310264_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Type of Visit: (CI.Cbm 'ance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access �
Date of Visit: "5u�4 ?Arrival Time: Departure Time: 0't;N County: ,�� Regfont// l./j
Farm Name: Co� .�-- Owner Email:
Owner Name: ���'"r� ,ram) ,J /lC Phone:
Mailing Address:
Physical Address:
Facility Contact: j1je.q_c6d Title:
Onsite Representative: L�
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: !qqS' M1 ( pt y
Certification Number: /6 V /
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D, P.oultfiY
La ers
Design
C_a aci_
Current
Pao ,
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
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?
❑ Yes ©No ❑ NA ❑ NE
❑ Yes ❑ No E NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes ❑ No
0 NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes ❑ No
ENA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes to No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes Kj No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

FacilityVumber: gi - 2-42off jDate of inspection: IS YuW-e
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
���
CJ Ko
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
Cg- A
❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure
5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
-Ib
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�Io
❑ 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 IRNo ❑ 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 ❑'ro ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [3 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
<o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[7 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 Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
Crop
��
12. Crop Type(s): 1JI0O0t
13. Soil Type(s): T
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q<o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[Erl�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
0'No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
®'NO
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[D,?4o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
C3I No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
2-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
[JINo
❑ 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
[fNo
❑ 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

Facility umber: jDate of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Eg<o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 2<0 ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard.problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [3No ❑ NA ❑ NE
❑ Yes [20'No ❑ NA ❑ NE
❑ Yes [Er -No ❑ NA ❑ NE
❑ Yes
[�No
❑ NA
❑ NE
❑ Yes
E2rNo
❑ NA
❑ NE
❑ Yes
E7rNo
❑ NA
❑ NE
❑ Yes
[El'No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
3.3 G- & - 357
to- 3v4' -
Reviewer/Inspector Name:
Reviewer/Inspector Signatuj
Page 3 of 3
Phone:J(L) - �3 37 �3 3
Date: IS';"Ic 11
21412015

' Division of Water Resources
FaCilify Number - Z G Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Corn ' ace Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: t / Arrival Time: Departure Time: © County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: / Title: /��
Onsite Representative: J %.•� ^ rc rr j 'till ue, / r`,
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: / (0 cd--/ I
Certification Number:
Longitude:
Swine
n to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
!Mayer
ign
CDesapacity
Current
Pop.
Design Current
Cattle @apacity Pop.
DairyCow
Wean to Feeder
�9
DairyCalf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dq P,oulh,
Layers
Design
Ca aci +
Current
P,o ,
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Pouets
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes El —No
❑ Yes E No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 21412015 Continued

21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysi
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
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?
Facility Number: 3 ) - 5 jDate of Inspection: ZP /
Waste Collection & Treatment �
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes K o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): , I
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
21 No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
reat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
N ❑ 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 I — _<o
---
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN> 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of 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 I iI No
`7"'
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Reuuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
❑ Yes YNo ❑ NA ❑ NE
s ❑ Waste Transfers ❑ Weather Code
Rainfall Inspections ❑ Sludge Survey
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility N mber: Date of Inspection: 2n L
24.'Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑-5o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes To ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes �No
❑ Yes O No
❑ Yes CrNo
❑ Yes / No
❑ Yes ONo
❑ Yes dNo
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
❑ NA NE
e[aA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Date: `�
Reviewer/Inspector Signature: ��� /Q
Page 3 of 3 21412014

(Type of Visit: U.Commpliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Visit: I
Reason for Vis-,sit: 01Loutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: I j Arrival Time: l n Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
(
l`-o-f 't (1
/
PA
a
• I�� O
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: Zy rg r
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
We[ Poultry
Layer
Design
Capacity
I
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
can to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
-U L OD
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Dry P.oult .
Layers
Non -Layers
Design
Ga acit +
Current
P,o
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Boars
Pullets
I lBeefBroodCow
Other
Other
Turke s
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 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
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
0
[-]Yes
No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 21412015 Continued

