820335_INSPECTIONS_20171231

Type of Visit: ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 12AM I Arrival Time: f Departure Time: County:, Region:
. I
Farm Name:
Owner Name: &,-A %V4/z*-
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: N Title: Phone:
sl-Ij
Onsite Representative:
U
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator: E t
Certification Number: 190,916
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 79
No [] NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes VNO
❑ Yes �pNo
NA ❑ NE
NA ❑ NE
[!jONA ❑ NE
E] NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412015 Condnued
Design Current
Design Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
11 jNon-Layer
I
Dairy Calf
Feeder to Finish
O
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
D , P,oul
Ca aci
top-
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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 79
No [] NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes VNO
❑ Yes �pNo
NA ❑ NE
NA ❑ NE
[!jONA ❑ NE
E] NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412015 Condnued

Facili umber: 03 Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No Q NA ❑ NE
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 D. Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable
�Crop
Window C L ❑lEvidence of Wind Dri❑ Applicatio Outside of Approved Area
12. Crop Type(s):��-it-�"
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
fo No
❑ NA
❑ NE
[:]Yes
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ Yes
Identifier:
❑ NA
❑ NE
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�jNo
❑ NA
❑ NE
(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
q�No
❑ NA
❑ NE
waste management or closure plan?
TT
If any of questions 4-6 were answered yes„ and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
Ep No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[�PNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
TT
9. Does any part of the waste management system other than the waste structures require
❑ YesNo
If
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] YesNo
❑ 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 D. Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable
�Crop
Window C L ❑lEvidence of Wind Dri❑ Applicatio Outside of Approved Area
12. Crop Type(s):��-it-�"
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
fo No
❑ NA
❑ NE
[:]Yes
�o
❑ NA
❑ NE
❑ Yes
[P No
❑ NA
❑ NE
[-]Yes No
❑ Yes No
❑ Yes EP No
❑ Yes Ir No
❑ WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1�No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis E] Waste Tra'ns'fers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/412015 Continued

till "Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? EJYes M No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes 7'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 kgNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes K3 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 CA WMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
any. YES
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes 1� No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA D NE
❑ NA ❑ NE
[:]Yes [PNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes 1PNo ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes] No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: R(�
Date:
Z/4 015

Date of Visit: J [, / j j� Arrival Time: O Departure Time: ,pr County: Region:�.�
Farm Name: �j D -1r rN Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: tie D f Title:
Onsite Representative:
rr
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Phone:
7iM//
' �/,
Certification Number:
4207b
Certification Number:
Longitude:
Des gn Current
❑ No
De"sign
Current
Design Current
Swine Gapactty Pop.
=Wet_Panitry
Capacity
Pop.
Cattle Capacity Pop.
Wean to sh
Layer
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish -7
Daijiy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . Woult ,
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes o [] 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 []PNA ❑ 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
Q§ No
❑ Yes
fa No
[� NA
❑ NE
❑NA
❑NE
E] NA
E] NE
Page 1 of 3 2/4/2011 Continued

Facili N ber: Date of Inspection:
❑ Yes
0 No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
P No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
" No
E] NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
® NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[� No
❑ NA
Spillway?:
Required Records & Documents
Designed Freeboard (in):
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[I�No
❑ NA
Observed Freeboard (in): 2j4" r/
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
19 No
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes
FMNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any ofquestions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Avylication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? 0
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ YesNo [—]NA [:]NE
F]Excessive Ponding E]Hydraulic Overload [:]Frozen Ground E]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 ndow ❑ Evidence of Wind Drift E] ZApplication Outside of Approved Area
12. CropType(s): i Ct<.4 a S L-�`� �%t �EJ �cM ev •�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
P No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[� No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[I�No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
19 No
❑ NA
❑ NE
the appropriate box.
❑ WUP El Checklists [:]Design [:]Maps ❑Lease Agreements El Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes (9 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes IQ No ❑ NA ❑ NE
Page 2 of 3 2/412015 Continued

Facilitv Number: 5?7- - 7.-2 C Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
fp No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
r'A:!No
❑ NA ❑ NE
the appropriate box(es) below.
IM No
❑ NA
❑ NE
0 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?
❑ YesNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
1� 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 J�j No ❑ NA ❑ NE
❑ Yes [� No ❑ NA ❑ NE
❑ Yes 9 No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes
FR No
❑ NA
❑ NE
❑ Yes
[PNo
❑ NA
❑ NE
❑ Yes
IM No
❑ NA
❑ NE
Comments trererjo•.quesuon ffi ,rlxpiam any -,Y nb answers'anaror any aaaunonai recommenuanons or any4otner+comments.
Use drawuiQs of;facility to better. egpiam;situafflanst(ttse-additional paces as.necessarv).� _
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: ep23 7
2141201S

