820417_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: 1 County: Region:9f PY � 4 1 I-rQ
Farm Name: _ 0 _ Owner Email:
Owner Name: pressasi Phone: _
Mailing Address:
Physical Address:
Facility Contact: 'JAY & L0„ f"I Title: Phone:
Onsite Representative: U Integrator:���.
Certified Operator: JQI hQ W Certification Number:. 00 _93ZID
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharges and Stream Imaacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes *o ❑ NA ❑ NE
a. Was the conveyance man-made?
-.HWERVti
❑ No
NA
❑ 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 Poultry
@apacity
Pop.'Cattle
Capacity Pop.
❑ NoNA
�NA
Wean to Finish
2. Is there evidence of a past discharge from any part of the operation?
La er
No
Dairy Cow
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Wean to Feeder
❑ NA
Non -La er
of the State other than from a discharge?
Dairy Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
Carrent
Dry Cow
Farrow to Feeder
D Paul
Ca aci_:- Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts 06
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Imaacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes *o ❑ NA ❑ NE
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
[:]No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[:]Yes
❑ NoNA
�NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2015 Continued

Facili Number: Date of inspection:
❑ YesNo
❑ NA
❑ NE
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
r_ No
❑ NA
E] NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[IR NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3y
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ YesNo
No
❑ NA
[:]NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes
1F
❑ NA
0 NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ YesP
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)
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[g] No
❑ NA
❑ NE
maintenance or improvement?
❑ NA
❑ NE
the appropriate box.
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
P No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload p Frozen Ground ❑ Heavy Metals (Cu, Zn, etc:)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into Bare Soil
❑ Outside of Acceptable C oprrWindow ❑ Evidence of Win Drift ❑ Application Outside of Approved
Area
C
12. Crop Type(s): l'N -
cab
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
0 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
PNo
❑ 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 ❑Ocher:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Tra6sfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 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 2/4/2015 Continued

Facili Number: -!Y IDate of Inspection: W Z3 1
2.4. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes n No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �Zj No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA [] NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately_
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewerlinspector 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 �q No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone:
Date:
2/4/1015

Ii ype of visit. a uompnance inspection V Vperanon xeview v structure Evaluation V t ecnntcat Assistance
Reason for Visit: ® Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:GIgr1 10Arrival Time: ,p Departure Time: County:
Farm Name: Owner Email:
Owner Name: Pat I �[e Phone:
el—.,.
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Region:
Phone:
Integrator: Q
Certification Number: /Co
Certification Number:
Longitude:
Design Current
❑ Yes
Design
-Current
Design Current
Swine Capacity Pop:
Wet Poultry
Capacity
Pop.
op.
battle Capacity Plow
c. What is the estimated volume that reached waters of the State (gallons)?
Wean to Finish
Layer
❑ No
�NA
Dairy Cow
Wean to Feeder
Non -Layer
No
❑ NA
Dairy Calf
Feeder to Finish
❑ Yes
No
❑ NA
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr. Peau!
Ca acity
P,o P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
ilts bg
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes P No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[:]No
rimNA
❑ 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 1 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 b No P NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes *o ❑ NA ❑ N>:
(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 09 No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[� No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[P No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes K) No ❑ NA ❑ NE
❑ Excessive Ponding [] Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus p Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable ZCrp rindow ❑ vidence of Wind ❑ Application Outside of Approved Area
12. Crop Type(s): G 5,,t
13. Soil Type(s)-
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑WUP [:1 Checklists ❑Design [:]maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VU No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes T No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 051
No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes KZ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ YesNo F]NA E]NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ YesNo [:]NA [:]NE
and report mortality rates that were higher than normal? 9.1
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ YesNo
❑ 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
❑ YesNo
❑ 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 ❑ 1-agoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
(M No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Wo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or.. any. other comments.
3
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 01191-W r2V610
Date:
2/4/2011

