820392_INSPECTIONS_20171231

NUH I H UAHULiNA
Department of Environmental Qual

awj
Division of MaNeRl RRoanes
•FWe- iiiU MW ® 61- Y 2 Division of Soil and Water Conservation
Q. Other Agency
Fype of Visit: 0"Gompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ®'Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: Y'i `� �� Owner Email:
Owner Name: fT�+i, {�O Cr~`- Phone:
Mailing Address:
Physical Address:
Facility Contact: 5 :) av -Gv tL'ti Title: Phone:
Onsite Representative: _ Integrator: 1^�Sfj
Region:r
Certified Operator: Oau4z'� Certification Number: [ '3
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine Capacity Pop. Wet Poultry Capacity Pop.
rF Design Current Design Current
Wean to Finish La er
MFeeder
Design Current
Cattle Capacity Pog.
Dai Caw
Wean to Feeder
Non -Layer
Dai Calf
to Finish
Farrow to Wean
Farrow to Feeder
Design Current
D , Poui Ca aci P,o ,
Layers
Dairy Heifer
Dry Cow
Non -Dairy
11 Farrow to Finish
Beef Stocker
Beef Feeder
I jBeef Brood Cow
Gilts
Non -Layers
Boars
Pullets
Other
Other I
Turke s
Turkey Puults
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 Quo - ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
❑ Yes
No
dNA ❑ NE
F:f1"A ❑ NE
[;[I�A
❑ NE
❑NA
❑NE
❑ NA'
❑ NE
Page I of 3 21412015 Continued

[Facility Number: Date of Inspection: w
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [a]_N,&--❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No E3--NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): f 3 t J(
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
P-1-No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[]].No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[ &o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[;�'No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
El"No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E3 No
❑ NA
❑ NE
maintenance or improvement?
i
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [3 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): �-r-p tcd a , �C. c> rL o {�
13. Soil Type(s): �IJ y
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [0-No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes " No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E2-No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑'<o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q'i\Io
❑ 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
[DNA
❑ 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 [2'gio ❑ 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 Ef)No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes FJ/No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number. _ Date of Ins ection- p
24_•Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes {❑ W ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes ❑ No FP16 ❑ 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 �o ❑ 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
[DXo
❑ NA
[3 NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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
Q 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
CZ17No
❑ NA
❑ NE
33. Did the Reviewedlnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[2 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E]"'No
❑ NA
❑ NE
Reviewer/Inspector Signature: \ �7 Date: Yokoot
Page 3 of 3 21412015

(Type of Visit: & Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: (a'ioutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: a Arrival Time: Departure Time: County:_
Farm Name: Z)" gpC'1 tst Owner Email:
Owner Name: apfil ; I o-n- Phone:
Mailing Address:
Physical Address:
Facility Contact; C,44"-TCl D 444r!04 Title: Phone:
Onsite Representative: '( Integrator: rrrl'_4e
Certified Operator:
�« Certification Number: I a
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Region:Fi�
DestgnCurrent
DesignCurrent
Design Current
Swine
Capac►tyPop
oulr
Wet Pty
i�Cattie
Capacty; Prop
l
Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
P
I
6~Ii
;e
Layer
INon-Layer
!
IDairy
r s
Designer Current_'
Dai Cow
Calf
Dairy Heifer
Dry Cow
Farrow to Feeder
Dry Poultr,
a ai CtPo _
k
Non-Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke sir
T r -
Turke Poults
no7tl
her
z_:
Other
-
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ®-ivo ❑ NA ❑ NE
❑ Yes ❑ No E-TNA ❑ NE
❑ Yes ❑ No [jrNA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) LJ Yes L] No L:j NA LJ 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 E�'No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: Date of Inspection: Q ,�
Waste C(Alection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes R;J-W o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No L],NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): c
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E?&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
eNo
❑ 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
E' No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[�fNo
❑ 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 Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[XNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below_ ❑ Yes VfNo ❑ 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 c� ❑ Evidence of Wind Drift ❑ yApplication Outside of Approved Area
N 12. Crop Type(s): e_t A&&.&_ 560 �W[J
13. Soil Type(s): Wti r_A_
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 2 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [ONo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Q No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2--No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
VNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ZNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [ZNo
❑ 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 VNo
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [�No
❑NA []NE
[] Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection:
24. Did tl c facility fail to calibrate waste application equipment as required by the permit? ❑Yes �o
25_ Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑moo
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 �o
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 2�`No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33, Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑NA []NE
❑ Yes E3'No [DNA ❑ NE
❑ Yes [ZI-No ❑ NA ❑ NE
❑ Yes eNo ❑ NA ❑ N E
❑ Yes [D No ❑ NA ❑ NE
❑ Yes EB No
❑ Yes y❑'No
❑ Yes ❑'No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
c-rd No- 3
Reviewer/Inspector Name:
Reviewer/Inspector Signatut
Page 3 of 3
Phone:g1 LU-3 —1 3 3'
Date: l0 / 1
2Z1,615

