820385_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

type of visit: tfj Compliance inspection U Operation Review U structure ]Evaluation U Technical Assistance
Reason for Visit: G4outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: i70 Departure Time: y�] County: �7 ��1'f Region: FiZfl
Farm Name: M i ff �7 Y( 1 Owner Email:
Owner Name: f`l f) 3 a � f tte__ 'I �(a S Phone:
Mailing Address:
Physical Address: ��lJ �
Facility Contact: Cu. A (�au� t5 �ca Title: Phone:
Onsite Representative: l ( Integrator: 6 S
Certified Operator: �ff� is t s (3" w "4 Certification Number: to a
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
p.
NNW
Wean to Finish
Wet Poultry
Layer
Non -La er
Capacity
I
Pop.
Cattle
Dairy Cow
Dairy Calf
Dairy Heifer
t
Capacity Pop.
Wean to Feeder
Feeder to Finish
9*Zj
oil
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design
Dry Cow
Non -Dairy
Beef Stocker
D . P,oult : Ca aci P,o
Layers
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes E['N-o- ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No Z3'11A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) [—]Yes❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes [:]No A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes [ErNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No [] NA ❑ NE
of the State other than from a discharge?
Page 1 of 3
21412015 Continued

Facilio, number: - $ Date of Inspection:
Waste Collection & Treatment
4_ Is storage Capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EA-�Ko ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [ &<A ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 36 33_ JIJ
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes Quo ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[]'No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[q'<o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ONo
❑ 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
[--Ko
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required butlers, setbacks, or compliance alternatives that need
❑ Yes
[E'No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes Lai' o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): t �j1
13. Soil Type(s): A44�lf V l (l e
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q-NO
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[g-Ko—
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E&Xb
❑ NA
❑ NE
acres determination?
17_ Does the facility lack adequate acreage for land application?
❑ Yes
NA
❑ NE
18. Is there a lack of properly operating waste application equipment`?
❑ Yes
[Zk6'
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Ea W
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E N�
—r/
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? 1 f yes, check the appropriate box below.
❑Yes
[3_Ner
[] NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
P /goo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[] No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facili Number: yz -,385 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑'No ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
R<0 ❑ NA
❑ NE
1.
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
R� No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
E 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 concem?
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 [q'No ❑ NA ❑ NE
❑ Yes E10 ❑ NA ❑ NE
❑ Yes CDANt) ❑ NA ❑ NE
[:]Yes �o ❑ NA ❑ NE
❑ Yes
[210
[-]Yes
0'<
❑ Yes
ERIC
❑ NA ❑ NE
❑ NA ❑ NE
C] NA ❑ NE
Commentsv(referfto.;gtiestion #): Explain any 1'ES_'answers.andlor aoy additional recommendations ©r any.=other comments
-. :. _
Use.dfrawings of factlty to better explain situatiaas;(use aldttiopal pages as necessary).
0P
7 b ��
3 • K 4,3 3
11
Reviewer/Inspector Name: �l
Reviewer/Inspector Signature:
Page 3 of 3
Phone: `tv_ ` — 33 1
Date: 1
21412015

t ype of v istt: 4o- ompuance inspection v uperatton Keview V structure Lvaivanon V i ecumcat Assistance I
Reason for Visit: `r Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: iftlArrival Time: x O Departure Time: Ll County
Farm Name: —I r' if,( -Cot Owner Email:
Owner Name: Ho 3 J �ml t 3 Phone:
Mailing Address:
Physical Address:
Facility Contact: s Q,�CV t 6 Title:
Onsite Representative:
Certified Operator: 7k6 �t11�
Back-up Operator:
Location of Farm:
Latitude:
J Region: F9
Phone:
Integrator: #1 tJne5
Certification Number: LT 88 W 2
Certification Number:
Longitude:
Design_ Curr�ent; �h�..
Design Current- Design Current
Swine
Capacity �Pop,� - ,., _. Wet Poultry
t±apactty Pop � Cattle Capacity Pop.
Finish
Feeder
�
Layer DairyCow
Non -La er Dairy Calf
o Finish
�" zz° j 'I.�
:V DairyHeifer
to Wean
pDesicg;�,�CurrentD Cow
to Feeder
to Finish
EBoars
. P.oultr,
Layers
t_Po� Non-Dai
rtD
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Broad Cow
Turkeys
Turke Poults
Other
-
j
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 [`f"" ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes E2-No
❑ Yes J�]-No
E4-KA ❑ NE
E3-i6A ❑ NE
E� <
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facili Number: Date of Inspection: f�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q-ro--- ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 5 L.
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [23"N"o ❑ 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 D. NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [21.o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [3 N ❑ 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 ENo ❑ NA ❑ NE
maintenance or improvement?
Waste Apnlication
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 &o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): G S C7
13. Soil Type(s): t
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 ['J No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[—]Yes [3'�To
❑ 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
E2-lo
❑ NA
❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
[
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
G No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement'? If yes, check the appropriate box below. ❑ Yes �No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [] Yes tNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Faciii Number: - Date of Ins ection:
24: Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes ONo [:]NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E3<o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
[;K,4o
❑ NA
❑ NE
❑ Yes
[�No
❑ NA
❑ NE
❑ Yes
[No
❑ NA
❑ NE
❑ Yes [jrNo ❑ NA ❑ NE
❑ Yes E�rNo ❑ NA ❑ NE
❑ Yes [No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E2'*`&o ❑ 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 9 No ❑ NA ❑ NE
Gonuneats (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use ad-cfitional pages as necessary,).
e-a,c-- 9- _ 30
C
e�X
L(
Cut fro- 30 S-4 ff5f
Reviewer/Inspector Name:
Reviewer/Inspector Signa
Page 3 of 3
Phone
tore: Dater
21412015

