820415_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Type of Visit: ® Compliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: ® Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:l y� -7 I Arrival Time: Departure Time: County: S iOPO/\ Region:
Farm Name: p' Owner Email:
Owner Name: ��� e. Phone:
Mailing Address:
Physical Address:
Facility Contact: a5 La j Title: Phone:
Onsite Representative: U Integrator: P� 9
Certified Operator: A4 ten rb,1-Lt_% Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude:
Longitude:
Design
Cnrren#
❑ Yes
Design
❑ Yes
No
Current
Design current
Swine Capacity
Pop.
Wet Poetry
@apactthumay
Pop.
Cattle Capacity Pop.
Wean to Finish
I a er
Dai Cow
Wean to Feeder
_Layer
Dai Caif
Feeder to Finish
DairyHeifer
Farrow to Wean 2X0
Design
Farren#
Dry Cow
Farrow to Feeder I
l .'
.a aci
P,o
Non -Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes M No [:]NA [:]NE
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes
[] No
❑ Yes
No
❑ Yes
No
NA ❑ NE
NA ❑ NE
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/2015 Continued

c acili ,sNumber: - Date of Inspection: !t lZgl
❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below.
Waste Collection & Treatment
❑ Yes
NM No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
17. Does the facility lack adequate acreage for land application?
❑ Yes
M No
❑ NA
T"t
18. Is there a lack of properly operating waste application equipment?
❑ Yes
CM No
❑ NA
Spi l Tway?:
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
D Yes
No
0 NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any pan of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ YesNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Ileavy 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
C_
12_ Crop Type(s): D�tS4t9'_( nn
5m. G"\' Soca
13. Soil Type(s): UC
❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below.
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
NM No
❑ NA
❑ NE
I5. Does the receiving crop and/or land application site need improvement?
❑ Yes
1� No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ YesNo
1P
❑ NA
[:]NE
acres determination?
❑ NA ❑ NE
Page 2 of 3
17. Does the facility lack adequate acreage for land application?
❑ Yes
M No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
CM No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes �`No
DNA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ®No DNA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
0 No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA ❑ NE
Page 2 of 3
2/412015 Continued

Facilit Number: - q1 I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 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 E� No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [4 No ❑ NA E]NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below,
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes 1� No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑Yes qNo ❑NA ❑NE
❑ Yes 1� No [] NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ET No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? 0 Yes `3 No ❑ NA ❑ NE
ReviewerAnspector Name:
Reviewer/inspector Signatur
Page 3 of 3
Phone. cl I o --V33 —3 300
Date: I I Zg/j -7
21;M15

Type of Visit: (0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 4P Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 1&?A� Departure Time: County Region:
Farm Name: Owner Email:
Owner Name: %O—C4^5 Phone:
Mailing Address:
Physical Address:
Facility Contact: 'Ge^� r"- �"� Title:
Onsite Representative:
Certified Operator: o-ov, pa"
Back-up Operator:
Phone:
Integrator:
Certification Number: �/ ♦�
Certification Number:
Location of Farm: Latitude: Longitude:
_
Design:.- Current
0 No
Design Current _
Design Gurrent
Swine -
Gapactty Pop. -
Wet Roultry
Capacity - Pop .:.
Cattle ~.._ Capacity Pop.
Wean to Finish
❑ Yes
Layer
NA
❑ NE
Dairy Cow
Wean to Feeder
❑ No
Non -Layer
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
Dairy Calf
Feeder to Finish
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
Dairy Heifer
Farrow to Wean
NA
1
Design Ctlrrentn=::'
Dry Cow
No
Farrow to Feeder
❑ NE
,
D P,a_nit .
Ca act = :1'0
Non -Dai ry
❑ NA
Farrow to Finish
of the State other than from a discharge?
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
0 No
❑ NA
[:]NE
Discharge originated at: ❑ Structure p Application Field F-1Other:.
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
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 I of 3 214/1011 Continued

