310263_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual
2 N
d

Operation
forVisiC QfRoutine O
O Referral O
Evaluation U Technical Assistance
Date of Visit:y Arrival Time: / r8Q Departure Time: .L`D
Farm Name: (�� vtT Owner Email:
Owner Name: CVi Vio". f l i&ywt I AC Phone:
Mailing Address:
Physical Address: �jIj/
Facility Contact: Kz+'�'N I-y 4l,6LQ.jTitle:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
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?
y O Other �O Denied Access/ I
County: ,�p Region:&)i I
Phone:, r
Integrator:yt,��
Certification Number: �.
Certification Number:
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)
a
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
❑ Yes FTjXo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [—]No
[-]Yes [-]No
❑ Yes C3 No
[—]Yes 6No
E�r`&A ❑ NE
[1IA ❑ NE
Ea'NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: $ - Date of Inspection:
1yaste 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?
❑ Yes
❑ No
g -<A
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 4q (a_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[3No
❑ 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
[20<o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[�No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E2fNo
❑ 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 dNo ❑ 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): 0 -e rAk"Aa
13. Soil Type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes EKo
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ®No
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes dNo
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes CE No
18. Is there a lack of properly operating waste application equipment? ❑ Yes Ef'N o
Reuuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [5-No
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes C'No
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements El Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes dNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ Yes [ 'No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Ins ection:—�
2}.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑-No ❑ NA ❑ NE
25.
Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
E No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a PDA 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
NA ❑ NE
27.
Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
AIo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
D40, ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
,� ❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
f 33 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 L.f24 ❑ NA ❑ NE
❑ Yes [i]No ❑ NA ❑ NE
[(dj<K�No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better explain situations (use additional pages as necessary).
V,rIwav 'e-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
fl(1) f6x Y
o -J16 .moo
-A10-'?0&-.601
Phone�l J
10 — -333
Date: S� I
Page 3 of 3 21412015

IType of Visit: PC ompliance Inspection U Operation Review (_)Structure Evaluation (_)Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 20 / Arrival Time: O Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: U4 j f ^ -/-O f Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: ) b ;-1
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Design Current Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pop.
an to Finish
I 11-ayer
I Dairy Cow
Wean to Feeder
I jNon-Layer
I Dairy Calf
Feeder to sh
Dairy Heifer
Farrow to an
Farrow to Feeder
Farrow to Finish
Design Current Dry Cow
Dry Pju-I , Capaci + l;o , Non -Dairy
Layers Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
L lBeefBroodCow
Other
Other
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 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 kj'No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes 25NOo❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: jDate of Inspection: L n
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [DN ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) 'Z 6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes O No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 6No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Ej 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 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
!rNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
g;No
NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
lal�o_
17. Does the facility lack adequate acreage for land application?
❑ Yes
f
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ca'No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
eN
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 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 [:DNA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

acili Number: Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ['Po ❑ 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 do ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [—]No 6NA ❑ 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 allo ❑ NA ❑ NE
❑ Yes E(NNo ❑ NA ❑ NE
❑ Yes ] NO ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes C!fNo
❑ Yes ❑'No
❑ Yes WNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
(Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawines of facility to better eXDIam situations (use additional paces as necessary).
Ir(Co,' c(i /iJn /C q oo4C/
Reviewer/Inspector Name: A, I C. /o c t
Reviewer/Inspector Signature: !2 -- --("" leo"e---� 4
Page 3 of 3
Phone: ��O 7 J 7>P�
Date: S L
21412014

Reason for Visit: Qf Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:�� Arrival Time: j0 „� Departure Time: 20o County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator: �{
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
p 1
jNon-Layer
11 11Dai
Calf
Feeder to Finish
D4 Poultry
Layers
Design
Ca aci +
Current
P,o ,
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
on -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Puuets
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 ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes gt( ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: 3 - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes To ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [✓ `N-o ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Ej`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
[allo
❑ 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 environment
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
ff No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[] No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
ff 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?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
EJINo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[J No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
do
❑ NA
❑ NE
Required Records & Documents �
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes U w ❑ 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 6No ❑ 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 min gauge? ❑ Yes Eno ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

�4
Facili Number: 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 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?
No ❑ NA ❑ NE
[]-KO'❑ NA ❑ NE
❑ Yes
Io
❑ NA
❑ NE
❑ Yes
❑ No
Q'1qA—
❑ NE
❑ Yes E]rNo ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[—]Yes No ❑ NA ❑ NE
❑ Yes No NA ❑ NE
❑ YesgNo ❑ NA ❑ NE
ElYes No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Rec9rj5 401-t-' yop�
�c Con i-/-Oi Ih 1C Y ('Pre
Reviewer/Inspector Name:
Reviewer/Inspector Signatw
Phone: q 0 116 7��y
Date:
Page 3 of 3 21412015

LType of Visit: (D Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: V1) Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ato I Arrival Time: 3v Departure Time: DO County: �t}Q(�,t, Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: 17oUGt ATy:rj4S Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number: C1o ✓ 73 p
Certification Number -
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
No a er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I)r. P,oultr,
Layers
Design
-a pa
Current
P,o
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
01
Boars
Pullets
I
jBeefBroodCow
Other
Other
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 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 Zo ❑ NA ❑ NE
❑ Yes [:]No
[:]Yes [—]No
❑ Yes [:]No
❑ Yes Z
❑ Yes L 110
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412014 Continued