V
IType of Visit: 0 Compliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: /�/-i/�, Arrival Time:�3�� Departure Time: /j County: cs�e_fdA1 Region:
Farm Name: I `F�i�•"a Owner Email:
Owner Name: �rQS`�Ipp_Fay, 5 Phone:
Mailing Address:
Physical Address:
Facility Contact: �t�1�eS L[�z•.(j Title:
Onsite Representative: G f
Certified Operator: e�C4 f 114
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: Trm
Certification Number: tl00 rr
Certification Number:
Longitude:
Discharees and Stream lmoacts
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 ® No ❑ NA ❑ NE
❑ Yes
Design Current
(;DNA
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
@attle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
7707 3382-
Design
Current
Dry Cow
Farrow to Feeder
D , P,o-1
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharees and Stream lmoacts
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 ® No ❑ NA ❑ NE
❑ Yes
❑ No
(;DNA
❑ NE
❑ Yes
❑ No
0 NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No 0 NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes � No [3 NA E] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes K] No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 214/2014 Continued

Facility Number: jDate of Inspection:
❑ Yes
P 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
On 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
❑ NA
Identifier:
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and V Rainfall Inspections
Spillway?:
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
P No
Designed Freeboard (in):
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
� No
Observed Freeboard (in):
E] NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
R 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
[P 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 Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
[� No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA
❑ 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
Wid Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �� � l a 5,"
❑ NE
13, Soil Type(s): a&
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [P No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes [P No ❑ NA ❑ NE
❑ Yes [9 No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
P 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.
p WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
`� No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and V 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
E] NE
Page 2 of 3 2/4/2014 Continued

a
Facility Number: 22 �4_ II'/ I jDate of Inspection: 1111 W2 j
24. Did the facility fail to calibrate waste application equipment as required by the permit? 0 Yes y No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E� No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA [] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ YesNo [3NA [] NE
0
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes [)] No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes [PNo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [� No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers andt6r any additional recommendations or anyrotlier comments.
Use drawtn of facility to better explain situations use additional. is es as necessary).
Reviewer/Inspector Name: es' t7
Phone:
Reviewer/Inspector Signature:
Date:
Page 3 of 3
214/2014

Type of Visit: 4) Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: ® Routine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County:.5AA'1'0--0N
Farm Name: -20 Owner Email:
Owner Name: res � Phone:
Mailing Address:
Physical Address:
Region: "
Facility Contact: `,QHS L.6LV 1O Title: Phone:
iJ
Onsite Representative: Integrator: Pw4y_
Certified Operator: a� • �-LL � Certification Number: Z? �' 3
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[:)Yes .P No ❑ NA ❑ NE
❑ Yes
❑ No
i
❑ NE
❑ Yes
❑ No
E�I NA
esigffCurrent
Design
@urrent
Design Current
SwineCa
aci Po
P z tY P• -
Wet Poul
Ca aci
P ty
Po P•
Cattle Ga aci Pa .
P t3' P
h
La er
Da Cow
r
Non -La er
Dai Calf
sh
=Feeder
-
�I
Dai Heifer
an
317
Design;
"Current
D Cow
der
D . Point :
Ca aci
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
pits2a
I
Non -La ers
Beef Feeder
Boars
Pullets
I jBeef Brood Cow
Turkeys
Turkey Poults
Other
I 10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[:)Yes .P No ❑ NA ❑ NE
❑ Yes
❑ No
[ )NA
❑ NE
❑ Yes
❑ No
E�I 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 P NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes 1� No [] NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes �rCIC No [—]NA ❑ NE
of the State other than from a discharge? `�l
Page I of 3 2/4/2014 Continued

acili Number: -Date of Inspection: I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ]O 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: I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [PNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
Qg No
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
P No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
E) No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
9. Does any part of the waste management system other than the waste structures require
❑ Yes
t No
❑ NA
❑ NE
maintenance or improvement?
❑ NE
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E�FNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [�3 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window 1 Evidence of Wind
`Driftft ❑ Application Outside of Approved Area
12. Crop Type(s): G5 W\ q 1 lJ+'_ s -q, u,�... O
s -
13. Soil Type(s):
❑ Yes
E] No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[D Yes
® No
❑ NA
D. NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[ No
❑ NA
❑ NE
acres determination?
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
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
CP No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E] No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
M No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [] Yes [M( No ❑ NA ❑ NE
Page 2 of 3 2/4/2414 Continued