Divi"sioa of Water Resources
Facility Number - ® O Division of Soil randWater Conservation
�
it Agency
Type of Visit: i Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: *Routine Q Complaint O Follow-up 0 Referral Q Emergency O Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region: 06Ad
Farm Name: p% X,, Owner Email:
Owner Name: 4412 4_ Phone:
Mailing Address:
Physical Address:
Facility Contact: fes/ - Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number: /909,2
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes f,;ja No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify 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)
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
[XNA
❑ NE
❑ Yes
No
❑ NA
I1111111I11111
Swine
an to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design Current
Gapacity Pap.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
Dai Calf
eeder to Finish
2 !SD 0 Z
D . P.oult ,
Ca acit
Current
Pio .
Dairy Heifer
Cow
Farrow to WeanDesign
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Other
Turkeys
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes f,;ja No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify 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)
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
[XNA
❑ NE
❑ Yes
No
❑ NA
[] NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 2/412015 Continued

Facili Number: Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes M No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No (SNA ❑ NE
Structure t Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: DL%
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes no 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
(V% No
[—]NA
[:]NE
waste management or closure plan?
❑ Yes
No
❑ NA
❑ NE
If any or 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
jM No
Lr
❑ 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)
❑ NA
f
T
17. Does the facility lack adequate acreage for land application?
❑ Yes
9_ Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
E] Yes
Waste Application
[DNA
❑ NE
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[N No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Q� No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground p 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
/W`,iindoww _ C] Evidence of Wind Drift l [:]Application Outside of Approved Area
12. Crop Type(s): 6a*f s„��� . Utsi far-ci�sr�r-�i� a cu✓/
13. Soil Type(s):
❑ Yes
No
❑ NA
❑ NE
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
❑ 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
Renuired 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 F] Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. '
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ t20 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
[:]NA
[:]NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
E] Yes
i� No
[DNA
❑ NE
Page 2 of 3 21412015 Continued

Facili umber: 91 Date of Inspection-
24.
ns ection-24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �A No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes( No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [� No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes ! No
❑ Yes ftf No
[:]Yes No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Reviewer/Inspector Signature: Date:
Page 3 of 3 2/4/2015

type or vtsir: w t-ompttance inspection v uperanon mevtew u btructure r,vamanon V 1ecnmcal Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: fj 107 1, Arrival Time: D Departure Time: County: Region: �
Farm Name: Owner Email:
Owner Name: �� Phone:
Mailing Address:
Physical Address:
Facility Contact: K=4 K&4 Title: Phone:
Onsite Representative: K Integrator: A4dV_ fJ
. I
Certified Operator: Certification Number: IAO rp
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish..I
Design Current
Capacity Pop.
WetPoultry
ILayer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
[ANA
❑ NE
Wean to Feeder
IN
INon-Layer
I
Dairy Calf
Feeder to Finish
- Farrow to Wean
/ AD
I 11 �'i���l��
�,�I � �I I �,
D . P,onl
Desi n
g
Ca act
Cu Trent
P,o
Dai Heifer
Dry Cow
Non -Dairy
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
lk
a
Turkeys
Turkey Poults
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ffj No ❑ NA ❑ NE
❑ Yes
❑ No
M NA
❑ NE
❑ Yes
[:]No
[ANA
❑ NE
Page 1 of 3
[:]Yes ❑No
[]Yes No
[:]Yes ® No
[A NA
❑ NE
❑NA
❑NE
❑ NA
❑ NE
2/4/2014 Continued

Facilitk Number: Q. - Date of inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes W No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes ❑No Qg NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: IVFW- O L
Spillway?:
Designed Freeboard (in):
3Zy
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes E�j 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
Qg No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NA
❑ NE
acres determination?
9. Does any part of the waste management system other than the waste structures require
❑ Yesjy�
No
❑ NA
❑ NE
maintenance or improvement?
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Waste Application
❑ NA
❑ NE
Required Records & Documents
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approve Area
12. Crop Type(s): rio Cnc a=I-r-e-&rti
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes Ej4 No ❑ NA ❑ NE
❑ Waste Application [] Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [!A No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes WNo ❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued
13. Soil Type(s): D
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[V No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[� No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
allo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
[�JNo
❑ 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 Ej4 No ❑ NA ❑ NE
❑ Waste Application [] Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [!A No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes WNo ❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Facili Number: -335 jDate of Inspection: `Z ?
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes P No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes J�j No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
[] Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ 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?
its_ (refer to question #) _Eaplaut_any YES answers and/or any additional recommet
wings of facility to better explain 'situations (use additional pages as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
[::]Yes
No
❑ NA
0 NE
❑ Yes
No
❑ NA
❑ NE
[:]Yes
[)g No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes [ No
[—]Yes No
0 Yes a No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Phone:
Date:
21412014

