateleaf-or
'MeYrar IooseIeaQ- . Wt1 3y1sLR, 1e6}lCh fetvkPd sQe),
�n1 y cOrh ��0�1Ie�, s'g7lm 9� 01007 (ho `� �� betel
-7, 9arh+ 1" oW_ pakh �Ok) in i flp off- fVJ i nit e 1"pej , Also PA► 4kl i n bank nPu--
i If,, %,d, e..s61ij � cov,P,,
agc - flehe, remvue,'t tos h ald clip infof )ajo�
(;O,j_UWCMf
[I NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
12128104

z z."/z eru (o
Type of Visit Q Compliance Inspection Q Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine Q Complaint 0 Follow up 0 Referral 0 Emergency Q Other El Denied Access
/
Date of Visit: 12-/8-40(q Arrival Time: Departure Time: Z 3 O County: Q OAI Region:
Farm Name: /YQu t�Olrt.J �!e 3' Z // Owner Email:
Owner Name: �DI�wi4n/ Ala [t 1+, Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 571,,N_o J /a Fr
Certified Operator:
Back-up Operator:
Phone No:
Integrator: �U �'� �� �/?.7 �✓�
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: E__1 o = ` = `= Longitude: E=1 o = "
Design Current-� Design4`Current Design Current
"Wean
Capacity Population 'Wet'ePouitry Capaity�Population Cattle Capacity Finish " ❑ Layer ❑Dai Cow
VeantoFeeder L ❑ Non -La er ❑Dai Calf
eder to Finish 2q D O :; a�M ,'_' ❑ Dairy Heifer
�`A,;'�' ❑ D Cow
Farrow to Wean M
.:Dry Poultry: .F.
❑ Farrow to Feeder ❑ Non -Dairy
❑ farrow to Finish ❑ Beef Stocker
FE313oars
Gilts ❑ Beef Feeder
❑ Beef Brood CoAJ
- - ---
Other
❑ Other Number o#�5trtschires:
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[WNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[M No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
OrNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: gZ - 31 & I Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
❑ Yes 10 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes No
❑ NA
❑ NE
Structureo Structur 20 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2 51— 2_7
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 [fl 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 I No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes Q6No ❑ 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 ElNA ElNE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes 0 No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [%No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) 62r PJL,-,- So 4 r a •✓x 7 s eu c- Al sA' .- 4
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16_
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
R No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
KNo
❑ NA
❑ NE
i &
Is there a lack of properly operating waste application equipment?
❑ Yes
P2 No
❑ NA
❑ NE
`Cotnuients (refer to question #) Explain any YES answers and/or any recotnmendations or any othercomments
Use drawings of facility to better explain situations. (use additional pages as necessary):
i
Reviewer/inspector Name ]Phone: 910) Y33- 333©
Reviewer/Inspector Signature: Date: %Z - / 8- Z 4 a (�
Page 2 of 3 17J28/04 Continued

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

Type of Visit 4D Compliance Inspection O operation Review O Structure Evaluation O Technical Assistance
Reason for Visit *Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: / Arrival Time: Departure Time: County: 5;(&,ee4K,__:Region:
Farm Name: 111�v�a/'t Sw,ne, f �..��,� Owner Email:
Owner Name: _ r IVr..: JQr Phone: 9/0_- Sa' . - '�CV -7
Mailing Address: 3Gi__ f /en _ G/.;, f�:� )VC —
Physical Address:
Facility Contact- SL,�.,.� 44a y Zoom/ Title: Phone No:
Onsite Representative:-�'6f.*04 ,, /vaxZQ Integrator: hlia'o�x ` aLLZ
Certified Operator: SA"a acki ��,0 r Operator Certification Number: r0 y! `1O 3
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 1 ❑ Longitude: ❑ o = 1 = "
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑'Feeder to Finish �711& 0 c1
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ on -Layer
Dry Poultry
❑ Layers El Non -Layers
Non -La ers
❑ Pullets
❑ Turke s
Other ❑ Turkey Poults
❑ Other ❑Other E
Discharecs & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance reran -made`?
Cattle
Design Current
Capacity Population:
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
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 &H o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NI
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
❑NE
❑Yes
[,:1,NNo�o
❑ Yes
L�'ivo
❑ NA
❑ NE
❑ Yes
E'IVo
❑ NA
❑ NE
12128104 Continued