. ype vi r tsu: %v a.ampiiance inspection v uperation xeview V Nrrucrure nvamation lJ i ecnmcai Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: MA (Zc. it, Owner Email:
Owner Name: L S=k� k-A4* � Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: j
yc
Title:
Region:t�
Phone::
Integrator: W
Certification Number: '�L5L]f
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Curren#`
Swine Capacity Pop.
Wet Poultry
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
La er
DairyCow
DairyCalf
DairyHeifer
D Cow
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Non -Layer
_
I
D , L',oult :
Layers
Design
Ca aei
Current
Pao -
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
I Beef Brood Cow
Other
Other
I
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 [ ' ❑ NA ❑ NE
❑ Yes
[:]No
CaXA
❑ NE
[]Yes
❑ No
[�NA
❑ NE
❑ Yes
[:]No
[!5 NA
❑ NE
❑ Yes
❑'No
❑ NA
❑ NE
[:]Yes
EjNo
❑ NA
❑ NE
Page 1 of 3 21412014 Continued

Facili 'Number: jDate of ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Uj>'B— ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Q5Ao
❑ 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
@al\ o
❑ 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
[!rNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[rNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
[ ,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 [],,1Go ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): yu.f,�->�a 5 L- Q —
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[allo
❑ 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
[]'lgfo
[] NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Cff'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[:�1Go
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[�o
❑ 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 [rN0
❑ 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 Z No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes gJ "'o ❑ 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 E�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 dNo ❑ 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 nfoNo ❑ 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 [!!fNo ❑ 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 L No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 2No ❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
21412014

Type of Visit: compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Ofloutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: s Departure Time: De3 County: s Region:
Farm Name d guA Owner Email:
Owner Name:�5 Phone:
Mailing Address:
Physical Address:
.r-
Facility Contact: J Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
q
Phone:
Integrator: W-3
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Design :.Current
Design.
Current
Design Current
Swine Capacity . Pop.
Vet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
I ILayer
Dairy Cow
Wean to Feeder
I INon-Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current =
jDry Cow
Farrow to Feeder
D-r;-y2P,o_ul
Ca aci
i'o P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
on -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
:,..-, ... .,
Turke s
Other
"Turkey i'oults
Other
I 10ther
Discharp-es and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ©.R'b ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[] No
LJ <A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
E2-NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[:]Yes
[:]No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
[a No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
E:fNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - Date of Ins ection: 7 '
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes PTNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [3-9A ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?-.
Designed Freeboard (in):
Observed Freeboard (in):_C9XZ�T ��
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Ld"'` o ❑ 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
[]-hf
❑ 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
Q-<o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
[:PXo
❑ 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
�o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
[DNA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑Z '�io ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): -- � 4r a c,_ 5 G D &, yw- -
13. Soil Type(s):
14. Do the receiving crops differ from thole 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 of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑'Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

0
Facility Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�o ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
Io� C3,Wi
❑ 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
['NNo ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
�o ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[2-1�0
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?]
Yes
o
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[�]o
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[:]Yes
CT'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
VfNo
❑ NA ❑ NE
Comments (refer to question:#) MrpIkin'nny YES answers and/or any additional'recommendations or any other commeAM nts: L r
Use'drawurs of facility to.berier exvlain situations (use additional napes as necessarvl.: s'
c(l L40'n - �( -3 - t� f
177
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: k3 �-3
31
7).— a Date: (�
21412014