FAcility Number: - Date of Inspection:
(10
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
P
❑ 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
Struckre
6
❑ NE
Identifier:' -
Spillway?:
❑ Yes
� No
E) NA
E] NE
Designed Freeboard (in):
❑ Yes
[P No
❑ NA
❑ NE
Observed Freeboard (in): 3 y
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
M No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes
No
❑ NA
❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
PW 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
[PNo
❑ NA
❑ NE
8. Do any of the structures 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(
No
F]NA
E] NE
maintenance or improvement?
T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
P No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 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 CropWindow ❑ Evidenc
e'd Drift ❑ Application Outside of Approved Area
0.5'w 12. Crop Type(s): "�S7 i -"t-
13.
"
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes PNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Tra sfers
[:]Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ YesNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? C]Yes ZNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/412011 Continued
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
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
E) NA
E] NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[P No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes PNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Tra sfers
[:]Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ YesNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? C]Yes ZNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/412011 Continued

f
FaciliNlumber: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes NA No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes EP 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:
25. 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 ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
0 No
[:]NA [:]NE
and report mortality rates that were higher than normal?
T
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
1� No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Werc any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
rR No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA ❑ NE
Comments (refer to question . Explain any YES answers:addfor!any additional recommendations or. an _other coiitments."
Use drawings of facility to beater explain situations (use additiona4pages_as necessary)
Reviewer/Inspector Name: T 614N
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 191291-1;6
114/7411

i ype or visit: a q.ompnance inspecuon v tiperarion xeview lJ arrucrure r vaivauon V i ecnmcai Assistance
Reason for Visit: 40 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: EOW Arrival Time: Departure Time:County: Region: Region: FRO_
Farm Name: P Owner Email: ^�
Owner Name: �+'�S q� ga,y-e'43 Phone:
Mailing Address:
Physical Address: � c
Facility Contact: JJ a vw S L Title: Phone:
Onsite Representative:
if
Certified Operator: 41 If—VI Pair -61 --
Back-up Operator:
Location of Farm:
Latitude:
Integrator: ffe�&!Je_
Certification Number: r T�b
Certification Number:
Longitude:
Discharges and Stream Im acts
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 RNA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
Design Current
❑ No
Design
Current
Design Current
Swine
Capacity Pop.
Wet NINEapacity
Pop.
Cattle Capacity Pop.
Wean to Finish
N NA
Layer
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Da' Cow
Wean to Feeder
0 NE
Non -La er
❑ Yes
® No
Da' Calf
Feeder to Finish
of the State other than from a discharge?
- '
Da' Heifer
Farrow to Wean
2AR7
Design
Current
D Cow
Farrow to Feeder
D". P,oul
Ca aci
P,o .
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
=
Turkeys
Other _
Turkey Poults
Other
Other
Discharges and Stream Im acts
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 RNA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[—]Yes
❑ No
5] NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
N NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
® No
❑ NA
0 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 I of 3 2/4/2014 Continued

r
Facility Number: JIS j jDate of inspection: j
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: A B—
�No E] NA E] NE
❑ No $�g NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in): ——
Observed Freeboard (in): �/ 1
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 No
❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes No
❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes No
❑ NA ❑ NE
maintenance or improvement?
Waste Aoolication
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 E]Evidenceof Wind Drift E] Application Outside of Approved Area
12. Crop Type(s): Lcas-k VII. -j el �Y�s s(t7A,..,�i Sri - o w l4e"
tom.
13. Soil Type(s): CaB
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes M 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 [P 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 [N No ❑ NA ❑ NE
❑ Yes [M No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA [] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [ No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists []Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes 1P No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 2/4/2014 Continued

• L
Faclli Number: - Date of Ins ection:
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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWIvIP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes No
❑ Yes No
❑ Yes y No
❑ Yes [�No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
0 N ❑NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
[:]Yes ® No
[:]Yes ® No
❑ NA ❑ NE
❑NA ❑NE
Reviewer/Inspector Name: 2:p6a,4— MP-ti�� Phone: /4 —Y3�33co
Reviewer/Inspector Signature: !9k4 - Date: 1/ 3�
Page 3 of 3 21412014