Facility Number:Till Date of Ins ec[ion: / 7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EfNo
a. If yes, is waste level into the structural freeboard? [—]Yes ❑ No
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure I Structure 2
2}
❑ 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 No ❑ NA ❑ NE
❑ Yes [2/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 2No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [r N ❑ 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 ao ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ YesNo ❑ NA
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Q o ❑ NA
❑ 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):
❑ NE
❑ NE
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E ry
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
do
❑ NA
❑ NE
acres determination?
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
�o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
En/yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Cn�No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check t appropriate box below.
Ell es
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Free Waste Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking 6'Krop Yield 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
L.�xu -❑
NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Vo
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facility Number: - Date of Ins ec[ion: (7
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [:]No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 54o ❑ 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?
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:
❑ Yes
LJ ' o
❑ NA
❑ NE
❑ Yes
[:]No
❑ NA
Q'IQE
❑ Yes [3-hf ❑ NA ❑ NE
❑ Yes J'No ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
[—]Yes Callo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes fNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes CNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ao ❑ 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 pa¢es as necessary). ._.
FA��r
C�Io 3 5-0-2019
Ifi �� SGO rn�•elJs
2� u fe ►,-ro � 4�a •S l
on irr%yuP0111.
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
P.3,, 1/ 9
r Q Sn3
nn iZr� Mr^ A lCiro
Phone: 110 77 ` VOY
Date: If 1 L/5-
21412015

J
` tv`ision of Water Resources
Facility Number 3 ( Z(p O Division of Soil and Water Conservation
Other Agency
Type of Visit: om ce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:Departure Time: O County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
OnsiteRepresentative: k-7
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: / 0 �—/
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Wet Poultry
Layer
Design
Capacity
C•urcent
Pop.
Design Current
@attle Capacity Pop.
DairyCow
can to Feeder
D�j
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I) . P,oult .
Layers
Design
Ca aci
Current
P,o
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
01 Other
Turkeys
TurkeyPoults
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 E211 to ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [—]No
❑NA ❑NE
❑ NA ❑ NE
❑ Yes 1n Igo ❑ NA ❑ NE
ElYes ©% o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3
21412015 Continued

Facili Number: Date of Ins ection:
Vraste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ED< ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1 Structure 2
1
W=
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 [/3No ❑ NA ❑ NE
❑ Yes [a/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ffNo ❑ NA ❑ NE
8. Do any of the structures 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 Eff No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes EfNo ❑ 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 CA W MP readily available? If yes, check
the appropriate box.
[:]Yes [ "0
ET'Yes [:]No
❑ Yes Eff No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
J[ NNo
❑ NA
❑ NE
❑ Yes
ffNo
❑ NA
❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ONo ❑ 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 o ❑ 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

Facility Number: 3- Iq Y Date of Ins ectiow. if
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes [n�No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes r% No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes [TNo ❑ NA ❑ NE
❑ Yes ]6No ❑ NA ❑ NE
❑ Yes ] No ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ffNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 0o ❑ 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 drawimes of facility to better explain situations (use additional oaees as necessarv).
a.CCPra 5 jo'�e
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 1 (n /77 v 73a
Date: ` y
214/ 015

Reason for Visit: (DRoutine O Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: I Arrival Time: Q Departure Time: County: QY(t_X�J Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: 1l+' I Title:
OnsiteRepresentative: ,) 60G— AtKI+5
Certified Operator.
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
9?S`73Y
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
p. Po
Design Current
Cattle Capacity Pop.
DairyCow
yc
Wean to Feeder
6
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P,oul
Layers
Design
Ca aci
Current
P,o
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
01 Other
Turkeys
TurkeyPuults
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)
a 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 n y]o ❑ NA ❑ NE
❑ Yes N ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
Page 1 of 3 21412014 Continued

Facili Number: - Date of Ins ection:
Waste Collection & Treatment
4.Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes d No ❑ NA ❑ NE
'I a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
S�tructur1ell 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: i 406(
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a [—]Yes L�rNo ❑ 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 V 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 0No ❑ 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 61No
❑ 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?
2fYes ❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes allo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes �
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes V
❑ NA
❑ NE
Required Records & Documents
N
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes E2
❑ 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 [3 o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [ fNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Fg,?4 ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Inspection,
24. bid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ZNo
25: Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes []"No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑ NA ❑ NE
❑ NA ❑ NE
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ['j No ❑ 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 5p<o
❑ 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 [�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 r�No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
/
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes C__I No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes E�No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes o ❑ NA ❑ NE
Comments (refer to, questiond/): Explain any YES answers and/or'any additional recommendations or any other -comments.
Use drawinvs of facilitvto better explain situations (use additional pages as:necessary).
i-J Anpfl(Ss foac5a CRAS-5
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone(V' 116
Date:
2/4l 014

