820323_INSPECTIONS_20171231

NUH f H UAHULiNA
Department of Environmental Qual

I
Type of Visit: fJCompliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: &I routine Complaint Q Follow-up O Referral Q Emergency O Other Q Denied Access
:a /114..5-
Date of Visit: `i / Arrival Time: �� Departure Time: ,= County: Region:—]
Farm Name: i ✓Y�� f�Z! 7"Gtrr77� Owner Email:
Owner Name: Cn�y t�'��yn �, Phone:
Mailing Address:
Physical Address:
Facility Contact:z-7./ 9�62."_ Title:
Onsite Representative:�e�r.L� `
Certified Operator: J�S`i u Q �P1rJrn�
Back-up Operator:
Location of Farm:
Latitude:
r. Phone: 1/
Integrator.
Certification Number:/
Certification Number:
Longitude:
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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes fig No ❑ NA ❑ NE
❑Yes
No
❑NA
❑NE
❑Yes
No
❑NA
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry ^�@apacity
Pop.
Cattle ' Capacity Pop.
Finish
La e5-
Dai Cow
Feeder
Non -La e5-
Dai Calf
feedero Finish
VFarrow
pa
Dai Heifer
o Wean
Design
Current
D Cow
o Feeder
Dr Pnrtlt
Cti acit
P,o .
Non -Dairy
Farrow to Finish
La ers
Seef Stocker
Gilts
';
on -Lavers
Beef Feeder
Boars
I
JPullets
Beef Brood I---
owTurke
s
Turkeys
"'
h
Other
Turkey Poults
Other
Other
i,, ,��
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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes fig No ❑ NA ❑ NE
❑Yes
No
❑NA
❑NE
❑Yes
No
❑NA
❑NE
[:]Yes ❑No
[:]Yes ® No
❑ Yes ® No
❑NA ❑NE
❑NA ONE
DNA ❑NE
Page 1 of 3 2/42015 Continued

Facility Number: - J DaEe of Inspection:
Waste Collection & Treatment
t 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):
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.)
�
Afo [DNA F] NE
❑No ❑NA ❑NE
Structure 6
[:]Yes ONo ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[Z No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
C -No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
8 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
MNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
KNo
D NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
Eg-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 ❑ Evidence of Wind Drift Application
Outside of Approved Area
%Window
�❑
12. Crop Type(s): �h'/Y' ,u �BZf7'� 7�t' _ Gr l Y� �LG%Ji��� S*1�1�Y�
• +S
/rS Ct ` -�
13. Soil Type(s): ,(f , r`' r_ G'fii
11
14. Do the receiving crops 4iffer from those designated in the CAWM P?
❑ 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
SMNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
allo
❑ 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
(LNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[R 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 aN
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [:]Waste Transfers
[:]Rainfall E]Stocking ❑ Crop Yield El 120 Minute Inspections ❑ Monthly and l" 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 [0 N
o ❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA F-1 NE
No
❑ NA ❑ NE
Page 2 of 3 2/412015 Continued

Facili Number: - 5 Date of Inspection: —/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ T No ❑ NA ❑ NE
25. Is the facility out ofcompliance with permit conditions related to sludge? If yes, check D Yes allo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [RNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes M–No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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 5jNo ❑ NA ❑ NE
❑ Yes [A No ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
[]Yes ELNo ❑ NA ❑ NE
❑ Yes [ No
[:]Yes ® No
[:]Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments {refer to gneshoii ia7 yExplam any;YES answers and/ortany additional recommendaiians,or,,any fltl�'elruCominentsik" ,
gs' of facilityi to beta. j -
Use�drawm er,explatn:s�titation.s,.(use additional gages asp©ecessary
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: '/�4~3D37__CV5_]
Date: Z 2_—aa
2/4/2015

t ype of visit: Kd-eompnanee inspection v uperaiion rcevtew u airucture r,vatuauon u i ecnnteat Asstsiance
Reason for Visit: O Routine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: Arrival Time: Departure Time: ' g -e) County: Region: 72L0
Farm Name: ; VV -3 /»'(, Owner Email:
Owner Name: p Phone:
Mailing Address:
Physical Address:
Facility Contact: /�/�}Os�� Title: r�
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:g
Certification Number:
Longitude:
Discharp_es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made`?
b. Did the discharge reach waters of the State? (If yes, notify DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes []No
❑ Yes EjNo
❑ Yes ( o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued
Design Curren
_.
ignzLUopurrent
Swine
C*apacity Pop.
Wet Poultry
Capacity Pop.
wo
Cattle Capacity
P.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Z3 Da
_=
Dai Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
I
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I 113eef Brood Cow
Turkeys
h
Other .
Turkey Poults
^-
Other
Other
_-
Discharp_es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made`?
b. Did the discharge reach waters of the State? (If yes, notify DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes []No
❑ Yes EjNo
❑ Yes ( o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: - Date of Inspection: �3 Q—
! Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? 0 Yes Wo ❑ 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 jq_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 12 -No
❑ NA
❑ NE
waste management or closure plan'?
❑ NA
❑ Yes
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 E4 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 [INo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required butlers, setbacks, or compliance alternatives that need ❑ Yes Jallo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 1310
❑ 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
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 0 No
❑ NA
❑ Yes
Ig No
❑ NA
❑ Yes
allo
❑ NA
❑ Yes
� No
❑ NA
❑ Yes
® No
❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [aNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes J�J_No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21 _ Does record keeping need improvement? I f yes, check the appropriate box below. ❑ Yes EZ -No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [3 Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes JZ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 1 -No ❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facili Number: -45 jDate of Inspection: L30 —
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [allo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® 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 0 No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [] Yes 'S No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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
E] NA ❑NE
D Yes RNo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes 3 No ❑ NA ❑ NE
❑ Yes C3 -No ❑ NA ❑ NE
[:]Yes
allo
[] NA
❑ NE
❑ Yes
Pj No
❑ NA
❑ NE
❑ Yes
®.No
❑ NA
❑ NE
Comments (refer,to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations fuse additional Wages as necessarvi.
Reviewerhnspector Name:
Reviewer/Inspector Signator
Page 3 of 3
Phone:/lJ-S'a0 r�L
Date:
21412015