I ype of Visit: ® Comptiance inspection V uperanon Review V structure Evaivaaon V i ecnmcai Assistance
Reason for Visit: • Routine Q Complaint O Follow-up Q Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: Couuty.�,_� Region:
��''
Farm Name: Owner Email:
Owner Name: ` (f �Q r"'i 7�4_Phone:
Mailing Address:
Physical Address:
Facility Contact: _(Y1i Title: Phone:
Onsite Representative
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:__�4G S�
Certification Number: /
Certification Number:
Longitude:
Design Cu
❑ No
8] NA
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Gallie Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Nan -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D . Poul
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
r Beef Brood Cow
Turke s
Other
TurkeyPoints
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes allo ❑ NA ❑ NE
❑ Yes
❑ No
8] NA
❑ NE
❑ Yes
❑ No
,rim
i NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify Di
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page 1 of 3
❑ Yes [:]No
❑ Yes ! No
❑ Yes ,� No
® NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
2/4/2014 Continued

Facil}tyNumber: - Date of Ins ection:
❑ Yes
Q No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
Q No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
ag No
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
® NA
❑ NE
Structure 1 Structtue 2 Structure 3 Structure 4 Structure 5
Identifier:
Structure 6
❑ Yes
Q No
❑ NA
[] NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
Spillway?:
❑ 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
Designed Freeboard (in):
❑ NA
❑ NE
23. 1f selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Observed Freeboard (in):�
❑ NA
❑ NE
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
Ej No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public
health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
® No
[DNA
❑ 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
fg No
❑ NA
❑ NE
maintenance or improvement?
Waste Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
Eg No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy
Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Ev]idence of Wind Drift [:]Application
Outside of Approved
Area
l
la
c
12. Crop Type(s):01 �U[�...'fr M Yl
j I
-Z Va (,
13. Soil Type(s): Ca 6
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Eg No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
&I No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
jj4 No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Q 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
Q 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
rB No
❑ NA
❑ NE
23. 1f selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
f�3 No
❑ NA
❑ NE
Page 2 of 3 214/1014 Continued

!Facility Number: I Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0 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 @ 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
perrnit? (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 CAWNP?
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?
omments;(r
As necessa" T-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ;D No ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes $a No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes B No ❑-NA ❑ NE
❑ Yes E] No �❑ NA ❑ NE
❑ Yes §D' No ❑ NA ❑ NE
Phone: �7
Date:
2/4%1014

Type of Visit: 0 Compliance Inspection V Operation Review (-) Structure Evaluation U Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I likh 2 Arrival Time: 'G' Departure Time: 1461 1County ks�) j^/ Region: Je
Farm Name: P-1
Owner Name: Tr -f ! 6_ S � r
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: S Integrator: Pes)�X
Certified Operator: Certification Number: 1 71% 0,
Back-up Operator: f CL11. lt'U+� Certification Number: q7646
Location of Farm:
Latitude:
Longitude:
Discharnes and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes rM No [:]NA [:]NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [—]Yes [] No ENNA ❑ 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 0 NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes P 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 I of 3 2/4/2011 Continued
g � s� � g t
Desi n CuPrrentWet "
Design Current
Swine
ry 4 p
Capac�ts Poult . Caea`c�CPop
ty�
Cattle Capacity Pop.
Wean to Finish
�op �. La e��
r
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
ACCO ?/ Design Current
D Cow
Farrow to Feeder
D.. il'oult , Ca aei Pa
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
On :
Turkeys
Other t
Turkey Poults
Other
Other
Discharnes and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes rM No [:]NA [:]NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [—]Yes [] No ENNA ❑ 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 0 NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes P 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 I of 3 2/4/2011 Continued

Facili Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 19�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 4 Z tf-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ YesNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes M 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? T
Waste Aunlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement? 7�
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 ❑ Evidenye-ef Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): L0QS7( SS�t'l a►,.
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
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination? 7�
17. Does the facility lack adequate acreage for land application?
❑ Yes
[4 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records &_Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
TT
❑WUP ❑Checklists E] Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes F] No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes P No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
Page 2 of 3 2/412011 Continued