Type of Visit: (DC'om lance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine Q Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: t' Departure Time: County Region:
Farm Name: tl f ?6C Owner Email:
Owner Name: `H p �
3 POi j- 4tt-t, � K-4f & I—f-Phone:
Mailing Address:
Physical Address:
Facility Contact: �Sz+rw1 3 Title:
Onsite Representative: l(
Certified Operator:
Back-up Operator:
Location of Farm:
M
Phone:
Integrator: A
Certification Number: 2a 7 r
Certification Number:
Latitude: Longitude:
Design Curreut
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Wet Poultry
La er
Non -La er
Design
Capacity
Cu.rr2ent
Pop;
Design Curr ent
Cattle Capacity Pop.
DairyCow
DairyCalf
DailyHeifer
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
a ° TM.
Design Current
Dr I;oul Ca aci IN .
Layers
Gilts
Non -Layers
Boars
Pullets
Other
Other
Turke s
Turkey Poults
HOther
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 B176❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
[qNA ❑ NE
[T NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No M-NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [allo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [3No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

lFacility Number: jDate of Ins ecdom
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q j>o— ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No �A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
EEI'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
Q o
❑ 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
allo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
0 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
�o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[—]Yes
dNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E-1+Jo ❑ 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
� [:3Drift Application Outside of Approved Area
12. Crop Type(s): ,U 11{,%4
13_ Soil Type(s): [�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[D>o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[ 0Po
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[TNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ff No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E�[`No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
5j_db
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
[2-No
❑ NA
❑ NE
the appropriate box.
❑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 Q4o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Fa< ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

FaciNty Number: jDate of inspection: 11)
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes EaXo' ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes to ❑ 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 El -No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 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 E 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 ❑/ NNo ❑ 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 [J"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 dNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes Z7 No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes eNo ❑ NA ❑ NE
gs:of facltty. to better explain situations`{use a bonsYoran o"tber�coifiments.
T p_ h ry)• r y= x -
omments (refer. to uestion . Explain an YES answers -and/or, any -additional recommenda
Use drawin ddttianal a es as necessary).
x� .
3
U 5L9wt�
Reviewer/Inspector Name: Photo:0` %J
Reviewer/inspector Signature: Date: t •+yL
Page 3 of 3 VV2011

�>I AS to 6c { �013 60
type of Visit: UCompliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0IR-outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ; DO Departure Time: County: T RegioFK
Farm Name: rT 133 1 z C."I Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
r
Facility Contact: S_'�(SgrW Title: Phone:
Onsite Representative: (,[ Integrator: -
Certified Operator: it Certification Number: V1
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Desi� Current_
:Design
Current
= Design Current
Swine
Capacity Pap.
°Wet Poultry
Capacity
Pop.
tittle _ Capacity Pap.
Wean to Finish
ILayer
Dairy Cow
Wean to Feeder
a
Non -Layer
I
Dairy Calf
Feeder to Finish
W
Dairy Heifer
Farrow to Wean
;;
Design
Current
Dry Cow
Farrow to Feeder
!D : 1'oultiy _
Ca $ci
Po P.
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
jPullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
10ther
Discharses and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
Jo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[] No
CgNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[5'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
[q_NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
dNo
© NA
❑ NE
3_ Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
C51No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: - Date of Impection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
Yes
Io
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
�o
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ' _ s 5 #
5. Are there any immediate threats to the integrity of any of the structures observed? t40 '�e❑
Yes
Mo
❑ 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
rttl�o
❑ NA 0 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
[RVo
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
FZKo
❑ 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
[Za'go
❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): d1r1'rA CA 16 9,60
13. Soil Type(s): e
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [—]Yes Fj'jo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [—]Yes [�o ❑ 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?
Renuired Records & Documents
❑ Yes EL�<o ❑ NA ❑ NE
[::]Yes [_gTl�o ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
EDAo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
EB 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
lo
❑ 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
[(f 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: -I Date of ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ -lq-o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ED X56 ❑ 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 EZ'Ko- ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Gj iWo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes [!3<o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [�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
[�rNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
62'No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
r No
❑ NA
❑ NE
Fuse7drawings.
ments (refer to question ft Explain any YES answers and/or any additional recommendations or any other commEents:
of facility to better exalain situations fuse additional naaes as necessary}.
GAtrwr4(o­�
914.e, �trve7
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Nno Pl,.r rxe,-4
S- r7- 7-013
i
0 �'_ '�'
6::-s.- IV
r;F4 14,7
Pt l —e?f
Phone 333
Date: cab O 1�
21412011