Reason for Visit: 0 Routine O Complaint O Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Q ,.t -S Arrival Time:O Departure Time: ) County: �= Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
P.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . Ppul
ILayers
Design
Ca aci_ +
I
Current
Pao ,
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
/hher
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
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes n �7o ❑ NA ❑ NE
❑ Yes N ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 21412011 Continued

FacRi Number: Z jDate of Inspection:
Waste Collection & Treatment
1 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [—]Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Q 1
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes VfNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
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 VNo ❑ 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 ENo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E; /4o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes (�/Xo ❑ 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
Eo
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[2 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
g o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[�KNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑i /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
o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a min gauge?
❑ Yes
g N
❑ 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: -QQ4
rj
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
�No
❑ NE
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 firs[ 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
o
❑ 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.
N
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
WNo
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
1
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�[J I/fib
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
T� o
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
rNo
❑ NA [3 NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other. comments. -
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone
Date:
I

Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: it Arrival Time: It Departure Time: County: -'..l..9CMIJ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: k--tJ OKUL 14 U(:PAAN Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Certification Number: 1(49q t`i
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle C apacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P,oult .
Layers
Design
Ga aci
Current
P,o
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars I
Pullets
Beef Brood Cow
Other
01 Other
Turke s
Turke 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 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 0 No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes Co ❑ NA ❑ NE
❑ YesVN(
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page ] of 3 21412011 Continued

Facili Number: 1p t i Date of Inspection. It
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes [:]No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LAG-M d
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.)
No
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
Q ❑ 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
Q No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
F34o ❑ 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
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
6/No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
❑ NE
acres determination?
'No
17. Does the facility lack adequate acreage for land application?
❑ Yes
Ca
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
91<0
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
C5 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�Zo
❑ 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 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [—]Yes Wo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes EZ ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: 1 Date of Ins ection. -) it Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes U 1V o ❑ NA ❑ NE
25. Islhe facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E�No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
0 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
E(No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[3/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
aeo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
91C
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
N
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?
34. Does the facility require a follow-up visit by the same agency?
❑Yes
❑ Yes
No
❑ NA
❑ NA
❑ NE
❑ NE
Reviewer/Inspector Signature: � (/ l� Date: -L/
Page 3 of 3 2/4/2 11

II'ype of Visit: (0 Co Hance Inspection U Operation Review O Structure Evaluation U Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: r
' 1 Arrival Time: Departure Time: ZL " County: \fie lit,! Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
OnsiteRepresentative: YxnooigL, . NU yyt Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Certification Number: 1 6,319
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Dai Heifer
D Cow
Non-Dai
Beef Stocker
Farrow to can
Farrow to Feeder
Farrow to Finish
Design C•unrent
Dr.. Roultr. C•a aci. P.o
Layers
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
jBeefBroodCow
Othe
Other
Turke s
ur ey 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 dNNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[—]Yes ❑ o ❑ NA ❑ NE
❑ Yes �/No
o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Pagel of 21412011 Continued

Facility Number: 51- Date of Ins ection:
Waste Collection & Treatment
Pt. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? [-]Yes [—]No
Structure 1 Structure 2
Identifier: LA
Spillway?:
Designed Freeboard (in):
❑ NA ❑ NE
❑NA ❑NE
Structure 3 Structure 4 Structure 5 Structure 6
Observed Freeboard (in): y Z/
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
dNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
dNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[—]Yes
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 2No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ 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 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
❑ jJo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
uZo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
dNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
dNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
dNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[Z"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 dNo ❑ 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 i No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

