820394_INSPECTIONS_20171231

b 11W [ I zlr-u
Division of Water Resources
^Facil6y Number ®- L 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: om liance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: CrRoutine 0 Complaint 0 Fallow -up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: urt C Arrival Time: 1 Departure Time: mTnCounty: �('�37aX) Region
Farm Name: _�k /L�l ff r-�t4 Owner Email:
Owner Name: C ha-tn //* S5, Co !`r Phone:
Mailing Address:
Physical Address:
Facility Contact: tau r � 1 S j� & �1u!`C I Title:
Onsite Representative:
Certified Operator: keo'l e t I'f ocrv"e
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
El —other
Latitude:
Phone:
Integrator: PIE
Certification Number: C W, ke 3
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
[TLayer
Non -Layer
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dai Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [a-1o❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No E3�N� ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
0 Yes
[] No
[J 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
FKA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
0 Yes
[]'N-o
❑ NA
❑ N E
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 1 of 3 21412015 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E2
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
Ege<
[DNA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 'f, S
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
©_W
❑ 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
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
I_7 "'U
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
eNo
❑ 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
2-No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Qo ❑ 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): 15 %''" SCE/0
13. Soil Type(s): I- 14-f[°"+ CZ,y ---.,,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes dNo ❑ NA ❑ NE
15. Does the receiving crop and/or iand application site need improvement? ❑ Yes DIN o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Q-Ko ❑ NA ❑ NE
acres determination'?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Cg-No- ❑ NA
[] NF
Required Records & Documents
19. Did the facility fail to have the 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
NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q_No- ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard [I 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 []-Ne- ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainhreakers on irrigation equipment'? [] Yes []-NT- ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

[Facility Number: Ds ection: utiat;
24' Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes f=?< ❑ 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 [n ti 1oo NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ to ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 0,N ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
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
[3'No
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
❑' �o
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
214
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative'?
❑ Yes
Q No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�No
❑NA ❑NE
DNA ❑NE
❑ NA ❑ NE
❑NA ❑NE
�] NA ❑ NE
❑ NA ❑ NE
Comments refer`ta'" uestipii°�' tiEx lain any":YES answers'andlor;Pan :addttional;;rec.ornmi n.datians or an bother comments �t �'���;
k�,�:R' 4 ' =F IF ^66r i1`,l�n9 i �h �:. Ji��"II'-,:u'�.�`�if l'V�.I'!Y "aV3 111„�1:� . f..� .� y ,�.�1 i y ; �€ �iF
( q ) p Y Y
Use.drawings',af�fael i •"tarbetter<ex lainaituations (use additional 'ages as:nece9sary). � � g
�kAk uLo
lo- 3ae-- � S- (
Reviewer/]nspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone, o_ 3z:.w
Dater u cr+{
21412015