i yp�sit: Ly Uompnance inspection U Operation Review C3 Structure Evaluation U Technical Assistance
Reason for Visit: [Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: I C A)W Ne-,I Departure Time: ipi Arn County: Region: T'PZ
Farm Name_���1 1P'Qtj Owner Email:
Owner Name: VA f33RAtrtS n:�&L C.Oe%soA`9 fit- Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: NI) %4,0
Certified Operator: 0—�^.4 KnAft-►A 1Z)1LvCNn'E
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: y4\0%%Sjh:A t'3 C1
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
can to Feeder
Design Current=
Capacity Pop. Wet 1?oulfry
La er
Non -Layer
Design
Capacity
Current.
Pap
Design Current
Cattle Capacity Pop.
DairyCow
DairyCalf
DairyHeifer
D Cow
Non -Dairy
X
Feeder to Finish
Farrow to Wean-'.
Farrow to Feeder
Design Current
D : Paul Ca NOP,o
Farrow to Finish
Layers
Beef Stocker
Gilts
Boars
Other
Other
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation? V.
❑ Yes
[3No
[] NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
�A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[ A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (Ifyes, notify DWQ)
❑ Yes
[] No
ENA
❑ 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
eNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3
21412011 Continued

Facili Number: jDate of Inspection: 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�,�
Bio
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[—]Yes
[:]No
[RNA
❑ NE
ai W 16 53A tz.
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: �.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z9_ iz� 10 54
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[5Ao
❑ 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
�o
❑ 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
J2 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
2' o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Q No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
Q'No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Eviden6e1of Wind Drift ❑ Application Outside of Approved Area
� c
12. Crop Type(s): f�R.SZ ss1 pit M Ga,S_ QAS't uM1>~ N : G
13. Soil Type(s): '1X%_ "Ry 11MX\L
14. Do the receiving crops differ from those designated in the CAWMP? [:)Yes [!3No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 2 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
EKNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q No
❑ NA
❑ NE
Required Records & Documents
19, Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
M No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Ef 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 g No
[:1 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 [Z No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes dNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

FaciliNumber: - Date of Inspection: 't
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes &�No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes [V'No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes UNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes [v No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
E. 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
E� 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
g 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
62-No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Q No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
d No
❑ NA
❑ NE
Comments refer to.'question y y ' .
Use drawings.of facigti;r to better explain situations-6-se aaataoual. pages as necess ry) menda4onsor anat�her�comments
I f
.*
W%to in
'ate a
'� t��iLF �9
lUD gaf�uCJ ILL
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
\ d - Phone: 16- 1
Date: '1 gal I
21412011

Type of Visit: 40 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: d ( Arrival Time: zgmiQ Departure Time: u-� County: bJ Region:
Farm Name: 1 * t I 1 VLLh Owner Email:
Owner Name: 4123 "Fi ,r1 s e f -fL 6-,yd,W S u6Phone:
Mailing Address:
Physical Address:
Facility Contact: Cq:n Daytw Title: Phone:
Onsite Representative: Ll Integrator:
Certified Operator: t1 Certification Number:
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
11 Design Current Design Current
Design Current
Swine Capacity Pop # Wct Poultry C*apa t Pop @tittle
Capacity Pop.
''
Layer
r'
DairyCow
Non -La er
DairyCalf
DairyHeifer
4
r Design Current. -
D Cow
M,
�D > P,ouit, Ga acity P,o ,
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Other
Other
Wean to Finish
Wean to Feeder
Feeder to Finish
2
�.
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
La ers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑Structure ❑Application Field ❑Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
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 ❑ NA ❑ NE
[:]Yes
[::]No
[] No
[:]Yes
NA ❑ NE
j NA ❑ NE
❑ Yes
❑ No
,® NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
� Na
❑ NA
❑ NE
Page I of 3 2/4/2011 Continued

Facility Number: Date of Inspection: 3 /
T
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
§4 No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: 2 4�
Structure 5
Structure 6
Spillway?:
1'S
Designed Freeboard (in):
k
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 No
❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
TT
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
Q9 No
❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
S. 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 [P No ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > t0% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Ai
12. Crop Type(s):
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?
1$, 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] No
r
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes � No
❑ Yes /E] No
❑WUP ❑Checklists ❑Design ❑Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑ NE
❑NA
❑NE
❑NA
❑NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
[:]Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412071 Continued

acility Number: Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? El Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ 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
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes fM
l No
❑ Yes T
No
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes T No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes T No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes EEQ No ❑ NA ❑ NE
Comments (refer. to question #f)t Explain any YES answers:andlor any additional recommendattons.ar'any outer coniments.T ".iW
Use drawings of facility to better explain situations -(use additional pages as necessary).
Sf317
I .� zJ` ee l�r��c ` / j '�"�' (/ D' ' ZD GL,
f fiw� /
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