t
1+acilityNumber: FE R I Date of Inspection: ( /
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 MNo
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
❑ NA ❑ NE
❑ NA ❑ NE
FL] NA ❑NE
DNA ❑NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[] No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
�] No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
®No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
P] No
❑ NA ❑ NE
Comments (refer, to question ft Explain any YES answers and/or any additional: recommendations or%any tl er comments:
Use drawings offacility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ?lerT3?1_?-�bo
Date: I V_4/ `-(
2/412014

Type of Visit: 40 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:Arrival Time: O ,.. Departure Time: b2;pp CountyS5Mj0S&J Region: AP -9
Farm Name- 1P /�� Owner Email:
Owner Name: �/� e 5 Phone:
Mailing Address:
Physical Address:
Facility Contact:a4lc&�
I — Title: Phone:
Onsite Representative: aM?--5 %i'l1 b Integrator:?E�i4mz=
Certified Operator: Sw he,,N AngL Certification Number: Wngs
Back-up Operator: Pa�'(,L C 1 Aled Certification Number: 2'63
Location of Farm:
Latitude:
Longitude:
�' Design
Current
No
Design
Current
Design Current
Swine :'�+"Capacity
Pop.
Wet Poultiy Capacity
Pap..
C►attle Capacity Pop.
[:]No
[Q NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[—]Yes
❑No
NA
❑ NE
ish
La er
Dai Cow
[:]Yes
eder
® NA
Non -Layer
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
Da Calf
❑ NA
❑ NE
VFccdernish
Da' Heifer
ean
3016
❑ NE
Design
Current
D Cow
eeder
D . P■onl
Ca aci
Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts /S
Non -Layers
Beef Feeder
Boars 1255 Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Imuacts
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
[Q 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 2/4/2011 Continued

f- It
Facili Number: jDate of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONO ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No [2 NA ❑ NE
Structure 1 Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes �n 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 `f3 No ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? Yes [�g 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 E] NE
maintenance or improvement? T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes NJ No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [55 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 100/. or 10 lbs. [] Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift c-❑ Application Outside of Approved Area
12. Crop Type(s): (OQS� oecrn4 44 G -,*&S r4qol r "4, 0004�
13. Soil Type(s): a _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes W 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
W No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
50 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
W No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
`P1 No
❑ NA
❑ NE
the appropriate box.
T
❑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 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ff] No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [P No ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: - Date of Ins ection: Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 5L] No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes m No ❑ NA] NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey F-1 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 M No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
[] Yes © No ❑ NA ❑ NE
❑ Yes ® No ❑ NA [] NE
❑ Yes W No ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
[:]Yes © No
❑ Yes © No
[—]Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
User&aw nes ' facility to better exalain'situations (use additional oa�es`as necessarvl.' ;I
Comments re er to question
Explain any answers and/or an a aona recommen atlonsor an „ot ercommen
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q1 �� W_
Date: l Z
21412011

IType of Visit: 0 Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance \j j I
Reason for Visit: & Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access �
Date of Visit: I q 41,20 Arrival Time: + Departure Time: County: ' m iRegion: XPO
Farm Name: Owner Email:
Owner Name: T—re! ¢ 1", 1C r Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator -
Back -up Operator:
Location of Farm:
Latitude:
Phone:
integrator:
Certification Number: �90
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes r No ❑ NA ❑ NE
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 M No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 13� No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued
Design
Currentp
Design
Current-
y Design Current
Swore
62 a,
Pop.
Wet Po 1 ryR_ Capacity
Pop.
p.
Cattle Capacity PaNJ
Wean to Finish
La er Da' Cow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
`
-
Da' Heifer
Farrow to Wean:;
raw` 'Design
Current'
D Cow
Farrow to Feeder
j
Y `'
�:;D . ;,P:ou1t �,;, Ca act
P,o �
Non -Dairy
to Finish
La ers
n Beef Stocker
Gilts
j
Non -La ers
Pullets
Beef Feeder
Boars
Beef Brood Cow
AM
Turkeys;
Other
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes r No ❑ NA ❑ NE
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 M No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 13� No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