a ype or visa: w t-omprrance inspection v uperatron rcevicw V structure r vaivanon V i ecnnicai Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arri
val Time: ; o Departure Time: B .•� County: n% Region:
Farre Name: Owner Email:
Owner Name: ke, 44 f Ay /per Phone:
Mailing Address:
Physical Address:
Facility Contact: c Title:
N
Onsite Representative:
Certified Operator:
Back-up Operator-,
Location of farm:
Latitude:
Phone:
Integrator:
Certification Number: 126 9td
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
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?
❑ Yes
T No
❑ NA
❑ NE
❑ Yes
n No
Design Current
❑ No
Design
Current
Design
Gnrrent
Swine
Ca'p'acity Pop.
Wet Poultry
Capacity
Pop �=
Cattle Capacity
Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
25-D0
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . Poul
Ca aci
Po P.
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
T No
❑ NA
❑ NE
❑ Yes
n No
❑ Yes
❑ No
[P NA
❑ NE
❑ Yes
❑ No
[�] NA
❑ NE
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
'PI No
❑ Yes
n No
NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 2/412011 Continued

[Facility Nuenber: IM - 335 Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes B4 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No NA ❑ NE
A) Structure r �`9 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ��
Spillway?:
Designed Freeboard (in):
p
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
P No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[nNo
❑ 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
T1 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
FO No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ 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 P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window j [] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Ak�- 0. 9'q �1� C' .. t-LAJa-,hea,., S 1 �G��-ker -4
13. Soil Type(s): A4 4 L' /V°
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
I9. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑ Yes No
❑ Yes No
❑ Yes [ No
❑ Yes No
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes F No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
[] Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
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?
[—]Yes No
[:]Yes No
❑NA E] NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 1/4/2011 Continued

[Fadfity Number: 912-33 jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[9 No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
Q9 No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes EpNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes CpNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [9 No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or anyother comments:;
Use drawings of facility to better explain situations (use additional pages as necessary). = -
❑ Yes '0] No ❑ NA ❑ NE
[:]Yes P No ❑ NA ❑ NE
❑Yes PNo ❑NA ❑NE
❑ Yes � No [:]NA [:]NE
Reviewer/Inspector Name:
Reviewer/]nspector Signature:
Page 3 of 3
4'i'
Phone:
Date:
2/4/2011

II ype of visit: 0 Compliance inspection U Uperation Review U Structure Evaluation V Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ! Departure Time: O %,/ County: S� FrD % Region: Pito
Farm Name: 98.4 B.} n%I r Owner Email:
Owner Name: e ii fit/ 8 Phone:
Mailing Address:
Physical Address:
Facility Contact: ��`i �� Title: Phone:
Onsite Representative:
N
p
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator: �r , r-gi pw A
Certification Number: �n10 1�ia
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Desgn�Cu rr ent
P No
Desi n Current
Design Current
Swine
Capacity Pop. - `�
Wet Poultry
Capac i
Pap.
Cattle Capacity Pop.
Wean to Finish
❑ No
[9 NA
ILayer
I
❑ Yes
Dairy Cow
Weanto Feeder
❑ NE
-I
jNon-Layer
I
Dairy Calf
Feeder to Finish
❑ Yes
❑ No
E3 NA
RDairy
2. Is there evidence of a past discharge from any part of the operation?
Heifer
Farrow to Wean
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Design
Current
Dry Cow
Farrow to Feeder
of the State other than from a discharge?
D . P■oWt ,
-a aci
P,o
Non -Dairy
Farrow to Finish
Layers
I
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
P No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[9 NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
E3 NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
C�bNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
�3 No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

f
Facility Number: jDate of Inspection: $
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ YesNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? E]Yes E No [� NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: B.TG 5MAU
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2 -LI u
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ YesNo [—]NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes W No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes � No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes JR 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): Gwt &Lo�l /n ' k I sc t n, n c t
13. Soil Type(s): jA "jj�— W"44; 5' — Rq
❑ NE
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® 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 ofthe CAWMP readily available? Ifyes, check
❑ Yes
[K No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [�] No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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 21412011 Continued