(Type of Visit 4) Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit ®Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑Denied Access
Date of Visit:
Farm Name:
Arrival Time: Departure Time: p County:
a [ � � t ) l 0.1 �� Owner Email:
Owner Name: I' '�'/ "tA_)"- `- �L ;20J 1�3 Phone:
Mailing Address:
Physical Address: /�,�
Facility Contact: lJ� `��"'i aW i- Title:
Onsite Representative:
Certified Operator: pfw--
Back-up Operator:
Phone No:
Integrator:
&w
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: = o =' 0 Longitude: = ° = I = is
Desigq Current Design._ .::._"Current Design
Current
Swine Capacity topulation VVet Poultry Capacity Population Cattle Capacity
Population
❑ Wean to Finish
❑ La er
❑Dai Cow
Wean to Feeder
❑Non -Layer
❑Dairy Calf
19 Feeder to Finish
airy Heifer
Dry Poultry El
❑ Farrow to Wean
D Cow
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure ElApplication Field ElOther
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 �No ❑ NA ❑ NE
❑ Yes
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure ElApplication Field ElOther
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 �No ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
/ El Yes
❑ No
;NA
❑ NE
❑ Yes -
ftNA
❑ NE
❑ No
❑ Yes
tDNo
❑ NA
❑ NE
❑ Yes
[�No
❑ NA
❑ NE
Page 1 of 3 12/28/04 Continued

Facility Number: — Date of Inspection i O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure i Structure 2 Structure 3 Structure 4
Identifier: 2ZQ6_31- ?DC6_Zj .-:?
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1 It Y-12
�_ S4
❑ Yes F No ❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
Structure 5 rtmcture 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No
❑ NA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
No
ElNA ❑ 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 o
ElNA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes 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 i�To
❑ NA [I NE
maintenance or improvement? t
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No
ElNA ❑ NE
maintenance/improvement?
]1. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 'RNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN [:IPAN > 10% or ] 0 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceutable.CrQv Window ❑ Evidence of Wind Drift ❑ ADDlication Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ENo
❑ 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
Jj�No
❑ NA
❑ NE
Comments Use drawings of facility#o b.etter explain s tuatio s' (use add►ti I pages as neces ery)ns or any, o� her comments.
( q ) p Y ,
f
AL
Reviewer/Inspector ]Same P. Phone: 3OO
Reviewer/Inspector Signature: 1 Date:
12128104 Continued

Facility Number: Date of Inspection O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 479 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 ❑ Desig
n ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No El NA ❑ NE
El Waste Application El Weekly Freeboard El Waste Analysis El Soil Analysis El 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
0 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[:]No
[51 NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
19No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0 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
4kNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[[INo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
y
❑ NA
El 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
tp No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
TNo
❑ NA
❑ NE
Page 3 of 3 12128104

J
Type of Visit * Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit • Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: r0 Arrival Time: /Q'lTy� Departure Time: � County: �PSOf—j Region:
Farm Name: — ;2OO/,3r R©0,2_,3 200,5 _ Owner Email:
Owner Name: /VIU4"0" —0qAV&An luc Phone:
Mailing Address:
Physical Address:
Facility Contact: �' 1r _ _ Title:
Onsite Representative: J
Certified Operator: u 1 t-rf
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number: Tr'
Back-up Certification Number:
Location of Farm: Latitude: = 0 = 1 = u Longitude: ❑ o = I =
11
Mgn�C111111nt
Design Current
Design Current
ine ulation
S-0
Wet Poultry Capacity Population
Cattle Capacity PopuIF
❑ Wean to Finish
j
I[] Layer
I
I
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La -Layer
El Calf
Feeder to Finish
❑ Dairy Heifer
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
El Gilts
❑ Boars
Dry Poultry
❑ Layers
Non -Layers
❑ Pullets
❑ Turkeys
❑ Dry Cow
ElNon-Dairy
ElBeef Stocker
❑ Beef Feeder
❑Beef Brood Co
Other
❑ Other
❑ Turkey Poults
❑Other 1 1
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
kNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
PNA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
[�JNA
❑ 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
RNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
qNo
❑ NA
❑ NE
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[�bNo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes JGNo [DNA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No D3 NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: OM)( 10)q- 2166Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 68 q 3 Y 32 4
5. Are there any immediate threats to the integrity of any of the structures observed? El Yes
No El NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
P 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? ElYes
p No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
N 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
1�1 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
Q No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
t3 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s,
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
11 Yes
)d No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
R 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
ElNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
Comments refer to uestion # Ea lain an YES answe s a ai► recomrriendations or any other comments."'N
( q ? P y y
Use drawings of facility twbetter explain situations {use additional pages as necessary)
Reviewerllnspector Name ` Phone: 0 33-33�
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: — Date of Inspection 6
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
19 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
N 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
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[] No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
MNo
[:1 NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
Ep No
❑ NA
❑ NE
Adciittonal Commen
.,and/or .D
A.
]MV04

