310191_INSPECTIONS_20171231

NUH I H CAROLIN
Department of Environmental Qual

Type of Visit: (a Pompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Gl outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: �Arrivvaal Time: coo Departure Time: ' Dd /0 County: y�Y� Region:�r�
Farm Name: ,�Q yw1 r(y-tiWu Owner Email:
Owner Name: Tbai'445 Stu-4( Phone: RErrfryED
Mailing Address:
Physical Address:
r
Facility Contact: v5�414_ t+t-rTi'^ Title:
Onsite Representative:
Certified Operator: 10 a bil _Lt �N
Back-up Operator:
Operator:
Location of Farm:
Latitude:
/Dwq
201?
Integrator: "Ice
Certification Number: I e f t{ 7
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
I
Wet Poultry
11-ayer
Design
Capacity
I
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
(q D A d
Dr, 1110ultr. •
Layers
Design
Ca ac_ity
jrent
P.o ,
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
L Beef Brood Cow
Other
Other
Turkeys
TurkeyPouets
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ErNo ❑ NA ❑ NE
[-]Yes [:]No D-NA ❑ NE
❑ Yes ❑ No [DNA ❑ NE
❑ Yes
❑ No
❑ Yes
ETNo
[—]Yes
[fNo
❑'NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

[Facility umber: 3 - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
FdNo NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[G]# D NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 33 13-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑L'No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
0-11-0
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑-No
❑ NA
❑ NE
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
[j'FIo
❑ 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 ONo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of
Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): lgWay w,l( c� J & V 7A ` V _rXy
13. Soil Type(s): �620 C Q %
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes P 3-No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes L21No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [a -No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
DlNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[g'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑'Flo
❑ 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
ElNo
❑ 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
[a No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[6No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facility umber: Cr, I Date of Inspection: /
24. t7id the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes MNoo ❑ NA ❑ NE
25 Is the facility out of compliance with permit conditions related to sludge? If yes, check B ' es 3-90 ❑ NA ❑ NE
the appropriate box(es) below.
❑ Tlure 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 ❑-<o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ©-Mo ❑ 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
[2 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
[]'90
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[3 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Q o
❑ NA
❑ NE
to question #): Explain any
FI-5- Ts
Reviewer/Inspector Name:
Reviewer/Inspector Signatw
Page 3 of 3
Phone:�io- L(3)- 333j�
Date: It J " I /
21412015

[vision of Water Quality -: y
Facfltt� Numb¢r �, _� O Division of Soil and`Water Conservation '"„
O Other Agency
Type of Visit .O'tompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ICJ Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: ,212p & I Arrival Time:
Farm Name:
Owner Name'
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: _
Back-up Operator:
Location of Farm:
Title:
Time: County:
Owner Email:
Phone:
Integrator:
Phone No:
Region:_
Operator Certification Number:
Back-up Certification Number:
Latitude: =c =' = Longitude: =o =,
T
Design
.Current ,--.- -
';Design- Current ' is D`esigrt
@urrent
Swme Capacity
Population - = Wet Poultry
Capacity -'Population,'-Cattle__ Capact ty..P,opulatihn_
❑
Wean to Finish
�. ❑ La er
I
I
Dairy Cow
❑
Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
❑Farrow to Wean
_
.y Dry Poultry
"'s' ' '. ❑ Dairy Heifer
.:c ❑ D Cow
"'❑
Farrow to Feeder
❑ Farrow to Finish
_'
El Layers
'� ❑Non-Dai
❑Beef Stocker
El Gilts
❑ Boars
�+' ElNon-Layers
1,13 Pullets
❑ Beef Feeder
❑ Beef Brood Co
❑ Turkeys
r r
Other w ❑ Turkey Poults.
_.
❑ Other ❑ Other
"...... r tructures
�
t
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 J No ❑ NA ❑ NE
❑ Yes
PNo
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
ErNo
❑ Yes
❑ NA
❑ NE
❑ Yes
JL?"&o
J/ No
❑ NA
❑ NE
Page I of 3 w 12128104 Continued

Facility Number: - ( Date of Inspection: U
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [3"No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes j� No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 7'- Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 0� L3 2,
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes [Z 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 JZ 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 ZNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes JZNo
❑ 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
❑ NA
❑ NE
maintenance or improvement?
'L�KNo
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes Z 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 Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
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 0 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 J�allo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
i
❑ Yes DNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes [ZNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes �No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ff No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes F34 ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: jDate of Inspection: �O
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �_e(No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 12 No
the appropriate box(es) below.
❑ NA ❑ NE
❑ NA ❑ NE
❑ 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 [PIo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes allo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ja 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 concem? ❑ Yes Zf 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 12 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 P 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 FZ'No ❑ NA ❑ NE
Comments, (refer to question q): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawingi of facility to better explain situations (use additional pages as necessary).
` Jo/� �57� CGI�.��-icp/ /✓Lc 1`' ��sa�T3 �GC� /'fAf— �0�7.� L"��!
L/ %} e_ /
Inc l 9° t `L, Ze, C-0 S G �-r Jo o d o mace"',
L
af., `
0. r 3
0.���°
Reviewer/Inspector Name: 19 La� X Phone: /Whg;
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412015

Type of Visit: �dmpliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit�t,_14(outine 0 Complaint 0 Follow-up Q Referral Q Emergency Q Other Q Denied AccessT
Date of Visit: }� / 1 J / d �frrival Time: Departure Time: County. )t , 0A t j, Region:
,Farm Name: O�Vy�G�C S M� Owner Email:—`
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator: on=!
Certification Number:
Certification Number:
Longitude: 1
Design Current
Swine Capacity P.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D .+P,oul ,+
La ers
Design
Cs aci
Curreut
P.o ,
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
O[her
Other
Turkeys
TurkeyPoults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
L�TNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
JED'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
_[ZNo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
f'No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes [3'No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facility Number: jDate of Inspection:
-'
-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes E] No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):'Z _ 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes P1No
❑ 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 j2fNo
❑ 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 0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ZNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes ZNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes WfNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes r1'No
❑ NA
❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc..))^"
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes L No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes 4�:fNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes .ffNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes �No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 2fNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes J2!]—No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes L i o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes /�No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes E�fNo
[—]Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 'C__I No
25. Is the. facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes f No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes jEfNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ZNo
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 CAW IT?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes K2 No ❑ NA ❑ NE
❑ Yes 10 No ❑ NA ❑ NE
❑ Yes 2f�No ❑ NA ❑ NE
[:]Yes PNo ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations. or any other comments.
Use drawings of facility to better explain situations (use additional -pages as necessary). 0
-4Ic.I(i-
CGv��(x <! S�' SG�. c.�1-QQO'. tC✓�T (0 1 ,
C� z
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: YL
Date: (/,

Reason for Visit: QJRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: .L Arrival Time: S: M Departure Time: 7:0� County: � Region: V RD
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: 7. �v.:•�,
Back-up Operator:
Location of Farm:
Title:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity P.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity .Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
DairyHeifer
Feeder to Finish
6(�Q
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
,
Layers
Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
I
Pullets
I
jBeef Brood Cow
t?ther
01 Other
I
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
O-No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[—]Yes
PrNo
❑ NA
❑ NE
❑ Yes
�TNo
❑ NA
❑ NE
Page I of 21412011 Continued