Facili Number: 2 - Date of Inspection: 7
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E� No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
® No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
® 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?
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 ReviewerlInspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Pq No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
[:]Yes No
[:]Yes ® No
[—]Yes ® No
❑ NA ❑ NE
C] NA ❑NE
NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any otiieracommeuts. "
Use drawings' of facility to better explain situations (use..addit►onal'.pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 910 -Z
Date: gZX3
21412011

Ii ype of visit: w o.ompuance inspection v operation xeview V Structure cvatuation V iecnnicar Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: f2 Arrival Time: Departure Time: County: Region:
Farm Name: ke- Rwip Owner Email:
Owner Name: f kt-� I Phone:
Mailing Address:
Physical Address:
IL
Facility Contact: K'et40"- N�--j( �6— Title: Phone:
Onsite Representative: I Integrator: A Id.,�..
K
Certified Operator: Certification Number: 110%
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes. notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes P No [] NA ❑ NE
[:]Yes
Desr
qq NA
Design
Curfent
Design Current
SwineCap
i
city Pop.
Wet Poultry
Capacity
Pop.x
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
` Wean to Feeder
]Non
-Layer
Dairy Calf
Feeder to Finish
;` . a"'
ii f
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dry Poult.
Ca aei
PAo
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
--
Turke s
other, � :_
k
Turkey Poults
Other
Other
-_. _.....-s....,..,,.:.e.,__.. .Rint,.i.., 6=
_.,�+iiY.ti2^3:dtiV�:➢:l ttsla..
.. �..:"",a„s...,.:.__:�
I�III�.�..:... @IiilYW1.
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes. notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes P No [] NA ❑ NE
[:]Yes
❑ No
qq NA
❑ NE
❑ Yes
❑ No
® NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No QjbNA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [-]Yes o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page l of 3 2/4/2011 Continued

Fscili number: - Date of Inspection
Z
❑ NA
❑ NE
❑ Yes
Waste Collection & Treatment
❑ NA
❑ NE
❑ Yes
[� No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[;NA
❑ NE
Structure 1 Structure 2 Stricture 3 Structure 4
Structure 5
Structure 6
Identifier: tG �SiHAIl-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
E� No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
Q9 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, ❑ YesNo [:]NA ❑ NE
F-1Excessive Ponding ❑ Hydraulic Overload p 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 `l ❑�Evidence
�of�Wind
,,�Drift
_ ❑ Application Outside of Approved Area
/
12. Crop Type(s): I.M_ LI_ Q "Ate_), la�,rvl. "� ; `*V 1 `" ►tlriP�✓ Le�✓I
13. Soil Type(s):
14. Do the receiving crops ditTer from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
lb. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment'?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropriate box.
❑ Yes
D§ No
❑ NA
❑ NE
❑ Yes
®No
❑ NA
❑ NE
❑ Yes
[� No
❑ NA
❑ NE
❑ Yes EO No ❑ NA ❑ NE
❑ Yes jj@ No ❑ NA ❑ NE
❑ YesNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V 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 2/4/2011 Continued

Facili umber: Date of Inspection: MOP
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes V9 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 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
No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations mr any4othim comments.
Use -Arawfngs=of:facility:ta better explain situations (use additional pages as' necessary):
_ _
j ,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 1/0r/j —72 4,
Date: Z
2/4/201I

'Division of Rater Quahiy
Facility Number 3®'Division of=Soi{`and Water Conservation
Other Agency
Type of Visit: *Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time:D _ ANI County: Region:P-2�0
Farm Name:
Owner Email:
1
Owner Name: L Phone:
Mailing Address:
Physical Address:
Facility Contact: 144 4qj"w Title: Phone:
t.
Onsite Representative: Integrator: �(/� � —b*Wk1 j L G
Certified Operator: 6z Certification Number: No Z
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
�jljjjjj
Design .Current
1P NA
Design .. Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity, Pop.
Cattle Capacity Pop.
Wean to Finish
a La er
Dairy Cow
Wean to Feeder
Non -La er
I
Daig Calf
Feeder to Finish
2 d0
'
Dairy Heifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
D ...Poul
_a aci _ P.a .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
I W-Tother
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes P No ❑ NA ❑ NE
[—]Yes
❑ No
1P NA
❑ NE
[-]Yes
❑ No
[RNA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No Ml NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

r
❑ Yes
No
❑ NA
❑ NE
Facility Number: - Date of Inspection: I
❑ Yes
No
❑ NA
❑ NE
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
��❑
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
No
® NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
�7 t
Observed Freeboard (in): r 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
CpNo
❑ 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
❑ YesNo
0
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[jj 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. ❑ YesNo [:]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/94tidge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of /Wind Drift J [:].. Application Outside of Approved Area
12. Crop Type(s): '" rc-P -zP /l . �&J. WLL, 5,
13. Soil Type(s): A , !!AQ
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes T No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Renuired 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.
T
❑WUP ❑Checklists ❑ Design p Maps ❑ Lease Agreements ED Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes (�] No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes 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 3 214/2011 Continued