Facili Number: JDate of Inspection: Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E� No ❑ NA ❑ NE
25. 1s the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes 0 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 T
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e_, discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the 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?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes V, No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes [ No
❑NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: qI� 7.3.3 —_'Vo7
Date: i Zell L
2/4/2011

Type of visit: 0 Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: 0 Routine O Complaint 0 Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Q Departure Time: County: Region:O
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: lRrbT Title: Phone:
Onsite Representative: �!'s integrator: r>QS
Certified Operator: Certification Number: J 7P
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
:.. Design
I'll Jill
Current - a �..� Design'
_Current -
Design Curren#
Swine 7 _ . - Capacity
Pop. Wet Poultry Capacity
Pop ..
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
�; "
Design
. D Poul Ca aci.
Current' ` .'
Pio .
Dai Calf
Dai Heifer
D Cow
Non -Dairy
Feeder to Finish
Farrow to Wean 2 -CM
Farrow to Feeder
Farrow to Finish
La ers
Non -La ers
Pullets
Turkeys
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Boars
TM
I urkey Poults
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes M No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes
❑No
[PNA
❑ NE
❑ Yes
[] No
® NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) L] Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ YesNo ❑ NA ❑ NE
9
3. Were there any observable adverse impacts or potential adverse impacts to the waters C:]Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page l of 3 2/412011 Continued

Facili Number: &9 - 141 jDateof Inspection:
❑ Yes
No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
W No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
r1a3NA
❑ NE
Struc e 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
identifier:
the appropriate box.
Spillway?:
Designed Freeboard (in):
Observed Freeboard 0�+�
(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
[� No
❑ NA
❑ NE
waste management or closure plan?
T
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
[DNA
❑ 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
Nfl No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] YesNo
[:]NA
[:]NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 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 ❑nEvidence of Wind Drift ❑� Application Outside of proved Area
12. Crop TYpe(s): �'1 � JQ C_'r6S D I `7'� ©!
13. Soil Type(s): Ca
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
l6. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination? TT
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[13 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
EP 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 [�3 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

IFaciUy Number:A91-4125- Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey E] Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® 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
[01- NA ❑ NE
❑ Yes ® No E] NA E] NE
❑ Yes �g No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
(A No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question ti): Explain any YES answers and/or any additional recommendations orAny16ther comments.
Ui a drawings of facility to better explain. situations (use:additional pages as necessary}.
Te,",s
43
Reviewer/]nspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: /'o " —3—RD
Date: 'efrl
2/4/2011

f
-1
IType of Visit • Comptiance Inspection O Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit 0 Routine O Complaint Q Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: !tom Departure Time: County: .5bAl Region:;'9-0
Farm Name: r
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:'' ^^ -- -- -- Title.
Onsite Representative: �itrvY�e4 t cel k
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone N,,o:
Integrator: � V&124 - p
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e ❑ I = 11 Longitude: ❑ o =' = "
M-101110 Swineapulation
❑ Wean to Finish
Wet Poultry Capacity Population
❑ Layer
Cattle Capacity Population
❑Dai Cow
Wean to Feeder
❑ Non -La er
❑ Dai Calf
poFeeder to Finish
❑ NE
El Dairy Heifer
NJ Farrow to Wean -2-WO
Dry Poultry
❑ Dry Cow
El Farrow to Feeder
❑ Layers
E]Non-Dairy
❑ Farrow to Finish
❑ Yes
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
El Beef Brood Cowl
❑ Turke s
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [ g No ❑ NA EINE
❑ Yes
❑ No
[4 NA
❑ NE
❑ Yes
❑ No
ONA
❑ NE
A NA
❑ NE
❑ Yes
❑ No
❑ Yes
'fRNo
❑ NA
❑ NE
E] Yes
'NNo
El NA
[I NE
Page I of 3 12/28/04 Continued