Wj
Type of Visit: 4aCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance i
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency Other 0 Denied Access I
Date of Visit:
Time: ��
Departure Time: ,'
County
Farm Name:
/Arrival
� i ,A !L— I), /ix_/»j
Owner Email:
WetiP;oultry
Capacity- Pop.
Cattle Capacity Pop.
Owner Name:
C 0j4j1 � 617 An
— Phone:
Layer
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:_
Certified Operator: ��� A � #�•7L 5
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: /%f
Region: /10
Certification Number: 9�r99"
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Design Current
run
Design Current
Design Current
Swine
Capacity Pops
WetiP;oultry
Capacity- Pop.
Cattle Capacity Pop.
Wean to Finish
❑ Yes
❑ No
Layer
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
Da'y Cow
Wean to Feeder
❑ NA
❑ NE
-Layer
Dairy Calf
Feeder to Finish
d. Does the discharge bypass the waste management system? (If yes, notify DWR}
❑ Yes
1' kd ILII IUP
IIS'
Dairy Heifer
Farrow to Wean
❑ Yes
No
r
Design Ceirrent
Dry Cow
Farrow to Feeder
E3 -No
❑ NA
"D .Point :
Ca aci -- I'o .
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
<
Turkeys
Other
, ':� "
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
run
❑ 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
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
E3 -No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2014 Continued

} Facility Number: - Date 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 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 0 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[a No
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
D,No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
aYes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
C, No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[4 No
❑ NA
❑ NE
maintenance or improvement?
J!�No
[] NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Waste Application
MNo
❑ NA
❑ NE
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
JE] 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
❑ 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):
❑ NE
14. Do the receiving crops
uvui uwx uc3Jrnatcu iu LIM %Z -L TV lru :
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes
❑ Yes
❑ Yes
Ni
❑ NA
❑ NA
❑ NA
❑ NE
❑ NE
❑ NE
❑ Yes ® No ❑ NA ❑ NE
[:]Yes [KNo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
JZ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
D,No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall E] Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and l" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
J!�No
[] NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
MNo
❑ NA
❑ NE
Page 2 of 3 2/4/2014 Continued

• Facility Number: - 3 Date of Inspection: -�
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Callo
i 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [::]Yes allo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a 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 allo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes a] No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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
E] NA ❑NE
❑ Yes 53 No ❑ NA ❑ NE
❑ Yes .® No ❑ NA ❑ NE
❑ Yesj� No ❑ NA ❑ NE
❑ Yes [allo ❑ NA ❑ NE
❑ Yes
[3 No
❑ NA
❑ NE
❑ Yes
[3 No
❑ NA
❑ NE
❑ Yes
12 No
❑ NA
❑ NE
Use drawtn of faciit #o better ex lain situations use addihoaal° � additional recommendations or any ot<rer cottimedt`s"�"' '� k
Comments (refer to question Explain an answers and/or an a
as aecessa
n') _- _ -
'— /jam r�Qt ✓tat-! ca-
r �f
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ��
Date:
2/4/2014

type of visit: tve:ompteance inspeenon v vperatton xeview V structure r,vaivanon u iecnntcai Assistance
Reason for Visit: ( routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:
Arrival Time: p p
Departure Time:
County: _Ilff� Region: Ei� (7
Farm Name:
; •l i -r S i � � f 42 y)" s
Owner Email:
❑ NE
❑ Yes
[a No
Owner Name:
❑ NE
Phone:
Mailing Address:
Physical Address:
Facility Contact: e& nE zn_on' - Title:
Onsite Representative: 1 s
Certified Operator: 464 aa- %U CZ,, A,A ?
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: iYJ,—.-n Offl r. -
Certification Number: z 2M a
Certification Number:
Longitude:
Design Current rt = Design�Current . Design Current
Swine Capactty Pop WetPo ltu ry Capacrty Prop. Cattle Capacity Pop.
Wean to Finish airy Cow
Wean to Feeder airy Calf
Feeder to FinishDairy Heifer
Farrow to Wean, _ . = Design Cuirent. Dry Cow
Farrow to Feeder D . W-�Uuzu.y Ca 40 Non -Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non -La ers Beef Feeder
Boars Pullets Beef Brood Cow
Turkeys
Other :a" Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes allo 0 NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[a No
❑ NA
❑ NE
Page I of 3 2/4/2011 Continued

i
1
R
r} FaciliNumber: - 3 Date of Inspection: / �- 3 /
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): r
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.)
a No ❑ NA ❑ NE
[]No ❑ NA ❑ NE
Structure 6
❑ Yes ®No ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a []Yes RNo ❑ 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 Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes r.No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving
unser from inose acslgmatca in the �rAwmr:
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
❑ Yes
® No
5No
O No
❑ NA
❑ NA
❑ NA
❑ NE
❑ NE
❑ NE
[:]Yes allo ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? []Yes 5,No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes KNo ❑ 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 KNo
❑ 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 [R No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes D3,No
❑ NA ❑ NE
❑ Weather Code
[—]Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 214/1074 Continued

r -
FaciliNumber: jDate of inspection:
j 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes (A No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes P No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [] Yes ® No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
f:7 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 file drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
to 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
[?I No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
fo No
❑ NA
❑ NE
Comments
in any
S Answers and/orany­ additional
Use drawings (refer
f.facility o better explaain situatio s {u a additional pages as neces ary) menda� ns or any ot>ie c ts. #
G•'� liar` �. �L.d��'-- ,�-�•
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2014