J.
Type of Visit: compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: "utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access � t�
Date of Visit: 1krrival Time: a ,j Departure Time: County: `S� � " l Region:
Farm Name: V 0 ✓ G[ { ` P, �"� �'til" t/ f Owner Email:
Owner Name: 04-dle Phone:
Mailing Address:
Physical Address:
Facility Contact: C',.44 -1 ?.a Y'w `Z'� Title:
t
Onsite Representative: (
Certified Operator; f'7 yl� / cC e vi
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: fCr
Certification Number: ; 03 7-C>
Certification Number:
Longitude:
0-111 6 D9 Paz ---;A 4 ,PC-13b
Desi n., Curr'eot , Dew s�
g ign� Current- . -
Swine Capacity Pop. Wet Poultry - Capacityr =Pop. Cattle
•
Design Current
Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
i.
Non -La er
Dairy Calf
Dairy Heifer
Cow
Non -Dairy
Feeder to Finish
TTW
Farrow to Wean
Design
D . FoulCa ac'_Po
Current -Dry
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Boars
—.Non-Layers
Pullets
Turkey Poults
Other
..,.-
*nt0jLf.Turkeys
Otherx:A,:: •
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?
❑ Yes EZPiu- ❑ NA ❑ NE
❑ Yes []No ED-KA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[:]Yes
[-]No
[E�NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
[-]Yes
[-]No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�lo
❑ NA
❑ NE
3_ Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
0'No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facility Number: t - +s '� Date of inspection:
/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[g-W
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
Q<A
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): J.7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�Io
❑ NA
[3 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
10<0
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
214o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[2-*1Go
❑ 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
[ "N' o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes ❑ IAo ❑ 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): GJ'4 . . 5-.G () G [�
13. Soil Type(s):yiJ_ t_A IDo
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes []>6 ❑ 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 ffNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes <0
❑ Yes [" No
❑ NA ❑ NE
❑ NA ❑ NE
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 ETNo ❑ 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 YNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [2No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: 15 ON - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes O 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 [ "'N' o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [TNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes Eq No ❑ NA ❑ NE
❑ Yes [Bc 'flo ❑ NA ❑ NE
[:]Yes [ 0f'4o [DNA 0 NE
❑ Yes [3] No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [] No ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? [:]Yes [2rNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes F,7;1-No ❑ NA ❑ NE
Comments (refer to question #) m Explain any YES answers and/or any additional recommendations or any other coments
r
Use drawings of facility to better ezplain situations (use additional pages as necessary).
st"t'j 'esk.'
P.- 211, �
-- ovkG l�
Reviewer/Inspector Name: l 1 U V_ Phone: >`
Reviewer/Inspector Signature: Date: Rk/4
Page 3 of 3 21412014

Structure Evaluation Inspection
Facility Number: O� -- , Date: C9�
Time in: f 3 6 Time out: 9),
�S
Farm Name: Farm 911 address:
Owner Name: / Phone
-� Facility Contact: Cj (t3c� w 0
Onsite Representative: ' C Integrator: 0*k z
Certified Operator: Cert. Number
Is storage capacity less than adequate? Yes No !/
If yes is waste level into the structural freeboard? Yes No
Was non -compliant level reported to DWR POA received
Structure: 1 2 3 4 5 6
Identifier:
Spillway?
Designed Freeboard (in.):
Observed Freeboard (in.):
Are there any immediate threats the integrity of any of the structures
observed? Yes No
Do any structures lack adequate markers as required by the permit? Yes r No
Does any part of the waste management system need repair Yes No
Condition of field's
Condition of receiving crop G—vo-ft
Comments:

aype or visit: E3Compliance inspection V Operation Review U Structure Evaluation U technical Assistance
Reason for Visit: Q-Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: .p rival Time: Departure Time: County:
Farm Name: b D i1 " Z Owner Email:
Owner Name: rf QCf/" Phone:
Mailing Address:
Physical Address:
Facility Contact: Cam, 'r 'f�4-te— Title: Phone:
Onsite Representative: L C Integrator -
Certified Operator: _ 'jta 4
Back-up Operator:
Location of Farm:
Latitude:
Region
Certification Number: A L L 0
Certification Number:
Longitude:
Design Current Design @urgent= Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
Myer
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
%a
a
Design
D , P,oultr Ca aci
Current
1'0
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Finish
Gilts
Layers
Non -La ers
I
Beef Feeder
Boars
Pullets
I Beef Brood Cow
-
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
l . Is any discharge observed from any part of the operation? ❑ Yes Q>w—o NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No []rNA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) [:]Yes [:]No Q 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 tNA
A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑Yes [�No ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes MNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Fac�Ii Number: 113ate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Q-Ne.— ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
- G-KA
❑ 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
Q5>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
[ffN
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[:No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
P7 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
FrNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes do ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes C3 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): C :J `v^ . J G (7
13. Soil Type(s):-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0-1 ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes C Rio ❑ NA 0 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes C3"i o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
C3'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[�to
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
Vo
[] NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
61<0
❑ 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
E gll' o
❑ 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
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ YesNo
g��o
❑ NA ❑ NE
Page 2 of 3 2/42011 Continued