c
Facility Number:
Date of Inspection
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 [,Z,47NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �� 3
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 lP No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [R No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EpNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes M 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 ❑ [ *CSS Evidence
�[9_
of Wind Drift ❑�+Application Outside of Area
12_ Crop type�
s) �Er�A,tr toe
l 00-, ) :
M • �\n
13.
Soil type(s) D ,
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement'?
❑ Yes
No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
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?
❑ Yes
Q9 No
❑ NA
❑ NE
r ,
Comments (refer 15Iuestion fl Explain any YES answers andlor any recommndations or any other comments.
Use drawings off cit to better,explain situations. (use adilitional{pages as necessary,):
Reviewer/Inspector Name � �
_ a �u ; Phone: [phone]
Reviewer/Inspector Signature:
Date: O
Page 2 of 3 12/28/04 Continued

IL
Facility Number: BPI Date of Inspection 1 D I
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 1ONo ❑ 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 ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes iQ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
P 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
50 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
29 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
F9 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EpNo
❑ NA
❑ NE
29_
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern`?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
T
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[p No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[B No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12/28/04

Type of Visit ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ] Arrival Time: O -BDA"" Departure Time: County: s4471650W Region: FRO
Farm Name: j2-1
Owner Name: - ?r^esl o RLryvl� - h C r
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: %r 'eF Title. Phone No:
Onsite Representative: ��'m�s Integrator:�-
Certified Operator:` Operator Certification Number: _ 17796
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: E] o = I = u Longitude: = o =' El "
Design Current
❑ Yes VNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
Design Current
a. Was the conveyance man-made?
Design Carrent
Swine Capacity Population
IN NA
Wet Poultry Capacity Population
Cattle
Capacity Population
❑ No
❑ Wean to Finish 1
10 Layer
❑ Dairy Cow
❑ Wean to Feeder 1
10 Non -Layer I
Dairy Calf
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Feeder to Finish
❑ No
0 NA
❑ Dairy Heifer
Farrow to Wean 2000 a030
❑ Yes
Dry Poultry
❑Dry Cow
Farrow to Feeder
❑ Layers
❑ Non -Dairy
❑ Farrow to Finish
❑ NA
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
12/28/04
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes VNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
IN NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
0 NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
12/28/04
Condnued

Facility Number: Ep,qg I Date of Inspection
Wtiste 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?
Stnicture I Stnicture 2 Structure 3 Stnicture 4
Identifier: $_
Spillway?:
Designed Freeboard (in):
Obsmed Freeboard [iny 11
❑ Yes Q_PNo ❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
Structure -1 Structure 6
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.)
ElNE
15. Does the receiving crop and/or land application site need improvement?
6. Are there structures on-site which are not properly addressed and/or managed ❑ YesNo
rp
ElNA ElNE
through a waste management or closure plan?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'[] Yes
No
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ Yes
N No
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
EA No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
W No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of AcceptableCrop Window ❑ Evidence of Wind Drift ElApplication Outside of Area
12. Crop type(s)cros w &r -Q S S SWC nn t
13. Soil type(s)Q,I Y1 fg
r
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[A No
ElNA
ElNE
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
[P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
N 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 row aw Cq� Phone: ro-4333Soo
Reviewer/Inspector Signature: Date: p
/ / 12!18/04 Continued

Facility Number: Date of Inspection
Required Records& Documents , r
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Ifi No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes in No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes C5No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 7 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No M NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
(:9 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
q No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
PLNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
MNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
5dNo
❑ 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
[PNo
❑ 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
10 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.
Cl NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
51 No
❑ NA
❑ NE
12/78104