i
' ' vision of Water Quality �""�
Facility Number ®- ® O Division of Soil and Water Conservation 13
eQ Other Agency
Type of Visit: ompliance Inspection 0 Operation Review ()Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency 0 Other 0 Denied Access
Date of Visit: - 3-13 Arrival Time: j D : Do Departure Time: : 3 County:, Region: lizz
Farm Names Z) J I � Owner Email:
Owner Name: �a r1 H rno-lc) /'l k Phone:
Mailing Address:
Physical Address:
Facility Contact: �� rf' %%�DII�`� Title: rjlYG. Sp 6 Phone:
Onsite Representative: Integrator:// 01'_pU.!%L
Certified Operator: LA), !t ate S Certification Number: V/v yam%
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Dischar es and Stream Im acts
1. Is any discharge observed from any part of the operation? []Yes ONo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [:]No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:)Yes ❑ No
[:]Yes CR No
[:]Yes KNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/412011 Continued
Design
@urrenf f
Design
Current
Design Gnrrent
Ca aci
P h
P 3 Wet Poultry
P
Capacity
Pop.
Cattle Capacity Pop.
Weaneto Finish
a er
Dai Cow
Wean to Feeder
on -Layer
Dai Calf
Feeder to Finish
Farrow to Wean
Dp
Design
Ctirrent
Dairy Heifer
Dry Cow
Farrow to Feeder
Dry P,oultr
Ca aciPo
. _
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
s
Beef Brood f--
owTurke
Other
+ Turkey Poults
Other
Other
_
Dischar es and Stream Im acts
1. Is any discharge observed from any part of the operation? []Yes ONo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [:]No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:)Yes ❑ No
[:]Yes CR No
[:]Yes KNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/412011 Continued

Facility Number: DateofInspection:
I Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ NA ❑ NE
❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes E. No ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[2 No
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
[S No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
[:]Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[3 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
17. Does the facility lack adequate acreage for land application?
❑ Yes
[a No
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[N No
❑ NA
❑ NE
maintenance or improvement?
❑ NE
Required Records & Documents
Waste Application
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
RNo
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[S No
❑ NA
❑ NE
maintenance or improvement?
❑ NE
the appropriate box.
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): 4:�'a rn
13. Soil Type(s): -r /�` r
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[S No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
B 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
[allo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
RNo
[] NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[ZNo
[] 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 UNo
❑ 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 [2LNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: - Date of Inspection: - l3
t 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [&No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes R 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 CR No
Other Issues
2$. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
[] NA ❑ NE
❑ NA ❑ NE
❑ Yes [a No ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
❑ Yes [2 No ❑ NA ❑ NE
❑ Yes 0 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 comments
Use?drawings of;.#acility:to better. explain.situations (use.additional pages as necessary). : _
low
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: '2�0 y3S 3�
Date: /p ;A_-1�70/3
2/4/2011

(Type of Visit: (ff Com Hance Inspection U Operation Review U Structure Evaluation O Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: lL.L Arrival Time: Departure Time: D County: Law!�P_
ov
Farm Name: Owner Email:
Owner Name: 4 D� n'wC r; X Phone:
Mailing Address:
Physical Address:
Region: )']Z fV
Facility Contact:�'� f rt—/ /yf�f� Title: S Phone:
Onsite Representative: 5a,� Integrator:
Certified Operator: �5:� Certification Number: 22en el,y2 %
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Curreuf
Swine Capacity Pop.
Wean to Finish
Wet Poultry r`.
La er
Design
' Capacity
C_ urrent
Pop.
Design Carrent
apac
Cattle City Pop.
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
eerier to Finish �uo
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , P.oult .
Ca aci
Eo P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Uthe
urkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge'?
❑ Yes RNo ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes 'Q No
❑ Yes [a No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 214/2011 Continued

Facility Number: - Date of Inspection: /—
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: _
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Structure 5
nNo ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑Yes ®No ❑NA ❑NE
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes ® No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 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 KA No [:]NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes M No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ®No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift p Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops
from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment'?
Reauired Records & Documents
❑ Yes JZNo ❑ NA
E4 Yes ❑ No ❑ NA
[:]Yes No ❑ NA
❑ Yes ® No ❑ NA
❑ Yes No ❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility tail to have all components of the CAWMP readily available? If yes, check
[:]Yes
0 No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
D Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: -Date of Inspection:
• 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [g No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes (&No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes ® No ❑ NA ❑ NE
❑ Yes (3 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes [g No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below. ❑ Yes MNo
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E4 -No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes 0 No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 29 -No
❑ NA ❑ NE
❑ NA ❑ NE
[] NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations oi•�any�otEier comments.
Use -drawings of facility to better,ea lain situations use additional> a es as.necessa 'r
�a',5lil('+G �'• `a -.S ��r �-i. � � j � � O� • �GZ rr1� �'1 Cz�` � L�-� %ra
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
L••••`41220011

Type of Visit:ommp�pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
G
Reason for Visit: loutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: O`` 3 /1 Arrival Time: 3 Departure Time: County: � q}-- Region: /�&
.
Farm Name: �Yrr,�-r,-•� Owner Email:
Owner Name: yvh w Phone:
Mailing Address:
Physical Address:
Facility Contact: Mo rz-- Title: Tal._ Ic - Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Integrator:
I
Certification Number:b��
Certification Number:
Location of Farm: Latitude: Longitude:
DesignCurrent
Design
Current
Design Current
Swine Capacity Pop.
Wet;I ,-U_t y Capacity
.Pap
Cattle 11111111Capacity Pop.
r
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish UD
Dairy Heifer
Farrow to Wean
Design
@urrent
Dry Cow
Farrow to Feeder
D ; fP.ou! a= -;Ga aci
P,o - Non -Dairy
Farrow to Finish
I a ers
Beef Stocker
Gilts
Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
lip
Turkeys
Other
Take Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page 1 of 3
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes [] No
❑ Yes [] No
[—]Yes ❑ No
[:]Yes No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
2/412011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes MNo [DNA ❑ 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
Observed Freeboard (in): _ .3 j
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ZLNo [] NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes Z[ No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? r,;2Pves JfM ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [-]Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ®. No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
L} Yes
No
Lj NA
Lj NE
15. Does the receiving crop and/or land application site need improvement?
O Yes
❑ No
❑ NA
❑ NE
I& 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
[g No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design 0 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 ® No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ® No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/412011 Continued