Type of Visit: omplianee Inspection 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: 1,' �I S Departure Time: ' 3 e County: ws Region:
Farm Name: �t �, %"o— Owner Email:
Owncr Name: ��a ���� f�Y+ rr y �OI�- Phone:
Mailing Address:
Physical Address:
Facility Contact: ( �'r,—JJj%fpf�`` Title: r rr. Phone: j
Onsite Representative: �'vi.�� Integrator: ';'f
Certified Operator: �' -4-y Certification Number: , 0�
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
., € f �i! I € € i � t e ;t ili 1 €t€ t .-I: �. I a , fIl I. q ¢ € 4 >..: 16 � S ! E' � 1 i'S'-• rsp r , � ;• - , I !€(€<
JI 4lt It JJ . I I I I ,II' If I I ,1 I 1t111 14i1J 9 r,€Hil ll i.::. A �,:,J�i lJ , IOI I I?; i Ill4€Ji I•l 11 [iP1gl I ..i 141 S1€11111111)Illl ;t •Jt I ; l ' l I-J tI[?. Il J !,. q NIJ 'l ! l If „ 4
4 I ..lG I i..11 ! u I; I fl1 i i �f ill illi,l .,,l:.l! slll, liiillii3 t j ..� {� j I U 1l1i1, 4lll�It... .iillll ,l�ti,4 , I .. I IIt } I Jl....kllll # IG Il I �lii I,li . II nllll ll i iii€., I
IM, I I :l 1. Il 111,11 1R I III ! . i i4 , #I {N 11 I �ii. 1 11
IJ l II � t: t .:,, ff E
I �IIII ,`{ fYDesi n Current ��Q II{1IryI ,.�t�l'!Desi nI�.:Currentlhl JII! yII{;=ltl;kII r41 Desi n`II�Currentl,l
I i , I,I� Ii !s, i I 11i71' �,, i IEN! 1 llll,6; F{JII�S !� t4 l " " 1:.:I€ i Illl IIf1 I,II I 1 II slY, u, 1' „III I, :I 4l �,� �II€I#IIIIIlIIn N1�i 1 ,.III I J nl II ,ii�r.► t.l � JlIlllldl,Y �E� .il� I �; ll� I;� II IJl4lllJp,,: IEII��� !I I,fiHili�jl�
it 5wine.acit�Fo �I�� Wet'Poult . #Ca aci IIPa�ill= I: Ca'ttleJ: �I�t.. 4.Ca acit ,�14(�Fo i,M
t��,l# Yl l .. , P i"l { y P t5' . , P• i a . I � 1 ! � p.. y l , F.,, I { l l
ii%EJ I�.. IY! StJ,SYE 1lX. f1,.I.wuIL. Ih€ �_,5�.�.1 d41ELtt; uaYIL.I!O b.In,iL���141.II,aY!!E�w�IE I . It I,iI]E ES'�iiti..511L ,;:1t IIIILI,6 _tea? llili.ar.�.�dl �s4:t.l ,l€i S�{Il,f„Y; ur+,Il�i�1�EJ` ' �EJYsa� _..TS�tdf3. M1..1SE.:� �� . , 1.+.� siJlll!Jlila!•!Ik €,I ,11. I1,9; I
6,lV,i Wean to Finish ? l a er DairyCow
I!,
Wean Fee Non -Layer a it Calf
1 .I,; W der IiJ N a e s,�i Da ,
Feeder to Finish >Il i,�� hair Heifer
J' Farrow to Wean D Cow ,E
1�.FI Farrow to Feeder I 1 �1� Non -Dairy
Farrow to Finish Layers Beef Stocker
q Gilts "� Beef Feeder �'I^
�( J
' BoarsI
Beef Brood Cow f 1x
.l f€ I • it 1 II 6
S t
`4
Y I I ITurkeys 1 4! l t €
I I I iti r l l
II III I� I �E
��I1
111 I P I I I I' Y 111 °V {
#,A„li:,Other€t,��IJlId�;Ilrtl,.����I�d1I,t�.Cl,;�i%,,a>ai.V,h�II�itGtYsst��'�I� iV411
1 Other iI
:'falli.r„l!.> E ctll�lllll�� iii�llr..riHa;�IElE11lSY�II,,ItlJ,ts .Jli�tJJI k i e.€.t ,it h€ .cl I�lltl
I t}4 I { I I I 11 €
"lill�l�l��iJllll Yit9t�il � � II����, ��ill�l�l ��l��l��ltl�
pll DcstgnE l¢ICu`iri�entji��
��lq!nayil�lt
,!Moult •l�r�x., Ca aci IIIY f, Mo g ;
1
E_a ers
I
Non-i.a ers
Pullets
�I
jI
' urke Po r offs
it
Other
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)`?
❑ Yes C&No ❑ NA ❑ Nf3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]NO ❑ NA [:]NE,
d. Does the discharge bypass the waste management system? (Ifyes, notify DWR) ❑ Yes ❑ No ❑ NA NE,
2. Is there evidence of past discharge from any part of the operation? ❑ Yes [,No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [j Yes 0 No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: - Date of Inspection: i- r'--f
! Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EjNo ❑ 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 B_No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? '-Yes [:]No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes M No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes M No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? Ifyes, check the appropriate box below. ❑ Yes ®-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) '
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable CropWindoww ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s);
13. Soil TYpe(s): L- '�-' /tl_� r 1a42r"r;�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes R,No [] NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [,7,No [:]NA [_]NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reouired Records & Documents
❑ Yes y No ❑ NA ❑ NE
❑ Yes ENo ❑ 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? Ifyes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste "Transfers
❑ Weather
Code
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes LO-No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

` Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes S No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check [] Yes R No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes � No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes CA No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
®. No
❑ NA
❑ NL
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
® No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? Ifyes, check the appropriate box below.
❑ Yes
(E No
❑ NA
❑ NF
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[] Yes
2 No
❑ NA
❑ NE
33. Did the Reviewerllnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
5No
❑ NA
[] NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
0 No
❑ NA
❑ NV
012-110MJ -7-o 7-� 2-- z�
G� 7
Reviewer/Inspector Name: s%'��� �eAy� Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412015

ivision of Water Resources
Facility Number ®- 7jg O Division of Soil and Water Conservation
O Other Agency'
Type of Visit: Q Ea Wpliance Inspection 0 Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:
Arrival ,rime:
Departure Time: '3 O County:
Region:
Farm Name:
Owner Email:
Owner Name:
Phone:
Mailing Address:
Physical Address:
Facility Contact:/WVa1-e_ Title: Phone:
D
Onsite Representative: s�wi.�%� _ Integrator:
Certified Operator: % V'�lt:� Certification Number:
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
Certification Number:
Latitude:
Design. Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Layers
Non -La
Pullets
Other
Poults
Design Current
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 reaches! waters of the State (gallons)'?
d. Does the discharge hypass the waste management system! (Il'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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy COW
[)air Calf
Dairy Heifer
Dry Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes gNo ❑ NA ❑ NE
❑ Yes
❑ No
[] NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes [!S.-No
❑ Yes ,® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 4f 3 21412015 Continued