Facili Number: - Date of Ins ectio
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 Q-Mo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
Q-Ko
❑ NA
❑ NE
❑ Yes
[]<o
❑ NA
❑ NE
[:]Yes
No
❑ NA
❑ NE
❑ Yes _E�15No ❑ NA ❑ NE
❑ Yes 21ITo ❑ NA ❑ NE
❑ Yes ETNo ❑ NA ❑ NE
❑ Yes
EJONo
❑ NA
❑ NE
[:]Yes
El"No
❑ NA
❑ NE
❑ Yes
dNo
❑ NA
❑ NE
Comments (refer to question#): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).`
C6la«'--7 IG_3 rY
8tu,�,s * (-- I o-:Lc./
7 r t
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
P �'f
a-31 - y ko'4 4-411%.0-W.
Phone:
Date:
21412014

i w.s is
of Visit: QTompliance Inspection 0 Operation Review (:)—Structure Evaluation Q Technical Assistance
►n for Visit: [�outine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: I Arrival Time: V2= Departure Time: County:
Farm Name: ktew& (, Owner Email:
Owner Name: ZI t, PcYa/1 et"_ Phone:
Mailing Address:
Physical Address:
Reg onV 0
Facility Contact: r_,iAtA�_T & vW t Title: Phone:
Onsite Representative: Integrator:
Certified Operator:` QC.1 Certification Number: oi!
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current r:, Design Current ..:_ Design Current
�CFPWeity
.,.�,.. .lh
Pop. WetBPoultry Capacity Pop. Ca tle a @agacR Pop.
Wean to Finish
ILayer Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
o
z>
-
Dairy Heifer
Des' Current
Farrow to Wean
Dry Cow
Farrow to Feeder
�� D aP,oult , Ca aci Po ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
turkeys
Othe
urkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes GD Ko ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [:]No L .NA ❑ 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? (If yes, notify DWQ) ❑ Yes [:]No A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes b [DNA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes lo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [!}}qt- ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No &KA ❑ 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
Gg-?io ❑ 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
[DIlo ❑ 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
23'No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
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
C!3'No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes E3,?4V-- ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence ofWindDrift ❑ Application Outside of Approved Area
12. Crop Type(s):3 N QJ' VL...�(
13. Soil Type(s):
14. Do the receiving crops differ
a
those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
t 1<
❑ NA
❑ NE
❑ Yes
to
❑ NA
❑ NE
El Yes
6<_
❑ NA
❑ NE
❑ Yes [ No ❑ NA ❑ NE
❑ Yes Fp�o❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes [I -No
❑ NA
❑ NE
20- Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes 6-1�`oEJNA
❑ 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 o
❑ 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 g�N�o
NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

[Facility umber: - DateoInspection: r
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [3-5o — ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Fj<o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Nan -compliant sludge levels in any lagoon '
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tilt drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
G],N—o
❑ NA
❑ NE
❑ Yes
[a4qo'_
❑ NA
❑ NE
❑ Yes 2'No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[:]Yes [A'Iqo— ❑ NA ❑ NE
❑ Yes ff No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWNW? ❑ Yes L"J 1" ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes V ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No 0 NA ❑ NE
Comments (refer to question #i): Explain any YES answers and/or any additional recommendations or any other comments. Y -
7se-iirawings of facility to better explain situations (use additional pages as necessary)..
Reviewer/Inspector Name: Phonk 13.
Reviewer/Inspector Signature: Gd Date:
Page 3 of 3 7 2/4 1111

I ype or visit: U Compli nce Inspection p Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ® Arrival Time: % i Departure Time: County•
Farm Name_ �;ct,+�,1;.ti1 '� ��� Owner Email:
Owner Name: — toml Tc74ICY.� �Q�r/�5 -:LX,7tr . Phone:
Mailing Address:
Physical Address:
Facility Contact: 'x "Wrt_ Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Region:
Phone:
Integrator:r a�
01
Certification Number:
Certification Number:
Longitude:
II .. D n Currennt pl JI f h agg
g Dgn�Current_
Design Current
1
Swine Capacity Pop. Wet Poultry Capacity.. Pop. Cattle
Capacity Pop.
inish La er DairyCow
eeder
Non -La er
DairyCalf
Finish
Wean
EBoars
p
D p
,•:: DairyHeifer
Des�igu Cirreat D Cow
Feeder
D : P-_oul .rYC
a _�1?0 Non -Da
Finish
La ers
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Turkeys
Other TurkeyPoults
01
17 Other Other
Discha es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 fiqNo ❑ NA ❑ NE
❑ Yes [—]No
❑ Yes [—]No
[:]Yes [:]No
❑ Yes RNo
❑ Yes i1 No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
M No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 9`
Observed Freeboard (in): 15
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
K No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
� No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
25 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
ER No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance altematives 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 C& No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ E//vidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �w /j9 e-p^/�7rs' fGt�rr—
13. Soil Type(s): A/Q
❑ NE
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
JR 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
O No
❑ NA
❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
❑ Yes
S No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
r 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
3 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 K 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 IN No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes MNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