Facili Number: - Date of Inspection: Q--
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[—]Yes
$ No
❑ NA
❑ NE
4 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
®No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA
{] NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
® No
❑ NA
❑ 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
5?� 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
[R No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
0 No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments.(refer to question ::Explain any YES answers and/or any additional recommendations oriany�other comments.
Use.drawings of facility to better explain situations (use additional pages. as necessary)..
06 X 'V"i t _ "'
TD
y
Reviewer/Inspector Name:a•-.f Phone: gia ,K✓'3�.33Da
Reviewer/Inspector Signature: i� �,�,y�— Date:
Page 3 of 3 214/2011
' r-

I
E4
Type of Visit ID06ompliance
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
.0'1Voutine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time:% i li Departure Time: ; Oa Conn Region: P_0
Farm Name: ���//m �9r.-��_Gt✓i..' Owner Email:
Owner Name: h vL �_�Q� ► _ Phone:
Mailing Address:
Physical Address:
Facility Contact: �� Title: Phone No:
Onsite Representative: t^�/`�Y/ /B�'L- Integrator: _.&4a::tz4 _
Certified Operator: �"� _ Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [:Do = ' = Longitude: [=]0=' ="
Design Current
Design Current
Design
Curren#
Swine Capacity Population
Wet Poultry Capacity Papulation
CattleCapacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
a. Was the conveyance man-made?
❑ Wean to Feeder
❑Non -La er
L] Dairy Calf
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Feeder to Finish p0
❑ No
❑ NA
El Dairy Heifer
c. What is the estimated volume that reached waters of the State (gallons)?
ElFarrow to Wean
Dry Poultry
[I Dry Cow
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
ElFarrow to Feeder
❑ No
❑ NA
ElNon-Dairy
2. Is there evidence of a past discharge from any part of the operation?
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ NE
Gilts
❑Non -La ers
ElBeef Feeder
❑ NA
PE]Boars❑Turke
❑ Pullets
❑ Beef Brood Co
s
Other
❑ Turkey Poults
Number of Structures
❑ Other
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
DiNo
❑ 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
MbIo
❑ NA
❑ NE
other than from a discharge?
12/28104
Continued

Facility Number: Date of Inspection
❑ Yes
®,No
❑ NA
❑ NE
15_ Does the receiving crop and/or land application site need improvement?
[LYes
❑ No
` Waste Collection & Treatment
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
KNo ❑ 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:
❑ NE
Spillway?:
Designed Freeboard (in): 9'
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
R o ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
KNo ❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 46 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
RNo ❑ NA
EINE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
kNo [INA
❑ 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
V,No ❑ NA
EINE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[,Vo ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s) ,. L11, /
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?
[LYes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
®, No
❑ NA
❑ NE
17_ Does the facility lack adequate acreage for land application?
❑ Yes
[SNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L&No
❑ NA
❑ NE
ReviewerlInspector Name �� � � Phone:
Reviewer/Inspector Signature: Date: //—,30—.;P10/D
Page 2 of 3 72/28/04 Continued

Facility Number: Date of Inspection a— Q
r
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [S No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 9No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists
❑ Design El Maps F-1 Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNo ❑ 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 CgNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes RNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[3No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
RNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
C3No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
CKNo
❑ 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
KNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
KNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
f2 No
❑ NA
❑ NE
Page 3 of 3 12/28/04

,2TAA-S / z /6 --Z00 9
Type of Visit U-Compilance Inspection U Operation Review U Structure Evaluation Q Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region: lz �
Farm Name: Ace- ti Owner Email:
Owner Name: J o ll,j 14c4a rr >e Phone:
Mailing Address:
Physical Address:
Facility Contact: & r«r M crD Y eJ _ Title: r u L. • SPec- Phone No:
Onsite Representative: Integrator: /f -8J-&=. Al
&4y -e- b ,raid n�. 98goSZ
Certified Operator: .i Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =o =6 [=.. Longitude: E --Io [=], =
Design Current
Swine Capacity Population
Design Current
Wet Poultry Capacity Population
Design GJnrren#
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dai Cow
❑ Wean to Feeder
❑Non -Layer
❑Dai Calf
Feeder to Finish .30 Z jo
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Layers
❑ Non -Dai
❑ Farrow to Finish
❑ NE
El Beef Stocker
❑ Gilts
Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
El Beef Brood Co
❑Turke s
❑ Yes
Other
-El
❑ Other
Turke Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
dNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
El Yes
[I No
,, __,,//
LANA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
E 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
IJ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
IJ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
01N o
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