L
]Facility Number: Date of Inspection: t
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o
2' . Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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.
❑NA ❑NE
❑NA ❑NE
❑ Yes ❑,No ❑ NA ❑ NE
❑ Yes &No ❑ NA ❑ NE
[—]Yes [�No ❑ NA ❑ NE
❑ Yes O/NNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other.
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ ❑ NA ❑ NE
Reviewer/Inspector Name: V ° lily 17A-a/jUA1 Phonec"1(Q ? 6 `� 3d d
Reviewer/Inspector Signature: '/1 '9 .. 7A.,. Date: I L 1
Page 3 of 3 21412011

.;6Division of Water. Qua
Type of Visit Qf,coop_�pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit CJ Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 944D
Arrival Time: Departure Time: County: i U 47.n1 Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: WJC- 1 LL_ Uu47,FMArj
Certified Operator:
Title:'
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: Q o = = Longitude: [� o 0 , 0 «
Design Current„ Design
CorrentM
1)esigp Current
,
Swore, Capacity, Pop ulahont . Wet Poultry Gapaci P,o ulahon =Cattle,: "Ca
_w y P . , n �
aci Po elation
P�.�X P
❑ Wean to Finish
❑ Layer
_ ❑
Dairy Cow
Wean to Feeder
$
_ ❑ Non -Layer
❑Dai
Calf
❑ Feeder to Finish
,,..,.. :'^„ ;.�>* "
: *;*"*"
Dry Poultry
4,,» ❑ Dairy Heifer
"'" ' El D Cow
r
El Farrow to Wean
"
El Farrow to Feeder
,
` _ -
❑ Layers
❑Non -Layers
'4 ❑ Non-Dai ry
-w El Beef Stocker
q ❑ Beef Feeder
:.
❑ to Finish
El Gilts
❑Boars
El Pullets
❑ Turkeys
; ❑ Turkey Pouets
❑Other
z ❑ Beef Brood Co
Num of Strudures.,,,�
Q'ther . , ...,.;;cw-.-.� t..
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 2�No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes ❑ o
❑ Yes L' IN
❑ NA
❑ NE
❑ Yes JQ No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Nytmber: — 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?
�Structure1 I Structure 2 Structure 3 Structure 4
Identifier: L �l
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): C
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 ll(J No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes dNo ❑ 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 ,.,(V No El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes I 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 El Yes I Q No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 17N(
/❑ NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El 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 Area
12. Crop type(s)
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El NA
ElNE
15.
Does the receiving crop and/or land application site need improvement?
El Yes
7 ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
Q o El NA
El NE
17.
Does the facility lack adequate acreage for land application?
El Yes
El NA
El NE
18.
Is there a lack of properly operating waste application equipment?
El Yes
� ❑ NA
❑ NE
Comments (refer to question #) •Ezplam any'YES answers and/or any recommendations or any othe comments
x
Use drawingsoffacilityto better,eaplain situations. (use additional`Qages 4s necessary) -
„ .
Reviewer/Inspector Name "" Phone: 6 _ 3
Reviewer/Inspector Signature: Date:'811046
Page 2 of 3 r 12128104 Continued

Facility Plumber: — Date of Inspection /b
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Ld No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VfNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
P�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 0
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
El NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElLJ Yes
�dNo
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ENo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
IJ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ENo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
,[2
CJ 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
��
U NO
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
—3/No
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ 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
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�,/h/lo
[� No
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit dCOpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other Q,Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: /O b Departure Time: County:
Owner Email:
Phone:
Facility Contact: -h Title:
Onsite Representative: jO�d6 �.Jyf Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o = ' =„ Longitude: = o = ,
Design Curren[
Design or en
Design Current
Swine Capacity Population
Wet Poultry C>a- parity Population
C+a[tle Capacity Populafion
❑ Wean to Finish
[E]Layer
❑Dai Cow
Wean to Feeder
09
10 Non -Layer
❑Dai Calf
❑ Feeder to Finish
❑Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
ElFarrowers Farrow to Finish
❑
El Beef Stocker
❑ Gilts
❑Non -Layers
❑Beef Feeder
❑ Pullets
❑ Boars
❑ Beef Brood Co
❑ Turkeys
Other
❑ Turkey Poults
Number of Structures: F
❑ Other ❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes E2 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes V<No❑ NA ❑ NE
El Yes ❑ NA ❑ NE
Page I of 3 12128104 Continued