FaciliNumber: - Date of Ins ection: — f
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 7gNo ❑ NA ❑ NE
1 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E�].No [] NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes M No [] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 5LNo [DNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes 5a No ❑ NA ❑ NE
[-]Yes 0 No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes I& No
❑ Yes tj� No
❑NA ❑NE
❑NA ❑NE
Phone: -Mr" o
Date:
21412011

type or visit: Cl uompuance inspection U Uperation Keview U structure Lvaluatton V technical Assistance
Reason for Visit: Routine Q Complaint Q Follow-up O Referral 0 Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: ;Oil p County:
Farm Name: R V NIVI AhCh a Owner Email:
Owner Name: [ PLY12- Z �__AQihs T nC + Phone:
Mailing Address:
Physical Address:
Facility Contact: (I'j9,Txg Title:
Onsite Representative: �?�1�� •_
Certified Operator: /'�prnt 'T. QpRydR
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Region: rx?
Integrator:
Certification Number: 1 q 100
Certification Number:
Longitude:
"Design Current
Desigp
_C•urrent
_ _ Design urrent
5wiae z' . Ca aci Po
P t5 P
Wet Poult t7'
Ca aci
P ty
Po P•
attle CC•a aci Po
P h P-
....
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish 1gV0 VSke
Dairy Heifer
Farrow to Wean
Design
G*urrent
Dry Cow
Farrow to Feeder
Dr Pauli a , ''"Ca ae_i
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
r , .
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [No ❑ NA ❑ NE
❑ Yes
[:]No
dNA
❑ NE
❑ Yes
❑ No
E;�NA
❑ NE
❑ Yes ❑ No
❑ Yes B'"No
[—]Yes E' No
["NA
❑ NE
❑NA
❑NE
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

FaciliNumber: - 34a Date of Inspection: u
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [5No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [g'No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: },
Spillway?:
Designed Freeboard (in): IRt
Observed Freeboard (in): L1 11
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes [2(No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes M No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [�No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes [2"No ❑ NA ❑ NE
maintenance or improvement?
I I _ Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Ej"No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > ] 0% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): ; l Ct\m ya" r GR%z0 I QZ.1 D ccom i WJ 'F p'� Jc 3 bs-o.
13. Soil Type(s): t AQ 3 CL v, ^ o - LAI ► R om \S 4 f kj2 O� Q
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E?I^No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[v"No
❑ NA
FINE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
0 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
B3"No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
52r�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
MNo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ZNo
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
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
ff No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes allo ❑ NA ❑ NE
Page 2 of 3 214,12011 Continued

Facili� dumber: Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Eno ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes / No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
[if No
❑ NA
❑ NE
❑ Yes
E2fNo
[] NA
❑ NE
❑ Yes
[OANo
❑ NA
❑ NE
❑ Yes &�No ❑ NA ❑ NE
❑ Yes [2"No ❑ NA ❑ NE
❑ Yes [;3"No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
[ffNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
[1-No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency'? ❑ Yes
g No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments. "
use drawings -of facility, to better explain. situations (use additional pages as necessary
Reviewer/Inspector Name: ,39, oc),
Reviewer/Inspector Signature: 3;&
Page 3 of 3
Phone: %0.:.kT5- LOW I
Date: l
21412011

3itA6 Z-/r4-/i1
Type of Visit: EMompliance Inspection O Operation Review Q Structure Evaluation p Technical Assistance I
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied'Access
Date of Visit: Arrival Time: Departure Time: ; County:
Farm Name., ` z Z' Owner Email:
Owner Name:[? Gt(- YES 4�L. Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: �ahyfi
Certified Operator: p�1 f[�VtX_
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Region:
Certification Number: j ! % 06
Certification Number:
Longitude:
Swine
-
Desi Des] gn .Current Design Current
g u
Capacity Pop met P erltry Capacity P,00 # Cattle Capacity Pop.
Wean to Finish
Layer DairyCow
Wean to Feeder
Non La er I Dairy Calf
Feeder to Finish
q Dairy Heifer
/ D�.
Farrow to Wean
f� Design Current D Cow
Farrow to Feeder
D P iti Ca acity Non-Dal
Farrow to Finish
Layers Beef Stocker
Gilts
Non -Layers Beef Feeder
Boars
Pullets Beef Brood Cow
*m Turke s
Othera
-' Turkc Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[—]Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[—]Yes
❑ No
C�r<A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
lA
❑ NE
e. 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
V No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
62<0
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: jDate of inspection:
Waste Collection & Treatment
4_ Is storage capacity (structurai plus stone storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[—]Yes
2'1`fo
[DNA
❑ 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
F No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[R 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
[E No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E3 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
No
W. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[I
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ETNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window f ❑ Evidence of Wind Drift JJ11❑ Application Outside oof�Approved
- Area
12. Crop TYpe(s): � [ �yr►.jpi) 1 J (� nWo
13. Soil Type(s): 006
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ETNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E3<0
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
g3 o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ids
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
[2-110
❑ NA
❑ NE
Required Records & Documents ,__,�
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes io ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes L'S"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 o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[2 o
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[] No
TA ❑ NE
Page 2 of 3 21412011 Continued