Facik Number: - Date of Ins ection: 6 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 5�/No
a. If yes, is waste level into the structural freeboard? ❑ Yes [—]No
Structure 1 Structure 2
Identifier: (A&a5 d
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ NA ❑ NE
❑ NA ❑ NE
Structure 3 Structure 4 Structure 5 Structure 6
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?
❑ Yes 27No ❑ NA ❑ NE
❑ Yes Q"o ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes dNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [�'�Io ❑ 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 Ej`No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes O/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.
❑ Yes (71 No ❑ NA ❑ NE
Yes ❑ No ❑ NA ❑ NE
❑ Yes 2/No ❑ NA ❑ NE
❑ Yes
E51No
❑ NA
❑ NE
❑ Yes
[,�Xo
❑ NA
❑ NE
❑ Yes No
❑ Yes Io
❑ NA ❑ NE
❑ NA ❑ NE
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. [-]Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes dNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E11<0 ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: Date of Inspection:
24. laid the facility fail to calibrate waste application equipment as required by the permit? ❑Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yesg�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 fast survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes CfNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 6<o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
�Io
❑ 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
E2,1�o
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[:J No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[ o
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
L_I N- o
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E2-N�o
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Io
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or, any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
IT,) ADDRC55 / o2C—.S6W C2R5S
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:

Reason for Visit: Q) Routine O Complaint Q Follow-up O Referral CQ Emergency U Other
Date of Visit: Arrival Time: Departure Time: ®County: D
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: D6y6- AT I=/`s Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Denied Access
Region:
Certification Number: 1 W 5 / jR
Certification Number:
Latitude: Longitude:
Design Current
Swine City Pop.
apac
Wean to Finish
W et Poultry
Layer
Design
Capacity
LGgrrenl
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
b
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr. P,oultr.
Layers
Design
Ca aci
Current
P,o ,
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
jBeef Brood Cow
Other
Other
Turkeys
Turke 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 [�J No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
❑Yes ❑N ❑NA ❑NE
❑ Yes VN ❑ NA ❑ NE
❑ Yes [VNo ❑ NA ❑ NE
Page 1 of 21412011 Continued

Facili Number: - Date of Inspection: y 1
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 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: � ruCO&j1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): LM
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes ZNo
❑ 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 El Yes ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑Yes `rf—'{/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
❑ NA
❑ NE
maintenance or improvement?
ZNo
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[—]Yes
❑ 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?
❑ Yes
❑ 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
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
C No/
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
7
❑WUP ❑Checklists ❑Design ❑Maps ❑LeaseAgreements ❑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 T ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Ins ection. Q y
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o ❑ NA ❑ NE
VNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑ 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
No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
N ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
VNo
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[—]Yes
❑ 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 VJ'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
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
�o
❑Yes o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 0 No
❑ NA
❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature,
Page 3 of 3
Date:

Inspection
Review
Reason for Visit: ( Routine ( Complaint O Follow-up ( Referral ( Emergency ( Other ( Denied Access
Date of Visit: 7 t Arrival Time: Departure Time:® County: j� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: 14QD&-C� 14LK-T /j Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number: �(,i�cj
Certification Number:
Latitude: Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Desigtt Current
Cattle Capacity Pop.
Da Cow
Wean to Feeder
Z$U$
2$0
Non -Layer
Dai Calf
Feeder to Finish
Farrow to Wean
Dr. P,oult .
Layers
Design
C•_a _aci +
Current
l;o ,
Dairy Heifer
D Cow
Non -Dairy
Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
I
Pullets
I JBeef Brood Cow
01
Other
01 Other
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 �No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[-]Yes �o ❑ NA ❑ NE
[—]Yes o ❑ NA ❑ NE
❑ Yes 2No ❑ NA ❑ NE
Page I of 21412011 Continued

Faciti Number: - Date of Ins ection: 7 b
aint
Was%Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[:]Yes
21 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[:]No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: (�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �L
5. Are there any immediate threats to the integrity of any of the structures observed?
❑Yes
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
YNo
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environment
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑Yes
71 o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
F�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
CJ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2No
❑ NA
❑ NE
t?
to enance or �mprovemen
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes C:�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?
❑ Yes
[!fNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
dNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
RNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
O�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
FT<Io
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
El'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[3'�Io
❑ NA
❑ NE
the appropriate box.
-
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [3'<Io ❑ 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 E'/❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - a Date of Inspection, 11 y
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes g �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 2fNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Q No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[2/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
do
❑ 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
Cl/No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
J/
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes[J
/
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ 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 facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
i'j4ti1'J
Phone: {�1(� 1`l,4U
Date: it L
Page 3 of 3 214120I7

(Type of Visit 0 Cort iliance Inspection U Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: „ t t Arrival Time: Departure Time: County:L)L2Pi -Lj Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: �CO D pt t _ H UPP4 01d Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number: 168 1 Q
Certification Number:
Latitude: Longitude:
Swine
Finish
Design C•ucrent
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Da' Cow
Feeder
$0
Non -La er
Da' Calf
to Finish
Dai Heifer
EtooF
to Wean
to Feeder
to Finish
Dry, UU-It . y
Design
C•a acity
C►orient
P,o ,
D Cow
Non -Da'
Beef Stocker
Beef Feeder
Beef Brood Coouets
nNon-Layers
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 [6/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[]Yes [:]No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
[—]Yes Ff No ❑ NA ❑ NE
Page I of 3
21412011 Continued

Facili Number: 1 - 6163Date of Ios ection_ 12. ( Il
r,
>> ste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes C3 No
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No
Structure 1
Identifier: LACn Kni
Spillway?:
Designed Freeboard (in):
❑ NA ❑ NE
❑ NA ❑ NE
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Observed Freeboard (in): q S
5. Are there any immediate threats to the integrity of any of the structures observed?
❑Yes d No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen 1 threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes V'yo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes UNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes o
W
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes Wo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes o ❑ 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 eNo ❑ 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 F�/No ❑ NA ❑ NE
Pagel of 21412011 Continued