Facility Number: - Date of inspection: L/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check []Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey E] Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27_ Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 0 No
❑ Yes 9a No
❑ Yes PNo
❑ Yes No
❑ Yes ® No
❑ Yes No
❑ Yes ® No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
lComments (refer to question f: Explain any YES answers and/or any additional recommendations orRany other4cornments: "
use,: drawings of facility to better explain situations (use additional pages as necessary _
Revi ewer/] nspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9lv �Y33r33�
Date: /7b
21412011

Type of Visit ® Compliance inspection O Operation Review Q Structure Evaluation U Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit:Ar�rival Time: O9� Departure Time: I0- 3Q�iy County: -0'"' ��f
Farm Name: / /")) Oy FawryOwner Email:
Owner Name: W i i 1 t,C ih C"'� ,`.'a'✓)in,r Phone:
Mailing Address:
Physical Address:
Region: AA .-
Facility Contact: /y Title: Phone No:
N
Onsite Representative: Integrator: Aco _AW
Certified Operator: N Operator Certification Number: 9� 9
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0 0' 0" Longitude: =0[=]' ="
Design Current
Swine Capacity Papulation
❑ Wean to Finish
Design Current<Design
Wet Poultry Capacity Population
❑ La er
Current
@attle Capacity Population
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ No
❑ Dairy Calf
❑ NE
® Feeder to Finish 25-00 /sZ,D
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder,
❑ Yes
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑Pullets
El Beef Bro Co
❑ Turkeys
Other
❑ Other
❑Turke Poults
❑Other
Number of Structures: a
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [4 No ❑ NA ❑ NE
❑ Yes
❑ No
RNA
❑ NE
❑ Yes
❑ No
[59 NA
❑ NE
[RNA
❑ NE
❑ Yes
❑ No
❑ Yes
[19 No
Cl NA
❑ NE
❑ Yes
�j No
❑ NA
❑ NE
Page 1 of 3 12/28/04 Continued

`Facility Number: — Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ 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: B 1 tr 5/HALL
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 36" 2s�1
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
❑ No ❑ NA
EINE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7_ Do any of the structures need maintenance or improvement?
❑ Yes
❑ No ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
❑ No ❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No ❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑ No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Drift ❑ Application
Outside of Area
,Wind
12. Crop Fes S � ,,, L
/� r
type(s) Cat
13. Soil type(s) 40VIA& ►v.5
14. Do the receiving crops differ from those designated in the CAWN4P?
❑ 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 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
Reviewerlinspector Name %' T'� ' Phone: 716,133-330V
Reviewer/Inspector Signature: Date: 2Z
Page 2 of 3 12128/04 Continued

Facility Number: — Date of Inspection
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes X No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ;K No ❑ NA ❑ NE
the appropriate box.
❑ WiJP El Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ;9 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
R9 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
01 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[P No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
lI
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
V0 No
❑ NA
❑ NE
29,
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
V1 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
'No
LP
❑ NA
ElNE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
P 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
[)9 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
$0 No
❑ NA
❑ NE
Page 3 of 3 12128/04

8r�s U -V
.S lolrloq
Division of Water Qualit}
Facility NuDivision 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
EDA
Date of Visit: I "11,'Sp 1O I I Arrival Time: Departure Time: O,� �Gt, County: : �' KD/J Region:
Farm Name:�' a. pym Owner Email:
Owner Name• Wr l Ici m 4t Q� il� )0.e- Phone:
Mailing Address:
Physical Address:
Facility Contact:
_4
a;� N 19..- Title: Phone No:
Onsite Representative: Integrator: M LJh Lt C
Certified Operator: 'l Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [� o [� + 0 di Longitude: =0=4
°=4
Design Current
Design
Design Current
Swine Capacity Population
g—J
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dai Cow
❑ Wean to Feeder
❑Non -La er EECurrent
El Dairy Calf
ElNA
10 Feeder to Finish OC7
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Dairy Heifer
El Farrow to Wean
DryPoultry
El Dry Cow
ElFarrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
La ers F::�ElBeef
Stocker
❑Gilts
Non -La ers
rEE11
ElBeef Feeder
❑ Soars
Pullets
❑ Beef Brood Cowi
No
❑Turke s
❑ NE
Other
❑Turke Points
qNo
❑ Other
❑Otherdumber
of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[gNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
1P No
ElNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
ElYes
9 No
[:INA
❑ 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
r�
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
qNo
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