Facjli Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes E?4 �40 ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes ❑t✓ 4o ❑ 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 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [] No lA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 L 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?
0 Yes 2 o ❑ NA ❑ NE
[]Yes ►. Vo ❑ NA ❑ NE
[:)Yes [ 1Vo ❑ NA ❑ NE
[:]Yes io ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
[]Yes @3"No ❑ NA ❑ NE
[—]Yes R No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or;any other co riaents. I�
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector
Page 3 of 3
Phone:9/0— 43=,i2�
Date:
410I

,a.Tms 2 -0_5'— 20/0
Type of Visit (EMompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: /-29-/ D Arrival Time: /: iS ,�, Departure Time: /; S"" County: SQh+ SON Region:
Farm Name: _ ku N'y1'A 'aV'ctNcln Z Owner Email:
Owner Name: _Toa.( Rxv-Ke_�— Fay., 1-ArC- Phone:
Mailing Address:
Physical Address:
Facility Contact: CGt� fi'S B`'rW' c- !� Title: r ��� Phone No:
Onsite Representative: Integrator: C-0 k "1
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
F2D
Latitude: = o = 4 = 4i Longitude: = 0 0 N =
11
Design Current
Design Current
Design
Current
Swine Gap4ty Population
Net Poultry Capacity Population
Cattle Capacity
Populatiou
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑Non -Layer
❑ Dairy Calf
Feeder to Finish /0
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Dry Poultry
El La ers
❑ Non -Layers
El Pullets
❑ Turkeys
❑ Dry Cow
❑ Non-Dai
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Co
Other
❑ Other
❑ Turkey Poults
ID Other
Number of 5truetures:
Discharges & Stream Impacts
1. Is any discharge observed from any pan of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 3No ❑ NA ❑ NE
❑ Yes
❑ No
L- <AA
El NE
El Yes
❑ No
E9<A
❑ NE
B' A
El NE
El Yes
❑ Yes
,❑_,No
No
Lt1'N�o
❑ NA
❑ NE
❑Yes
B o
❑NA
El NE
12128104 Continued

Facility Number: 8Z-3qZ Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes El NA
El NE
a. If yes, is waste level into the structural freeboard?
,—,'No
El Yes Lilow ❑ NA
❑ NE
Structure Structure® Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2
5. Are there any immediate threats to the integrity of any of the structures observed?
,,��,,/
El Yes LYNo ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes [l< ❑ 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, notlfy DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes L7 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 LS 1�o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes D-Igo ❑ NA ❑ NE
1 I. Is there evidence of incorrect application? if yes, check the appropriate box below_ ❑ Yes ❑"Ko— ❑ 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 CropWindow❑ Evidence of Wind Drift ❑ Application Outside of Area I
12. Crop type(s)� e Irth.. ttid e— (G ►^4!l r— SMAAtl G r-„y t%O. S . � el vi f _LA -Ai - &"V:S
13. Soil type(s) W0__B Pa- f qo A
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes C7 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes B'�io ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ,_,�No ❑ NA ❑ NE
l�
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 E4- o ❑ NA ❑ NE
k
Comm" ents (refer to question#) .Explain an} lE S an and/or any recommendations or any other coriinnents
Use drawings of facility to better. explain 'situations. (use additional pages as necessary): 4;
Reviewer/Inspector Name � `�,� �2v �S — Phone: 9/o,113,3 , 3360
Reviewer/Inspector Signature: e�..¢�„_� Date: I_Z9- 21o10
12128104 Continued

Facility Number: 82 -392,1 Date of Inspection J-29- / D
Re4uiredRecords & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes B<o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 1KNo ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes B o ❑ 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!E] Weather Cade
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes R o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes U o ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0<o ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ,L---i_�K-011 ❑ NA El NE
26. Did the facility fail to have an actively certified operator in charge? El Yes ,L9'lvo ❑ NA ElNE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? [IYes L9'ivo ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Rl�"o_ ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
9 1
❑ 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
2<
❑ 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
D<o
❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
, �
❑
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Gd o
❑ NA NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
®-go—
❑ NA ❑ NE
Additional{CommentDrawings
T
12128104