Facili Number: - Date of Ins ectlon: Iz t
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
dNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
Cff No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
E�rNo
[DNA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
Ey o
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
�--
[/No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes ONo
❑ 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 dNNo
❑ 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 [J 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 EJ'N�o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes n No
�j'
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes o
❑ 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 paces as necessary).'
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: (91014 —730A
Date: 11Z t
21412 11

2 0 Division of
Type of Visit eF C.,ommyliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0"Routine 0 Complaint O Follow up O Referral O Emergency 0 Other /❑ Denied Access
Date of Visit: ? ID [O 1 Arrival Time: ® Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Phone:
Phone No:
Onsite Representative: K6d)Ofiq_ %lV�lhAA/ Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: E__1 o E I--] Longitude: [� o `
Design _.,Current..-
"Design� „`Current Dest nCurrent
B
..Swore 'Capacity,'Population'
u� •
- Wet Poultry '.:CapacityrPopulatlon: Cattle--,- :Capacity —Population
`-El
Wean to Finish
10 Layer
❑ Dairy Cow
Wean to Feeder
I Z$2J$
lym I':
❑ Non -Layer
I
❑ Dairy Calf
Feeder to Finish.'_'::..
"x'. ❑ Dairy Heifer
' _ ❑ Farrow to Wean
D Poult
"r i'Y__.
El Dry Cow
❑Farrow to Feeder
' r El Non -Dairy
❑ Farrow to Finish
❑ Layers
" ❑ Beef Stocker
El Gilts
-= ❑ Non -La ers
El Feeder
❑ Boars
❑Pullets Pallets
ElBeef Brood Co
❑ Turkeys
Other ❑ Turkey Poults
❑ OtherJ
1. ❑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 2 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes E ❑ NA ❑ NE
❑ Yes LJ No ❑ NA ❑ NE
Page l of 3
12128104 Continued

Facility Number: — Date of Inspection O is
rite 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 III Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: CC�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes �[1J 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 tlyeat,
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 dNo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes �No
❑ NA
❑ NE
maintenance or improvement?
Waste Application ,�
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes C No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
.❑10 ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
o ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
/No
Ll1 N/q ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
7 "" ❑ NA
❑ NE
Comments (refer to question #)i "Eiplain any YES answers and/or any recommendations�or any other comments
Use drawings of facility to be"tterexplain situations. (use`adddtonal=pages"as iiecessary)i
w ,_W
IReviewer/Inspector Name I , � q ;T" ?j Phone: IP% /T 6 — 59 I
Reviewer/Inspector Signature: 44 Date:
12/2R/06 Candnued
o --

Facility Number: — Date of Inspection
Required Records & Documents ,�,�'
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes LI No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [j/o ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
fj'No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections
❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
,P40
Ld o
❑ NA
El 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
El NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
L"J
❑ NA
❑ NE
�No
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[2/No
❑ NA
❑ NE
Other Issues
�
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LJ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
-- //
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
E1 o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
�,,,�����,,,//////
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
7N,'o
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

IType of Visit .(6 C pliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance I
Reason for Visit Routine O Complaint O follow up Q Referral O Emergency 0 Other ❑ Denied Access
Date of Visit
Farm Name:_
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: © Departure Time: County:
Owner Email:
Phone:
Facility Contact: L.� Title:
OnsiteRepresentative: U01je,- &&azl Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: F70 I_ 1 n Longitude: no n n 11
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
Wean to Feeder
b
❑Non -La Non -Layer
El Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
El Dry Cow
El Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
ElNon-Layers
❑Beef Feeder
❑ Pullets
❑ Boars
❑Beef Brood Co
❑ Turke s
Other.
El Turkey Poults
Number of Structures:
❑ 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?
Page I of 3
❑ Yes E4 No []NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
o
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Condnued

Facility NumDate of Inspection
aste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): l
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes El No ❑ NA ❑ NE
❑ Yes ./ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [�(No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 9No ❑ 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 ❑ Yes /U No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes JZ No ❑ NA ❑ NE
maintenance/improvement? //
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
15. Does the receiving crop and/or land application site need improvement? ❑Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
W0 ❑ NA ❑ NE
.Noo ❑NA ❑NE
❑ NA ❑ NE
1L1 No ❑ NA ❑ NE
IReviewer/Inspector Name I �,j (. Phone: //® /r —73 I
Reviewer/Inspector Signature: d Date: (%
r
Page 2 of 3 11128104 Continued

V
Facility Number: Rj ? — /a3 Date of Inspection r1 [
4teauired Records & Documents 1
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes E No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily;available? If yes, check ElI,/J Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g � ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EYNO ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ElYes LJ,(No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes 2No ❑ NA ❑ NE
❑ Yes D No ❑ NA ❑ NE
❑ Yes "' ❑ NA ❑ NE
❑ Yes G N [INA ❑ NE
El
Yes No ❑ NA ❑ NE
❑ Yes LS/N El NA ❑ NE
❑ Yes 7 No ❑ NA ❑ NE
❑ Yes 9 - ❑ NA ❑ NE
❑ Yes Li] No ❑ NA ❑ NE
❑ Yes Z El NA El NE
❑ Yes No ❑ NA ❑ NE
Page 3 of 3 12128104

3
Type of Visit (6,C(9_T�pliance Inspection 0 Operation Review 0Structure Evaluation 0 Technical Assistance I
Reason for Visit lJ [routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: E, lei Arrival Time: 66 Departure Time: County: Ol/PL= Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative: VLC'J0 Lt. [JUFfMA�
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
o = ' = « Longitude: = ° =
m
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 2�No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
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
�N
El NA
El NE
❑ Yes
o
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