Facility Number: - q Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:] No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Identifier: L I -[5a LA -Tsj %3 TSt� 1-1-r
Structure 5 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
P�rNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
FT No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E!fNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
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 Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
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
PTNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
VrNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
(7TNo
❑ 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 0 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes V5 No
❑ Yes VNo
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facifl Number: Icil Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
_ Z No [_]NA [:]NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
ONo ❑ 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
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
AON0
0No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
6 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
V I No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
11""
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
VI No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
E6No ❑ 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 VNo ❑ NA ❑ NE
Reviewer/Inspector Name: —7s14Si'rh 06'V7 Phone: 95a-36h2a51)
Reviewer/Inspector Signature: \ 1AA/�;" Date: $' t '
Page 3 of 3 v 21412014

�0.
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: eRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: c Arrival Time: Departure Time: County: U —i-hn Region: �lRn
Farm Name:_ sry " J � &1yyll' Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
OnsiteRepresentative:
Certified Operator: NYMO.
t.(A
f-01n/1a�+f'
Integrator:
Certification Number:.
J; i/Yq�'r \
y�Q aa13
MI L - 1
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design C•urcent
Wet Poultry Capacity P.
ILayer IDa
Design Current
Cattle Capacity Pop.
Cow
Wean to Feeder
Non -La er IDai
Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D , P,oult , C_a aci Pao ,
Layers
Dairy Heifer
Dry Cow
on -Dairy
Beef Stocker
_
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
L I Beef Brood Cow
Other.
Other
Turkeys
TurkeyPoults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
6No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
e No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
ONo
❑ 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
ENo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑Yes
KJ "
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑Yes
V
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 21412011 Continued

' '4
Facili Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
El"No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier: L �� —TS 13
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ri_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E] 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
dNo
❑ 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
eNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E
fNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[6No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ff No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
allo
❑ NA
❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[(j No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ENo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E?fNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
f6No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EfNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
121—INo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
eNo
❑ 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 ErNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ]rNNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ETNo ❑ NA ❑ NE
Pagel of 21412011 Continued

Facility Number: -P I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or 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
❑ Yes
eNo
❑ NA
❑ NE
�TNo
❑ NA
❑ NE
No
❑ NA
❑ NE
No
❑ NA
❑ NE
❑ Yes dNo ❑ NA ❑ NE
[—]Yes C No ❑ NA ❑ NE
❑ Yes f�No ❑ NA ❑ NE
❑ Yes fNo ❑ NA ❑ NE
❑ Yes
f] No
❑ NA
❑ NE
❑ Yes
6 No
❑ NA
❑ NE
[—]Yes
Ca No
❑ NA
❑ NE
Comments (refer to question t/): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
com� alrow� ��,
Reviewer/Inspector Name: __��*Y_11 Lam'
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

Reason for Visit: U Routine U Complaint U Follow-up U Referral U Emergency U Other U Denied Access
Date of Visit: G ys Arrival Time: 0 0 Departure Time: County: � Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: I O W
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Da Cow
Wean to Feeder
Non -La er
Da Calf
Feeder to Finish
(o(o m
(.o�o W
Da Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr P,oult .
a ers
Design
Ca aci_
Current
P,o P.
D Cow
Non -Dairy
Beef Stocker
Gilts
Beef Feeder
Boars
RNon-Layers
ulletsurke
sOther urke PoultsOther ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes goo ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ LJ Yes No ❑ NA ❑ NE
Page I of 21412011 Continued

Facili Number: 1 -rj ( Date of Ins ection: -Li
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA(,axJ I LACsa wZ- CA&-tcVJ3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): $ o 36 2--1-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[Z(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
dNo
❑ 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
V�No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
6 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 E2No ❑ 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 [ jNNo ❑ 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 Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o
❑ 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
�
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[No
❑ NA
❑ NE
Required Records & Documents
ENo
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
s
❑ 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 bo .
L24UP ❑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 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Pagel of 2/4/1011 Continued

Facility Number: `j Date of Inspection:
24. Did tbp facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Q No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes [/ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes bIo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes dNo ❑ 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
pemdt? (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 I 'I No ❑ NA ❑ NE
❑ Yes D No ❑ NA ❑ NE
❑ Yes E3 No
❑ Yes [�f'No
❑ Yes [2fNo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
4.o.) GEl" SL'GAIE-19 co?" d C NE1J WLIC Ta w=26.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
I;k& ( L,
Phone: ( 3
Date: 2/
214/ 01

Reason for Visit:
Date of Visit:
Farm Name:
-
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Inspection U Operation Review O Structure
O Complaint O Follow-up O Referral O
O Denied Access
Arrival Time:® Departure Time: ®County: 1/ Lyj Region:
Title:
Owner Email:
Phone:
Onsite Representative: ?iTr zC'y_ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Wet Poultry
La er
Design
Capacity
I
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
Farrow to Wean
0
33ca
D ,ry $oulh.
Layers
Design
Ca ace_
Current
P,o ,
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
01 Other
Turkeys
Turkey Pouets
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—)Yes O/No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 21412011 Continued

Facility Number: Date o(Ins ection: Q //
Waste Collection & Treatment
4. Is.storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes e�No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Identifier:
Spillway?:
Designed Freeboard (in):
Structure 1 Structure 2 Structure 3 Structure 4
Ln6v6N I (.p6ffar1L e,rot-)3
Observed Freeboard (in): 3(, 37
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., 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?
❑ NA ❑ NE
❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes E/ No ❑ NA ❑ NE
❑ Yes [�Io ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
0Yes ❑ 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 EJ'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes rjNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes El -No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure
to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
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.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes W' o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a min gauge? ❑ Yes 2 <0/ ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ®'1 o ❑ NA ❑ NE
❑ Yes :�No ❑ NA ❑ NE
Yes No ❑ NA ❑ NE
❑ Yes �lo ❑ NA ❑ NE
❑ Yes do ❑ NA ❑ NE
❑ Yes FaIo ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑Yes
❑wo
❑NA
❑NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection: [ D A, N
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. 1S the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Ej/N o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [—]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ,fNo ❑ 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 Callo ❑ NA ❑ NE
❑ Yes Io ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes Ej No ❑ NA ❑ NE
❑ Yes eNNo ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
[—]Yes ['No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments '
Use drawings of facilitvto better explain situations (use additional pages as necessarv). -'
%) Meeo CT LA CmtJ 2 [�.vL-c, GAV6-6 .
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 7 1--
Date: Q 31 /
214 011

Drvtston if Water Quality
Facility-NumbeC. 3 f 14 O Dtv�ston otSod and. Water Conservation .�, -'*
Q Other Agency a
.r�
Type of Visit X Compliance Inspection Q 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: / / Arrival Time: ® Departure Time: County: I ISAP?" / Region:
Farm Name: SM I TN IFA Z (Yl s Owner Email:
Owner Name: HCAYIAS S(nITH (j \/Phoone: /Q59-S/�&S-t-�LIT38
Mailing Address: QJ(4rAPQ FARM PINK`AIC.C. /YC 9RS-qOt 71
Physical Address:
Facility Contact: Title:
(�
Onsite Representative: Y A 1 Q-)CIC Y— / U.SSELx—
Certified Operator: �NNl4' ] • . M 17-F}
Back-up Operator:
Location of Farm:
Phone No:
integrator:CQMO
peratorr Certification Number: ' 8 y /Q
Back-up Certification Number:
Latitude: I to l l' l l" Longitude: I Io
kW,. o m
Design , 'Current Desgt, 3" Current
Swine `Capacity Population EWet Pool[ryCa act Population Cattle
P, tYd�per.
..
�Desirgnurrent
oI" "on
❑ Wean to Finish
❑ La er
`- ❑ Dairy Cow
'
❑ Wean to Feeder
I
ILI Non -Layer I
I
❑ Dairy Calf
r"
'Other
Feeder to Finish
- """'�,,`"', t . ;=�4....
" �, „ . ,„,- r'*'
Dry Poultry k,„ri , , �.
'" �9""'
❑ Dairy Heifer
❑ Dry Cow
❑Non-Dai ry
Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
`, ❑ La ers
' ❑Beef Stocker
El Gilts
m ❑Non -Layers
❑ Beef Feeder
❑ Pullets
❑Boars
❑ Beef Brood Co
-
' ❑ Turkeys
_ ❑ Turkey Poults
---
_ .. -
-
Number„of Struduresi
❑Other
❑ 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?
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 XNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
b�No
❑ NA
❑ NE
❑ Yes
O[No
❑ NA
❑ NE
12128104 Continued