1 a
Facility Number: S,Z - jz 3 Date of Inspection F/2 -/f o
❑ Yes
1�Vo
El NA
El NE
Waste Collection & Treatment
El Yes
�,/
❑ NA
F-1NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
Elb Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
E No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
18. Is there a lack of properly operating waste application equipment?
ElYes
VN
❑ NA
Spillway?:
Designed Freeboard (in):
2
Observed Freeboard (in): .�7 ©
5. Are there any immediate threats to the integrity of any of the structures observed?
El Yes
�/
EJ No
[:INA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
El Yes
/
R 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 [R<o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,�,�
9. Does any part of the waste management system other than the waste structures require El Yes [3 o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement? 1. ��,,"
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Lr
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 Manurc/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crap type(s) Bers--4c. (F/6., iGrcz c�J SSU G r�;,J lo- S. Fescue' _ (IIS„ �, Cori✓ -B�,.g t^� �-
13. Soil type(s) JAJ6rr 'f-NGh C � i p l�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
1�Vo
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
�
❑ NA
F-1NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
VNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[:1NA
ElNE
18. Is there a lack of properly operating waste application equipment?
ElYes
VN
❑ NA
❑ NE
Reviewer/Inspector Name [:.. f�rc � 1,ko' �(
Reviewer/Inspector Signature:
Phone: 9/40 , 9x.33.330 O
Date: l Z -/y - ztfo 9
12/28/04 Continued

-
Facility Number: 6Z -3z j Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 214o ❑ NA E3NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check C1E Yes No ❑ NA ❑ NE
the appropirate box. ❑ W�
- [__1 Checklists [:1 Design El Maps El Other ��
21. Does record keeping need improvement? If yes, check the appropriate box below. [3 Yes Et<o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (id discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
❑ Yes
Ef'�lo
❑ NA-
❑ NE
❑ Yes
21Go
❑ NA
❑ NE
❑ Yes
D<o
❑ NA
❑ NE
❑ Yes
E7T
❑ NA
❑ NE
❑ Yes
2<o
❑ NA
❑ NE
❑ Yes
E o
❑ NA
❑ NE
❑ Yes
fffNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
Et -No
t No�❑ NA
El NE
ED Yes
2 ❑ NA
❑ NE
❑ Yes
3NEl NA
El NE
❑ Yes
2,Ko-o ❑ NA
❑ NE
12128104

' ✓yy� _S / -b g - d �r .ems
Z
Type of Visit (31�o'_mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: /: Departure Time: County: Region:
or
Farm Name: ���Ar►#1.._ �–K-- _.— Owner Email:
z'i
Owner Name: ' 'Ht-wd''r, Phone:
Mailing Address:
Physical Address:
Facility Contact: �� tW Nowrt_ Title: SDw! Phone No:
Onsite Representative: �r�✓�- Integrator: �• 41%� 4✓/lJ
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = = = Longitude: [= ° [� g =66
-
Design Current© gn Current
Design Eurrent
Swine
Capacity Population wet Poultry ; `C p ityPopulation
CattEe Capacity Populafion
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
Feeder to Finish
Z Oa
El Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Caw
❑ Farrow to Feeder
❑ NE
ElNon-Dairy
El Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑Non -La Non -Layers
El Beef Feeder
❑ Boars
El PulletsEl
eef Brood Caw
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Turke s
El No
3'9A
❑ Turkey Poults
2. Is there evidence of a past discharge from any part of the operation?
❑ Other
� ❑Other
Number of Structures:
a
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
ElYes
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
El Yes
_ ,
E3
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
[I NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
D<A
❑ 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
El No
3'9A
ElNE
2. Is there evidence of a past discharge from any part of the operation?
ElYes
1vo
BIZ
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
ElYes
No
[:3NA
–1 NE
other than from a discharge?
Page I of 3
12/28/04
Continued

r
❑ Yes
BN
[j NA
[:1 NE
Date of Inspection z o _
❑ Yes
/o
❑'NCO
El NA
Facility Number:
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[]
Waste Collection & Treatment
0 -go
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ioNA
ElNE
a. If yes, is waste level into the structural freeboard?
❑ Yes
o ❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: 0-1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z 7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
B< ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
Ergo'-_0 NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No ❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑Yes
,�,
LI'No [:1 NA
[:1 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
0<0_ ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window/ ❑ Evidence ofWindDrift Application Outside
of Area
�❑
�(,7
12. Crop type(s) e4_A4 L•t6(G-- (�7 4 h G_J _ �lr// C9i��ill [O.sr�
S1'eee_
Gni/'/—�cl�ac71- ar es
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
BN
[j NA
[:1 NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
/o
❑'NCO
El NA
[3 NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[]
Yes
0 -go
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
E N*�o
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
l__fNo
❑ NA
❑ NE
Reviewer/Inspector Name iL. V 2� S Phone:
Reviewer/Inspector Signature: Date: %L
Page 2 of 3 12/28/04 Continued

Z'%4_o 8
Facility Number: gZ— -3231 Date of Inspection OHO
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 appropirate box. ❑ WUP ❑ Checklists ❑ Design g El Maps [:1 Other
❑ Yes
ffNo
❑ NA
❑ NE
❑ Yes
LTNo
❑ NA
❑ NE
21.
Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
9"No
❑ NA
❑ NE
❑ Yes
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ NE
❑ 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
�Z
u tvo
❑ NA
EINE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
BIG-
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[a<o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
0 -go—
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
3 a.
r
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
O No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
L1 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
❑<14o
❑ 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
�,/
LJ 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?
[:1 Yes
,�,�
[:1 NA
[INE
33. Does facility require a follow-up visit by same agency?
[:1 Yes
_No
tfiNom
EJ
❑ NA
❑ NE
Addit�onal�Gommeats andlor Drawin s•
3 a.
r
Page 3 of 3 12/28/04