Number: - `�`� I}ate of Ins ection:aste
r4.cility
Collection & Treatment
Is storage capacity (structural plus storm storage plus heavy rainlall) less than adequate'?
❑ Yes
[59ZNo
❑ 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):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity ofany of the structures observed'?
❑ Yes
a 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
Z_No
❑ NA
❑ NE
waste management or closure plan'?
If' any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
[] Yes
Q No
❑ NA
❑ NE
R. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
®-No
❑ NA
❑ NE
maintenance or improvement'?
11. Is there evidence of incorrect land application? Ifyes, check the appropriate hox below.
❑ Yes
[ZFNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraalic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ihs. ❑ 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). ! . . Olfr'�fr'y�
_P
13. Soil Type(s):
14, Do the receiving crops differ from those designated in the CAWMP'?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
No
❑ NA
❑ NE
lb. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[ZNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application'?
❑ Yes
No
[] NA
❑ NE
18, Is there a lack of properly operating waste application equipment'?
❑ Yes
No
❑ NA
❑ NE
Reouired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'?
❑ Yes
2 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 ycs, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ itainfalI ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and f" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge`'
❑ Yes
E�-No
❑ NA
❑ NE
23. Ifselected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�-No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

cility Dumber: - . Date of Ins ection: ��
6
. Did the facility fail to calibrate waste application equipment as required by the permit?
F25.
❑ Yes
�No
❑ NA ❑ NE
Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
5_4 No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
F);I-No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
allo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[] Yes
No
❑ NA ❑ NE,
If yes, contact a regional Air Quality representative immediately.
30, Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[�J_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
allo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Q No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative'?
❑ Yes
allo
❑ NA ❑ NI
34. Does the facility require a follow-up visit by the same agency'?
❑ Yes
fZ�No
❑ NA ❑ NE
(qE )s p andloran additional recommendations or any other comments.
y
drtiwlnT facility to better explain.si(uations (use additional pages as Use s.a necessary).
Reviewer/lnspector Name:
Reviewer/Inspector Signatui
Phone:
Date:
21412015
Page 3 of 3

Q"ivision of Water Resources
Facility Number ®- O Division of Soil and Water Conservation
O Other Agency
Type of Visit: Z57=pllance Inspection 0 Operation Review Q Structure Evaluation p Technical Assistance
Reason for Visit: (2)-koutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: /D N7 ! Arrival Time: Departure Time: County: Region: �=70
Farm Name: s `� ; ( ( �a t n —, _ Owner Email:
Owner Name: C�o V_ �r� c ✓� r e0 r Phone:
Mailing Address:
Physical Address:
Facility Contact: r co,--c— Title: L
Onsite Representative: `jam
Certified Operator:
Sack -up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
,Eeederto Finish
Farrow to Wean
Farrow to Feedei
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
'ram Phone:
Integrator: h71`
Certification Number:
Certification Number:
Design Current Design Current
Capacity_ Pop. Wet Poultry Capacity Pop.
La er
[Non -Layer
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made`?
Longitude:
Design Current
Cattle . Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes g[No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b, Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
[]No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
[] No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge'?
Page 1 of 2/412014Continued

_ Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[a No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 1.9
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the strictures observed?
❑ Yes
®.No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6, Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
� No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement'?
❑ Yes
fa No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit'?
❑ Yes
2 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
�allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes (VI ❑ NA ❑ NF
❑ 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): z-111Mto/ i U7i1- /ny r tJ
p •—._
13. Soil Type(s):_�ff
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
5jNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application`?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE;
Reouired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'?
❑ Yes
12 No
❑ NA
❑ NE:
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
0 No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements
❑Other:
21, Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Eallo
❑ 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
JgNo
[DNA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0 No
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facility Number: -7
9T Date of Inspection: O`- —!
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 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ®, No ❑ NA ❑ NE
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Fg[ No
❑ NA
❑ N E
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
�-No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[E,No
❑ NA
0 NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ELNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ELNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
0 No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recomtnendatlons or ady416their comments
Use drawings, of,facili "', to:.better ex lain'situations`(use;additional 'a _ es as necessa .).' "; . , „ rx� n„4 N,'�, ,� rt ,r�'+?��I 1.'1';
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: %/D—
Date:
214//2014

OrDivision of Water Quality
Facility Number ®- 0 Division of Soil and Water Conservation.
0 Other Agency
Type of visit. Momppliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for visit: G tcoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: f TT 9-1/ Arrival Time: Departure Time: County:
Farm Name: Owner Email:
Owner Name: fdr%Ys %��y, �'p��r_ Phone:
Mailing Address:
Physical Address:
Facility Contact: _ f r. r/ Nape-,— Title:
Onsite Representative:
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:
Integrator:
Region: J= C D
Certification Number: }*1517)
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Layers
Non-L,
Pullets
Other
Pouits
Design Current
Discharges and Stream Impact
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)?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes g�J_No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation'? []Yes ® No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [&No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

F'acilit y Number: - Ds ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ®, No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 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
[_No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property 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
® No
❑ NA
F] NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
5� 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
L&No
❑ NA
❑ NE
maintenance or improvement'?
Waste ARIflication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[K No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop
/Window= ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Or/'/rliu7st_ 4u�r�r rr�
13. Soil Type(s): gfL4&.a�' / 6 --p AAA- n
14. Do the receiving crops differ frorn those designated in the CAWMP? ❑ Yes Z No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes � No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes � No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
►ems! No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
� No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Callo
❑ NA
❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
KNo
D 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 allo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes allo
23. II'selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 1WNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Inspection: d —
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ 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 ZI No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes � No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the ReviewerlInspector 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 0 NE
❑ Yes R No ❑ NA ❑ NE
❑ Yes ;a No ❑ NA ❑ NE
❑ Yes Z_No ❑ NA ❑ NE
❑ Yes 8 No 0 NA ❑ NE
❑ Yes allo
❑ Yes CgNo
❑ Yes gj No
[]NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Comments refer to question • Explain an YES answers and/or an additional recommendations or -any othei comments.
( a )• p y y
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: -d a
Date: --6
21417014