Facility Number: — J
Date of Inspection Gr Tn
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 19%t6l ..trruuccture 2 Structure 3 Structure 4
Identifier: 715 I A �, J J I T-S
Spillway?: 11 7
Designed Freeboard (in):I��
Observed Freeboard (in): (FT
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
❑ Yes LYI No
El Yes J❑I No
Structure 5
❑ NA ❑ NE
El NA ❑NE
Structure 6
❑ Yes $� No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) wl'FC--ITT E Y ESLtAG LP)
T0(34c c0 (R(AF G "b
13.
^ f
Soil type(s) 63"S TDA/ �inLM(60e0 / ag.F 4C
14.
Do the receiving crops differ from those designated in the CAWMP?
El Yes 30 No ElNA
ElNE
15.
Does the receiving crop and/or land application site need improvement?
[:3Yes �(No ElNA
ElNE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes No ElNA
ElNE
17.
Does the facility lack adequate acreage for land application?
ElYesNo ElNA
iqNo
ElNE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes ❑ NA
❑ NE
Comments (refer to question #):
Explain any YES answers and/or any recd`m`mendatio'us or any other comme s n x
Use, drawings of facility to better
explain situations. (use.addttiotialipages�ss•necessary
Reviewer/Inspec[or Name r..
(pj - D A 6a/ r- S , . 4, Phone: %/6
Reviewer/Inspector Signature:
Curl'WJ Date: WOO
Page 2 of 3 12128104 Continued

Facility $lumber: 3 1 — f91 I Date of inspection [ d
Required Records & Documents j,_/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes LYJ No El NA [I NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes ' \ No ❑ NA ❑ NE
the appropriate box. 0 WUP E Checklists Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
0 Waste Application ❑ Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑ Waste Transfers `❑ l�rnual Certification
El Rainfall ❑ Stocking ❑ Crop Yield B 120 Minute Inspections El Monthly and V Rain Inspections [I Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
'p� No
't
❑ NA
[I NE
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
Wo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
Yes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge? -
❑ Yes
'; �No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
XNo
❑ 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
t7{1 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
4 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
x
w- A ?S�
eQ/ko/ro a.b 1.9 2.v
&-vai 1.'a
il� ,�tcALSPEuaus; N4NDLtAI�
SLcxoC� Sc��U��FoC�- oq - N6�
Q.�cl�Q-D� j /o sc.¢.UE�W1t�t3COw/IE �U��
GFFU Pi6tATl On! DUG Jd
Page 3 of 3 12128104

Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit MRoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: � Arrival Time: ® Departure Time: County: hk:6.�N Region:
Farm Name: SMITE PAL(y"g Owner Email: q
Owner Name: HCK ,f iAS SM1TAl �7 Phone::
Mailing Address: MLI FARIA Z 2iNIC 11/� /YC .% SV-39SQ�
Physical Address:
Facility Contact:
Title:
Onsite Representative: Ao G b4 I C r— Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: n o n' n« Longitude: I I o I I a n
Design Current
Design Current
Design Current
Swine Capacity Population
Wet PoultnY Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er 1
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish (o taO
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
El Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Cowl
El Turkeys
Other
❑ Turkey Poults
❑ Other
❑Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
X No
❑ NA
❑ NE
❑ Yes
U§,No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: —
Date of Inspection Mpga
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structurle�3 Structure 4
Identifier: 1 5 1 7S QL
Spillway?:
Designed Freeboard (in): 9. S q. S 19. S
Observed Freeboard (in): n� ti 5 �(E)W-5 S4
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 ANo
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
❑ Yes JKNo ❑ NA ❑ NE
❑ Yes N 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 ,,,I--XL..No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,����1{{{{{{
9. Does any part of the waste management system other than the waste structures require ❑ YesNo ❑ NA El NE
maintenance or improvement? ,,,,,,
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA ❑ NE
maintenance/improvement? yyy{{{
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes „ ,,,may No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
F
13. Soil type(s) lYnUOLK GOr-DS6CV_Q C-01g-I✓STC-W
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
XNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
KNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
1�No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
[:1 NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
AN` o
❑ NA
❑ NE
;Cortiments (refer to q e s t i 6 i f #) E"spIam anYES auswe"�s and/or�anny recommeudattonsXo any oYheh corn ern ; [;
Use4drawmgs of facihty to better explain ati situons (use additional pages as necessary)
�9.
w. Ts ►
7
Ts3�
_
y
S 190 /o & 1, (9
�. (�
/. S
Reviewer/Inspector Name
AN
f a ES Phone:
Reviewer/Inspector Signature:
Date:
Pao, 2 of ?
12128104 Continued

Facility No Date of Inspection ( O
Reunited Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
ONo
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
XNo
❑ NA
❑ NE
the appropirate box. G WUP ❑ Checklists 0 Desi n g ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
XNo
❑ NA
❑ NE
0 Waste Application ❑ Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ /inual Certification
0 Rainfall ❑ Stocking ❑op Yield El120 Minute Inspections El Monthly and V
Rain Inspections El
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
9No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ONo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
D(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
XNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
XNo No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
[I NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
��4
t)p No
[I 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?
ElYes
4 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
El Yes
6No
❑ 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
------������
ttttttp, pNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Gc--r Co�)�o r 10Y O ►G CA LV) a `J(A-T w Gu ckiluJ - c left 91043
* () I CG Ate I U r
Iv y) a C1�7� TGL-S FP o k OF LAC UO�! J S
Page 3 of 3 12128104

�� Division of Water Quality
Facility Number � � � 9 � � Division of Soil and Water Conservation
0 Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit gRoutine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: � 9 Departure Time: County: G UUJV Region:
Farm Name:
Owner Email:
Owner Name: l 14000 19 S'F I�/V A Sm i TH Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
L
Onsite Representative: _Saf�iyNu NI e (L-
Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =o=,=„ Longitude: =o=, =„
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page l of 3
❑ Yes A No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes X No ❑ NA ❑ NE
❑ Yes b(No ❑ NA ❑ NE
12128104 Continued

Ficility umber: — f
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 �Sttructure 3 Structure 4
Identifier: 1ru>) Td S S s
Spillway?:
Designed Freeboard (in): 1 _I .S 19.5 5
Observed Freeboard (in): /on t 13 L/ & n- -
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 X No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes NNo ❑ NA ❑ NE
❑ Yes ONO ❑ 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 N No ❑ NA ❑ NE
8.
Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
j4No
❑ 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
X No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.
Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ONO
❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
�kNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ 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 CA WMP?
❑ Yes
.0"y No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement?
lO 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
RNo
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
U No
❑ NA ❑ NE
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
g15. FIGubS I46B%To 6E `nowEb
I(�ETC oQ�o F Coc-°+�p�2i"��T �-��► w/ REcoG�-�S
o1C tdarcAf�l� 1-P�i ICJ/�E�oRf�S
Reviewer/inspectorName C Z(/[S Phone: 9/o'
Reviewer/inspector Signature: Date:
Continued