Type of Visit 4D Compliance Inspection U Operation Review V Structure Evaluation U Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: !AW/Se/k/_ Region:
Farm Name:
Owner Name:
Mailing Address:
Owner Email:
Phone:
Physical Address:
Facility Contact:'1 Title: Phone No:
Onsite Representative:S �^",� Integrator: e
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o ❑ 1 =44 Longitude: =0=, = u
Design Current Destgn �Currenty Design Current
Swine Capacity Population Qt"pultry Capacity Population Cattle ; Capacity Population
❑ Wean to Finish ❑ Layer ❑ Dai Cow
❑ Wean to Feeder ❑ Non-Layer❑Dai Calf
❑ Feeder to Finish- ❑ Dairy Heifer
', #,
Farrow to Wean ,, . ❑ Da Cow
Farrow to Feeder ❑ Non -Dairy
❑ Farrow to Finish ❑ Layers
- ❑Beef Stocker
❑Gilts ❑Non -La Non -Layers
❑ Pullets ❑ Beef Feeder
❑ BoarsCo
.. . , .....- .. ElTurkeys
^ BeeBroo
Outer x ❑ Turkey Poults I I Irte-
❑ Other ❑ Other tures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�Io
`(
El NA
El NE
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
❑ Yes
❑ NoNA
ElNE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
ElNo
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
ftNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ONo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
PNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128/04
Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z
Structure 4
❑ Yes �INo ElNA ElNE
ElYes ❑ No _NA E]NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ YesNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
O§No
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes �No
El NA
[INE
through a waste management or closure plan?
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
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?
❑ YesA No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ YesNo
[:1NA
ElNE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes $No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes KNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable /Crop Window El Evidence of Wind Drin El Application Outside of Area }
12. Crop types) � m,,;i ' ar Cq v 1 l& )l �, 6}�.�" C V &A, / a -k-
13. Soil type(s)
1
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
49 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
O§No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
RgNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
CgNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
N No
❑ NA
❑ NE
Reviewer/inspector Name , . ,. L, Phone:
Reviewer/Inspector Signature: Date:
Page 1 of s 1Zi-16iu¢ 4.uniinuea

Facility Number: Date of inspection l
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0§'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes U§No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
2L . Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )9 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stacking ❑ 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 JP No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 1P No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[n No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
-0 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
Yn No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
6 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
fp No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
IFNo
❑ 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
fe 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
�QNo
❑ 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
61 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
&No
❑ NA
❑ NE
Page 3 of 3 12/28/04

It
Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
- D Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit • Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: f .z$ 0 Arrival Time: Departure Time- 1 :qo County: �5Z " 't SW Region: AiW
Farre Name: —P-1 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
14
Onsite Representative: Integrator: Tc 2P.
Certified Operator: Operator 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
Back-up Certification Number:
Latitude: F -I 0 0 O N Longitude: =°=I = u
Design .Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
I❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other I F::�
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
M
Design -Curren
Cattle Capacity PapuI -.
❑ Dairy Co771
❑ Dairy Calf
❑ Dairy Heifer
EfDry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
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 6 No ❑ NA ❑ NE
❑ Yes ❑ No tp NA
❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes ❑ No 0. NA
❑ NE
❑ Yes r#No ❑ NA
❑ NE
❑ Yes k'�No ❑ NA ❑ NE
12/28/04 Continued � A

Date of Inspection �S 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. 1f yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: ) 9
❑ Yes No
❑ Yes ❑ No
Structure 5
❑NA El NE
ZNA ❑ NE
cture 6
Spillway?:
Designed Freeboard (in):
D
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes(
No
'❑ NA
El NE
(ie/ large trees, severe erosion, seepage, etc.)
ff
6. Are there structures on-site which are not properly addressed and/or managed
❑ YesNo
ElNA
E]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 environment,
notify DWQ
7. Do any of the structures need maintenance or improvement?
El Yes
o
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
1.PNo
❑ 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 ❑ YesNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ YesNo ElNA ElNE
❑ Excessive Ponding [:1Hydraulic Overload [IFrozen Ground ElHeavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Cro➢ Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
1
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes UNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes EMNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes fZNo [INA ❑ NE
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
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name fiAlP ti'lit-! ' Phone: 33`330
Reviewer/Inspector Signature: Date: t77
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 ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
r No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
P No
❑ NA
[:1 NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ YesNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
E]YesINo
No
[__1 NA
El NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes 1P 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 q 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 ONo ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes It No ❑ NA ❑ NE
Additional Comments and/or Drawings:
12/28/04
YA