!�.i*A_s /0 -as-- zoo
(}vision of Water Quality
Facility Number 82 3 q Z 0 Division of Soil and Water Conservation
0 Other Agency 11
Type of Visit ( —Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit ('Youtine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: `%/$-O Arrival Time: 9. i�0 Departure Time: County: _/arv^� Region: F2�
Farm Name: RU'j'V1"V rf�t'�^�tli #Z Owner Email:
Owner Name: .� oe { rA�irKe� F-t7r�+.s , mac- Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
11410
1 / TWO]
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Title: t S�t' c - = Phone No:
Integrator C"t—, ` �--
Operator Certification Number:
Back-up Certification Number:
Latitude: = o=. Longitude: 0 0 0 1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkcx Pouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: E!
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 ErNo ❑ NA ❑ NE
❑ Yes
❑ No
[3- A
❑ NE
❑ Yes
❑ No
�A
❑ NE
[_J'5A
❑ NE
❑ Yes
❑ No
❑ Yes
2<o
❑ NA
❑ NE
❑ Yes
9-N-o
❑ NA
❑ NE
12128104 Continued

Facility Number:82
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(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 N-�o
❑ Yes B<O
Structure 5
El NA [3 NE
❑NA ❑NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental) threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes L7 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 El Yes No ❑ NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [3-1-0 ❑ NA ❑ NE
maintenance/improvement?
1. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 3 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 El Evidence of Wind Drift [IApplication Outside of Area
12. Crop type(s) �E.fHn:4dC� C �ov';r- ) gill-1i r. I . :.,j co, 5;.. ) Co'.-Pj - W�", 1 - J. -
13. Soil type(s) i­Jcz 43 Re- ALA
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
E3<o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
El NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�,[�'�lo
L[3<oo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
3 No
❑ NA
❑ NE
Comments (refertotgtestton{#) Explain any YESgnsviers and/orany recommendations o1°r any other comments.
y� N', ter.:
�d.
Ilse draw gs of facttily to better exp.n sttuattoos"(use addthonai pages as necessary). ,
L
Reviewer/Inspector Name iG 1V— crtilJ'_s Phone: 4/O. V33. 333 V
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: 92- -39 Date of Inspection ` -1 `a 9'
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E! No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes L3No ❑ NA ❑ NE
the appropirate box.
❑ WLTP El Checklists ❑Design El Maps [I 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 1"
Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
ETNNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0 io
El NA
El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
LJ/vNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
El Yes
[�,,<�3o
L_1"i�o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
L 3No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
B<o
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EJ N
❑ 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
LJ 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
�
B o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
El'&�o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
ElYes
B<O
❑ NA
❑ NE
Comments and/or Drawings:
12128104

gTwts 9-o6-_o6 &R
%2 Division of Water Quality
Facility Number 1 $Z 0 Division of Soil and Water Conservation
C1 Other Agency
Type of Visit
ompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
0'g-o utine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of visit: -19-OB Arrival Time: /7: 2S Departure Time: 12: 'i19 County: Region:
Farm Name: RQAIM;N &rwAIG4 l" Z Owner Email:
Owner Name: �O e. Pa ►rK �-+� Phone:
Mailing Address:
Physical Address:
Facility Contact: CKrft 5 Title: Phone No:
Onsite Representative: s g�"W ' �' �� Integrator: C044j'lC- F�xt"`� S
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: ❑ 0 0 d Longitude: = ° = = K
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish /0 1/O S
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non-Layet
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
ElTurke Pouets
ElOther
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Daia Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge!
❑ Yes ( o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NE
Elu Yes
❑ No
,OFIA
NA
❑ NE
❑ NA
❑ NE
❑ Yes
Q No
❑ Yes
E3<o
❑ NA
❑ NE
❑ Yes
01o
❑ NA
❑ NE
12128104 Continued

Facility Number: gZ -3 2-
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):7 !�
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 DIN'- ❑ NA ❑ NE
❑ Yes LJ'No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes E7 No ❑ NA ❑ NE
❑ Yes io ❑ 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
o
❑3 NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
ElD Yes
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
No
❑ NA
[I NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
�
9
❑ NA
❑ NE
maintenance/improvement?
1 I .
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
Q 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 Area
12.
Crop type(s) Ref -AY
13.
Soil type(s) /L�p/¢ Ra,
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
2rNNo
El NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
'No
El NA [I NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ YesE�fNo
,L��J,,
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
IJ No
❑ NA ❑ NE
18_
Is there a lack of properly operating waste application equipment? ❑ Yes
2 No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector NamePhone: 944, fI33.333 a
Reviewer/Inspector Signature: Date: 9-/9'000 $
12/28/04 (:ondnued