Facility Number: 3 1 —)9 / Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Jk Yes [-]No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes IyNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ftNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall El Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? []Yes %No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[I NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
BNo
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
ro
[INA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
( No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
ElNA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Yes
Elr
�t
\ No
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit JZ Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 10 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: ID/�/OBI Arrival Time: Departure Time: County:
Farm Name: /h�- -.//- n/.4Q/YI �i Owner Email:
Owner Name: 1,/ 1c,4945 & l/On�/�A- �m y�iY Phone: _
Mailing Address:
Physical Address:
Region: / .PQ
Facility Contact: Title: Phone No:
Onsi[e Representative: "R Integrator:
Certified Operator: —,I; Operator Certification Number: 1 g1
Back-up Operator: Back-up Certification Number:
Location of Farm: _. Latitude: [ ---- IV
L-1, [� Longitude: =c =
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes )ZfNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse, impacts to the Waters of the State
other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes ONo
❑ NA
❑ NE
❑ Yes gNo
❑ NA
❑ NE
12128104 Continued

1
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): 15
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
❑ Ye ❑ No
Structure 5
❑NA El NE
❑NA ONE
Structure 6
❑ Yes yNo ❑ NA ❑ NE
❑ Yes,���JfffNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or envir1p,
..///o___,,,nmental threat, notify DWQ
1(
7. Do any of the structures need maintenance or improvement? J Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ElNA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ZO
IV
9. Does any part of the waste management system other than the waste structures require ❑ Yes (/J No ❑ NA El NE
maintenance or improvement? l
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement? /
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
/o//l /3/7 9 /�
12. Crop type(s) ��Q /t//1� Z 1 J.6 l �!//5�'Sf_fO1 /`F5CC/f AA4;1��
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes IJLI(((No
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ICJ No
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes XNo
17. Does the facility lack adequate acreage for land application? ❑ Yes o
18. Is there a lack of properly operating waste application equipment? ❑ Yes t
❑NA ❑NE
❑NA ONE
❑ NA ❑ NE
❑NA ONE
❑ 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):
15 `jo2�/h; �Posz� 2 D9 Lzm!_ NftOFo j .7n/ 4
:
Reviewer/Inspector Name Phoneda
Reviewer/Inspector Signature: Date: /j O
12128104 Continued

Facility Number: — q Date of Inspection
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
.10No
❑ Yes XNo
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps
p El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
El Waste Application El Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste
Transf rs ❑ 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 IQ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes�No
❑ NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes 2No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes rrrrJXXXNo
❑ NA
[I NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes ly,�pNo
El NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes /lYJ No
/
El NA
El NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
ElYes X No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes No
ElNA
[INE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
��� ///
El Yes LQ No
[I NA
El NE
If yes, contact a regional Air Quality representative immediately ..
I,_,(
31.
Did the facility fail to notify the regional office of emergency situations as required by
Yes J[I No
[INA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
//
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes /jNo
ElNA
ElNE
Does facility require a follow-up visit by same agency?
❑ Yes LNo
❑ NA
❑ NE
rr33.
lAdditional Comments and/or Drawings: .
"66 __5-
7�5
12128104

Facility Number: — q Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes oNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes XNo ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists Design ❑ Maps
❑ Desi p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No El NA [I NE
❑ Waste Application El Weekly Freeboard [I Waste Analysis ❑ Soil Analysis ❑ Waste Trai rs/ ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections El Weather Code ,
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes IQ No El NA ❑ NE
23. If selected, did the facility fail to install and maintain minbreakers on irrigation equipment? ❑ Yes / No ElNA [INE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes VNo ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes /yJyNo ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? El Yes !t/� No ElNA [INE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes XNo ❑ NA ❑ NE
Other Issues
f
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
ElYes J[� No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes No
El NA 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?
���,ll
❑ Yes L,d No
El NA
El 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 JCJ 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 Xj No
ElNA
ElNE
33.
Does facility require a follow-up visit by same agency?
❑ Yes LNo
❑ NA
❑ NE
—1
Additional Comments and/or Drawings:
I2128104

gDivision of Water Quality
Facility. Number 3 / l / 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit (Compliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
s f �j
Date of Visit: D Arrival Time: ;15, Departure Time: r C unty: Ltd Region:
Farm Name: n'1 �T<7� �//i�S Owner Email:
Owner Name: /lf0e7111-.S !j? Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Al Z�e=/P Integrator: yApz �4C1)_U
Certified Operator: ���" mLT Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
S,wore
Other
In Other
Latitude: F__jo M' F__].. Longitude:
Design. Current. Design Current
rapacity .Population -> Wet Poultry ..Capacity Population Cattle ,
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
o=. =..
Number of Structures: ; Fi
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes PNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
12128104 Condnued

w, •, 16
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ZNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes [--]No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: TS2 _ s.13
Spillway?: � �4k_ _Al ,
Designed Freeboard (in): �� r�q r /9S
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes XNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes WNo ❑ 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 XNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes ;ZNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes tZ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes PNo ❑ 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 Ibs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window/J ❑ Evidence of
Wind Drift ❑ Application Outside of Area
12. Crop type(s) C A66ri,�VtC fDt/f/LSE¢p, . i 5�'C/� l VKgL£ / �r "
13. Soil type(s) NO ( 'fo %_0
t4.
Do the receiving crops differ from those designated in the CA WMP?
❑ Yes
F fVo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
';2'No
P14No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
�_ 2/No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/InspectorName IPhone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 — 12128104 Condnued

Facility Number: —/ Date of Inspection 7 O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JXNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes /No ElNA [:1 NE
the appropriate box. ElWUP ElChecklists ElDesign ❑ Maps ElOther
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ]KNo ❑ 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 min gauge?
❑ Yes ONo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
JLZrNo
❑ Yes XNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes XNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes ZNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes 9No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes ❑'No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes XNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes XNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
!!l���yyy
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes {q No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes ONo
❑ NA
❑ NE
Additional Comments and/or Drawings:
25 T �P. ��Kf� �.9�GG%� OL✓L�C/ (�/O1�r' �L SGclDC..f S�cZ c��
.
Page 3 of 3 12128104