i ype of visit O Compliance Inspection Q Operation Review V Structure Evaluation V Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: I
lag ( 't Arrival Time: Departure Time: _ County: -5dr"1-SOA Region: FPO
Farm Name: M �7011 aZ j0-� a�i _ Owner Email:
Owner Name:—er?acvn, PLC Phone:
Mailing Address:
Physical Address:
Facility Contact: Gwy— Title:
H
Onsite Representative: Certified Operator: Brad f 4nfle
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =11 =1 1 ="
Longitude: = ° = f = u
Design Current Design Current Design
Swine Capacity Population Wet Pogltry Capacity POPulation Cattle Capacity
Current
Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
/a g
f7U
❑ Dairy Heifer
Dry Poultry ❑ Dry Cow
❑ Non -Dairy
❑ La ers
El Beef Stocker
❑Non -La ers
❑ Beef Feeder
❑ Farrow to Finish
❑Gilts
❑ Pull
Pullets
❑ Beef Brood Co
❑ Boars
❑ Turke s
❑ Turke Poults
❑ Other
Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
9No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
�NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
10NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
11
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
0 NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
I? No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: �— Date of Inspection a7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes N No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes El No � NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: e2701 AIDSB p 0A
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S V .tea `1 N 3 �p'Y
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
JDNo
❑ NA ❑ N E
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
E3 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
bNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
91 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
6 No
❑ NA . ❑ N E
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
�q
No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes]
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yey/�jNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Q5 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
0 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
EP No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
I&RNo
❑ NA
❑ NE
Comments (refer toqueshan;#)E%plain any YES answers an agrecotendattons or OUR comments.
Use drawings of facaltty to better explain�situations. (nse addtiionalkpages�asue�eessary):
Reviewer/inspector Name Phone: 10- "3
Reviewer/Inspector Signature: Date:
Page 2 of 3 I2/2SIU4 Continued

Facility Number: - Date of Inspection �o3CyJ
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g El Maps El Other
❑ Yes To ❑ NA ❑ NE
❑ Yes N No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ,N No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27_ Did the facility fail to secure a phosphorus loss assessment (PLAT) certification'?
Other lssues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Addihonhi CommeifWan'd7or Drawings: s r;
❑ Yes
JRNo
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
[]Yes
E3No
❑ NA
❑ NE
❑ Yes
n No
❑ NA
❑ NE
❑ Yes 19 No ❑ NA ❑ NE
❑ Yes ,)] No [INA ElNE
ElYes 9No ❑ NA ❑ NE
❑ Yes V No ❑ NA ❑ NE
❑ Yes 10 No ❑ NA ❑ NE
[:)Yes
'Q No
❑ NA
❑ NE
❑ Yes
K] No
❑ NA
❑ NE
Page 3 of 3 12128104

0 Division of Water Quality
LFacility Number— 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection O Operation Review () Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint O Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 7 31 Ori Arrival Time: Departure Time: County:-9T""+ Std Region:
Farm Name: 2-0013 . a0Q_ 3. -)iJnZJ Owner Email:
Owner Name: /' i L.GrP &Ltd h Phone:
Mailing Address:
Physical Address:
Facility Contact: 6 LA,! C Title: Phone No:
Onsite Representative: Integrator: _� F�►4[.9�! _
Certified Operator-- Operator Certification Number -
Back -up
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: = o = S Longitude: = ° 0 1 ❑ "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
: ❑ is er
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouits
❑ Other
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
EFDry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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 PNo ❑ NA ❑ NE
❑ Yes
❑ No
�NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No P NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

' Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes No in NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: __0013 2 W 9-3 900S 3 -�C3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z �'
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
`1
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes El NA
❑ NE
through a waste management or closure plan`?
�No
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 j No ElNA
El NE
maintenance or improvement?
Waste ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ElNA ElNE
maintenance/improvement?
11. Is there evidence of incorrect 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 I0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑%Evidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s) &y- lL
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[A No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
to No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
M No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�9 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ZNo
❑ 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):
1J I
Reviewer/inspector Name z
e- Phone 7 � 3�
Re-0ewer/Inspector Signature: rD Date: 3
1t/146/V4 4Unlfnuer�

Facility Number: — Date of Inspection
Re aired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes g� 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 appropirate box.
❑ WUP ❑Checklists ❑Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNO ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
91 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ZNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
1!�No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ON o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
b No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
19vo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
F9)No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31 _
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
PNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
4 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

l ype of visit 0 Compliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine 0 Complaint O Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: © Arrival Time: Z`, l Departure Time: County: �h
Farm Name:'g 11 D,��i f a ll0 a� 13, 20p230 2'a53)Owner Email:
Owner Name: M(AI & P" w w Phone:
Mailing Address:
Physical Address:
Facility Contact: _ _fir Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Region: r 9
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =1 e = , 0 Longitude: ❑ ° = f ❑ u
Design Current
Design Current
Design Current
Swine
Capackvopppulat'on
Wet Poultry Capac>ty Population
Cattle CapacityPopulation
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
ILI Non -Layer I I
❑ Dairy Calf
Feeder to Finish
(24 I'zt
❑ Dairy Heifer
❑ Farrow to Wean
Dry Cow
ElFarrow to Feeder
D Poul A.El
rY
El Non -Daily
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑Non-1 a ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Co
-
❑ Turkeys
Otherf
❑ Other
❑ Turke Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes [8 No ❑ NA ❑ NE
❑ Yes
❑ No
® NA
❑ NE
❑ Yes
❑ No
P NA
❑ NE
SNA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

racility Number:Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 1p No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes P No ❑ NA ❑ NE
tcre 9re4 ScD
Structure 5 Structure 6
Identifier: a'7� i a-1 O D�14 �IV9
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): N ��17
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes] No El NA [I NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes W 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 [jj 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 managemeyt 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 ElNA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
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?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
Ep No ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
�No El NA ❑NE
P No ❑ NA ❑ NE
Reviewer/Ins ector Name " ate"
P t = -�. .r�erh �,,; �: Phone:
Reviewer/Inspector Signature: Date: 7 0
Page 2 of 3 12128104 Continued

3 85�
Facility Number- Date of Inspection
Required 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 W No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [' No ❑ NA ❑ N E
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ SoiI 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
D9 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]
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
V1 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
IM No
❑ NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
El NA
❑ NE
and report the mortality rates that were higher than normal?
!
1
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
M 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
V 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
[P No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit Q Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit At) Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
C
Date of Visit: Z Arrival Time: : jp Departure Time: County: �6�51,erl� Region: f AQ
Farm Name: _ _ t�n4:�vt_ a bpi f� 01 2165-- Owner Email:
Owner Name: Phone:
Mailing Address: P� _Qc ��fu-� , ., t 1� «1 ,, N Z
Physical Address:
Facility Contact:
Title:
Onsite Representative: _G7­e-'� CAIZL__
�j
Certified Operator: &y f f -e ; J-, IL'A
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator: L�'Tyz� -` &'_C'_'�..._
Operator Certification Number: to,
Back-up Certification Number:
Latitude: = o = 4 [ Longitude: = ° = = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
Z
��
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Soars
-Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current-- .
Cattle Capacity :Population.
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
Beef Stocket
❑ Beef Feeder
I❑
FI Beef Brood Co
r.
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes. notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 4No ❑ NA ❑ NE
❑ Yes
❑ No
RNA
❑ NE
❑ Yes
❑ No
�NA
❑ NE
XNA
ElNE
❑ Yes
❑No
❑ Yes
DJ�NNo
❑ NA
❑ NE
❑ Yes
ff�o
❑ NA
❑ NE ,
12128104 Continued,

Facility Number: xi — S
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1f Structure 2, Structure 3 Structure 4
Identifier: 5A �S
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 04:No El NA ❑ NE
El Yes ❑ No ,[DNA ❑ NE
Structure 5 Structure 6
❑ Yes 4No ❑ NA ❑ NE
❑ Yes 'S No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes � No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? Yes No El 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
maintenance/improvement?
❑ Yes 4 No ❑ NA ❑ NE
I I . Is there evidence of incorrect application? If yes, check the appropriate box below. [:]Yes &No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12. Crop type(s) <
4� �, i Cam_
13, Soil type(s) .�v .
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes O'No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes KNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[] Yes PiNo ❑ 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 R.No ❑ NA ❑ NE
�-. !'�c,.,,,�� 1�-�- ::T�, �s.: G-v. •-�,� o-� � ��� `� lre re rti.� � �:,Ks .�a ccr►��c�
r ti
Reviewer/Inspector Name �k� �= Phone: /�''yPiiO �l$�/
Reviewer/Inspector Signature: 1A Date: 29 Cl
12128104 Continued