Facility Number: $Z -jy2 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [] No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑Maps ❑Other
21.
Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
B<o ❑ 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
NNo�o El NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
,,3�
[3 o ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
,[<fo
C21 oo ElNA
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
CKo ❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P o ❑ NA
❑ NE
Other Issues
28_
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
�
e1N_ o ❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
9'No ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
ElD Yes
o ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
B No ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
,�
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
L��'IVa El NA
El NE
33. Does facility require a follow-up visit by same agency?
Yes
ElIj
"1Vo L7 NA
❑ NE
A'dditioQal Comments and/ar Drav�vtgs:
Page 3 of 3 1228104

8 Division of Water Quality ✓
Facility Number I $Z .3 Z O Division of Soil and Water Conservation
- Q Other Agency
Type of Visit ®Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /0 03 O% Arrival Time: A.' if0 Departure Time: ,/'/S County: _ ,iyOSecI _ Region:
r7
Farm Name: _ K u&,,:vrya C.4 4t Z Owner Email:
ilwnnr Nnmp• ne_1 t`dL%rV—e_ti Phnnp.
Mailing Address:
Physical Address:
Facility Contact: Ctlt. _s _��i"Grk Title: O✓y 1#4i-, Phone No:
Onsite Representative: 8'aww i :- % Integrator: Co�.d.+-i -r F74 b P.%S
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Latitude: =
0
Back-up Certification Number:
M
0 Longitude: 0 ° = ` = u
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish / O
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
F
La er
Non -Lay a er
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: ©)
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes W No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
ZI No
❑ Yes
[A No
❑ NA
❑ NE
❑ Yes
2f No
❑ NA
❑ NE
12128104 Continued

Facilitv Number: K2 —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes [29 No ❑ NA ❑ NE
❑ Yes a No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Q
5. Are there any immediate threats to the integrity of any of the structures observed?
❑Yes
Na
❑ NA
El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[0 No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
Q9 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
M No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Q6 No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [A 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 Drifl ❑ Application Outside of Area
12. Crop type(s) tir 6r r ZJ�c� S
13. Soil type(s) //6 A Rg& iAJuJ�
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
R 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
[@ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Ri Jf )Za v e,t 5 Phone: g/O. -K3.3. 330 d
Reviewer/Inspector Signature: 4.� Date: /0-03-Z.407
12128104 Continued

Facility Number: gZ -39z Date of Inspection /0-03-47
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? 1f yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists El Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 99 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? ❑ Yes [9No ❑ 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
$0 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
99 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
M 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
[6 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
EN No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
,[�
No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

t.
r
r I�
Facility Number �Z f 39z
0 Division of Water Quality
0 Division of Soil and;VVater Conservation -
0 Other.Agency
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ® Routine O Complaint Q Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: S-Q F- O Arrival Time: 3; Departure Time- County: �Region: F/QO
Farm Name: PU"AJ%A!G Bi qa Owner Email:
Owner Name: , T -� a E - P0_ e t— Phone:
Mailing Address:
Physical Address:
Facility Contact: Z3oe.\ Q Title:
On site Representative: Sal-w1 -k
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other - -
Phone No:
Integrator: Co4a�_l.--
Operator Certification Number:
Back-up Certification Number:
Latitude: [� n F-1 A 0 66 Longitude: ❑ o =1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I 1 7—
[__1 Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & 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
❑ Daia Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: �I
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [8No ❑ NA ❑ NE
❑ Yes
0,4 No
❑ NA
❑ NE
❑ Yes
IXl No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[�fNo
❑ Yes
[) No
❑ NA
❑ NE
❑ Yes
R No
❑ NA
❑ NE
12128104 Continued

' Facility Number: ?Z —39 Z Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes IN No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ;K No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / 9
Observed Freeboard (in): -
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
[A No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
[� No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑yes
� No
El NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
9M 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 l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[ANo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® 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
n No
❑ NA
❑ NE
Reviewer/ins ector Name Phone: �g/O,$( --%SwI
p C
Reviewer/Inspector Signature: �e,.� Date: -!7'"09— Z 00
12128104 Continued

r'
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes IN No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 91 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Ad dttronal,couiments and/or Drawings ` '°
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes]
No
❑ NA
❑ NE
❑ Yes
❑ No
® NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
❑ No
IKI NA
❑ NE
❑ Yes ja No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑Yes ®No El NA El NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
JM8104