Type of Visit QJ Compliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance I
Reason for Visit /Routine O Complaint O Follow up O Referral O Emergency O Other [I Denied Access
Date of Visit: Arrival Time: :�� .,, tDeparture Time: �iSf� unty:
Farm Name: �/Y1272f //gQl/ V Owner Email:
Owner Name: /01-065 Dr fdk Phone: _
Mailing Address:
Physical Address:
Facility Contact: Title:
l
Onsite Representative:
Certified Operator: ,419,4, 14—
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o = , Longitude: = o = , = "
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes RfNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes X No ❑ NA ❑ NE
❑ Yes /No ❑ NA ❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
/PlNo
❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier. Ts2 _7
� /3
Spillway?: D O Ale) /v0
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No ❑ NA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
���///
El Yes tq No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes /� No ElNA El 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 P No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ElNA ElNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [;tNo ❑ NA ❑ NE
❑ Excessive Pointing ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs
❑ Outside of Acceptable Crop Windo
12. Crop type(s)
13. Soil type(s)
❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
w ❑ Evidence of Wind Drift ❑ Application Outside of Area /0�
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination i ❑ Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
YNo
No
No
An
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
�gc 2S)TS�wo4� Zs N,) z�u� �o.e G Za.�s TS/a (/s ',We) /��.0
%SZ. JSI9 �BEGF_O AS L�44iJ0IS>�Ti1�� 0,_- �lOC.�SViPt/�y
T5z448&ceo 45 7-3 pN �u��� Sys✓f�
— �LabOCe Aenov 9r_ /✓FEDED
Reviewer/Inspector Name I /
Reviewer/Inspector Signature:
Date:
Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �oNo ❑ NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes l�l No ❑ NA ❑ NE
ElEl[I❑ s
the appropirate box. WUP Checklists Design Map
s ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes /No ElNA ElNE
ElWaste Application ElWeekly Freeboard ❑ Waste Analysis ElSoil Analysis ❑ Waste Transfers Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes XNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 'V 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
VNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
NE
Other Issues
'0Z
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
I/J 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
I/J No
❑ NA
❑ NE
32.
General Permit? (ie/ discharge, freeboard problems, over application)
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
LNo
❑ NA
❑ NE
Addition it Comments and/or Drawi ngs:
��ft1 � n1� o /L�u�»� �ji✓O /T�-�G. �2t-C. / �,�p T ��fl r/E /7
A/j4.,910 A)R"-%%�/v /oILSGL/OC�.
1212&04

(Type of Visit 9tompliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number I I� Date of Visit: 27 6 Time: I O
Q Not Operational Q Below Threshold
Permitted fi Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ............
Farm Name: JO.U_ l._.'"S._. County: .... .... .��2�:t1......... .................... _ ..... _._
Owner Name:
Mailing Address:
Phone No:
FacilityContact: ............. _................................... _._._...._._... Title:.._......_.._..__..__._ _._.._.__._..._._. Phone No: _._.__._ _.-.----..---.•--
OnsiteRepresentative: .... .fhnnti1i J.M4..._._........... ..... _.............................. Integrator: _............ __Crr6 +j
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =' =11 Longitude =• =' ="
Destgn Current 'd Design + ;Current - Design Currt nt
Swine Ca as .Poulation _ 0k3 _Ca' act : Po elation ;CaWe4___ Ca"acit , -Po elation-
❑ Wean to Feeder ❑ Layer ;; ❑ Dairy
21
Feeder to Finish 6(0 0 SU60 ❑Non -Layer =i_ ❑ Non -Dairy
A,
z
'- Farrow to Wean - - - =--
r
Farrow to Feeder .; ❑Other
Farrow to Finish Y
Total Destg Ca p actIt i
Gilts
1 S
Boars Total SSLW,
,, ��NnmherofLagoons '�r -
f y Y
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Q No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes DNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [Z) No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes [3No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ....... !=L......._.....................:.'L............. _......... T..... _............ ... ........ I7............. _...... ........................ ..... .............................. _...
Freeboard (inches): 27 3(o 31 LI3
12112103 Continued

Facility Number: 31 — Q Date of Inspection 2 0�
5?,Are there any immediate threats to the integrity of any of the structures observed? (id trees, seven: erosion,
❑ Yes
B No
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
❑ No
closure plan?
(D' any of questions 46 was answered yes, and the situation poses an
7.
immediate public health or environmental threat, notify DWQ)
Do any of the structures need maintenancelimprovement?
❑ Yes
�/
No
8.
Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
—d
14
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
[:rNo
elevation markings?
Waste Application
10.
Are there any buffers that need maintenan�mprovement?
❑ Yes
� /
� NN/�o
11.
Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
[j "No
❑ Excessive Pondinng❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12.
Crop type (2ra DP (G) F(ScuF (a) SGJ ("SW
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
b) Does the facility need a wettable acre determination?
❑ Yes
��rNo
1
c) This facility is pended for a wettable acre determination?
❑ Yes
/No
NNo
15.
Does the receiving crop need improvement?
❑ Yes
�O
DIN
16.
Is there a lack of adequate waste application equipment?
❑ Yes
No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
❑ Yes [a No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
[]Yes
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑Yes Q No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes C No
Air Quality representative immediately.
Commepts (refer [o answers reco�a6om ory othLer commetsqution#n anyE
Use drawings of facdtty to better explain srtaations (ase'addthonal pages as necessary) ❑ Fteld COPY ❑ Final Notes
vnl-
NEED To 6,6T uPNTEp WuP tNct uoTuG tFIE StmttYlE2 ANIJ<Jt9t 5. Sort W tJA E9,
35.) S�sPfcf�n,� AFTER, k"eAr.0 kbECS F- (U DONE.
UPDRTE CwP Y%FLD F0a4VVs, '
SI�oGe SutzJE'( 0)0tX 013TAZlj Copy Win. 9CcnfLO15.
UtCr�rJ 'FNomAS HE&11 SLueGE fo(t_. 1ZuYw Al.
Reviewer/InspecforName s.-_­AWn?
Reviewer/Inspector Signature: Date: 6
12112103 Continued

Facility Number: 3 - q I Date of Inspection JqWlaq
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes 01,410
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WIT, checklists, design, maps, etc.) 2Yes ❑ No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes p No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes &No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
28. Does facility require a follow-up visit by same agency? ❑ Yes
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
-O- 'N/o
❑
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
p No
34.
Did the facility fail to calibrate waste application equipment?
❑Yes
No
35.
Does—//
s record keeping for NPDES required forms need improv ent? If yes, check the appropriate box below.
QYes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
dditronal Comments apd/or Drawings
12/l2103

Type of Visit P Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit fo Routine o Complaint O Follow up O Emergency Notification
Facility Number Date of Visit:
Permitted [3 Certified 0 Conditionna Certified Q Registered
Farm Name:
Owner Name:/n,(�-� '/,dL/V ii' . .Zj I�
Mailing Address:
O Other ❑ Denied Access
Time:
Date Last Operate r Above Threshold: _
County: G/PC�nI
Phone No:
Facility Contact: Title: Phone No:
Onsite Representative: 5_ /)74:J /��T/� integrator:
Certified Operator:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =* =' =� Longitude =* =' =u
Design Current
Design Current Design Current
Swine Ca achy P.o ulation
Rpult4Y. Ca aci P,o ulation Cattle Ca aci Eo Motion
❑ Wean to Feeder
.- ❑ La er ❑ Da'
eeder to Finish-
❑Non -La er
❑Non -Doi
Farrow to Wean
❑ Other
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Total Design Capacity
❑ Boars
Total SSLW
N
110 Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding Ponds / Solid Traps
❑ No Liquid Waste Mana ement System
Discharges & Stream Imuacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 1 r1-- Z 17 191
7 L Freeboard (inches): 3 9 �115
05103101
❑ Yes 0 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ONo
❑ Yes Id No
❑ Yes XNo
Structure 6
Continued