'AaTivision of Water Quality
Facility Number®- u 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: CYCompliance inspection U Operation Review 0 Structure Evaluation U Technical Assistance I
Reason for Visit: 01<utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ; O C7 Departure Time: [�= County:
Farm Name�4'%; ���,�tyL. Owner Email:
Owner Name: r/_�' %�S �`r�� Y �p �t- T Phone:
Mailing Address:
Physical Address:
Facility Contact: ��/�-L.�'rpp,ti� Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish p nta
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Region:
Integrator:
Certification Number: �y
Certification Number:
Design Current
Wet Poultry Capacity Pop.
La er
Non -Layer
Design Current
Dry Poultry capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
TurkeX Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Da Cow
Non-DaiEx
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes allo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes RNo
❑ Yes E�No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

[Facility Number: jDate of Inspection;
w Waste Collection & Treatment
4. Is storage capacity (structural pius storm storage plus heavy rainfall) less than adequate? ❑Ycs 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): C�_
Observed Freeboard (in): r
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes
PLNo
D 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 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
JaNo
❑ 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
(:;q No
❑ NA
❑ NE
maintenance or improvement?
Waste Aaalication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lhs. ❑ Totai Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ L"vidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): � r• �.�j`� /Z Q e4:5i r� `
13. Soil Type(s): j c*- / Il4.b7��
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? 0 Yes Callo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 4 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Ycs ]�& No ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes KNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available`? If yes, check ❑ Yes fK No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes g] No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge`? ❑ Yes 2] No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes rM No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
[]NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: - C} jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes PLNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes gNo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes �No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes KNo
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 Reviewerllnspector 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 2 No ❑ NA ❑ NE
❑ Yes KI No ❑ NA ❑ NE
❑ Yes J?�_No ❑ NA ❑ NE
❑ Yes § No ❑ NA ❑ NE
❑ Yes & No
❑ Yes JR No
❑ Yes g�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 Pam as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: D 2--33nt-
Date: o
21412011

I ' A! AAS I /&-2009
ivision of Water Quality
Facility Number 0 Division of Soil and Water Conservation
Q Other Agency
Type of Visit
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
,,..,,ompliance
E7mp�
outine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: 2 ZSr Departure Time: County: S"`PSa.✓
Farm Name: Sa r jcL w i l Owner Email:
Owner Name: _. Ci��-��C- !=QI C__ Phone:
Mailing Address:
Physical Address:
Facility Contact: �'�'� ���'�`- Title: �'� -r- Phone No:
Onsite Representative:
]integrator:
Certified Operator: CA GLC,l< Cb j,_ Operator Certification Number: 96908 Z_
Region: I-A0
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = O = I = « Longitude: 0 0
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Populatlon
❑ La er
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
11440 p
/ 00
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Cilts
❑ Boars
Other
❑ Other
Dry Poultry
Layers
Non -La
Pullets
Points
Discharp-es & Stream Impacts
1. Is any discharge observed from any part ofthe 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
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
_
J
b. Did the discharge reach waters of the State? (Ifyes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:' Ell
d. Does discharge bypass the waste management system? (Ifyes, notify DWQ)
2. Is there evidence ofa past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes M No ❑ NA ❑ NE
❑Yes El No D<A ❑NE
❑ Yes ❑ No OVA ❑ NE
❑ Yes ❑ No [ fA ❑ NE
❑ Yes D zoo ❑ NA ❑ NE
❑ Yes 9'No ❑ NA ❑ NE
12128104 Continued

Facility Number:
Date of Inspection !1 aS o 9
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
a, If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: Lit /
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 26
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 El -No
ElD Yes o
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
❑ Yes ErNo ❑ NA ❑ NE
❑ Yes 2<o ❑ 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 E? o ❑ NA ❑ NE
R. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes LSNo ❑ 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 01 o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2rNo ❑ NA ❑ NE
maintenance/improvement? ,_ ,
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2<o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s)
13.
Soil type(s) 136 E
14,
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
B o
❑ NA
El NE
15.
Does the receiving crop and/or land application site need improvement?
El Yes
L7, N
❑ NA
[I NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`:
❑ Yes
<o
E o
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
3-f o
❑ NA
❑ NE
19.
Is there a lack of properly operating waste application equipment'?
❑ Yes
t` tvo
❑ NA
❑ NE
IReviewer/Inspector Name3S4c�k '° I V f'�' F: ' v.,;' 4r) rt ; r Phone: 9�b• `F33 , 330
Reviewer/Inspector Signature cr�, n-h� Date: /Z -/.S-Zoo
12128104 Continued

Facility Number: 82 -3Date of iuspertiou /27-57— 9
Required Records & Document. �,...�,/�
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes I_'TNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes No ❑ NA ❑ NE
the appropiiate box. ❑ WUP ❑ Checklists ❑ ❑ Maps
Design
g p El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
f S o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
M.
❑ 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
ffNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
I�:J, NNoo
El NA
ElE N
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
lT No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
= No ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ETNo ❑ 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
E3,<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
2No ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
a<o ❑ NA
❑ NE
Comments and/or Drawings;
11/18104