I}'islivision of Water Quality
Facility Number 0 Division of Soil and Water Conservation
- 0 Other Agency 11
Type of Visit
ompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
tine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: I Z -b7 Arrival Time: Departure Time: 'bS` r.. County: Region:
Farm Name: -� o �^' �'-*-' �r Owner Email:
Owner Name: a -o ki" kLf!!d X14 Phone:
Mailing Address:
Physical Address:
Facility Contact: 0(om-. Title: '-�-��,• Phone No:
Onsite Representative: r Integrator:
Certified Operator: DOperator Certification Number: 2!g2'0gZ
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: =11, =1 ="
Longitude: = ° = I = u
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish Z300
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Dairy Cow
❑ Daia Calf
❑ Daia Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Col I
Number of Structures:
r
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 M No ❑ NA ❑ NE
❑ Yes
[� No
❑ NA
❑ NE
❑ Yes
EZ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[51 No
❑ Yes
W No
❑ NA
❑ NE
❑ Yes
W No
❑ NA
❑ NE
12/28/04 Continued

� r
A .
Facility Number:
Date of Inspection Z`13'ZT7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: # 1
❑ Yes M No ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 e ff
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes R No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes ® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes M No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes allo ❑ NA ❑ NE
maintenance or improvement'?
Waste ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
'1 No
❑ NA ❑ NE
mai ntenance/improvement?
Reviewer/Inspector Name �;� ��� Phone: rl�i]. 33. 33&0
`$
Reviewer/Inspector Signature: Date: /Z —13 — Zara?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
RNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑PAN> lo% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) Swat/ 6►s : u CGv -3t ,4 e� w . s, `� `� � . F-B'C{t C—
13.
Soil type(s) LJ -iv. -
,,
J -i r14.
14.
// ❑ Yes
Do the receiving crops differ from those designated in the CAWMP?
1p No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
[ No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[ No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
No
❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
T
Reviewer/Inspector Name �;� ��� Phone: rl�i]. 33. 33&0
`$
Reviewer/Inspector Signature: Date: /Z —13 — Zara?
12/28/04 Continued

SZ - 3
Facility Number: I?Z. 7323 Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [F No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes P No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.❑Yesto [INA [__1 NE
Iff-❑ 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 10 No [:INA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 7 No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[� No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[4 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[� No
❑ NA
❑ NE
2T
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
W 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
4 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
L No
❑ NA
❑ NE
]2/28104

4
14122 GN I61J 73_Dvf '
Division of Water Quality
=Facitity,mber Z - 3Z 3 Division of Soil Fand Uater W&onservation
� Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ®Routine O Complaint Q Follow up Q Referral O Emergency 0 Other ❑ Denied Access
'4 Sar, «'O
Date of Visit: lI"�� "Q�O Arrival Time: z . / Departure Time: /.QQ County: Region: - g�
on:
Farm Name: J[t A, d 1r1 J'. � 8044^,L,_ ,L,_ Owner Email:
Owner Name: Zzo- l .1 "J'Iry, Phone:
Mailing Address:
Physical Address:
Facility Contact: C7Yc cr' c_ Title: ~-CL_ :Zee -r_ • Phone No:
Onsite Representative: b D j 6ct Ve Integrator: NU r0 L rn]ej Al
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 1=10
I--]' E --]"
Longitude: E] ° =1' = u
Design Current
Design Current
Design
Current
❑ NE
Swine Capacity Popnti tion
Wet Poultry Capacity Population
Cattle Capacity
Population
❑ Wean to Finish
ID Layer
❑ Dairy Cow
❑ NA
❑ NE
❑ Wean to Feeder I
I0 Non -Layer I I
❑ Dairy Calf
❑ NA
❑ NE
Feeder to Finish 1 2- 0a Z/O
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
Dry Poultry
E] Layers
❑Non -La Non -Layers
El Pullets
❑ Turkeys
[:1 Dry Cow
❑ Non -Dairy
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Cold
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
0 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
QTNo
❑ NA
Other
❑ Other
❑ Turkey Poults
❑ Other I
um. of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[9 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
U�No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
M 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
DTNo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
0 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
QTNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

Facility Number: K2 3�
Date of Inspection
t Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1
Identifier:
Spillway?: NO
Designed Freeboard (in): /9
Observed Freeboard (in): 269
Structure 2 Structure 3 Structure 4
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 0 N ❑ NA ❑ NE
❑ Yes [V No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes [� No ❑ NA ❑ NE
❑ Yes [1 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 [21No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Qi 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 [9 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [A No ❑ NA ❑ NE
maintenance/improvement?
1 l .
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
0 No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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.
Croptype(s) Suezll C9yn.A/ Lgi'a-3L� 1.-"'eyn,.V_J'— (q FS[Ge
l
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
[NNo ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
[2fNo ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
No ❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
,�q
ICS No ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
�Z No ❑ NA
❑ NE
Reviewer/inspector Name% + CIf� ���.V S Phone:( 9492) 1%33' 3330
Reviewer/inspector Signature: Date:
rage .4 uj
1L/tB/V4 uununueu

i
Facility Number: SZ —3Z3 Date of Inspection
4 Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [WNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 'No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists
❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 N ❑ 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
ONo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
[9No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
WNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
N No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P1No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�gNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
pNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
PVNo
❑ 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
[XNo
❑ NA
❑ NE
General Permit? (icl discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
WNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
0 No
❑ NA
❑ NE
Additional Comments anllor Drawings:
Page 3 of 3 12/28/04
Page 3 of 3 12/28/04

r
r
O Division of Water Quality
Taci�tt� :.Number
O Division of Soil and Water Conservation,:
Q Other Agency
Type of Visit * Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: -13-OY Arrival Time: I ; O Departure Time: County: Region:
Farm Name: :Rha blead-- .X Owner Email:
Owner Name: T�i�—�j,'x Phone: '1/0 -2/(o
Mailing Address: t H S �9 � -" ��� �q� HA N C 8K
Physical Address:
Facility Contact: 9rtr�e No�c,.G..7� Title:
Onsite Representative: ,Nerv;�. f[aPGv
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone No: 9/0 - 990-9G 3S
Integrator: l'�r 'L%�r✓
Operator Certification Number: /1'07j?
Back-up Certification Number:
Latitude: [ o ❑ , = Longitude: = o ❑ , =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ La °er
❑ Wean to Feeder ❑ Non -Laver
PTeeder to Finish _2 o O
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkev Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made.'
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
❑ Yes LSI-?d'o ❑ NA ❑ NE
b. Did the discharge reach maters 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
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
9<oo
❑ NA
❑ NE
❑ Yes
Dlo
❑ NA
❑ NE
12/28/04 Continued