FaciliNumber: - 14 j Date of—inspection:
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:_
�INo ❑ NA ❑ NE
T❑ No P NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a 0 Yes No
❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No
l[/�
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No
`�'
❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E�j No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No
❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below, ❑ Yes ® No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window Evidennof Wiind, Drift ❑.Application Outside of Approved Area
12. Crop Type(s): CbaS-W ove6md
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes a] No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes TP No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes EP No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [j] No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes M No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists [3 Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [n No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 2/4/2011 Continued

Facility Number: 9, 141 Date of Inspection: �(
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Q9 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ YesNo [—]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 Iagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[3 Yes1�C11
No
`❑
❑ NA
❑ NE
E] Yes
No
NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes J�j No ❑ NA ❑ NE
❑ Yes [a No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes U No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes � No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes r'71 No ❑ NA ❑ NE
Use drawings of facility to better explain situatio s (use. additional pages as necessary), mendations orany coinnie'nt
Comments (refer to question q. -Explain any YES answers and/or any ots
(fie"dS Y_evi-
,�e V-0- ok glMl
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone:
Date:
214/2011

i
IType of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 0 Arrival Time: 3: QQ Departure Time: County: r 4&j
Farm Name: `– Owner Email:
Owner Name: f Phone:
Mailing Address:
Physical Address:
Facility Contact: IL Title:
Onsite Representative: T_a;66t-YIYJ
Certified Operator:
Back-up Operator:
Location of Farm:
=Latitude-
Region:
Phone No:
Integrator: q�
Operator Certification Number: r r 0
Back-up Certification Number:
Longitude: =0=6 = «
J
iLQp–Cs—ign urrent
Design Current
Design Current
❑ NE
—0
Swine Capacity Population
Wet Pouttry Capacity Populatiou
Cattle Capacity Population
❑ NE
❑ Wean to Finish
❑ Layer
&NA
❑ Dairy Cow
❑ Yes
❑ Wean to Feeder
ID Non -Layer I
El NE
❑ Dairy Calf
�
0 No
❑ Feeder to Finish
❑ NE
❑ Dairy Heifer
Marrow to Wean
Dry Poultry
❑ Dry Cow
El Farrow to Feeder
❑ La ers
❑ Non -Dairy
❑ Farrow to Finish
❑Non -La ❑ ers Pullets
❑ Turkeys
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Co
Gilts
Boars
Other
❑ Turkey Poults
❑ Other
❑ Other I INumber
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 PNo ❑ NA FINE
❑ Yes
❑ No
'P NA
❑ NE
❑ Yes
❑ No
[;bNA
❑ NE
❑ Yes
❑ No
&NA
❑ NE
❑ Yes
�1 No
[j NA
El NE
E1 Yes
�
0 No
❑ NA
❑ NE
Page 1 of 3 12/28/04 Continued

f' 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?
❑ Yes U�No
❑ Yes ❑ No
❑ NA ❑ NE
1PNA ❑ NE
Stru tore 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(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
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 No ❑ NA ❑ NE
P[erd i Y-" a Ajdot ql em/l ° .
Reviewer/Inspector Namer' i [ * ' Phone:
Reviewer/Inspector Signature: A0 Date: O t(eo
Page 2 of 3 1 titaiva W,onunuru
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
{{
9_ Does any part of the waste management system other than the waste structures require El Yes
�No
El NA [:1 NE
maintenance or improvement?
Waste Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[2fNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
h No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
QPNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
( No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
[ No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
1PNo
❑ NA ❑ NE
P[erd i Y-" a Ajdot ql em/l ° .
Reviewer/Inspector Namer' i [ * ' Phone:
Reviewer/Inspector Signature: A0 Date: O t(eo
Page 2 of 3 1 titaiva W,onunuru