1
Facility Number: —a Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 /No ❑ NA ❑ NE
a. If yes, is waste level into the _structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Y t
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EfNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes CN/o ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes EfNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes a/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 ❑ YesCl/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [j-i�o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [P NNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[3No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
Q'No
❑ NA
[:3NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
N��/��o
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
,,,,
����7No
❑ NA
❑ NE
Is there a lack of properly operating waste application equipment?
El18. Yes
❑ NA
❑ NE
Reviewer/Inspector Name
Reviewer/Inspector Signal
Pane 2 of 3
Date: _
12128104
Continued

r
Facility Number: — Date of Inspection t l
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
g ❑ Maps ❑ Other
❑ Yes D(N ❑ NA ❑ NE
El Yes ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
[:]Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
ElLJ Yes
_,(❑
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
tvo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑'/1lo
❑ NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
O No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CA WMP?
El Yes
�/
L� �7o
❑ 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
D/N�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
�,/
L1 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑l ElNA
ElNE
33.
Does facility require a follow-up visit by same agency?
ElYes
❑ v❑
NA
❑ NE
Page 3 of 3 12128104

Type of Visit CJo�n pliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit f� Routine O Complaint O Follow up 0 Referral O Emergency O Other 0 Denied Access
Date of Visit: 1l O Arrival Time: ® Departure Time: County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative: 1<6M12ALt 14UF(MAl,.)
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: [o [=, = Longitude: Oo =,
a
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
10 Layer I I
❑ Dairy Cow
Wean to Feeder
UON
JLJ Non -Layer I I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
❑Beef Stocker
❑ Gilts
N
❑ ers
❑Beef Feeder
❑ Boars
❑ Pullers
❑Beef Brood Co
❑ Turkeys
Other
❑ Turkev Puults
❑ Other
❑Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes L 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 Continued

FacilityVumbet- — Date of Inspection tt k o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes CkfNo ❑ 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
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes �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 El Yes d No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LYNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ENo ❑ 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
❑ o
ElNA--[]NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
0o
❑ NA
El NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Xo
[INA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
ntments (refert[o question #) Explain any YES answers and/or any recommendations 11 lidnyI other comments.
a
Use drawmgsdofacdtty to bettereexplamgsttuahonsR(useaddthona�lapaages as•necessary)
r
Reviewer/Inspector Name Phone: Q/ 3
Reviewer/Inspector Signature: Date: t a. o
n..,.., 7 _r x 12128104 Continued

Facili j Number: — (a Date of Inspection 11 ! o
Renuired 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
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 V Rain Inspections [I Weather Code
22. Did the facility fail to install and maintain a rain gauge? El. Yes ,��I/NNo [I NA NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes CI o [I NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? [I Yes
Z�10 ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? El Yes �CJ No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes O No ❑ NA ❑ NE
❑ Yes 2No ❑ NA ❑ NE
❑ Yes [,}'No ❑ NA ❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
J o
E[3/No
❑ NA
[I NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[I Yes
[3 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
QlNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
/No
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
Cf
❑ 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
K
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
El Yes
,
l� No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

® Division of Water Quality
Facility Number 31 Zfdi O Division of Soil and Water Conservation
O Other Agency
(pe of Visit Q(Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
eason for Visit 6 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: tr r Arrival Time: I oo Departure Time: County: QUI`L—k) Region:
Farm Name
Owner Name: —
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Phone No:
Onsite Representative: W_re�)QAy 6 14%�c rw.At­;, Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: r ---- 10 F-7
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
® Wean to Feeder ,I 2,P9 I I JLJ Non-Layet
i
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Longitude: = o = , = "
Design
Cattle Capacity
E]Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes D o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
El No
❑ Yes
L�J IJa
[I NA
[I NE
❑ Yes
❑/No
❑ NA
❑ NE
12128104 Continued