;RY
J Ai3 / , 08 09 tee_
-
--- - -- - Division of Water ualitx��`
p��1 Q y y s k
Ftacill. y Number SZ 3 I T O DlV1SlOn of Soil and Water Conservation ���
,3 ` ' � - � _ � ;� O�Other Agency: �, �r 4
Type of Visit
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
,C,,ommpliance
routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival ,rime: S 20 Departure "rime: County: .y
Farm Name: _ all.) i„ 1 f Owner Email:
Owner Name: C �4 V I —.s rn c Phone:
Mailing Address:
Physical Address:
Facility Contact: G irG[_V MOOV-4— Title: �`' S�� G Phone No:
Onsite Representative: G'r�-✓ �r'�— Integrator:
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
Boars
her''
Other
Operator Certification Number:
Back-up Certification Number:
Region: 1--X-0
Latitude: = a = I = Longitude: ❑ o =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
[:]Layer
❑ Non -Layer
/UQo 1 4.
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Dischames & 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-madc?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dair Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
El
11
b. Did the discharge reach waters of the State'? (Iryes, notify DWQ)
e. What is the estimated volume that reached waters of the State (gallons)?
Beef Feeder
is
Beel'Brood Cow
Number of Structures:' =j.
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
nNo
NA r❑ NE
❑ Yes
❑ No
NA
❑ NE
DNA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes�o
❑ NA
❑ NE
12128104 Continued

Facility Number: g2 -39y Date of Inspection z-iJ�4
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[3"No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
C?'No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: I
Spillway?: No
Designed Freeboard (in): 14, S—
r�
Observed Freeboard (in): yo
5. Are there any immediate threats to the integrity ofany of the structures observed`?
❑ Yes
ENo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
Lf 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
["NNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'?
Cl Yes
No
❑ NA
❑ NE
(Not applicable to rooted pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
El Yes
�,/
t�i No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�,/
l7 No
[]NA
❑ NE
maintenance/improve ment?
11.
Is there evidence of incorrect application'? Ifyes, check the appropriate box below. ❑ Yes
L2<0
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10`% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) L� tt,f�
13.
Soil type(s) 80g _
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
E ff No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement'? ❑ Yes
�o
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
E N//o
El NA El NE
17.
Does the facility lack adequate acreage for land application`.) El Yes
D o
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
(3lo
❑ NA ❑ NE
r 9t r
Reviewer/inspector Name k t n 9/n. y133• 3330
Phone:
Reviewer/Inspector Signature ,u Date: /Z -/S"— 2 tl0
Page 2 of 3
12128104 Continued

r '
, t
Facility Number: gZ — 3r1 Date of Inspection !Z -J'-D
Re uired Records & Documents ��//
19. Did the facility fail to have Certificate of Coverage & Permit readily available'? ❑ Yes ONo ❑ NA ❑ NF
20. Does the facility fail to have all components of the CAWMP readily available? 1Pyes, check ❑ Yes []"No ❑ NA ❑ NE
the appropiiate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other --
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
3"'No
❑ NA
❑ NF
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ETI�o
❑ NA
❑ NE
24,
Did the facility fail to calibrate waste application equipment as required by the permit'?
❑ Yes
E3 o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit'?
❑ Yes
Ea-fJo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge'?
❑ Yes
E?<o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[3lo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Clo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
O'�o
❑ NA
❑ NG
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
0'�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
DIN-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
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
.'M!o a r'i yi 1+e 'Z.� PP f Z h t T { ij4 1:4
Addltronal Comments and/nr DrAwin s �-A �`: � �.: � � �7 °�.� ,� .r�r, ,�..< A
AL
r
Page 3 of 3 12128104

%_�17_d/ r J7 I it,2 w e.i% -%
Q' ivision of Water Quality
E�niuber z �9` O Division of Soil and Water Conservation
O Other Agency
Type of Visit &fompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit G�<outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /7 -/i'- O i ArrivalTime: 12 ;; /O Departure'/Time: County: 5_6 kM IA/ Region: ��Q
Farm Name: r%-1t0^44S �fu dSoN f'd-kAm (5­491/6,m) wner N mail:
Owner Name: .2t�� S �%u c� Se�tJ Phone:
Mailing Address:
Physical Address:
Facility Contact: `V_ a oOn—Title: u�,•S C, • Phone No:
Onsite Representative: [ V-f_e_— moors integrator: +� Murowel
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =o = = Longitude: =o = 4 = {I
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La ei
❑
Wean to Finish
❑
Wean to Feeder
®
Feeder to Finish
! DO
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Lavers
❑ Plilfets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
it. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ [)airy Cow �-
❑ Dairy Calf
❑ Dairy I-leilci
❑ Dn, Cow
❑ Non -pair
❑ Beef Stocker
❑ Beef [Feeder
❑ Beef Brood Cow
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:
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
[2 No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
El Yes
EpNo
❑NA
❑NE
❑ Yes
® No
❑ NA
❑ NE
12128104 Continuer!