FacilityNumber: — Date of Inspection tt q o
i
Waste Collection & Treatment
4. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes [2/No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes [jNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental treat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ,[1,J{/No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E! No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) /
9. Does any pan of the waste management system other than the waste structures require ❑ Yes E 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 YJ No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
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?❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
DNA El NE
❑ NA ❑ NE
❑NA El NE
IReviewer/Inspector Name uU46)( Phone: G)IU g6 I
Reviewer/Inspector Signature: n M Date: II o
Papa 2 of i

Facility Number: sjl — 6� Date of Inspection ll t
L'
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes dNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes ENo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes I /J No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections Weather Code
El22. 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 O_ No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ILI o ❑ NA El 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 brN, o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes I No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Q/No ❑ NA ❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[7No
❑ 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
,_,(
�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
Ko
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
L�Jf No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
JZ/No
❑ NA
❑ NE
Additional Comments and/or Drawings:
a
Page 3 of 3 12128104

i
40 Division of Water Quality Facility Number 3 ( a(o3 O Division of Soil and Water Conservation ✓/
O Other Agency
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: t t o) Arrival Time: ® Departure Time: County: b0Lx:k_1 Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: 14-oN0 nu. La VFAanA j Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Swine
Other
❑ Other
Operator Certification Number:
Back-up Certification Number:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
I I ❑ Layer
fL80d I ❑ Non -Layer
Dry Poultry
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?
Longitude: =o =, =
Design Cur
Cattle - Capacity Popul
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes LJ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑l No
❑ NA
[-INE
ElYes
E3 No
❑ NA
❑ NE
❑ Yes [/ No ❑ NA ❑ NE
12/28/04 Continued

Facility Number: ) — a(o
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: LA C�.%
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S 6
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 2 o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental tflr¢at, 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? El Yes ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes � N ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect 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 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?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
o ❑ NA El NE
�No ❑ NA ❑ NE
L�JNo El NA El NE
070 ❑ NA El NE
o ❑ 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):
Lt.) 06" TO -LNbTSPL_ lu v t9J .LN5P6c.'>; r(1NS ANo IJ(A-TjEt_ Go�E, dl-'._7JCfC.
Reviewer/Inspector Name a 14 ri
/� Phone:
Reviewer/Inspector Signature: n , . A i Date:
12128104

Facility No Date of Inspection �t
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes E No ❑ NA ❑ NE
❑ Yes Io ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard Waste Analysis El SoilAnalysis El Waste Transfers ElAnnyaI Certification
❑ El Stocking Crop Yield 120 Minute Inspections [I Monthly and 1" Rain Inspections — Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or
❑ Yes
0-1vo
❑ NA
❑ NE
❑ Yes
ETN-o
❑ NA
❑ NE
❑ Yes
�J
LNNo
❑ NA
❑ NE
El Yes
—�o
❑ NA
❑ NE
❑ Yes EfN�❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes B<oo ❑ NA ❑ NE
❑ Yes L3"No ❑ NA ❑ NE
❑ Yes
E)X6
❑ NA
❑ NE
❑ Yes
Io
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104

Division of Water Quality
Facility Number /p 0 Division of Soil and Water Conservation
__- _-1 -- -- — - 0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit f Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: t Departure Time: � / ; 4�p ounty: LZ
Farm Name: /V (/ZQd�S Cy Owwnner Email:
/11 /
caner Name: L 99d,5F'n 722L Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: /� Fy2� /1OP.ti, /, E/ �Integrator: M-6
Certified Operator: ���Q;�` ` ���� Operator Certification Number:
Back-up Operator:
Location of Farm:
roe
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feedei
Farrow to Finish
Gilts
-vmer
❑ Other
Back-up Certification Number:
Region:
Latitude: =o Q ' =„ Longitude: =o =, =„
Design Current - Design. Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
2s3 fjg� II ❑ Non -Layer
Dry Poultry
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design - J
Cattle Capacity Pi
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures;
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes xNo ❑ NA ❑ NE
❑ Yes )0 No ❑ NA ❑ NE
12128104 Continued

Facility Number: — 3
Date of Inspection 2 D
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 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes 9No
❑ Yes ❑ No
Structure 5
El NA ❑NE
El NA ❑NE
Structure 6
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.) //////rV
6. Are there structures on -site which are not properly addressed and/or managed El No
El El 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 �1J No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �No
0
El NA 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 IjJ 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. El Yes No
El NA El NE
❑ Excessive Ponding El Hydraulic Overload [:3 Frozen Ground El Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibis ❑ 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) &4'e lmnq 64!! Yj , ':� e--'. �(%/rl15F_ifD�
13.
Soil type(s) Oa 6 2
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
yJ 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
VNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
1] 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):
' ® � Ax/n 4n1D 4CORl15 ooltF
F, r/fiQALL L L/ d�.
Reviewer/Inspector Name117- 4'j O Phone: - Z
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: 3 V —143 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ( No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VJ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9-N,No ❑ NA ❑ NE
[I Waste Application El Weekly Freeboard [I Waste Analysis El Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
YJ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
A
NA
[I NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
C/�
P, No
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
gNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
0 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
)XNA
❑ 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
4 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
,_,(
VJ No
El 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
YNo
❑ 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 Drawines:
f
Page 3 of 3 12128104