1
Facility Number: — Date of Inspection
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
VJ No
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
(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?
XYes
No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
El Yes
rrr❑���ttt
No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
ZNo
Waste Aonlication
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
4o
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydmu 'c Overload
❑ Yes
No
12.
Crop type
//•/
13.
Do the receiving crops differ with those/designated in the Certified Animal Waste Managem t Plan (CAWM ?
t3,y,s
No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
/No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
XNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
)ZNo
Renuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
El Yes
,�(�
yJ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
�ZrfNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
El Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
El Yes
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
�No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑YesXND
t
0 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit
Comments (efer to question Explain any YES answerssnd/'or any recommeodahooslor'any ottier commas"ents. i * ' r'
F ct sK'.f'wa .... w t X . ..
;,Use drawings :offacrhtyyfo better�eaplatn situations (use additional pages as necessary) F-� Field Copy El Final Notes
1479,9. W00,0y �aa20� o�nhJ yACaof�S L?
�/
FzXCO CRACK-60 owRzfj� PEE MOM r/9G-ADef5�`�� 14r
_
Reviewer/Inspector Name 7777
Reviewer/Inspector Signature: df Date: 4FI-1060
05103101 v Continued

Facility Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the Flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes 10 No
❑ Yes //Af�'I0
❑ Yes I[I No
❑ Yes /21 No
❑ Yes I
❑ Yes I
❑ Yes ❑ No
Auumonar "mmems anmor.urawtngs:, ,a. , . i �F -,: "
SLup pr4gp5 it> g� �uZG�zn)G P N
GDo>v 7—/,
�/�EC'rF_0 L� �G� Gi4Goan►5 �lJ /�,Ernav� ��
P3)- o
`jtPRE % 416,�5
_F0ln
allot
Flo>E; �✓�� 7 /�f�Z,�G-�1 LS E /7�'��fl-RS
/JF2
O5103101
,8E 5,U
`jtPRE % 416,�5
_F0ln
allot
Flo>E; �✓�� 7 /�f�Z,�G-�1 LS E /7�'��fl-RS
/JF2
O5103101
,8E 5,U

y

Type of Visit,,0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number / Date of Visit: Time: / 0,30 Printed on: 7/21/2000
t7 Not Operational 0 Below Threshold
Permitted [3 Certified ❑ Conditionally Certified ❑ Registered Date Last Operated or Above Threshold: ..
Farm Name: ... Tit— j? A C.0 1...4. ' .._. � L, Fm- - ^, S Countv:._D V .. / ; �..._..........................
................... ......................................... ..........
Owner Name: ,%l.or-� I.
P ............................ .N_'.�............................. Phone No:................................................. ----------
Facility Contact:
Mailing Address:
Title:
Phone No:
Onsite Representative:.._�.......Q.?^ a.s...........S
................................. Integrator:..._V ........... .....I....a....r.....✓...`.v....J........................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
Swine ❑ Poultry ❑ Cattle []Horse Latitude O.010.1 Longitude =• 0` =.,
vtscnaraes at otream impacts -
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure ' StructureT3 7Sttructure 4 Structure 5
Identifier: .................fit............... .................1. ��-- ,../
I� ............................. ...................................................
Freeboard (inches): 2 / 31 Z S Z�0
5100
[]Yes 0"No
❑ Yes No
❑ Yes No
V[ ZA
❑ Yes ONo
❑ Yes dNo
❑ Yes Ej"No
❑ Yes-,ffNo
Structure 6
Continued on back

Facility Number. 0 % — 1_2M Date of Inspection Printed on: 7/21/2000 1
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes Vl No
seepage, etc.) ///---
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes j2rNo
(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 10"No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? []Yes VNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes XJ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes )�J`No
1 I. Is there evidence of over application? ❑ Excessive Ponding /❑ PAN ❑ Hydraulic Overload ' ❑ Yes ONo
12. Crop type F—csG oe. 'PC4v(2 ro��t in�u�! G✓a n �er�%jU�ti Pc��U�C w�JPnl
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes )�fNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
b) Does the facility need a wettable acre determination?
/ZNo
❑ Yes
c) This facility is pended for a wettable acre determination?
/grNo
❑ Yes E�'No
15. Does the receiving crop need improvement?
Yes ❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yesjj'No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes Y] No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
i
(ie/ WUP, checklists, design, maps, etc.)
[]Yes No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes )zNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes �No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes �No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes,/dNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ;�, No
24. Does facility require a follow-up visit by same agency? ❑ Yes XNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes12 No
El. afititis:oi tlefciencie$ were itoteed during this:visit; You wit. -receive Rio further
• : • coriesuoiideiice: abotif this visit: .
Comments (refer to question"#)i _Explain any YES answers and/or any 'recommendations or any other comments
Use drawings of facility to better explain situations. —(use additional`pag+es as necessary)_._-
im�neOl�a�eltf..rwtul� �ytr�,h
-1 LitN c4 oh rots,V r Gor ir; e,I A f %-t a S 6een d sw e,'n . l Am �, I �09e
o�i7%O1 ie,d -to steal l �f5, . ✓lee�(1 44' be,deQ ✓nfed �rnM }I,,� h
otl�owghce 14C L0'ep �
rtj jt .e_ svt-e-{-�,.it"1' g61--eAges o,, Te&Z'I •vta4c4 -iI'lose-tr�i^-y tr/'t tah
ofeS;S t, %6ee -V-A pAN aIle L hCPS �rP1vt ��
"4e FlAh eye
T
Used on — tf-Z's,
Reviewer/Inspector Name ,S fp T7 rt-j
Reviewer/Inspector Signature: 7(A_DfZ77 Date: Lt//V/Ul 5/00

Facility Number: 3= Date of Inspection O i
Oddr Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ iVo
roads, building structure, and/or public property) T
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes gNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
'Additional or: rawings: �-
Overa li ���� �tic,J I� aid recoeds a/-e well j4ef�

Routine
Facility Number 19 j I
review OOther
Date of Inspection
Time of Inspection
Wermitted [3 Certified [3 Conditionally
`�\Certified Q Registered
Farm Name: ........ ....\. f.�.rf.73.....:^\.3...`.\..................................................
Owner Name:
Facility Contact:
Title:
24 hr. (hh:mm)
lot Operational I Date Last Operated:
County: ........
...........
Phone No:
.........................................................
Phone No:
MailingAddress: ..................................................................................................................................................................................................... ............-..-..........
Onsite Representative:
�"^EC.✓,,,,,,,..._.___.__...-.-.__„-,_,,..,. Integrator.--,---�,................................ ..... ............................................................
Certified Operator: ................................................. : . ............................................................. Operator Certification Number:..........................................
Location of Farm:
Latitude =• 0, =" Longitude =• 0` =11
Design Current- - Design Current . = DesignCurreut
,Swine Capacity Population Poultry - Ca acity. Po'-ulation .Cattle :;,. Ca acit 'Po ulatiou-
❑ Wean to Feeder ❑Layer 10 Dairy
Feeder [o Finish d ❑ Non -Layer ❑ Non -Dairy
...., ❑ Farrow to Wean_.,,
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity.
❑ Gilts - -
❑ Boars Total SSLW-=-
Number of Lagoons ❑Subsurface Drains Present ID Lagoon Area ❑Spray Feld Area
Holding. Ponds / Solid Traps ❑ No Liquid Waste Management System
u1scnarees A mream impacts
1. Is any discharge observed from any part of the operation? ❑ Yes EWNo
Discharge originated at:❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (Ir yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes [�rNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes RNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes O�No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LXa- 1 _5't-Grsrw
Freeboard (inches): ,,,,_......�,Q, 35 30
................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, [:]Yes A(No
3/23/99 seepage, etc.)
Continued on back