Facility Number: 31 a(,4 Date of Inspection t ru o t
Waste Collection & Treatment
�/
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes
d 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: Lt°C. ,J '
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 5
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Z/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
Ld 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) th7at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes (--No El NA FINE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes I�"No El NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) /
9. Does any part of the waste management system other than the waste structures require ❑ Yes L� No ❑ NA ❑ NE
maintenance or improvement?
Waste Application /
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes CJ 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 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ 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 RI No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes [N
El NA
El 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 dVN,
El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑Yes —✓j/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):
al,) rJ6Er� To 1.1-JrTLAX- 17-0 F =IJ JWSPE CT L&,Jf Fir. WEgTH ErL_ ConE a,j ZfCft- I
Reviewer/inspector Name 0 fUJcu- Phone: Qlo 756 -1 88
Reviewer/Inspector Signature: Date: t t S o�
12128104 Cantinned

Facility Number: 1j — Date of Inspection iy
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ff hj, ElNA [INE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes LJf/No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
In Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard Waste Analysis [I Soil Analysis El Waste Transfers
El Annual
Certification
El Rainfall ❑ Stocking ❑ Crop Yield 120 Minute Inspections [:]Monthly and V
Rain Inspections E Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain minbreakers on irrigation equipment?
❑ Yes
2 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EjKo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Nq
El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P(No
IjNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
u No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ZNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
P40
❑ 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
N
[I 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
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
,,..//No
IJ No
❑ NA
❑ NE
Comments and/or
12128104

Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
— Q Other Agency �..s•:
(Type of Visit j0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 2 O Arrival Time: Departure Time: County:
Farm Name: �F� , Owner Email:
Owner Name: l�nli/22c� �f�G/� �AOmS z/�G Phone: _
Mailing Address:
Physical Address:
Facility Contact: L Title: Phone No:
Onsite Representative: h f tl n� f40_i9� Integrator:
Certified Operator: t t_4Lj ✓ 'o Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Region:
Location of Farm: Latitude: V Longitude:
z. Design Current - Design Current Design , CurrenYr;
-;_ - - <__
Swine Capacity• Population Wet Poultry Capacity Population Cattle CapacityPopulation,41
Other
In Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures : U
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[]No
❑ NA
❑ NE
0
[]NA
❑ NE
❑ Yes
❑ No
❑ Yes IL1 No ElNA El NE
❑Yes ;LINo ❑NA ONE
Page I of 12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 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: k/
Spillway?: 1l/
Designed Freeboard (in): /9.✓
Observed Freeboard (in): 39, ,}
5. Are there any immediate threats to the integrity of any of the structures observed? El Yes yJ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) l,,,___,,,(((
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes �[I No [I NA 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 ,,,�___,,,,1(((No El NA ❑ NE
8. Do any of the smctures lack adequate markers as required by the permit? El Yes / No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) l
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 I/J No ❑ NA ❑ NE
maintenance/improvement? r,,,___,,,{{{
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes I/� No ❑ NA ❑ NE
[I Excessive Ponding El Hydraulic Overload ❑ Frozen Ground [I 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)
PA
13. Soil type(s) OR e�z '
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes VfNo ❑ 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 acre determination ? ❑ Yes No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes / No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes [;I No ❑ NA ❑ NE
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.:"I
Use drawings of facility to better explain situations. (use additional pages as necessary):
;ev ; � WRZC, ��M AIDACO"?,05 Goy; �o � .
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Phone:
Date:
Page 2 of 3