Fadi ity Number: — Date of Inspection"l I iU I
Required Records & Documents t
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists
❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
r 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
F1 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
09 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
1� No
❑ NA
❑ NE
Other Issues
2$.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30_
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
r
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
is -w4
Additional Comments andfor Drawings: * �
Page 3 of 3 12/2$/04

f'
Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit • Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:
Farm Name:
U0Arrival Time: Abe M Departure Time: !f County: Region:
Owner Email:
Owner Name: r"eSTLZ�@etP'1S 'Tile- Phone:
Mailing Address:
Physical Address:
Facility Contact: aWf_Title: P one No:
Onsite Representative- - a `a""� Integrator: P(V �'^ 0
P �
Certified Operator: � net1 S Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o =I ="
Longitude: = n ❑ t ❑ u
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
IP No
Design Current
Design Carrent
Design Current
Swine Capacity Population
Wet Poultry M
Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ No
Q9 NA
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer I
❑ No
[8 NA
❑ Dairy Calf
❑ Feeder to Finish
Dry Poultry
❑ Dairy Heifer
❑ Dry Cow
Farrow to Wean
❑ Farrow to Feeder
Layers
ElNon-Dairy
❑ Farrow to Finish
❑ N Mets era
El Pullets
❑ Turke s
❑ Beef Stocker
El Beef Feeder
[I Beef Brood Coyd
Gilts
Boars
Othe
❑ Other
10 Turkey Poults
❑ Other
Number of Structures:
ElYes
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
IP No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
Q9 NA
❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
❑ Yes
❑ No
[8 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
R] NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation'?
❑ YesNo
[INA
ElNE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
ElYes
No
❑ NA
❑ NE
other than from a discharge'?
12/28/04
Continued

'4
Facility Number: I;O/Ar gm
Date of Inspection
Taste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If ves, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: I
Spillway?:
Designed Freeboard (in):
Observed Freeboard tin):
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 �lo
ElYes l❑ No
Structure
El NA El NE
D�FNA ❑ NE
Structure 6
❑ Yes o ❑ NA ❑ NE
❑ Yes �Ao ❑ 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?
(Not applicable to roofed pits, dry stacks and/or wet stacks) El YesPNo El NA El NE
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No ElNA F1NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes &?Ko ❑ NA FINE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes VNNo
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ TotaI Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑E,,��vidence of WindCDrifl ❑ Application Outside of Area
12. Crop type(s) Gas a GM &-MU S5 7M - 6��n ©U'�
e
13. Soil type(s) n .aq
❑ NA ❑ NE
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
B o
❑ 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 acre determination: ❑ Yes
❑ NA
El NE
'No
17. Does the facility lack adequate acreage for land application?
El Yes
,./NNo
[0
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
R 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):
L
Reviewer/Inspector Name A4 Phone: 3,!7J)0
Reviewer/Inspector Signature: nada Date: '9
12128/04 Continued

Facility Number: a q Date of Inspection
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ W ­Up ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes
LSI No
❑ NA
❑ NE
❑ Yes
LH'No
❑ NA
❑ NE .
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ 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
<o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
9�o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
BN.
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
U<o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
910N'o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
L'7 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ErNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LT 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
do
❑ 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
El Yes
,_.,/
S/J 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
Q No
❑ NA
❑ NE
Adtlirional Comments and/or Drawings:
•
12/28/04