r t3-
f8 Division of Water Quality
Fa¢llity Numb¢r 02�3 �' Division of Soil and Water Conservation
-' Other Agency
Type of Visit JO Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /'L /J Arrival Time: Departure Time: County: t/PGZA/
Farm Name: l�iQ/✓F�� Owner Email:
Owner Name: _/t� [�PPQ �F�'fi /QQ/!iS 1/� Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: _
Back-up Operator: _
Location of Farm:
Region: Alf
Phone No: Q ��
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =o =' =" Longitude: =o =. =„
Sw�me
.Destgn,y
4 s uis h ;
syCapactty
Current
,rs
Population
WON
,�;rY t
Wets a try
"`Design
!apacctty
Cuilrent q'
"3"g9' a,F r
P.O(ldlatmn CattleA�a� r
Designii_Current
Cam pacp y' Population
❑
Wean to Finish
Wean to Feeder
00
1-000
da ❑ La er
1 JLJ Non -La et
❑ Dairy Cow
El Dairy Calf
❑
Feeder to Finish
Farrow to Wean
, ,+'*�G �*
c f U � ,'
- DrV Poultry b
❑ DairyHeifer
❑ D Cow
Non -Dairy
❑ Beef Stocket
El Beef Feeder
❑ Beef Brood Co
Number of'Struetures:.
❑
❑
El
❑
Other
Farrow to Feeder
Farrow to Finish
Gilts�^
Boars
h r, v
a
❑ Layers
Non-LayersEl
❑ Pullets
❑ Turkeys
. ❑ Turkey Poults
❑ 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?
❑ Ye/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ILI No ❑ NA ❑ NE
❑ Yes XNo ❑ NA ❑ NE
12128104 Continued

l ,•
Facility Number: — �p Date of Inspection /Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes A No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
�/_
Observed Freeboard (in): 73
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes RfNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes VNo
❑ 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? El Yes ICI No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes /No ElNA ElNE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes oNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.
Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
No ❑ NA
ElNE
maintenance/improvement?
ZO
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
❑ NA
❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
ioNo
❑ PAN ❑ PAN> 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop WindowEvidence of/Wind Drift ❑ Application Outside of Area
1❑
12.
Crop type(s) A-11jema'0_4
13.
Soil type(s) ee 18�
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
ONo ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
A No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
W(No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
gNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes EgNo ❑ NA ❑ NE
;2,7 �RdcEss l/i Z,,6a.va- /`2,¢7-
AJ2;re; ��ca�os Nelf7 Avo ow'e w'-Ooy '61,6ega, 1155�127
Reviewer/Inspector Name 1 4
Reviewer/Inspector Signature:
Phone: L
Date: o
12128104
Continued

Facility Number: — Date of Inspection i
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 VNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ 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
VfNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
O No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�dNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
XNA
NE
Other Issues
!!!�}Rer
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
XNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
rrrXXX
tt� No
❑ NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
ElL,� Yes
,,,/���///
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
/No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104
12128104

of Visit 'O'Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
t Facility Number Date of Visit: d Time:
ii O Not Operational O Below Threshold
Permitt!d Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
FarmName%....._ _ ._.....-- --._.....__._........_...... _._......._....-- — -- ._... County: ... ........... ..................
Owner Name:
Mailing Address:
Phone No:
Facility Contact: ................. _................... _........................ _....... _... Title: ... ........... ..... . Phone No: _.__..
OnsiteRepresentative: ... L�I���_._.._14✓F�11nA!!___...__._.__Integrator:_._._.__.__..___.
Certified Operator: .— .................................... _. Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =1 =[I Longitude =• =, =,.
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? []Yes 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 gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ N
2. Is there evidence of past discharge from any part of the operation? ❑ Yes roo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes zo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ......... ..... _............ ...........................
Freeboard (inches): �-
12112103 Continued

Facility Number: — Date of Inspection Z 6
5. Are there any immediate threats to the integrity of any of the structures observed? Oct trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any smctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type B>6zrntym (A) SGd
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes Zo
❑ Yes No
❑ Yes � 0
❑ Yes Le+"0
❑ Yes
❑ Yes Noo
❑ Yes QNo
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
Y
Comments (refer,to question #)02 Eap any answoran9Aothee mu t
Use drawings; of facdrty;to better e'xplatn sitmthons. (ase;addthonal pages as nececrary) ~�'jI
.. � _�� �-.K �,�-t��s`- �-�'m $r � , �+—❑ Field Co�PY ❑Final Notes c ,�
A"v 'ZE-ct5n.. CAD-0K G-cyz�D,
Name Reviewer/Ins ector
P
Reviewer/Inspector Signature: Date: 7JL
aulsipa Continued

Facility Number: — Date of Inspection �/ 2
i
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ZOX
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o
❑ 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 lGl
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
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? El
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? [IYes jNo
\IDES Permitted Facilities /
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes t'-A'"1G oo
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall [:]Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
I0 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit
12112103

o t
Type of Visit ? Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Pauline O Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit:
O Permitted D Cer M dd- D ConditionalW Certified D Registered
Farm Name: ki I � to
Owner Name:
Mailing Address:
Facility Contact: ,T-iittllee/:
Onsite Representative:
Certified Operator:
Location of Farm:
Date Last Operat / Above Threshold: _
County:
Phone No:
Phone No:
Integrator: A&18ff—
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0• =` =- Longitude 0' =` =_
Feeder to Finish
Farrow to Wean
Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon El 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 J[� No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑Yes 1
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure
Identifier: /
Freeboard (inches):
05103101 Continued

Facility Number: —2Z31 Date of Inspection
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
[;(No
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
❑ Yes
No
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes�
No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
0 No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
/�
elevation markings?
❑ Yes
No
Waste Aoolication
10.
Are there any buffers that need maintenance/improvement?
El Yes
rrr���ttt
o
11.
Is there evidence over application? Excessive Ponding El PAN [IHy lic Overload
❑ Yes
/Z No
12.
Crop type S62` n 2
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP).
❑ Yes J 0
14.
a) Does the facility lack adequate acreage for land application?
El Yes
J[J 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
ANo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
lllXNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
El//�
Yes
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
Pd No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
�No
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
XNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
,,,,,,������//////
(ie/ discharge, freeboard problems, over application)
El Yes
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
El Yes
10
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?
El Yes
VNo
__. __. __ a,✓nnnucu