i
Facility Number: —21,,t1jDate 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 IdNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes y,_I 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 [IWeather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
1[J No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
w No
!6
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
VJ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
/❑ No
7rNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
[I NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
,�.[yJS,rNo
(ILl No
❑ NA
[I NE
and report the mortality rates that were higher than normal?
!�f
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
L4 No
❑ NA
El NE
If yes, contact a regional Air Quality representative immediately
�No
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ 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
P(No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit Q3 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other El Denied Access
� %
Date of Visit: / � � 2tQ Arrival Time: f� Departure Time: County: Region: I/I/�•
Farm Name: ��Nff� Owner Email:
G i
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title:
Certified Operator: F'aV
Back-up Operator:
Location of Farm:
Phone No:
iS Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: [c = [� Longitude: =° [�.
Destgn
Swine r•r :Capacity
❑ Wean to Finish
Wean to Feeder `� S
Feeder to Finish
Current
.0 illation
6W
''r' �f,�
Destgn
o. Wet Poultry 'C pacify
❑ La er
1 10 Non -Layer I
,,_�. "t
x `
Dry Poulry
❑ Layers❑
Current
P p lation
tt ❑
❑
Y _ ; r, ❑
❑
❑Non
❑Beef
`z „ Destgn Current
Cattle Capacity Psopulation
Dairy Cow I
I
Dairy Calf IJ
Dairy Heifej
D Cow
❑ Farrow [o Wean
❑ Farrow to Feeder
Farrow to Finish
-Dairy
Stocker
Non -Layers
❑ Gilts
❑
Beef Feeder
+
❑Pullets
❑ Boars
� ❑Beef
Brood Co
❑ Turkeys
❑ Turke Poults
❑ Other
x_,
r
-
©[_he:.-'- __ .�w' x`.
❑ Other?
m„
P ,•
REWS
Numb'er 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 ;9No Cl NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

M1
1
Facility Number: —Z(O Date of Inspection I/G
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: No
Designed Freeboard (in): �g5
Observed Freeboard (in): y 3
S. 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 )z No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes A No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes /No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes No ElNA ❑ 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 I/J No El NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ,CJ No ❑ 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 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, El Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
VJ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
G f
lot;
7f ; 'b' cow 05 l e� 4f AV-0 A'0'6.'P1_i�� LLo�E�J
Reviewer/Inspector Name 9 QBjj . I Phone: ( VIV ) fYG- 7'u°`r
Reviewer/Inspector Signature: / Date: /¢,OS

Facility Number: Z(p Date of Inspection VL1
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 CA WMP readily available? If yes, check El //////� No ElNA ❑ NE
the appropirate box. ElWUP El Checklists El Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
P(No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections
❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
XNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain minbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
IdNo
l" No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
XNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
XNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
�AA
E
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAW W?
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 Drawings:
❑ Yes
El NA
El NE
,I/J.No
El Yes /VJ No
❑ NA
❑ NE
❑ Yes 10 No
❑ NA
❑ NE
❑ Yes ,,( No
❑ NA
❑ NE
❑ Yes No
/
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
12128104

Type of Visit 41Compliance Inspection O Operation Review O lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number •• Date of Visit: Z 6 Time:
10'Not Operational Q Below Threshold
/Permitted Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: -----.-._.._._....
Farm Name: _._ County: ....... DWIP1: SL_......
______ .._._.__._.__.
OwnerName: ............. .............................--......__......._._......_............._........-----........ Phone No: ... ............................ ....................
-Mailing Address:
Facility Contact: ......................... __._......... ....... __._._....__ Title: ... ........... ___. .... Phone No: ..... ............ ................
OnsiteRepresentative: ...... CA LL.-._!PYLS !S]L.WIntegrator ............... ......_._.
Certified Operator: _....... ........... ........... _............ __............... .......... .. Operator Certification Number:._.__.....................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =' =11 Longitude =• =' =11
Wean to Feeder
> ❑ Layer
` ❑ Non -I
Feeder to Finish
Farrow to Wean
Over
Farrow to Feeder
Farrow to Finish
-t
ct-.
Gilts
Boars
I- Hot in¢:Po s'/ Solid Tian§: t
Discharaes & 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 gal/rain?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ Nq
2. Is there evidence of past discharge from any part of the operation? ❑ Yes YINP
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes O No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Struce I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ----.---.. _._......_.. .. _ __------------ ------ .... __................... .......... ........... ...... ...
Freeboard (inches):
12112103 Continued

Facility Number. a�Ll abl/ Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (iiee/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 [IYes No
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑Yes o
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type q�EfZA�(%�q 1>60 VN
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes
14. a) Does the facility lack adequate acreage for land application? ❑ Yes
b) Does the facility need a wettable acre determination? ❑ Yes c) This facility is pended for a wettable acre determination? [I Yes V
15. Does the receiving crop need improvement? ❑Yes
16. Is there a lack of adequate waste application equipment? [I Yes No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
o%
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)
❑ Yes
;�O/
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
Air Quality representative immediately.
Comments (refer to question #) Explmn any YES answers and/or any recommendations or any othercomments -
Usc.drawmgs;ijf facilrty to better explam sttpahoas. {use addrhonal pages as necessary) Field Copy ❑ FinalNotes -®�`` �
FAW AVD d2GcoF0J T4-J G c� SNNIPAS
Reviewer/Inspector Name �_ = v v A T .
Reviewer/Inspector Signature: Date:
ILUZIU1 Lonanuea