Division of Water Quality i
,F'�1y NumberJ0 tf j Q Division of Soif and Water Conservation i'
Other Agency
Type of Visit m ce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Reg)
Farm Name: 7 1 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: QnjLa integrator: ,4-"
Certified Operator: Operator Certification Nu er:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: =0
0i
=66 Longitude: [=0=6
°=6 =
46
Design Curren#
iisDesign
' Current
Design Current
Swine Capacity Population
W- e-11 Poultry
Capacity Population
CattleCapacity Population
❑ Wean to Finish
❑ Layer
LI 'NA
❑ NE
❑ Dairy Cow
❑ No
❑ Wean to Feeder
❑ Non -La er
EINE
ElYes
❑ Dairy Calf
❑ NA
❑ Feeder to Finish'
't '
?"
❑ Dairy Heifer
arrow to Wean Z
D , Poul
ry
❑ Layers
K
:�,';�+ay�..a �.
El D Cow
❑ Non -Dairy
❑ Beef Stocker
El Farrow to Feeder
ElFarrow to Finish
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowl
-.; -
❑ Turkeys
z -
Other
❑ Turkey Poults
❑ Othcr
❑ Other
Numlierof3Struetures:
may,
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes Ltd leo ❑ NA ❑ NE
❑ Yes
❑ No6NA
❑ NE
❑ Yes
❑ No
ETNA
❑ NE
LI 'NA
❑ NE
❑ Yes
❑ No
❑ Yes
oNA
EINE
ElYes
o
❑ NA
EINE
12/28/04 Continued
1f

Facility Number: Date of Inspection
T.
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Na ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [1 NA ❑ NE
Stru ture I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: G
Spillway?: p
Designed Freeboard (in):
Observed Freeboard (in): 3,9
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Ivo ❑ 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 CfNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes dNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) �.,/
9. Does any part of the waste management system other than the waste structures require El Yes [! No ❑ NA ❑ NE
maintenance or improvement?
Waste Aunlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes KrNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. Cl Yes 03"N'o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P,eNo
El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
LJNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
IZNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
UNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ 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 NamePhone: C) 3
Reviewer/Inspector Signature: Date:
Page 2 of 3 12/28/04 Continued

,Facilij Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [RrNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes ffNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other �,-,`
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes L]d'tvo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ AnnuaI Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Cade
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
dNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
O No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
MNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�io
❑ NA
❑ NE
Other Issues
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
B"
No
IJ NNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E!(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?
El Yes
,,..f
IJ 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
ENo
❑ 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
ENo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
►IJ' No
❑ NA
❑ NE
Additional Comments and/or Drawtags
Page 3 of3 — -- 12/28/04
Page 3 of3 — -- 12/28/04

i
Type of Visit 40 Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: y Ja�Jns Arrival Time: $ : ad Departure Time: County: Region:
Farm Name: P^ Owner Email:
Owner Name: , er cw5} 4k c ar V%- } _ Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone No:
Onsite Representative: Integrator: Pr GST <
Certified Operator: RR Ci a,rt -Q1n1r. Operator Certification Number: / 7 75 C
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: F --I o =A
= Longitude: ❑ ° ❑ ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ; ❑ Layer
❑ Wean to Feeder ❑ Non -La et
❑ Feeder to Finish
© Farrow to Wean beau i ils
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
3
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, Populations
❑ Dairy Cow
i:.
❑ Dairy Calf
❑ Daia Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Humber of Structures: .®�
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 7 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
EINE
❑ Yes
❑ No
❑ Yes
Cfl No
❑ NA
❑ NE
❑ Yes
U9 No
❑ NA
❑ NE
12/28/04 Continued