1-pncility;''umber:8Z —3yy Date of Inspection I 1Z-13--d7
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?: No
Designed Freeboard (in): I`1- S
❑ Yes ® No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
Structure 5 Structure 6
ii
Observed Freeboard (in):15
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 n No ❑ NA ❑ NE
8, Do any of the stuctures lack adequate markers as required by the permit'?
❑ Yes
P 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
Q No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
;D No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
R No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10%, or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Wind/ow ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) i�e.v'.+ti,.`d (i�a S. G . �pvwS�c� J
11 Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'?❑
Yes
[A No
❑ NA ❑ NE
17, Does the facility lack adequate acreage for land application?
❑ Yes
[A No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[M 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 �L eyC-LS Phone: `10.9L33, 3300
Reviewerllnspector Signature: Date: %Z -13 - ZOO %
12128104 Continued

Facility Number: Z --q 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 7 No ❑ NA ❑ NE
the appropirate box.
❑ Wi1P El Checklists El Design El Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below, ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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 it regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require it follow-up visit by same agency?
Additional Comments and/or Drawings:
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes [)I No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes [3 No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
[I Yes
No
❑NA
El NE
El Yes
[ No
El NA
El NE
El Yes
U1No
El NA
❑NE
12128104

'p Division of Water Quality.
Facility Number O Division of Soil and Water Conservation'
O Other Agency
Type of Visit 61coompliance
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
0 Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
Q'Urher ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: ; E".04 L{�t �rl�y Owner Email:
Owner Name: _J�M"46 f�"%i%�f 1�6�"`� Phone:
Mailing Address:
Physical Address:
Facility Contact: 1`• Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Region: 'F�D
Latitude: o = , Longitude: = o =
Design Current Design Current Design Current,
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity' Population
10 Wean to Finish
❑ Wean to Feeder
eederto Finish pO
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
LJ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La ei
Dry Poultry'
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other r
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?
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stockei
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures: �J
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 io ❑ NA PSNE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑l Ny�oy
ElYes
250P
❑ NA
5,NE
❑ Yes
W11-
o '
❑ NA
%NE
12128104 Continued

t \
Facility Number: T3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus stone 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
R,rnrhirP. I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed'? ❑ Yes PNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 9 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 gLNo ❑ 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 J@NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA 0 NE
maintenance/improvement?
I. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA XNE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, 7n, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
XNE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
fK 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
19 NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
t9 NE
4-7 i vim— QD( e "Tv f ��14 bcw.46 n `T 4C Arto-
Reviewer/[ns ector Name r �'_`
p
'_�;y
:;���'��t
�a �r
'� , � �1 Phone:
,.� f� �
4�-'`^',�r�x�a�'�
��.�
Reviewer/Inspector Signature:
Date:
3—(a C9-i'0 �
12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available'? ❑ Yes ❑ No ❑ NA XNE
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 El Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes []No [DNA ONE
❑ Waste Application []Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers []Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
5aNE
23.
If selected, did the facility fail to install and maintain rainbrcakers on irrigation equipment'?
❑ Yes
❑ No
❑ NA
9NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
R NE
25.
Did the facility fail to conduct a sludge survey as required by the permit'?
❑ Yes
❑ No
❑ NA
WNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
M NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification'?
❑ Yes
❑ No
❑ NA
[ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
JN 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
ONE
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
[Z NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/]nspector fail to discuss review/inspection with an on -site representative?
❑ Yes
J9 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
jjj No
❑ NA
❑ NE
Additional Comments and/or Drawings:
AL
Page 3 of 3 12128104

q— L_— le
1
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: f/-/3� OZ'/O Arrival "fime: i'���r� Departure Time: County: -540'% � OAI _
Farm Name: -7;(o •-Ic S crg jrAa Owner Email:
Owner Name:. Phone:
Mailing Address:
Region:
Physical Address:
Facility Contact: tom►-reP- ,&nyL Phone No:
Onsite Representative: i-e c lr Afnn r-f Integrator: /i..//.�,,,,,,_„_
Certified Operator: Operator Certification `umber:
Back-up Operator:
Location of Farm:
Y
s Design
"Capacity Fo
J Wean to Finish
] Wean to Feeder
Feeder to Finish
] Farrow to Wean
] Farrow to Feeder
] Farrow to Finish
] Gilts
] Boars
Cher'
] Other
Back-up Certification Number:
u = ` = g = o =, � tl
Latitude: Longitude:
rent Design Current
lotion ' 'Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
Dry Poultry
❑
Layers
❑
Non -Layers
❑
Pullets
❑
Turkeys
❑
Turkey Pouhs
❑
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application 1�ield ❑ Other
a. Was the conveyance man-made`?
Design:,,
Cattle ".Ct'ipaeity
❑ Dairy Cow
❑ Dairy Calf
❑ Dair X Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
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
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ®No ❑ NA ❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
5?No
❑ NA
❑ NE
❑ NA
❑ NE -
❑ Yes
51 No
El Yes
�No
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
12128104 Continued

Facility Nbmber:ti —3 ' Date of Inspection
t Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? ❑ Yes P No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 10 No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: /V0
i
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [7 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 Q� 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 ERNo ❑ 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
XNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application'? If yes, check the appropriate box below.
❑ Yes
[�g 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 Rare Soil
❑ Outside of Acceptable Crop Window ❑ Evidenceof Wind Drill f ❑ Application Outside oArea
12. Crop type(s) Lae l-wt itdej /4 h - q4111 Cl- e-V't/ �U�J
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[ZNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA ❑ NE
16. Did the facility tail 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
0 No
❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment?
El Yes
(�No
❑ NA ❑ NE
hirhents.(refer to question 4) Ezp1:iiih 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 rlC I�p�J S - — Phone:
�g/O� f 3.� --3300
Reviewer/Inspector Signature: Date: -_ZDO (�
rage -, of s 12128104 Continued