IFacilityNumber: 8,2 —3,J3 I Date of Inspection /J d
Waste Collection & Treatment ��
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El,�--,, Yes I_�_'o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: .a„
Designed Freeboard (in):
Observed Freeboard (in): mq- °
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
D -<o
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
Dl<o
❑ 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
[�]'Ro
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
B<o
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
ElQ Yes
o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
04o
❑ 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 > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application O tside of
Area
/rd
Sa 7V r3r
46
12. Crop type(s) 4el-11,11, Q,sc
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q<o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[3<o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[--]
Yes
❑ No
❑ NA
glgE
17. Does the facility lack adequate acreage for land application?
ElYes
❑ No
El2 NA
E
18. Is there a lack of properly operating waste application equipment?
❑ Yes
El -<o
❑ NA
❑ NE
EYplwn any YESiansvi
Reviewer/Inspector Name f►1��.�� � � ie . :'`; s Phone: '7/O-YX `��x%30
Reviewer/Inspector Signature: Date:
12/28/04 Continued

Facility Number: Date of Inspection
Required Records & Documents.
19. Did the facility fail to have Certificate of Coverage & Permit readily available? M-1 —es ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check es ❑ No [:INA ❑NE
the appropirate box. ❑ ur; rar ❑Che �sts esign ❑ M ❑
21. Does record keeping need improvement? If yes, check the appropriate box below.. ❑ Yes ❑ No ❑ NA ❑ NE
❑ eekly Freeboard ❑ �is ❑ S,e��rbs El❑ n
ai
t nfall ❑-Ste�ki•rrg [-t rop Yield Ly'tvtonthly and I" Rain Inspections Bather 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 tail 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?
0 --res
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑-ht£
❑ Yes
❑ No
❑ NA
E3 NE
❑ Yes
El No
NA
[:1�
E
Yes
Elt-
► Itao
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
D -111E'
❑ Yes a-igo ❑ NA ❑ NE
❑ Yes E?I�o ❑ NA ❑ NE
❑ Yes [allo ❑ NA ❑ NE
❑ Yes O No ❑ NA ❑ NE
❑ Yes
Elfq'o
❑ NA
❑ NE
❑ Yes
[�o
❑ NA
❑ NE
Aaddit'-21 Comments andlar Drawings:
P1. Pleza6 , A,, e_ 6Cc7;J<'cc.>l� D� �avr�ag� u.d ppr.,,>L rv:Y{ �c+i� %'ecar�5,
RC1 7101�ds� /Ae /a
9ap., �ifig n .n raiH f�Lor S,
keep r
Ale) V
r �sSu� S
plPdse �nS .z an Hra; n
a rO ,`h gsav9
le s P�lNn li T He l^rda.✓� O O4 G
c►itie
4r Pr
,� sof b>ct
12/28/04

i
t
Type of Visit ® Compliance Inspection O Operation Review O Lagoon E=valuation I I
Reason for Visit a Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied
Facility Number Date of Visit: 7 v Tune: ' d
0 Not Operational O Below Threshold
errnitted [-Certiified © Conditionally Certified D Registered Date Last Operated or Above Threshold: .......•..............
Farm Name: ..............�.1 ....Far 7..5.�..........- - ........ County:"
Owner Name: Y _...... HQrzc. ---............... Phone No:
Nlaiiing
Address:..-��??30
Facility Contact: ------- H?�.�._ ...l1dnP �u?`�..._. Title:.._........ .._...... Phone No: 9/0- /%0'V, ?3...
Onsite Representative: .------�Herkc:� ........ t?�!� �, �:------- -_-_------- _----- ------- --- Integrator:
Certified Operator :............... Rnc .�f _ ,-_- Nen GV .... Operator Certification Number:
Location of Farm:
E�Sw'lne ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• ��«
Swine
Wean to Feeder
e-eder to Finish :2,300
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
13 Boars
Dili Ci rre�ut = =Design Current'_
I❑ Non -Layer I I I:1.' I❑ Non -Dairy
;` Number of Lagoons � i
r
" Other
Tofai Design Capacity
-
SSx
T, ._i
Discharees 8 Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ .--
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made'? ❑ Yes EW6
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑Yes a Nil
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 0-!46o_
2. Is there evidence of past discharge from any part of the operation? ❑ Yes GHN0_
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes O -Ko
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes !moo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: f
Freeboard (inches): a1 5-
12112103 Continued