Facility Number:�
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a_ If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: 1P i2
Spillway?:
Designed Freeboard (in):
j
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes U No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) r 4� j� I QS
13. Soil type(s) C a
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [M No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes m 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 tack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Reviewer/lnspector Name - V. , y/ Phone:
ReviewerlInspector Signature: Date: Y %J 710,T
12/28/04 Continued

Facility Number: 9.2 —14fs Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes m No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below, ❑ Yes ® No ❑ NA ❑ NE
/.4 /,
El Waste Application [I 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
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Ej No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
® NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
5 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Adcl�tlooai Cominents:andlor Drawings
(�
�aG�
12/28/04

r
IType of Visit & Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Omer ❑ Denied Access
Facility Number s' Date of Visit: Time:
O Not O erational Q Below Threshold
�ermitted �.ertifiied [3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: Co
............. Je -./'L........................ ........ County: ..... Scr2n.�os� _.. �Ii �.
Owner Name: - ?�_ Phone No:
--- —1-- _.W� • -
Mailing Address:..P:. :...!aQ.......3.ii............ ........... � n!�R.!?yc %U�......... __ .�'� ..... ............
_. ..... ._....._. ... .. --...
_..,• c iuf t c tide PhoneNo:
Contact: �.../._..--•---�--•-------W_..W....W.............W..........�....._..-------.......... •--......�.�_�—.�...........
Onsite Representative;__ ieoaU.._._�ff�--••-•-•-•--•-••-•---�.� ......W . In tor• -- P ts..... �¢�'m ?.� _, --------
Certified
tea - ��G ..�.. .
Certified Operator: RA2r�? _._ . _�i:r �tQ p .... .------- Operator Certification
Location of Farm:
[wine ❑ Poultry ❑ Cattle ❑ Horse Latitude a 4 &° Longitude • 4 «
Swine
urireat
iulaiion ;`Poultry
Wean to Feeder
Feeder to Finish
EDT -mow to Wean aD0 v
Farrow to Feeder
El Farrow to Finish
Ej Gilts
El Boars
iiirrent_
=.j[] Non -Layer J
J
J .i: [] Non -D
Other
T6ia1 DesignCapacil
- - Total'Ss LV
Discharge & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 21To
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes Kwo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
El Yes a'Iqo
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes M -No
❑ Yes &No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [moo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes EJ -114'o
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ........EL --h- .......... Pz:. ..._-- •-----.... ......
Freeboard (inches): 3I 3
12112103 Continued

Facility Number: —51
Date of Inspection 3- o
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ 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?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
S. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste ARplication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type Ccz7S)'Ll , _" �i S
❑ Yes Leo
❑ Yes D -No
❑ Yes gNo
❑ Yes D No
❑ Yes [c No
❑ Yes [-No
❑ Yes OlWoo
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [ .No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes IM
b) Does the facility need a wettable acre determination? ❑ Yes ❑- O
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes UNo
❑ Yes E�No
❑ Yes t[ Wo
❑ Yes [9-#o
❑ Yes p -W
❑ Yes [g.N'b
❑ Yes 0N—
Comments (refer toires�on #) Explain anyYF$aaswers and/or any recaammendgtzons a y
:Use drawings of facility to better explain tua o . { se�addxtxonal pages as necessary) field Copy ❑ Final Note10s
T
Reviewer/inspector ]NameG
Reviewer/inspector Signature: fit: Date: 3 —§L -0L
12112103 Continued

Facility Number: Date of Inspection
- LIe S /(/)i/3
Required Records & DocumenLs
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
\TPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Form ❑ Crop Yield Form []Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes ❑-o
❑ Yes [ ,No
❑ Yes 0340
❑ Yes Q'No
❑ Yes GW6
❑ Yes M.Wo
❑ Yes El -No
❑ Yes OlNb
❑ Yes Quo
P-Y—es ❑ No
❑ Yes M -No
❑ Yes ❑,Ko
EU.Yes ❑ No
E&fes ❑ No
❑ Yes [P-ro
o violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
-_ _ _ _
dditaonal Comments andlor Drawutgs . --. - - "�
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