Facility Number: SZ -3,9VI Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 1P No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement'? If yes, check the appropriate box below. ❑ Yes r'VNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
U No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
rn'No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[PNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
19No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
P6 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
PO No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ONo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[XfNo
❑ 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
[XNo
❑ 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
�RNo
❑ 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
FerNo
❑ NA
❑ NE
Page 3 of 3 12128104

® Division of N'ater Quality
=014ityumberDivlsian of Sail and Water Ganservatian
0 Qtlter Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Dale of Visit: Arrival Time: AQ • (J Departure Time: County: / w _
Farm Name: Owner Email:
Owner Name: lit o <-Q s 14liXDit Phone:
Mailing Address:
Physical Address
Facility Contact: �L ]r «s- 6f1&o r e Title: _
a
Onsite Representative: rw�r �s r
Certified Operator:
Back-up Operator:
Location of Farm:
'Swine
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = 0 0 g 0 Longitude: ❑" ❑ ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
19feeder to Finish
/d
ifld!>
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry.
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dai a Calf
❑
Daia Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
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:
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 2No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
2No
❑ NA
❑ NE
❑ Yes
[?No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection IOS/21`/Qj�
Waste Collection & Treatment r
4. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural frechoard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): Al
Observed Freeboard (in): �j //
❑ Yes �fNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed'? ❑ Yes 0 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 O/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 0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'? ❑ Yes 0 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [.rNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Z No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application'? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc,)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) S s
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP'?
❑ Yes
�,r
I �l No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
[�J'No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination':
❑ Yes
[3`No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application'?
❑ Yes
ONo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
D<o
❑ NA
❑ NE
Comments (refer to q£D u'�cstia#)::Explain anyxYrES'nswe s and/or any rec mmendations or any other commentts.
Use drawings of facility to better eaplain situations. ( ' additional pages as necessary):
-� ----��
Reviewer/inspector Name '` :'"' � ;. s` • r+is:'. f « � " 5. Phone: �7/0 '}P% /j✓ z
Reviewer/inspector Signature: Date:
12128104 Continued

Facility Number: — g Date of Inspection 45' O
Required Records & Documents ,�/
19. Did the facility fail to have Certificate of Coverage & Permit readily available'? El Yes LJ No ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available'? If yes, check ❑ Yes E?(No ❑ NA ❑ NE
the appropirate box, ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement'? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Wa4e Armita n ❑ Week rt, d ❑ Wmte-A+ttrlgsrs- ❑ Sai1,u;is ❑ Waste Transfers ❑ AAnual Certification
❑ 14I1- ❑ Staalciug ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge'?
❑ Yes
ff No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
ZNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit'?
❑ Yes
❑ No
[ "NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
[�fNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ffNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification'?
❑ Yes
YNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
YNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ZNo
❑ 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
[fNo
❑ 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
l_,1No
❑ NA
❑ NE
General Permit'? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ErNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[f No
❑ NA
❑ NE
Addettona[�Cnments�andlarDrawings: _
_ 'h.:
12128104

Type of Visit: ®'Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 01 routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency Q Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County8­ Region:CZ
Farm Name: s�; (( fizz, Owner Email:
Owner Name: at^�{j Ilgp J) Phone:
Mailing Address:
Physical Address:
Facility Contact: r� r%jfpdTitle: ��� sp�G, Phone:
Onsite Representative: -PJ Integrator: Gar
Certified Operator: ��— wJ Certification ,Numbe : <ye_' 0$._.7_...
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Design
Capacity
Current
Pop.
Wet Poultry
r
EENoLa er
D�: P-oWtr.
Layers
lacyop.
Design
Ca aci
urrent
Current
Pp
Design Current
Cattle Capacity Pap.
DairyCow
Dai Calf
DairyHeifer
D Cow
Non -Dairy
13eef' Stocker
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Turke s
Turkey Poults
Other
Other I
IOther
Discharees and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
( No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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�7 No
❑ NA
[] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge'?
Page 1 of 3 21412011 Continued

Facility 1''umber: - ,3 Date of inspection:
Waste Colleclipn & Treatment
4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
❑ Yes
RNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway'?:
Designed Freeboard (in):
Observed freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[S No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[Z�No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any ofthe structures need maintenance or improvement?
❑ Ycs
® No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit'?
❑ Yes
[S 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 huffers, Setbacks, or compliance alternatives that need
❑ Yes
O No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? lfycs, check the appropriate box below.
❑ Yes
I No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 1hs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
flare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application
Outside of Approved
Area
12. Crop Type(s): — mdLio'- f
13. Soil Type(s): �.r�-✓ —If=, LL Inf-0-
14. Do the receiving crops dillter from those designated in the CAWMP?
❑ Yes
r5;LNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E4 No
❑ NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable
Yes
[�No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application'?
18. Is there a lack of properly operating waste application equipment'?
❑ Yes �No ❑ NA ❑ NE
❑ Yes �.No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Z No ❑ NA ❑ NE
20, Does the lacility fail to have all components of the CAWMP readily available'? It -yes, check ❑ Yes to No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design 0 Maps ❑ Lease Agreements ❑other:
21. Does record keeping need improvement'? If yes, check the appropriate box below. ❑ Yes gLNo
❑ Waste Application ❑ Weekly freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes RNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? El Yes
0 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 . 21412011 Continued