L
Facility Number: T Date of Inspection 9 D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if ves, is waste level into the structural freeboard?
Structure l Stnicture 2 Structure 3 Stricture 4
Identifier: BX& SMALL
❑ Yes $ No ❑ NA ❑ NE
❑ Yes ❑ No rANA ❑ NE
Structure Structure 6
Spillway?:
1�No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
Designed Freeboard (in):
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate ManureJSludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Area
Observed Freeboard (in): 37 30
12. Crop types) Fyks z C(Ww 1 , C4_zH LQ24S 5ULMVVW �Q
13. Soil type(s)
5. Are there any immediate threats to the integrity of any of the structures observed?
❑Yes
No
❑ NA
El NE
(' large , , page, etc.)
tell a treessevere erosionsee
[15No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination' ❑ Yes
T No
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
[!1No
❑ NA
❑ NE
through a waste management or closure plan?
❑ 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
[jd No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
y 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[
No
El
El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
1�No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
Reviewer/Inspector Name Phone: 6)1"39 -3360
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate ManureJSludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Area
12. Crop types) Fyks z C(Ww 1 , C4_zH LQ24S 5ULMVVW �Q
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
CoNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
[15No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination' ❑ Yes
T No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
EF No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
E% No
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: 6)1"39 -3360
Reviewer/Inspector Signature: Date: q l
I7/18/04 Continued

Facility Number: - Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes V No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [P No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design El Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
M No
❑ NA
EINE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�d No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E] No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
P 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
09 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
1P No
❑ NA
❑ NE
Page 3 of 3 12/28/04

Type of Visit *Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint Q Follow up Q Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: CA:SDA Departure Time: O 3o County: Region:AF-100
Farm Name: l ' j Owner Email:
1N
Owner Name: ../1lkCt ' tV��l� Phone:
Mailing Address:
Physical Address:
Facility Contact: "h, I Title: I Phone No:
Onsite Representative: Integrator:
Certified Operator: y Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e E=, D u Longitude: = o = I = "
Design Current
- Design Current
Design Current
Swine Cap5ac�it71Population
Wet PouItry��_tt �� Popu on Cattle Capacity Population
[:]No
❑ Wean to Finish
❑ La er
El Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Yes
El Dairy Calf .
❑ Yes
[�PNo
Feeder to Finish bO
Dry Poultry
El Layers
El Dairy Heifer
El Dry Cow
ElNon-Dairy
ElFarrow to Wean
❑ NA
ElFarrow to Feeder
❑ Farrow to Finish
❑Non -La ers
El Beef Stocker
Gilts
❑ Pullets
❑ Beef Feeder
10 Beef Brood Co
POBoars
❑ Turke s
-
Oti
❑ Other
❑ Turke Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes RNo ❑ NA ❑ NE
❑ Yes
❑ No
PINA
❑ NE
❑ Yes
[:]No
PNA
❑ NE
[?PT1A
❑ NE
❑ Yes
❑ No
❑ Yes
[�PNo
❑ NA
❑ NE
❑ Yes
V2No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: J3 Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Mo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [�FNA ❑ NE
��S77truuctture 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Com-[ ;5M A -L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): C; aa`t
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes PNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes $PNo ❑ 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
El NA
[__1 NE
S. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
fr 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
❑ YesNo
[INA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes EffNo ❑ 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 ❑ Evidenceof
-Wind Drift ❑ Application Outside of Area
12. CTOP tyPe(s) F2x� CGS ! 87fi LLL sk.M '�T` .
13. Soil type(s) B -t
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes P No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 10 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[-] Yes N No [:INA ❑ NE
17. Does the facility lack adequate acreage for land application?
1 S. Is there a lack of properly operating waste application equipment?
❑ Yes �j No ❑ NA ❑ NE
❑ Yes OR No ❑ NA ❑ NE
Comments refer to ueshon # � �,' yyyy�laapy YE � p � �+YY ry
( q " ) p S ans�ers and/o.r��an'y�4frecommendations,or any other comments.
Use dra wings offfaciLty'to better�egplaxn�s� boas. (use addt�ttoual�pagesda�sV necessary)..
L
r
�J
Reviewer/inspector Name I r Phone:
Reviewer/Inspector Signature: Date: 2/!Yoqffl
Page 2 of 3 12128/04 Continued