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit B Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: / County:
Farm Name: 0 Owner Email:
Owner Name: rnsG„ Phone:
Mailing Address:
Physical Address:
Facility Contact: 1 ^ - Title: Phone No:
Onsite Representative: Integrator:�s
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Region:
Location of Farm: Latitude: = n =I = u Longitude: = e 0 I= u
i
Design Current,; Design C ent
wxw.et
Design Current
Swine
Ga aci Po ulation� '�' PouttryCapactty Population
p ty p
Cattle Capacity Population
❑ Wean to Finish
...
❑ Layer
Dairy Cow
❑ Wean to Feeder
Non -Layer
❑Dairy Calf
Feeder to Finish
x
❑ Dairy Heifer
Farrow to Wean❑
El Farrow to Feederryryr
,. .
D &Point � k� - � � �.
"'" -"`�
D Cow
Non -Dairy
Farrow to Finish
El Farrow
Lavers �
El Beef Stocker
Gilts
❑Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
Other
v ❑ Turkeys
�:.. ❑ Turkey Poults
gin-�
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
i 9 No
❑ NA
EINE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
rNA
❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
❑ Yes
❑ No
�PNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
r NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
)0 No
[:INA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
ANo
❑ NA
❑ NE
other than from a discharge?
Page l of 3
12128/04
Continued

Je
Facility Number:Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes A No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No 9NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
F
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
OPNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ NA
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
0 No ❑ NA ❑ NE
through a waste management or closure plan?
jj�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
0 No ❑ NA EINE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
rNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ Yes
9. Does any part of the waste management system other than the waste structures requireNo
❑Yes
El NA NE
maintenance or improvement?
18. Is there a lack of properly operating waste application equipment?
Waste Aoolication
&No
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
KNo ❑ NA ❑ NE
mai ntenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
55No ❑ 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]- El Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) Coal -W hMa.OIQ QK,5 Q ar) ; SAS- "�_
13. Soil type(s) LQ ia,
r
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
jj�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
ZgNO
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
&No
❑ NA
❑ NE
Reviewer/Inspector Name t n Phone: q T'f3Q�
Reviewer/inspector Signature:Date: I &T 10 ffim
Page 2 of 3 12/28/04 Continued

Facility Number: Date of Inspection
Re uired 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 El Maps El Other Ig
No Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes cT No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
KhNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
6 N
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
bNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
19 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
fgNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
)9 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
IS 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
$3 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
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
Q No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
4 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
A,
12/28/04

W 1%44;
Facility Number r
0 Division of Water Quality `
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 4D Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:1. nn Arrival Time: U `C Departure Time: County: /`� Region:
Farm Name: rOwner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
1 frx% R_
Onsite Representative: Integrator: 11
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =o =1 Q" Longitude: 0° 1:3 E__1 u
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity :Population Wet Poultry Capacity Population
' ❑ ILayer
I❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population.
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:F1 I
J:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes YONo []NA ❑ NE
❑ Yes
❑ No
RNA
❑ NE
❑ Yes
❑ No
RNA
❑ NE
*A
❑ NE
❑ Yes
❑ No
❑ Yes
)Q No
❑ NA
❑ NE
❑ Yes
O No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: — Date of Inspection a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ YesNo F-1NAElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes �jNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes bNo ❑ 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 ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes W No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes OjNo ❑ 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) &,C "o L � 1 • 9 Q'
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Docs the receiving crop and/or land application site need improvement?
❑ Yes
e�B No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
C 9 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
J�j No
❑ NA
❑ NE
I S. Is there a lack of properly operating waste application equipment?
❑ Yes
[�No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
lA h. de .
,4o 'eq 06 - &4'i -,t / A IC4
Reviewer/inspector Name Phone:O .V,- .300
Reviewer/Inspector Signature: Date:
12/28/04 Continued

Facility Number: 11 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes PjNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and 1 " Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
PENo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
PO No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
WNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
QgNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
KNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
O No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Wo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
qi +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
[:1 NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/]nspector fail to discuss review/inspection with an on-site representative?
❑ Yes
O No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency`?
❑ Yes
J6No
❑ NA
❑ NE
Comments and/or Drawings:
12/28/04