® Division of Water Quality
Facility Number fj� 1 � �� 0 Division of Soil and Water Conservation a�
O Other Agency 1
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ail 1.?3 /70;1 Arrival Time: !D: iC Departure Time: County: s Region: IF
Farm Name: -u.V% r.%,knA ... e L d 62 Owner Email:
Owner Name: tic,- Phone:
Mailing Address: 4a . e L-4- C'-.1 t • +& .,I 1\i C DQ3:?X
Physical Address:
Facility Contact:
Title:
Onsite Representative: C. ,-k-.ss I ititr. P-A.�
Certified Operator: _ �� p e 1 �Ll,.
Back-up Operator:
Location of Farm:
Phone No:
Integrator: Co k., V'k a t` 4 r V'V, S
Operator Certification Number: ) 9 1 b
Back-up Certification Number:
Latitude: = o = Longitude: = ° 01 = u
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish ),i to
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La ei
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Puuets
❑ Other
Disci har2es & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifef
❑
Dry Cow
❑
Non-DaiTy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
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)?
Number of Structures: TI
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
© No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
12128104 Continued

Facility Number: —39.2 Date of Inspection •z .23
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? [I Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: %
Spillway?:
Designed Freeboard (in): c.tws c.lcr r� , �:4( r►�o_ `` n.s ���, �r''
Observed Freeboard (in): 37 3 7 "
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(Not applicable to roofed pits.. dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes © No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [:1 Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > ]0% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drib ❑ Application Outside of Area
12. Crop type(s) LAJ
13.
Soil type(s) V
14.
Do the receiving crops direr from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
[9 No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[]
Yes
[9 No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
[3 No
❑ NA
❑ NE
Reviewer/inspector Name a _ Phone: 1 /o
Reviewer/Inspector Signature: Date: a / 3 /or

F-icility Number: 9.1 -39.Z Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check © Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. rr❑ Yes ❑ No ❑ NA ElNE
El Waste Application El Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste�I rransfers El Annual errttification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
© No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
[2 NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
[4 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
Cl NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
U 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
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
A�d^d� 6ii4kCom&ents'andl/o1r Drawingsl: i
d� S1C.AOQN �cj`�cir� {�.C'�l S{'or-� Cw�LC CObv %%9*
Gl}a.�•...'�0p�� d.r� {.�•To��•.�� lrG�-tlopr� TCaf �•�-S�
15GW+ch�G S�4�G
�cr..�\�
CGg4.trGh—cr�{
G�
+
QkC. W .*A�' C;? 1,j
GGXr4 [i_(�
ep-V,— ..i�- `lL1 cam
2+"<
12128104

of Visit prCompliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit OrRoutine O Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: .Zn O Time: % - o 1
Facility Number $oZ 3R�
Q Not Operational Q Below Threshold
Q Permitted EfCertified J] Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .... . -
a •
Farm Name: ... _art"$�.........._......._..----..._.......w......_...__. Couniv..._.�
Owner Name: __, , .[..... Bm. �.........._ PhoneNo.
Mailing Address: V1, 1AU sr'.......... _.-----
Facility Contact: lee ��........_............. Title:.......... . ............_......... ..... ............ .... Phone No:
Onsite Representative: P 1�..................... ............------•-......_... Integrator: _..............._ . _ �it^+ w�...._— - ..... ._ ..
Certified Operator:,,__..- �atkc� Operator Certification Number: ......... .__..
Location of Farm:
O-Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 1 44 Longitude • ° 64
Design Current- Destg� Currput M,.
ae CapacityPouCo aey obiationP. dCattle
z_
Wean to Feeder
eerier to Finish
/4 / p
110
-0
Farrow to Wean
Farrow to Feeder
El Farrow to Finish
El Gilts
Boars
Number of oohs
Dkcha es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes [RONo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ErNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ["io
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure ; Structure 4
Identifier: .. ....._................. _....W....._�._ .._ w _ - -- .....
Freeboard (inches): it
12112103
❑ Yes 0'No
Structure 5 Structure 6
Continu: j

Facility 1< umber: ga — a Date of Inspection L2L�l2�J
5. -Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
+QNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
QNo
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
8. Does any part of the waste management system other than waste structures require maintenancc/improvement?
❑ Yes
B'Nio
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
62rNo
elevation markings?
Waste Aaulication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
Sio
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
QrNo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type} to SPqli a
13. Do the receiving crops differ with those designated in the Certified A �mal Waste Management Plan (CAWMP)?
❑ Yes
QNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
2No
b) Does the facility need a wettable acre determination?
❑ Yes
C9No
c) This facility is pended for a wettable acre determination?
❑ Yes
1 'No
15. Does the receiving crop need improvement?
❑ Yes
["io
16. Is there a lack of adequate waste application equipment?
❑ Yes
QNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
[ o
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
9No
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
QNo
Air Quality representative immediately.
ReviewerAnspector Name
Reviewer/Inspector Signature:
[+gTield Copy ❑ Final Notes
Date: Vgo /a +
Condnued
12112103

Facility„Number: rr;IL —34p. I Date of Inspection D p
Rea-0ired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
EOio
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ WUP, checklists, design, maps, etc.)
❑ Yes
jErNo
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
M'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
2fio
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
fffiio
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
O fVo
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
O"No
28. Does facility require a follow-up visit by same agency?
❑ Yes
2"'No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[(No
!NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
Q 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.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103