f •rt
Facility Number: — Date of Inspection
REguired Records & Documents
19. Did the facility fail to have 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 9 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 bNo ❑ 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
)Q No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
& No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
F5No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Pallo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
MNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Q!PNo
❑ NA
❑ NE
Other lssues
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
hNo
❑ 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
29)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
E? No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
®No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
&No
❑ NA
❑ NE
Additional..Comments`and/or Drawings:
•
Page 3 of 3 12/28/04

0 Division of Water Quality
FFacifity Number 2 j3 0 Division of Soil and Water Conservation
- O Other Agency
Type of Visit Y Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit *Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
FAZ
Date of Visit: 1t) 7-31:0'j] Arrival Time: Departure Time: County: SR "^ Region:
Farm Name: V-KJA N ov- �M Owner Email:
Owner Name: i 4 t a m �`'t"'s Ishn, low— Phone:
Mailing Address:
Physical Address: J.
Facility Contact: Title: Phone No:
q .1 j
Onsite Representative: Integrator: offt
N
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude:. = o = I = u Longitude: =o=, = 1i
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ La er
❑ Wean to Feeder❑Non-Layer
Feeder to FinishkM I o
El Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ 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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design' Current
Cattle Capacity P_oprilatioo
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑
Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cod I
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
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 ANo ❑ NA ❑ NE
❑ Yes
❑ No
IZPNA
❑ NE
El Yes
El No
;9 NA
El NE
❑ Yes
❑ No
P9 NA
❑ NE
❑ Yes
1PIsio
❑ NA
❑ NE
❑ Yes
)KINo❑
NA
❑ NE
12/28/04 Continued

Facility Number: -3
Date of inspection O O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes *No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No INA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: i SM
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 30"_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ YesNo F-1NA[INE
(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 CVNo [:INA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes (r No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [p No ❑ NA ❑ NE
maintenance or improvement?
Waste Annlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EANo ❑ 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.)
❑ FAN ❑ 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
f
12. Crop type(s) t'es� CPAL�_j S s . -S�Lr� MPT,yL6tR1 T�1f[ le -4-
13. Soil type(s) Alp A, RQ
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �9No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 9No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes t%No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes LANo ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone:
ReviewerAnspector Signature: Date: JI)Ia 31n
12128/04 Continued

Facility Number: $;2 —3 gT Date of Inspection o`7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes IffNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[& No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
fjg�No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
nNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
EgNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ffi�No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
T No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
MNo
❑ 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
ERNo
❑ 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
qjNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32_ Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
P -No
❑ NA
❑ NE
12/28/04
E

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /Z Arrival Time: Oq: �i !{ Departure Time: �0: `� Fi County: r -sy� Region: R (/
Farm Name: tJal.,19-V- F0-4'fV1) Owner Email:
Owner Name: ` r'^ ley -bone:
�j
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: l
Certified Operator: N
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o =I = 11
Longitude: 0 ° ❑ I = u
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Design Current
Design Current
Design Current
❑ NE
Swine
Capacity Population Wet Poultry
Cap�aci;ty Population
C►arl Capacity Population
❑ Wean to Finish
❑ La er
❑ No
CNA
❑ Dairy Cow
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Wean to Feeder
x ❑Non -La er
E�INA
❑ NE
❑ Dairy Calf
Feeder to Finish
co r kms' ,b :
❑Dairy Heifer
❑ Farrow to Wean
D Poul:
4`
❑ Dry Cow
❑ Farrow to Feeder
2_ Is there evidence of a past discharge from any part of the operation?
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
EINE
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ NA
ID Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
12/28/04
Continued
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
0 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure [] Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
CNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
E�INA
❑ 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
El NE
2_ Is there evidence of a past discharge from any part of the operation?
El Yes
1 �No
I NA
EINE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
9 No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

Facility Number: g�)- Date of Inspection
Soil type(s) nip
Waste Collection & Treatment
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ANo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
10 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
lj� NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
❑ Yes
N No
❑ NA
❑ NE
Spillway?:
Is there a lack of properly operating waste application equipment?
❑ Yes
[�;No
❑ NA
Designed Freeboard (in): CPO
r� des
Observed Freeboard (in): MA IE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
Tj 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
q, No
❑ NA
❑ NE
8_ Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
15 No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Q9 No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ,S 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
11 Outside of Area
12. Crop type(s) Fes n ---Q C�'Q ZP r (�,I'v� , wl. _ 5 �1 f /,P s�, 0Wj/�
13.
Soil type(s) nip
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ANo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
1�;] No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ yes
�9 No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
N 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 oe anyother comments.
UseArawings'of facility to better explain situations. (user additional pages as necessary): llvw,
Reviewerfinspector Name �r Phone: [q101 Imf
'
Reviewer/Inspector Signature: Date: L f�
Page 2 of 12/28/04 Continued