Facilit --Number: - A lbate of inspection:
ZL-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ 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 10 No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® 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 R1 No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes O No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes
O-No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
[FKI No
❑ NA
❑ NEi
Comments (refer to: question #): Explain any YES answers and/or any additional recommendations or anyother comments.
Use4rawlnas of facility to,better;explain situations-1use additional paces as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9/Q-f �3ap
Date:
21412011

Type of Visit: QCompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: outine 0 Complaint p Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: ,' Departure Time: 'z2 County: Region: LT-v.
Farm Name: �o.,,dl� /� ;�Q Owner Email:
Owner Name: e7p/ Phone:
Mailing Address:
Physical Address:
Facility Contact: e,',er r� Title: Phone:
Onsite Representative: Integrator: ll/`
Certified Operator: Iv� Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Destgn
Current
Qesign Current
Swine
Capacity Pop. Wet Poultry,
Capacity
Pap
Cattle Capaclty Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
l'' Non -La er I
Dairy Calf
Feeder to Finish
DO 0- a _' i '
1 Ii
DairyHeifer
Farrow to Wean
Destgn,
Current
D Cow
Farrow to Feeder
D , I Poultr _.
a
"a'"°'
Gu actt
kP
1'0 �i
Non -pair
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
"Beef
Feeder
Boars
Pullets
I
113eef Brood Caw
Turke s
Qther
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 �LNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes C5.No
❑ Yes [0 No
❑ NA ❑ NE
❑NA ❑NE
❑ NA [] NE
Page 1 of 3 21412011 Continued

Facility Dumber: - Date of inspection:
Waste Collectign & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Eallo ❑ 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):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc,)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): fjtq� /d//r-�'`S ,
13. Soil Type(s): _ f �,rz,
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 [KNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes gj No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[a No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
rNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[RNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
M 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 1. No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge'? ❑ Yes [N No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes ZLNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

s
Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C&No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [S—No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge'? ❑ Yes JK No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes RNo ❑ 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 the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative'?
34. Does the facility require a follow-up visit by the same agency'?
❑ Yes [,No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes CR No ❑ NA ❑ NE
❑ Yes Callo ❑ NA ❑ NE
❑ Yes MNo
❑ Yes ® No
❑ Yes ;,No
❑ NA ❑ NE
❑NA ❑NE
❑ NA [] NE
Comments (refer to question #):.Explain any YES answers and/or'any additional recommendations 6roany other &inruentstt1i1V M ,t
Us'idrawines of facility to better exnlain situations (use additional uaees as necessary),
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
ti
Phone: Z t L
Date: _l a-:;e�— /,/
21412011

0'11rivision of Water Quality �-
Facility Number _ 3 O Division of Soil and Water Conservation "'PL—ID
- — -- Q Other Agency
Type of Visit 9-f-o-mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (qr outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of VlAt: Arrival'I'ime: Departurc Time. County
Farm Name: �.+SCGj„� +ar_1- I Owner Email:
Owner Name: [ /In C1 cS_ C rL t:x 6n r_ Phone:
Mailing Address:
Physical Address
Facility Contact: C iotar'r1r3 CD r� - Title: C�W Yt y.'" Phone No:
Onsitc Representative; T 'r'Yr— Mow-r— Integrator: ✓
Certified Operator: ta�'��s Lo%� Operator Certification Number:
Hack -up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
��
Back-up Certification Number:
Region:19 v
=o = = =o =' =,I
Latitude: Longitude:
Design Current Design Current
Capacity ,Population Wet -Poultry Capacity, Population.
I . ❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
Design Current
Cattle„ Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beel'Stocker
❑
Beef Feeder
❑
Beef Brood Cow
b. Did the discharge reach waters ofthe State? (Iryes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: '--r j
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of 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 5kNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NI
❑ Yes
❑ No
❑ NA
❑ NE
[]Yes
Z'No
❑ NA
❑ NG
❑ Yes
Eallo
❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q 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 b
Identifier:
Spillway?:
Designed Freeboard (in): / 9
Observed Freeboard (in): QZ !
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
(�No
❑ NA
ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
yZy.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
o
❑ NA
❑ NE
S. Do any of the stuctttres lack adequate markers as required by the permit?
❑ Yes
ZNo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
(0 No
❑ NA
❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? lfyes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zrt, etc.)
❑ PAN ❑ PAN > 10% or io 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) j9U '
13.
Soil type(s) fjr Ir�(�Sku
._
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E,No
❑ NA ❑ NE
15,
Does the receiving crop and/or land application site need improvement'?
❑ Yes
No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
�, No ❑ NA ❑ NE.
17.
Does the facility lack adequate acreage for land application?
❑ Yes
Q No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
ENO
❑ NA ❑ NE
r- „Ir ; y ,}li..Nil; {� a 4 �.-" �f'" r r:
�C ^mments (referrtt¢questton;;#)�s EzplaipWany YES answeis and/or any recamn endatibns_orany other comments . r T Y
Use,drai0d4s of faciflty to better'explain situations. (use additional;pages as necessary): t�
Reviewer/i��nspector Name „n,. t� r iPhone:
Reviewer/Inspector Signature:
Date: //
PaKe 2 q1'3 12128104 Continued

r
Facility Number: — g Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes CZ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [K No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists El Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. [--]Yes O No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and[" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ZNo
❑ 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
[9No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RNO
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
9 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
RNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ER No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
KNo
❑ 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
J4 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
L249 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
Page 3 of 3 12128104