Facility Number: —%(p 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 ❑ No
❑ Yes No
El Yes /Ld No
L■�M.M
❑ Yes Vt o
❑ Yes No
❑ Yes ❑ No
Additional Comments and/or Drawings: . „„„ ,, a�;, , . ,, •,... ;.
O5103101
O5103101

i
D�piston ofwater
e
^
ty DIVISiOD OI',SO11 and.Weter CpacervallpD
i=
IDOlber Agency
(Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit }n-noutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit:
31 2 3
E3 Permitted '0 Certified,^, J0 Conditionally Certified D Registered
FarmName: ...... C o✓.L.._.................................................... ..............................
Owner Name:....rn.g/..k.4...r`? Facility Contact: .....................//........................../.............................. Title:..........................
Mailing Address:
Date Last Operated or Above Threshold: ..
i
County: ,,,..._Vf /I✓1
Phone No:
Phone No:
Onsite Representative: .,Ke. "'ta L) t7Ur�u >,.
.................................................................................................... Integrator: ... Y..!'.P.....d ".N,^.t„f
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
Swine ❑ Poultry []Cattle []Horse Latitude Longitude �• �«
Design Current Design Current Design: Current
Swine Capacity., Po ulati
Capacity Population Poultry Capacity Population Cattle
on
Wean to Feeder Z $ 0 ❑Layer ❑Dairy
❑ Feeder to Finish ILI Non -Layer I ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity -
❑ Gilts
❑ Boars Total SSLW
_ Number of Lagoon[[]Subsurface Drains Present ❑ Lagoon Area I0 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gaVmin?
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 2 Structure 3 Structure 4 Structure 5
Identifier: ............))...��1.............................................................................................................................................................
Freeboard (inches): TO
5100
❑ Yes 1Y No
❑ Yes 0 No
❑Yes 12fNo
❑ Yes Vf No
❑ Yes 9No
❑Yes No
❑ Yes '0 No
Structure 6
Continued on back

Facility Number: 3) — 3 Date of Inspection I//9/n/ I Printed on: 1/9/2001
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ yes Z 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 Q No
(If any of questions 4-6 was answered yes, and the situation poses an r
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes 0 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes J9No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes $No
Waste ADDlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes jKNo
11.
12.
Is there evidence of over application? ❑ Excessive P Iondingg+ ❑ PAN ❑ Hydraulic Overload
Crop type $evr-� Vag 0.4, �• t4Vl Cyr ��lh
❑ Yes
❑ No
13.
,
Do the receiving crops differ with those destg aced in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
Ej 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?
)RrPes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
fiirNo
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes )ONo
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 0 No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes $J No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes Xf No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ONo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes j No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
24. Does facility require a follow-up visit by same agency? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
iVq•yi61htiplis:oj: deficjend0$ •wgre np' 00tiilg thjs:vjsit:, Yol) wtt j•tecgiye ijd fuftpgt' • : -: -
:: comes ondeii&Abrifthisvisit:::::::::::::::::::::::::•:•:•:::•:•:•:-:-:•:•:
/5, 'V"'e- ( -%o �1r r; �tfc ��oad%ac{ yileCGPS o S)acre AeId .
T may (� /e� vcl�; n� �tt2 S� gall e� • a ;v. cr��l,'c�rl'o>ti Pgco,_ Brice
4AQ necJ wRl>� ring// y s, f is f'eGei✓e� -
sName .' O✓CB Wei � , = t �'.. � -�,;� � �_ _� , :.g..- f ,-5-1 .,. `,
Signature:
Date: / 9 O 1 5100

II Faci►ity Number: 3/ -,2Date of Iuspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge At/or below ❑ Yes p(No
liquid level of lagoon or storage pond with no agitation? j'
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes �O No
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 KNo
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 9No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes ONo
32.
Do the Flush tanks lack a submerged fill pipe or a peirnanent/temporary cover?
❑ Yes -J�No
5100

rvrston`oFWaterQualityr, 4 =
'Division of Sall and Water Conservation. -
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit )6Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3 Date of Visit: Time: 1310 D Printed on: 7/21/2000
yyy,,,,,,��� 0 Not Operational O Below Threshold
E3 Permitted {� Certified ❑ Co-n/fIditionally Certified E3 Registered - Date Last Operated or Above Threshold:
: .........................
Farm Name: /..........Y `�Y_n.. e..Y'......_ Count•:.....Pet nn I W i go
.........................................................................r................................................................
OwnerName: ..................................rn_✓.r%`.`f.......�r_...................................... Phone No:.......................................................................................
Facility Contact:
Title:
MailingAddress: ....................................................................................................................
Onsite Representative: .........................
1�e-hy�_ _I_�.............)._u. ttitc.l�..............
Certified Operator: .......................... Cl
...`..f........................................._.. ...................
Location of Farm:
Phone No:
Integrator:.._,..__, M..... r._
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0• =` 0^ Longitude =• 01 =..
Design Current
Wean to Feeder 1 2 'j 0$
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Cl Farrow to Finish
Number of Lagoons
Holding Ponds / Solid Traps
Design Current
Poultry Capacity Po ulation
❑ Layer
❑ Non -Layer
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy
❑ Non -Dairy
Total Design Capacity
Total SSLW
No Liquid Waste
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes fR�o
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 XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ YesN0
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _...................
.............................................................................................................................................................................. ...............
Freeboard (inches): -5-2
5100 Continued on back