r }
Date of Inspection �r1
Facility Number: —
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Q-<o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?: n o h
f
Designed Freeboard (in):
Observed Freeboard (in): ,-;2-,Sj
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Q W ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
©moo ❑ 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?
©ems
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
DNo (DNA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
El Yes
M'o El NA [I NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El,�--,,
Yes
�
L y'►�o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
,�
Q< ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ]0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
L • n
�.7V 06 3ti 0. 6
12. Crop typeC�' A
a/,- `17
dcc�,r s
7d
i s)
lL�t �� ,. ,l �. n e3 �1�, Cra.,, k-_ ' ,�'
Ers �� e
13. $oil type(s) /�n Lrl
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
D-N ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No ❑ NA ❑-Nf
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
❑ No ❑ NA 0-TTE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[a<o ❑ NA ❑ NE
18. Is thereta lack of properly operating waste application equipment?
❑ Yes
❑ < ❑ NA ❑ NE
t(fq;. 4 Es �ut �j.-. mu.:.�Sd`��b[t�.!�'. .
mnu3
ny
oEpx er comments.
Use drswmygs`�onfEfacthty tolhetterfezplasu srtaations. (nse�addthonal pages(asroneces ------
7' �Gv:J , - GYFrrS 0 F c'![*s;n u.-ac nc� r�sc�l ujr lo,;oe5 n eec/ /c 4e /tf+u•:r��
(� UfP[ti a c'err.% IG <!C'1' /11,^ AIC,7Iv bus P ejS �c, rel r"r T-Ae,,
Reviewer/Inspector Name �•r �YP7 / , Phone: ��/O- 4ye /S`r/c'.��
Reviewer/inspector Signature: ,. Date:
I2/2&04 Continued

. .
[Facility Number: �.. — 314 1 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes © TKo ❑ NA ❑ NE
20. Does the facility fail to have all com nents of the CAWMP readily available? If yes, check ❑ Yes 2-f fro El NA ❑ NE
the appropirate box. ❑p ❑ Ch�ek'lis[s �t}� ❑De ❑❑ er
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes O'l�o ❑ NA ❑ NE
❑ Waste AWfication ❑ weekip mr-d ❑ Was ❑ Sad Analysis ❑ Waste-Trattt;fers ❑ Annual-Gertifiration
❑ Rain€all ❑ st e g ❑ C-rop-Yieizl- ❑ 1-M-Minute-haspections ❑ Mon44y-and4-L-Ram4=pections ❑ Weatkw*-Eoc
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
O-Wo
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
EJ-1'GE
❑ Yes
❑ No
❑ NA
ONE
❑ Yes
❑ No
❑ NA
�TE
El Yes
❑<lo
�❑ NA
©-9E
❑ Yes
❑ No
❑ NA
aE_
❑ Yes a -No ❑ NA Cl NE
❑ Yes ErNo ❑ NA ❑ NE
❑ Yes [rNo ❑ NA ❑ NE
❑ Yes [a No ❑ NA ❑ NE
❑ Yes ED"No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
J c
1-P C c7etl
7 re(
4-.f e/s
e,, 7 eJ n&
�
12128104

Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit *Routine 0 Complaint C)Follow up O Emergency Notification O Other ❑ Denied Access
Facility_- \umber Date of Visit: �Off/ Time: i0 = b O
ro Not Operational Q Below Threshold
JZ Permitted ® Certified ❑ Conditionally Certified ❑ Registered Date Last Operated or above Threshold:
Farm Name: A/ar S 4 'a 'I A County: aV1, la.S0 AJ FR-0
Owner Name: AR A A Ly 4L,
W A Phone No:
Islailing Address:. 3 G Q %loafs Gic'f>� /tp� _ _ �� t+ Q,,,r .�� 3
Facility Contact: Title: Phone No:
Onsite Representative: 5 9 a h a y�1 Integrator: •fir — B r is w N
Certified Operator: L4 AJAJ*" NT44 Operator Certification Number: _A 102,
Location of Farm:
QrSwine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 0° �" Longitude « �• ��
Design Current
Swine Canacity Ponnlation
❑ Wean to Feeder
® Feeder to Finish
❑ Farrow to 1Vean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Ca acitti Population Cattle Capacity Population
❑ Laver I I❑ Dairy
❑ Non -Laver I I Non -Dairy
Other
Total Design Capacity
Total SSLW
Number of Lagoons I a(❑ Subsurface Drains Present J0 Lagoon Area !❑ Spray Field Area
Holding Ponds /Solid Traps ❑ No Li uid Waste Management Svstetn
Discharges S- Stream Impacts
1. Is any dischame observed from any pan of the operation? El Yes No
Discharge originated at: ❑ Lagoon ❑ Sprav Field ❑ Other
a. if discharg is observed, was the conyevance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed. what is the estimated flow in sal/min? /V /A
d. Does discharge bypass a lagoon system? {If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any pan of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [X No
Waste Collection 8- Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes to No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): 3 02 A <S
05103101 Continued

Facility Number: 9 a — ,3/j, Date of Inspection
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
closure plan? El Yes ® No
(If any of questions 4-6 was answered yes, and the situation poses as
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes [30 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9_ Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste Annlication
10_ Are there any buffers that need maintenance/improvemcnt?
❑ Yes
® No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
[] No
12. Crop type eSC
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
® No
b) Does the facility need a wettable acre determination?
❑ Yes
U No
c) This facility is pended for a wettable acre determination?
❑ Yes
M No
15. Does the receiving crop need improvement?
❑ Yes
[B No
16. Is there a lack of adequate waste application equipment?
❑ Yes
® No
Reauired Records & Documents
17, Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes [Z No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes E� No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes 53 No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ® No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes [�] No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes V] No
23. Did Reviewer/hispector fail to discuss review/inspection with on -site representative? ❑ Yes [IANo
24. Does facility require a follow-up visit by same agency? ❑ Yes M No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 71 No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
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Reviewer/Inspector Name
Reviewer/Inspector Signature:
O5103101 V
® Field Copy ❑ Final Notes
❑i
Continued

Site Requires Immediate Attention:
Facility No. .2 - f
DMSION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 7�tv as , 1995
Time: t a, 00
Farm Name/owner: LOCO
'Mailing Address:
'County:_ Sa r•+ nson
Integrator: C .�M ws
On Site Representative:-,
Physical Addressll=ation:
Type of Operation: Swine X Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:E ° Qom' , :T Longitude: $ " Z&' M
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or(& Actual Freeboard: Ft. L�Inches
Was any seepage observed from the lagoon(s)? Yes or(&Was any erosion observed? Yes or No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
• Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin s? J&or No
100 Feet from Wells? or No
Is the animal waste stockpiled within l00 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray -irrigated within 25 Feet of a USGS Map Blue Line: Yes or No "CA.
Is animal waste discharged into water of the state by man-made ditch, flushing system, or -other
similar man-made devices? Yes or® If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No .� �l��kd a,�
Additional Comments:
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Inspector Name tkkA,;tlt ?e��..at o t�ticc Signature
Su; t•t 714 h)e.C"v.a 13td.
Ro.y t4-1e..; ere Ne =aso 1
cc: Facility Assessment Unit Use Attachments if Needed.