04
Type of Visit (VCo Hance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit 4KOutine O Complaint O Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: '=-2—... Arrival Time: Taj f K l Departure Time: "L1 County: Region:
It
Farm Name: T •_, Owner Email:
Owner Name: Phone:
Mailing Address: ,
Physical Address: ,^
Facility Contact:
Onsite Representative:
Certified Operator: —
Back-up Operator: _
Title:
Phone No:
Integrator 'C -i' e S
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: E= e El' ❑" Longitude: = ° =I = u
Discharges & Stream Impacts
Design Current
w Design Current
=: c,t.r. r: c ,
Design Current
Swine
Capacity Population
Wet Paultry�pacrty 1?opulation
Cattle C►apacity Population
❑ an to Finish
❑ NE
❑ La er
❑ Dairy Cow
❑ an to Feeder
❑Non -La er
❑ Dairy Calf
❑ Feeder to Finish�
❑ No
" '
❑ Dairy Heifer
arrow to Wean
M 0 1 0
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
c. What is the estimated volume that reached waters of the State (gallons)?
ElNon-Dairy
❑ Farrow to Finish
El Layers
❑ Beef Stocker
❑ No
2 nIA
❑Non -Layers
❑Beef Feeder
❑ Boars
❑'lqo
❑Pullets
El Beef Brood Co
xa
❑ Yes
El Turkeys
❑ NA
Other
❑ Other
other than from a discharge?
❑ Turkey Pou Its
❑Other
Nurn er ofa5tructures:
Page I of 3
12/28/04
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
EP/No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
9NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
03 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
2 nIA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑'lqo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
BIo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [D No 2<A ❑ NE
Struc re 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Flo
❑ NA ❑ NE
Observed Freeboard (in):
]L _ is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
Ej�<0
/
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
5. Are there any immediate threats to the integrity of any of the structures observed?
El Yes
,�,
L�INo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc_)
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)— CHLU0
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
LI'No
❑ NA
❑ NE
through a waste management or closure plan?
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 'U/N.
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
LQNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
7_ Do any of the structures need maintenance or improvement?
❑ Yes
VNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
�lo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
El Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Flo
❑ NA ❑ NE
maintenance/improvement?
]L _ is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
Ej�<0
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)— CHLU0
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 'U/N.
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
LQNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
PrNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
E �No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E5 $lo
❑ NA ❑ NE
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 2 of 3
Phone:
Date:
12128/04 Continued

Facility Nhmber: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes 9No ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
914o
❑ NA
❑ NE
❑ Yes
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑Maps El Other
❑ NA
❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
�
EIN"o
❑ NA
❑ NE
❑ NA
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute inspections ❑ Monthly and V
Rain Inspections❑ Weather
Code
❑ Yes
H/No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
31. Did the facility fail to notify the regional office of emergency situations as required by
❑NA
[__1NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
CJ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
❑ NA
El NE
26.
Did the facility fail to have an actively certified operator in charge'?
❑ Yes
,Er,No
IJ NNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
L'rNo
❑ NA
❑ NE
Other Issues
2$. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
I•'J No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
H/No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[ vo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
LTJ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[2/No
❑ NA
❑ NE
Additional Comments and/or Drawings: ;x 3_k
&
Page 3 of 3 12/2$/04
Page 3 of 3 12/2$/04

sa
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: % r Arrival Time: Departure Time: County: i- N Region: Ffw
Farm Name: _ aV Owner Email:
Owner Name:._ Pr C -$_ Phone: ? 7 /
Mailing Address: PD , / Al C .24-3-7
Physical Address:
Facility Contact:
Title:
Onsite Representative: a.. shy lSi+r G4�•c -' -_
Certified Operator: T., Y i vyt
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator: 140,C-14.- a r
Operator Certification Number:�-
Back-up Certification Number:
Latitude: 0 0 = & F --I « Longitude: =0[=d
o[=d = 4f
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder j ❑ Non -Layer
Feeder to Finish-
❑ Farrow to Wean
® Farrow to Feeder j3_;70 113 g
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Lavers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
y_
Design Current- `
Cattle Capacity Population'
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ gr
y Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Covd
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[I Yes
El No
[_1 NA
❑NE
❑ NA
❑ NE
❑ Yes
❑ No
[I Yes
V1 No
El NA
El NE
❑ Yes
[A No
❑ NA
❑ NE
12128/04 Continued