Facility Number: I -2(p.3 Date of Inspection =1 _00 Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
p9,jVo
seepage, etc.)
C
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?
❑ Yes �.No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
C
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
PINO
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
o
11. Is there evidence of over application? []Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
No
12. Crop type .S/Net / .,1^
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
1slo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
,
g NVo
b) Does the facility need a wettable acre determination?
El Yes
L❑`No
c) This facility is pended for a wettable acre determination?
❑ Yes
[]No
15. Does the receiving crop need improvement?
❑ Yes
RrNo .
16. Is there a lack of adequate waste application equipment?
❑ YesN0
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
El Yes
�,.�
� 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
�:IC
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
El Yes
pT%4'N_o
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
o
21. Did the facility fail to have a actively certified operator in charge?
ElYes
No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
(�TNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
IC} o
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?
❑ Yes
No
.. .. violatitir... tlet.... les were it.. during this:visit; You will i eeeipe tip: further
cori es orideitce: about this .visit_
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):
-
-
�c,,r+ It,a�S �aa�•
I�c.oicQl arm 5ryvc�.
Reviewer/Inspector Name K v
Reviewer/Inspector Signature: �/� (;,./,/ / Date: 1��—I-)__0 .% 5100

Facility Number:31 —Zb j Date of InspectionPrinted on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or glow
[]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
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
PO
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
I�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
t1k��'' o
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ YesT0
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑Yes
o
5100

I Facility Number QVI I
of DSWC review
Date of Inspection
Time of Inspection
0 Permitted Certified Conditionally Certified E3 Registered C
.._ h................1-.-................................. .....................
Farm Name:....�.
Owner Name:
Facility Contact:
Title:
Not Operat
County:
Phone No:
24 hr. (hh:mm)
Date Last Operated:
Phone No:
MailingAddress: .......................................................................................................... :..........
P................Tote rator:............................. ..........................
OnsiteRepresentative: .................... .........................................................._ g t-w .........................................................
Certified Operator:.....'.......................................................................................................... Operator Certification Number:..........................................
Location of Farm:
Latitude =*=' =" Longitude =• =' =11
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes VNo
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 DW Q) ❑ 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 ONo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 4No
Waste Collection & Treatment -
4. Is storage capacity (freeboard plus stone storage) less than adequate? ❑ Spillway ❑ Yes VNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ............................................................................................................................................. .
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ONo
seepage, etc.)
3/23/99 Continued on back

Facility Number:3 Date of Inspection
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?
❑ Yes
�No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
O�No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
El Yes
,y,�
t,� No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
�ZNo
l 1. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
[IYes
NrNo
1
�j�
12. Crop type
4 M
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
IgNo
14. a) Does the facility lack adequate acreage for land application? -
❑ Yes
hj No
b) Does the facility need a wettable acre determination?
❑ Yes
P9 No
c) This facility is pended for a wettable acre determination?
❑ Yes
[�rNo
15. Does the receiving crop need improvement?
❑ Yes
5rNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
NNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
??��,,��
(ie/ WUP, checklists, design, maps, etc.)
[Itn Yes
No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
WYes
OIN0�9
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
b�No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
MNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
)4No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[RNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
UrNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? -
❑ Yes
No
IVti vi6lati6is;or. detid6nd •Mere itofed d4tt iitg this;visit: You will receive tio: furthgr • ; • ;
cories otideike: about: this visit.:::...::.. .
.Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments
-Usedrawings of facility_to Better explatii sitoahons. (useiadditional`pages'as necessary)s, ,,
_. -
-
4•t"t"�!'�6-c
`
SiL�zaT ,
Reviewer/Inspector Name;..-
Reviewer/Inspector Signature:
Date: 11— 19-
3/23/99

Facib y Number: — Date of inspection ej
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes.j
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
KNo
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
KNo
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
9No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
�TNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
L'No
3/23/99

•- V
�� r '❑ Division of Soil and Water Conservation ❑Other Agency ��
�.... t �' <- n
3
Division of Water Quality -.
jok
Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number
Date of Inspection
Time of Inspection Z 30 24 hr. (hh:mm)
E3 Registered P3 Certified E3 Applied for Permit U Permitted JE3 Not Operational I Date Last Operated: ..........................
FarmName: ...... (Ocn.... FSd...._U..................................................................................... County:.. pI h,.....................................................................
Owner Name:...... klugAj...... }A1�,�1�..... DiAwS....................................................... PhoneNo:...Oza .. . 1411.................................................
Facility Contact:... ��4t+�tst.....1:61M...................................... Title:...... p 2r................................ Phone No: �.11f��.. d �Z. i1'�.......
MailingAddress: .....Q..&y........ 7�..t....................................................................................�1`. .c...............................................7Z&,,' .....
Onsite Representative: ..... I.�1;6tU,...... t4AVS............................................................. Integrator: ......
..4ttit/ t�.....
.................
.....................................
.
Certified Operator................................................................................................................ Operator Certification Number:.........................................
Location of Farm:
E crx....... Z5.... t?t,...... na ........AVG...a1.....Sx...Wr....a .....oj.......SA..t.?.3.:............................................
..........................................................................................................................................................................................................................................................................
Latitude =•='=" Longitude =•=[=<1
General
I. Are there any buffers that need maintenancelimprovement? ❑ Yes [$'No
2. 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 dischar-e 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 pan 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?
7/25/97
❑ Yes P No
❑ Yes ® No
❑ Yes 14 No
n,4
❑ Yes [� No
❑ Yes No
❑ Yes No
0 Yes ❑ No
❑ Yes 04 No
❑ Yes IAA No
Continued on back