Facility Number: -3 — C[ Date Inspection
of
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
J'No
(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?
boyes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
[J Io
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
VYes
❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
RNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
kNo
12. Crop type �Y� 1brJ CGt't''• S9
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
P(No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
X,No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
[�Mo
16. Is there a lack of adequate waste application equipment?
❑ Yes
KNo
Renuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
KNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
XNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
KNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
CYNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
CS�No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
No
(ie/ discharge, freeboard problems, over application)
❑
dry
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
24.
Does facility require a follow-up visit by same agency?
ElN Yes
,rNo
rio
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
2rNo
•
CVO VlOI 'tiUIls,oC. dt riclentiCS •WCrC I ofjecj• O(WiiI 4bjs,vlslt. • Y'pu ,will-tebQ1VC i10, t�UI'th�I' .
cories orideitce. abbuti this *.visit*,-*.'.'.-*-"..'..'.'.-'-'.'..'-'.'.'.*.'-'.*-'.'-'.'-.::::::::::: :
__.
Comments (refer to question #) Explain any'YES.answers and/ocan recommendations or.aGn -otbercomtiients
Use drawings of facilityrto better;explatn situations. (use additional€pages'as necessary); r,
\�-5 •• s � to VeSC-� 19CA,� tee.
A`
IReviewer/InspectorName �.C�
Reviewer/InspectorSignature: S\ Date:

• Facility Number. 3 — Date of Inspection DV
Odor Issues - ���,,,fff
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes tip No
liquid level of lagoon or storage pond with no agitation? '
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ''No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes Ikf`No
roads, building structure, and/or public property) TT
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes IR No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ,fNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes W No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes PrNo
rb , ( ,( 11('-e -ru

0 Division of Soil and Water Conservation Operation Review
r �.'0 Division of Soil and Water;Conservation Compliance Inspection
�jDivision of Water, -Quality -,Compliance Inspection
0 Other Agency -.Operation Review.All
,Routine Q Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other 1
Facility Number f Date of Inspection r�
/ Time of Inspection p! 24 ha (hh:mm)
,Q] Permitted �'Certitied 0 Conditionally Certified Q Registered Q Not O erational Date Last Operated:
..,4 d lid 5' r Tip- County: _...,..�:J,PL al
Farm Name:.......................M.............................................................................................................................
.....................
Owner Name:
Facility Contact:
Title:
Phone No:
Phone No:
MailingAddress:..................................................................................... ..........................
.....................................................................................................................
Onsite Representative:-r4d.r: _06:. ...�%�n!'n�: ......sibI.7# ...................... Integrator:........�a.'1...4...5......................................
Certified Operator:
Location of Farm:
Operator Certification Number:
Latitude =• =' =• Longitude =• =' ="
_ _ Design Current
Swine Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
G6 B o
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
[]Gilts,
❑ Boars
Design Current - _ Design Current -
Poultry Capacity Population Cattle Capacity Population
❑ Layer JE1 Dairy
❑ Non -Layer I I JEI Non -Dairy
❑ Other
Total Design Capacity -
Total SSLW
,Number,of Lagoons 0 -. ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps E� ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
[]Yes
ONo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
-
a. If discharge is observed, was the conveyance man-made?
❑ Yes
INo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes
00
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
7NO
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
;6No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
�fNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
'R<'s
❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: ( t Z
Freeboard(inches): ..z�....Z.6....................8........................_.Z4................ .................. ................. ...................................
...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
seepage, etc.)
JR<0
3/23/99
Continued
on back

Facility Number: 3 i — tq I Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste AvPlication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over appQlicationt�? []Excessive Pending ❑ PAN
F'ASrURt< Y tAA4
12. Crop type C-
yl
❑ Yes ZNo
❑ Yes 2 No
❑ Yes j(No
❑ Yes '0(No
❑ Yes /No
❑ Yes ONO
13. Do the receiving crops differ wiTh those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes Jo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes A{, No
b) Does the facility need a wettable acre determination?
❑ Yes A
c) This facility is pended for a wettable acre determination?
❑ Yes (INo
15. Does the receiving crop need improvement?
❑ Yes VNo
16. Is there a lack of adequate waste application equipment?
❑ Yes JNo
Reouired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
;irNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) /
❑ Yes
�rNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
ZNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ONO
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
ZNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
ZNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
o
24.
Does facility require a follow-up visit by same agency?
❑ Yes
T
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
dwibtatiotis;otdefciencies•wereitot;edduringthis;visit--You;will-teeeiyeiio;futther ;
ctiriesnotideitce: abbot this :visit_ .:...::................. .
Use drawings of facility to better ex lain situations: use additional pages as necessary):.
U e T-� SEJEr: t r ccjj it �tai.J t•J Ptu c 2-4 FLo,_R S _
0aaaDvcF-4l— W,'LL rJQ-CA is ✓A•tP P&S SaZW tFr soi r445-t.E CZIJf0i TI'a✓t ALLb%A/_
SAQCt Lo cr3 /1 ttcr WtT% jt= maR£ Qo "J c gws�S torfcF{z^f1 A�ac�T
STABrC i4� TµES�F 6?C kC"ftn1�S.
Reviewer/Inspector Name 1 - J� " _ _- - 9191
- --"
P at�Inf /.1 _-_:y,.3P" _ _
Reviewer/Inspector Signature: ����, 4.:....._ Date:
3/23/99

1
Facility Number: 3 (— /ct I Date of Inspection 9
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
I No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
PrNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
/No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
ONo
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
ElYes
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
N/o
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
�1VO
3/23/99

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
Date of Inspection f o/Ld149
Facility Number I Time of Inspection 0 24 hr. (hh:mm)
E3 Registered Certified [3 Applied for Permit [I Permitted E3 Not O erational Date Last Operated:
FarmName: ...................: e�...... &YK-t........................ ........................................... County: ....... bu..JiA...................................... .......................
Owner Name: ................. . r.^rnS....................... .............................................. Phone No: t--Ert...... C�:S.�...�.�%...`�.�.`.�:......................._.
FacilityContact: .............................................................................. Title:................................................................ Phone No:
Mailing Address: ...... L1.4......lii,?.( .... ir........�J..!.............................................. ......... f� cY k...... L L.,_NL. .............................. 3WX..........
Onsite Representative: ............. (C.�+� .. . g CP.^!'d.1S....................................................... ..... 5......_`��.M-.t.......................................................... Integrator:
Certified Operator: .............. ...�anAJL.... A:..... ....... 5.ihs.. {. .............................. Operator Certification Number:.. I 3........................
Location of Farm:
Latitude 0• F67 , ®" Longitude 0• E 4 0` ®"
Design �._ Current ,;
Design `Current
Design ` Current
Somme 'Capacity Popiilation
'Poultry
Capacity"° Population ' Cattle', `..
Capacity Population "=
❑ Wean to Feeder
I0 Layer
❑ Dairy
Feeder to Finish
(y p
10 Non -Layer-.
❑Non -Dairy
,..
Farrow to Wean
_
❑ Farrow to Feeder
❑ Other
-
"
❑ Farrow to Finish
-
To DOSIgn_
(y (y 6O
❑ Gilts
❑ Boars,
Total SSI W..
�i op
Number of Lagoons / Holdrng Ponds ©M
Subsurface Drains Present ❑ Lagoon Area pray Field Area
'
(2,`
..
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenancelimprovement?
❑ Yes
® No
2. Is any discharge observed from any part of the operation?
❑ Yes
ONo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
No
c. If discharge is observed, what is the estimated Flow in gal/min?
N
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑Yes
No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
® No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
P No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
[9 Yes
❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of desiga?
❑ Yes
IN No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
IPNo
7/25/97