-lFacility Number: Z -3Fj5 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 9No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUr ❑ Checklisfs ❑ Design- ❑ Map*' ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ,91 No ❑ NA ❑ NE
❑ Waste Applicatiop- ❑ Weekly Freeboard- ❑ Waste Analysis- ❑ Soil Analysis, ❑ Waste Transfers ❑ Annual Certification —
El Rainfall- ❑ Stockitig- ❑ Crop Yield- ❑ 120 Minute Inspectione­ ❑ Monthly and 1" Rain Inspections- [:1 Weather Code-
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
ONo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
,29,No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
q No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
R] 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
9 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
,�
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
0No
❑ 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
5� 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
KNo
❑ NA
❑ NE
Aaatttodal c mmentsla-, *1 wtttgs t
I2128104

Type of Visit ® Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Mac of Visit: � Time: ' O6
FacilihNumber 3 3 FS
Iro _71170irlerational Q Below Threshold
UPermitted M—Certified 0 Conditionally Certified 0 Registered Hate Last Operated or Above Threshold:
Farm Name: 0 C o17-), d /o z , �=_!aS County: S nso..A FtQo
Owner Name:
Mailing Address:
FacHith- Contact:
Title:
Phone No:
Phone No:
Onsite Representative: 01 r_Integrator: M u e121
Certified Operator: RF-.k Sr. 1A C'. I V'%. Operator Certification Number: -F'
Location of Farm:
Swine ❑Poultry ❑ Cattle ©liorseL atitude �� �� Longitude
Design Current
Swine rn-o4 :ty Pnnnlatinn
❑ Wean to Feeder
Feeder to Finish
/000
® Farrow to '%Vean
/a as
® Farrow to Feeder
i'
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Laver ❑ Dairy
❑ Non -Laver JE1 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons 1LJ, Subsurface Drains Present AL_ J Lagoon Area _ jLI Spray- Field Area-1
Holding Ponds / Solid Traps ❑ No Liquid waste management System
Discharges & Stream imoacts
1. Is anv discharge observed from anv part of the operation?
❑ Yes
®No
Discharge orie-inated at: ❑ Lagoon ❑ SDrav Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. If discharge is observed, did it reach Rater of the State? (if ves. notify DWQ)
❑ Yes
❑ No
c. If discharge is observed. what is the estimated flow in gal/min?
NJA
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
_
❑ Yes
❑ No
2. is there evidence of past discharge from any pan of the operation?
❑ Yes
No
3. Were there anv adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
© No
Waste Collectiou & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
® No
Structure 1 Structure ? Structure 3 Structure 4 Structure ;
Structure 6
Identifier: '.e / 4 .40 °2 -S ,4 sg
Freeboard (inches): + �� �% 3 h '93"
05103101 3 +f 4a /1
Continued

Ccitity Number: ffa — 397Date of Inspection 7 �
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ® No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ® No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? Yes ❑ No
S. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑ Yes P No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
UNo
elevation markings?
Waste ARvfication
10. Are there any buffers that need maintenance!unprovement?
❑ Yes
[9 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 Re , ^ k -*4- r
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAVVMP)?
❑ Yes
® No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
® No
b) Does the facility need a wettable acre determination?
❑ Yes
® No
c) This facility is pended for a wettable acre determination?
❑ Yes
P No
15. Does the receiving crop need improvement?
[B Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 12 No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ® No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes No
Air Quality representative immediately.
❑ Field Copy ❑ Final Notes
7--) 4��100/+1 b6�1✓, PfaJG {I�CGN Wor"+o PrfCt7�6F� t/LG�1cCc4�Y� GPdCrecgC
6.,,. �•.1 F.]'lti
G ILc►A .N
M+- 13r.t•+
r7ci bcc SP,�cttcQ� 6.a ��r�a�s Ar
PIT ,.� c c� -
}- • G 1 �,L` I i S ►"-�, iC t o�. cf� r ra. 5 3 c .. � � c ,. ,.. c,.c�4 n„ ay b c 5 � .i � �cQ. 1 flr
Reviewerffmpector Name
Reviewer/Inspector Signature: Date: 7 - ,I /— O y
12112103 Continued

acility Number: � _31,s Date of Inspection
Required_ Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ® 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 ® No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® 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 No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes ® No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 5 No
27_ Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes [�No
28. Does facility require a follow-up visit by same agency? ❑ Yes P No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP. ❑ Yes 0 No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) m 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 ® 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. Q'Yes ❑ No
❑ Stocking Form Crop Yield Form ❑ Rainfall ❑ Inspection After 1 " Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103