Facility Number: 3 —2-6
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes ® No
Structures (Lagoons.Iloldine Ponds, Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 'YJ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
...................................................................................................................................................................................................................
Freeboard(ft):.........L4.....................................................................................................................................................................................................
10. Is seepage observed from any of the structures? ❑ Yes ® No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes ® No
12.
Do any of the structures need maintenance/improvement?
❑ Yes
® No
(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?
_ ❑ Yes
® No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
N No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ...........'W"ttifn..................................... ......... .................�1M. 1f......9).........................................................................................................,
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
M No
18.
Does the receiving crop need improvement?
❑ Yes
[A No
19.
Is there a lack of available waste application equipment?
❑ Yes
N No
20.
Does facility require a follow-up visit by same agency? -
® Yes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
J%No
22.
Does record keeping need improvement?
10 Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
[P No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
q No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
❑ No
❑ No violationsor deficiencies were noted during this.visiL You.wilt ieeeive naftirther .
correspondence about this:visif.:::
s. t �u r cec r s�rxl �te�t), zG.TS area should be avotd 1 ra�uy s in
P �N S Or S6ovIt� 6e
�vVZO 0�4V.e"Seer)ed. Le eartQ o- Slo�in� F�(d 4o aver tf'un'-g
zz. )ngac ncot�z or si c. (M-1 4- IKR-L (sY c �t Ae 6e vse� 4z aocumw�
Na"V ctt XO%6 c-13 YIiZS4, loar)iv�, jrr194M ft-" (dQ 4� 5i4c.
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature:__6.41 X., Date: y)11 AT

10DRoutine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number
Farm Status: ❑ Registered ❑ Applied for Permit
® Certified ❑ Permitted
❑ Not Operational Date Last Operated:
Date of Inspection I Vlea 77
Time of Inspection Ej ? : 30 24 hr. (hh:mm)
Total Time (in fraction of hours
(ex:1.25 for 1 hr 15 min)) Spent on Review
or Inspection (includes travel and orocessim
Farm Name:...�QLJLfpN�t... _.... County:P�IL+...._...._.._�....__...._.._._....__.
Land Owner Name:.. �..1S�zh¢_tt.'.�?521�1 _radllriS_.... _....__....._...... Phone No: Ly�O�._5r2 i ��....__.... �....__....__...._...
Facility Coact act: .... _.....^11.... 501I.Lh..._.........._...._._. .. Title:.St! (Ltr .._ _ ...... Phone No:.. .._ _.......
Mailing Address: —..L—Q.EIIY. Z1M .... ...... _.... _..... _..... ....�.... ....._....- .....pjtfl�..�i lj Nf�_.... ...._._ _..__.... ZZ5..7Z.....
Onsite Representative: ..... %uujlt—... 1LC....______...._.... .... �..__ Integrator: __ --- ....�.......... ....__.
Certified Operator:....._ .... _.................. _....._...................._...._._....._....._........_....._..... Operator Certification// Number: ... ............... _...... ...........
Location of Farm:
Latitude 0*0`=" Longitude =0
=1=11
General
1. Are there any buffers that need maintenance/improvement?
2. 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 Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaVmin?
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
4/30/97 maintenance/improvement?
❑ Yes ® No
❑ Yes
No
❑ Yes
No
g
❑ Yes
JA No
❑ Yes )a No
❑ Yes 19No
❑ Yes ® No
Continued on back

Facility Number:.....3...�_—....24a.3_
6.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
® No
Structures (Lagoons and/or Ifoldina Ponds)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
No
Freeboard (11): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
__ sZ...W. —..... _.... _.... ....... ...... ...... _ ..... ...... _...... _.. _..... __.... —....
_......
...._
10.
Is seepage observed from any of the structures?
❑ Yes
j19 No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
® No
12. Do any of the structures need maintenance/improvement? Yes ❑ No
(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? ❑ Yes No
Waste Application -
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 __..... a*SilJO.3df.YY1J.JA..—...........__......._........_.sw},L1_...�lA......_._....__.....__....._......_
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? OLYes RrNo
17. Does the facility have a lack of adequate acreage for land application? -
❑ Yes
No
18. Does the receiving crop need improvement?
Yes
❑ No
19. Is there a lack of available waste application equipment?
❑ Yes
® No
20. Does facility require a follow-up visit by same agency?
A Yes
❑ No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
For Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
® No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
24. Does record keeping need improvement?
® Yes
❑ No
Comment's'(refer to question #) =Explain any YES answers and/or anyrecommendahons or"any other comments
—
Use,drawings 9f,. facility to better explain situations (useadditional-pages as necessarv).11
12- o boo* deaf t) be wwcrl.
r-"a shad') 6 in\ re`d or (}il(t��nJeY akt 5mal( gmin pl"k6 t ire I- [&It,
A�
:5 f4 j I-tfjas S6L'1� be lh � �1 �n' S�✓bul rfcofjS skould vy
IDy rOV69-/run fwm6fr ani) field 11LIM 's, 1
Reviewer/Inspector Name i i4xi .4iAirr eaJ1- e ZIAI
Reviewer/Inspector Signature % Date:
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

,•
Site Requires Immediate Attention:
Facility No. Z I - Z C.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: j 2 � , 1995
Time: ('� )-
Farm
Mailij
County: _1),P), r`
Integrator. IM ti d off. t Phone: t o S
On Site Representative: 1 11f '(1A Phone(�t
Physical Address/Location: I�CSX 1'76S_ 3 m:let 51,L. f1 -4 Aic ,
i
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: 2 "D O Number of Animals on Site: J 6 * U. .
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude::' 0_' t b " Longitude: -7 7 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) &s or No Actual Freeboard: __� Ft. 0 Inches
,. Was any seepage observed from the lagoon(s)? Yes or(13[b Was any erosion observed? Yes or 6
Is adequate land available for spray? Q or No Is the cover crop adequate? &�A or No
Crop(s) being utilized: C ool+pI o\-a, ri w/ e,k
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Oee or No
100 Feet from Wells? 0e 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 1N0�
Is animal waste discharged into waters of.the state by man-made ditch, flushing system, or other,
similar man-made devices? Yes or 9 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 "- " "/' �'4 'f-� sPAY
Additional Comments:
Inspector Name
Signa e
cc: Facility Assessment Unit Use Attachments if Needed.