r 4
Facility Number:
Date of Inspection /9
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): aD C>,r 4
Observed Freeboard (in): 310 I�
//- Y7- 51_�
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?
El Yes ®No El NA El NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes W 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 FO No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. 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 Q No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drif, ❑ Application Outside of Area
12. Crop type(s) ctiQJ' r. S ro ov t.. -J c ccs
3
13. Soil type(s) (!
Illr �,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes q No [JNA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes W No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes No ❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
Reviewer/inspector Name
Reviewer/Inspector Signature:
Phone:
Date:
12/28/04
9/a
Continued

a
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes W No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EE No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design g El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® 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
[A 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
E] 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
[$0 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
n No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
O No
❑ NA
❑ NE
12/28/04

c.
Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: I -? - /Q - d Time: ; I D /►'i
Q Not Operational Q Below Threshold
»emitted �rtified © Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
FarmName; .......... .......... _ .....C7..................................................... ......... County: ...411-1
Owner Name:... L...r ....fRC..S............................. ......... ........... -........ Phone No: --- _;S
Mailing Address:.. d !Qri:s.... L. -Y -3-g ----1-
Facility Contact: .....Ran.a/ ......_,l3. . e { ! ...._._Title:.. ..... Phone No:
Onsite Representative:..c��.__ .Ct.r ezt........................................ Integrator:
Certified Operator: .......... — ,r.74 ..... ` n�------ -----Operator Certification Number:
Location of Farm:
[18 vine ❑ Poultry ❑ Cattle ❑ Norse Latitude • ° 66 Longitude • 4 «
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes EJ -90
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes allo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ©filo
c. If discharge is observed, what is the estimated flow in gallmin?
d_ Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes Digo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes Eg-No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes QNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes EINo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: J... .......
Freeboard (inches):
12112103 Continued

Facility Number: g.Z — q P7
Date of Inspection IO' `(
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑,No
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or ❑ Yes R Vo
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes O No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ONo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes E9,Ko
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [9 -No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes 9-14o
❑ Excessive Ponding ❑ /PIAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type Cori /1a / . SMcc// a rcr,'h
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes PNo
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
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 alar 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 044o
❑ Yes 0 -No
❑ Yes MNo
❑ Yes U -No
❑ Yes El-fio
❑ Yes [9 -go
❑ Yes [ANO
❑ Yes D No
❑ Yes G14o
�Comment�s (refer Lagr��n �)Explarn zany YFS answer and/or anyxfrecwmmendaiions oraapother ca .�mmeflts ��- W,��LL �-�-� y
Use diwmgs�ty to betker�explaur silnahons (ase addac�anal pages as necessai7') Meld COPY Ftnal Notes
�c,si_
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Reviower/Inspector Name fYf p A ; .
- GY/^!7 1..7/�Q'!?�u_ ...r„ �'.. — .. '.�xmF,. J ms.k
Reviewer/Inspector Signature: Date: 3 - a- v
12112103 Continued

Facility Number: S.;7 Date of Inspection
Required Records & Document~
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?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. 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 Farm ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes ELble—
❑ Yes M.Ko
[I Yes E],Ne-
❑ Yes Q4d_
❑ Yes MW -6
❑ Yes MXo
❑ Yes D3,14o
❑ Yes M-wo
❑ Yes O�No
0-1'es ❑ No
❑ Yes M -Ko
❑ Yes M -Wo
O -Yes ❑ No
fifes ❑ No
❑ Yes ❑-4,0,
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
W
dd:ttoinal. Comments and/or Drawmrigs -- W" = ""
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1212103