Y
Faa ty Number: 3 —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Layoons.Holding Ponds. Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structm e 2 Structure 3 Structure 4
Identifier:...............5.....(*z.... ..............._� 5........................_.T 5...........................................
S.
Freeboard ft : ..............
........... �-:3:5 ................. 4_..... 9
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste ADDlication
❑ Yes P No
❑ Yes
P No
Structure 5 Structure 6
................................................................
.................................................................
❑ Yes
[P No
❑ Yes
(9 No
[Yes
❑ No
❑ Yes lI No
14. Is there physical evidence of over application? ❑ Yes [g No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ) 1
15. Crop type ....... �.UAI OI....._6 �U.lr........... G V. .............. 0..! St1...........Sot .rimer. ....................... ...................................,,,.ii�i.--.tttt..................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? [Yes []No
17. Does the facility have a lack of adequate acreage for land application? //❑__Yes IN No
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
correspQtidence about this:visit::
❑ Yes OlNo
❑ Yes IgNo
[oyes ❑ No
❑ Yes ONo
'Yes ❑ No
❑ Yes [SbNo
El Yes 0No
❑ Yes t1 No
5. V�elrtiiol c'W✓ 6u ww--t.6� o, jyh�Atd &jkWw--1.
(z Iwltt ,ft+Pt. i- fiw�os laywr sla,ld b.. ae�+� etl W 4-L exorleJ -4t - ilu(t4U w W c�
i rtSc,Q- Rodu-: hobs ',mna5 (<�\ J:1 ukl\ servo✓W bd f;1W 4- vcsecOeJ . to"'(- k'"
en �o.�aeY. asks Wa-Ili <I.oa,1J `o - afelee.J.
i6. t �tiwL p1w.W a tcr4on at held Ua (T SG$ Wi+.ar P d ih W3 $ 1 1 %SAGS.
2Az. A\\ uoPs 4II .6e �r•�n :•• splr 4r)jS SLwvl� lie lcs�t� i . Wu)'.Cal lams a t�%„a(;a
Fr Tint irf'lgp.` c-A �y CiGM-- Ll�a✓(ti l+t :�- '}a.y�,., rtcvdi, SIn vtitavJt %r 1�i Sk,,AJ be- kx+
Y` AO •Fe I11odo &S soo+. as rsgitb, 1
7/zs/97
Reviewer/Inspector Name � =' -��
,, �
�
�x w - < ,,;. � � �- � ="
vs,€�`c.�t..
Reviewer/InspectorSignature: _
Date:tl

y� 13 Division of Soil and Water Conservation 0 Other Agency
Division of Water Quality
10 Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
ity Number
Date of Inspection o
Facil
Time of Inspection ULtij 24 hr. (hh:mm)
0 Registered 13 Certified 0 Applied for Permit O Permitted JE3 Not Operational 1 Date Last Operated: ..........................
Farm Name:.T.I:�D.was.,_A.o_h...:�s�r...�r..-r�....LA.:.�.a.^..^ .._ .Vv!,.�- County:.b.U.f..U...r..a....................................le-I..r..no
F4.rm q p
Owner Name:.',jkn.n,tj._.taaea....S..y,...'%!.......................................... Phone No:•.1.....)...5..6.._-... ...................
FacilityContact: .............................................................................. Title:.......................................................'........... Phone No:...................................................
Mailing Address:........ _ :i......�.4-. -_'........1=.aeY...�s:.a.....�r�..:....................... ...P.i.+n.k--.kY:x.. _ .}..... .�..r.................. 2-1 .. Z-
Onsite Representalive:...._`-0..vx::a:t...S.Yv�:...%I�f......>i....'.�r .. ^..,^.k........... Integrator: ..... Ce�r.Y..a......f.................................................
Certified Operator: ..... :............................................ ............................................................. Operator Certification Number,............:............................
Location of Farm:
Latitude I I ' 1 11 Longitude I . I 11 11
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge ori-inated at: ❑ Lagoon ❑ Spray Field ❑ Other
- a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated Flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7125/97
❑ Yes ® No
❑ Yes .® No
❑ Yes
4�3 No
❑ Yes
® No
b5l
❑ Yes
RNo
❑ Yes
J No
❑ Yes RNo
Yes ❑ No
❑ Yes [K No
❑ Yes KNo
Continued on back

' Facility Number:
J 8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Laeoons.Holding Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure ............... ;�
...................................
Freeboard(ft):............................................................................................................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste ADnlication
❑ Yes
M.No
❑ Yes
KNo
Structure 5 Structure
...............................................................
6
.................................................................
❑ Yes
KNo
®Yes
KNo
E Yes
❑ No
❑ Yes
® No
14. Is there physical evidence of over application? ,® Yes ❑ No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .. ..t=.rx.W....fix....... ............4..-S.tta.g.........CA.r.:.......... .a.'�
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes ® No
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
No.violationsor deficiencies were noted during this,visit. You.wiH receive ito further
etirresppndehce, about this:visit. '
)RYes ❑No
RYes ❑ No
❑ Yes Id No
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4/30/97

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
/C DATE: s�o 1995
•Q1 �1/ J��C i�O Time:
Farm Name/Owner: O -,- 4 Srn; -I�'A
Mailing Address: -i t y 7?qev F 4X,+ ,_ Q.J( voj° n K f-/j / A/ir a
County:
Integrator. (A-ffJll I Phone: 5 L V? 9e
On Site Representative: t4 Phone:
Physical Address/Location: �,v @ Sit /70 c( /2 ";I e So w7k ✓�
Type of Operation: Swine Poultry _ Cattle
Design Capacity: 3 Sl a-o . Number of Animals on Site:
DEM Certification Number: ACEDEM Certification Number: ACNEW
Latitude: 3 S ° �' 31" Longitude: `fk .24 Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) or No Actual Freeboard: _._5Ft. 1� Inches
• Was any seepage observed from the lagoon(s)? Yes ofl� Was any erosion observed? Yes or No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments: S%/! w.a-dr �f9fr,� 3ee-1 Ae6-etce J *A -A re
A-Ce*'
• (eef A-1 wr I J1il
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

•
•
Site Requires Immediate Attention:
Facility No.-•
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERA SITE VISITATION RECORD
DATE: �, 119995
_ Time:
v
Farm Name/Owner: 4/7I7� _fm / Th i #91 vvf ks �m 1 i H
Mailing Address:
County:
Integrator. C c
On Site Representative:
Physical Address/Location:
Type of Operation:
Design Capacity: -
Phone:
Phone:
Poultry _ Cattle
Number of Animals on Site:
7?
DEM Certification Number: ACE DEM Cerdfica 'on Number: ACNEW
Latitude: �°o' 31" Longitude: �_' ��' Vf_" Elevation: __Feet
Circle Yes or No
Does the Animal Waste Lagoon ha, ufrtcient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) (Y/eti or No Aal Freeboard: � Ft. -Inches
Was any seepage observed from.th , agoon(s)? Yes or63Was anv erosion observed? � or No
Is ad --quite land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dweiluigs? V or No
100 Feet from Wells? �aor No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or 10
is animal wasteland applied or spray irrigated within 25 Feet of a USGS Map Blue 1_,ine? Yes o(o
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or s %r
similar man-made devices? Yes orpl If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied
spray irrigated on specific acreage with cover crop)? Yes or No
Comments:
cc: rac:tty Assessment Unit Use Attachments it Needed.