A.
Y�
Facility Number: Date of IAspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [gNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes KNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes PsNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [�No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes O[No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
9No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[&No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
EXNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No ;R NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
MNo
❑ NA
❑ NE
29. Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
n 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
CD 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
NNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[gNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12/28/04

Type of Visit ® Compliance Inspection Q Operation Review Q Lagoon e=valuation
Reason for Visit 4BRoutine O Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Datc of \"eget: 56' T p Time: I Io : T
FacilittiNumber a 3 S
ro not Operational 0 Below Threshold
® Permitted ® Certified ❑ Conditionally Certified Q Registered Date Last Operated or Above Threshold -
'nn
Farm Name: __ �_� L'� car v+11 County: Fina . �AS�n
Owner -Name: _ Reaz 4 a in 5 t Fn M .., A Phone No:
Nailing Address: //� �+
Facility Contact:
Title:
Phone No:
Onsite Representative: L 1 ►+ of a- Integrator: M u. jn 4...
Certified Operator: L-,) . r 4 rvt _ r Operator Certification Number:
Location of Farm:
1A swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �4 - Longitude ' 1 r ��
Design Current
Swine rgnarity Vnnnlatinn
❑ Wean to Feeder
® Feeder to Finish .1 aSOb S*` o
❑ Farrow to Wean
E3Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Laver I 1 10 Dairy
❑ Non -Laver I JE1 Non -Dain
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons a -Msubsurface Drains Present Ho Lagoon Area ❑ S rav Field Area
Holding Ponds / Solid Traps ❑ N o Liquid Waste Management System
Discharges S Stream Impacts
I . Is any discharge observed from any part of the operation?
El Yes No
Discharge originated at: ❑ I_apoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man, -made? ❑ Yes ❑ No
b. if discharge is obsen-ed, did it reach Water of the State? (if yes, notify DI3'Q)
[I Yes ❑ No
c. If discharge is observed. what is the estimated flo-w in gal/min? H J/A
d. Does discharge bypass a lagoon system? (If yes. notiN, DWQ) ❑ Yes ® No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillwav ❑ Yes M No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: t! ci?
Freeboard (inches): _ .��.y aZ ~
05/03/01 Conrinreed

Facility Number: — 335 Date of Inspection Jo-a7�
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 60 No
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or ❑ Yes ® No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental dweat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ® No
8. Does any part of the waste management system other than waste structures require maintenaneelimproverneut? ❑ Yes W No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes [19 No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancerunprovement? ❑ Yes ® No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes No
[] Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type net. ratan . r_.,...., -VIAP Lc . S A. D... .
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is peaded for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
Reviewer/Impector Name
Reviewer/Inspector Signature:
❑ Yes No
❑ Yes No
❑ Yes [P No
❑ Yes 0 No
❑ Yes Cg No
❑ Yes 0 No
❑ Yes E4 No
❑ Yes (W No
❑ Yes 13 No
❑ Yes ® No
® Field Copy ❑ Final Notes
Date: A
12112103 Z7 / Coked

FacilitT Number:
Required Records & Documents
Date of Inspection ia-a7..oN
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes E] No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes [3 No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes jO No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes [A No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes No
27. Did Reviewer/inspector fail to discuss reviewfmspection with on-site representative? ❑ Yes [P No
28. Does facility require a follow-up visit by same agency? ❑ Yes C1 No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes [A No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) 29 Yes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes 91 No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ® No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ® No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. Yes ❑ No
❑ Stocking Form [a Crop Yield Farm ❑ Rainfall Erinspection After 1 " Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
-r
35- ,r�n.•�,a1 �.+�sp��'.o+,.s cor►oQ��sa� a�kc� lu ter, grc.a-��.r ra;�n� ,
ooCl,tw.4v`^t mOr,t�1'� `tt.15pC[��a.^ Q.� wa��cG-irrr_ol4r.�cnt' 5�s-�'cm.
11
Re_p)&e_ YQi�-► g4�cq�.
�o; So►� plc jas b,e.h
12112103