Facility Number: —2,23 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes BN -0
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or ,--,��
closure plan? Cl Yes L� tvo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes Ergo
----
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
EI -No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
elevation markings?
❑ Yes
Elwo
Waste Annlication
❑ Yes
Qblo
10. Are there any buffers that need maintenance/improvement?
❑ Yes
[-Nb
11, Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
[] Yes
[}No-
12. Crop type S � /� (rrq; �} UE��s_ Gc�� �/� �ros ew
194NO
21.
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
01' 4o
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
MN6
b) Does the facility need a wettable acre determination?
PXs
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑, No
15. Does the receiving crop need improvement?
Yes
[IE
kxb
16. Is there a lack of adequate waste application equipment?
❑ Yes
[T�o
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
2We—s
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ )D , ,rhaWcFists, desigmapr, etc.)
❑ Yes
Qblo
19.
Does record keeping need improvement? (ie/ jpigadbn, freeboard, wasta vrafy5i� & s reports)
des
❑ No
20.
S'- -> > �2. L. 2 -NQ 0?'
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
194NO
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes [IKU
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑ Yes 0"1 o
24. Does facility require a follow-up visit by same agency? ❑ Yes O -Ko
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes [31II—
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Catnmentsti(refer to question #) Explaio any -YES answers and/or any recommi ndahuris:tivauy other cdinme©ts
U es :d $r wings,of facltty to better explain situations. (use;addttional pages as necessary) Jd Copy ❑ Final Notes
rz w='ll 41.: / a cagy,
ly P/Past
kr Pree[ooare rec& mrs WEVk1,v of oec ., 76 f/, a �.tn oral P�� yrs;
)�
1 WerA.' . vr� /01 Hal �ecl' , L / 144-PQ4/p a«C5 I re le'vi Ale &L' - _'2 Por
i S
TrpsA i, 11, 1,30tn IAAa /a 4e re,oved,
Reviewer/Inspector NameA.
Reviewer/Inspector Signature: ?7LkA_ AI Date: d
05/03/01 Continued
0

_ ....
�k ❑ DSWC Animal Feedlot Operation Review «�
® DWQ Animal Feedlot Operation Site Inspection°
'Routine 0 Conmlaint 0 FUIIow-un of MVO insucction 0 Follow -un of DS WC review 0 Other
Date of Inspection � /l L
Facility Number Z
Time of Inspection �D 24 hr. (hh:mm)
Registered M Certified 0 Applied for Permit 0 Permitted 113 Not Operational I Date Last Operated: ..
Farm Name: .............. ........... }VdB'... .._.......-----.._._........... County:........ eco' ^..........................................
Owner Name: �'�'' Phone \o (�/d s3+Z`
JJ... . �r ......................... ).. ......-----...............
Facility Contact: ...... 11 3,r.. % v im.. . Title I......... Phone No: .................... . .............................
99 /
Mailing Address: ... �..................../...�....•z...�.i�f0p
......................... .......................
Onsite Representative. ........ r..t.. !'...-. ......... :...... ................... .................. Integrator: ..... 066 !-.!v..,...J^^-' ..........................
Certified Operator;,.,. s,,.,.-. ?...I.Ar wecc. I........... Operator Certification Number;... -oz &X Y
Location of Farm: Z--- t-2,1 -:,Z-j J.J,t' IZ- _- 4-67 / f - AZ .G _ rL.,.l
.................
:...:. .
.
..Q�....�,�........................................... _
Latitude �` �� ��� Longitude
Design Current Design"' Current Design`.Current
Swine. Capacity Population Poultry Capacity Population Cattle Capacity" Population .
.; . ,..
x° ❑ Wean to Feeder ❑ Layer ❑ Dairy
® Feeder to Finish .'3dD❑ Non -Layer 10Non-Dairy
❑ Farrow to Wean -
❑ Farrow to Feeder 10 Other r
❑ Farrow to Finish Total Design Capacity. .
❑Gilts
❑ Boars Total $SLW
_,Niimber of Lagoons / Holding Ponds U ❑ Subsurface Drains Present 110 Lagoon Area ID Spray Field Area
❑ No Liquid Waste Management System
General
I. Are there any buffers that need maintenance/improvement'! ❑ Yes eNo
2. Is any discharge observed from any part of the operation? ElYes Q'No
Discharge originated at: ❑ Lagoon [1Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-Enade? ❑ Yes leNo
b. If discharge is observed. did it reach Surliice Water" (If yes. notify DWQ) [:]Yes JgNo
c. If discharge is observed, what is the estimated flow in-al/min?
d. Dries discharge bypass a lagoon system? (II' yes. notify DWQ) ❑Yes )allo
3. Is there evidence of past discharge from any part of the operation? El Yes Di'No
4_ Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes Wo
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes N'No
maintenance/improvement's
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes r9 -No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes IWNo
7/25/97 Continued on back

Q No.violations or. deficiencies. were noted during this.visit..Voumill receive 'no ftirttier
correspondence about this:visit ,'.
Cd ents:(refer to question #) ;,,Explain any 1'ES;answers and/or any recammendattons or any other comments d
Use dra��si� of facility to better explain situations (use addttipnal pages as necessary)
:. „-
Facility Number: � 3R.3
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
X No
Structures (Lapaons.Holding fonds, Flush Pits, etc.}
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
Al No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard(ft):...../"`S'(A.
..................... .................. ......... ..................................................... ................ .._.......................I........---.............
10. Is seepage observed from any of the structures?
❑ Yes
I#No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
P No
12. Do any of the structures need maintenance/improvement?
❑ Yes
J9 No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
ffid No
Waste Applieation
14. Is there physical evidence of over application?
❑ Yes
01 No
(If in excess of or runoff entering waters of the State, notify DWQ)
/WMP.
tS. Crop type --..% -su.1 �.1�? h�# ✓,r 1.... R7�................................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
X No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
KNo
18. Does the receiving crop need improvement?
DrYes
❑ No
19. Is there a lack of available waste application equipment?
❑ Yes
JO No
20. Does facility require a follow-up visit by same agency?
❑ Yes
A No
21. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
k No
22. Does record steeping need improvement''
�
PW No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
KNo
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
KFNo
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
allo
Q No.violations or. deficiencies. were noted during this.visit..Voumill receive 'no ftirttier
correspondence about this:visit ,'.
Cd ents:(refer to question #) ;,,Explain any 1'ES;answers and/or any recammendattons or any other comments d
Use dra��si� of facility to better explain situations (use addttipnal pages as necessary)
:. „-
�r.� � �aa� �'� Vii✓ ,4,�c��%� o,� i
7/25197
,r
Reviewer/lnspectar Name t g'
wer/Inspector Signature: ��"�� Date: J� p