Facility Number: '� _�(� Date of Inspection'(
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes o
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 N
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes i 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 [. <0
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 o/
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes o
28. Does facility require a follow-up visit by same agency? ❑ Yes o /
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes [� o
NPDES Permitted Facilities /
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes 21SO
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
12112103

Type of Visit (�Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit/ 0 Routine Q Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit:
Permitted [3/(T' rrtifreldG U Condjtionally Certified 13Registered
Farm Name: (�r/!�/�`r / � 2 l
Owner Name: 7�IeAMK
Mailing Address:
Facility Contact: Title:
Onsite Representative: /) F(� FF/1i�nl
Certified Operator:
Location of Farm:
Time:
Date Last Operate r Above Threshold: _
County: C/�G�N
Phone No:
Integrator:
Operator Certification Number:
Swine ❑ Poultry []Cattle ❑ Horse Latitude F---l* =, =` Longitude =' =' =
Design Current
Design Current
Design Current
e Ca aci Eo pition
Poultry Ca aciri P,o ulafion Gatti-e
Ca aci Eo uiati in
ean to Feeder D
❑ La er ❑ Daieder
to Finish
❑ Non -La er❑Non-Dairrow
to Weanrrow
FEI
❑ Otherrrow
to Feeder
to Finish
Totai Design Capacity
ltsoars
Total SSLW
Number of Lagoons ❑Subsurface Drains Present ❑ Lagoon Area
❑ Spray Field Area
Holding Ponds /Solid Traps
❑ No Li uid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes XNo
Discharge originated at: ❑ Lagoon ElSpray Field [IOther
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? ❑YesONo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes E I No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes eNo
Stm tore I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ICI No
seepage, etc.) /
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes �No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidencee19f over application?
%�%� Excessive ondiinng` ❑J PAN ❑ H�aulic Overload ❑ Yes No
12. Crop type �L=J F1', %%l r/.i��" 1 /T/•fY \ 7i�ir/t c /'j l
13.
Do the receiving crops differ with those designatea3 in the Certified Animal Waste Management Plan (CA VAIP)?
❑ Yes
m No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
ONO
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
O] No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
dNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ 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
V o
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
El Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
El Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
VNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
1zNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
ElYes
VTNo
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?
El Yes
�No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
'C+i 3. t ,s a; 44 -t? # - z A Y: t2r .y4 �. •�..:�
omments (refer to question #)'Explain anyikES answers,and/or anv recommenW.dations or any o er comments.
Use drawing bf faci,Lty�,foabetieraexp)am situations (useyaddihonal pages as necessay) , Field Copy ❑Final Notes
.a 1,1, p-
.h'-
LFX 12IOF Fi1'oM Gf}Goo/✓ s SaoN ossz�F
2( C'Ct'US Z/J
0If
Reviewer/Inspector Name I --, - % _ , ?^ •_
Reviewer/Inspector Signature: / Date:
05103101 / I Continued

Facility Number: — Date of Inspection
*21—
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor 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
❑ Yes ONO
❑ Yes XNo
❑ Yes ��lo
❑ Yes No
❑ Yes ❑ No
Additional Comments and/or Drawings: „: >.:. .�,. r,.r,. '.=- .a. '4 0, rka 4 "y f: ,a - 1, &,
05103101
05103101

4
Type of Visit -ygrCompliance Inspection O Operation Review O lagoon Evaluation
Reason for Visit ',*Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3l Date of Visit: O Time:
O Not Operational O Below Threshold
E3Permitted Certified /0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .........................
Farm Name: CD �'✓I-icj _ ........................ County:. ,.12�1 tn..........................................................
....................................................................................................
Owner Name: ....... ✓% Y fl.9 y. C 't Y t.l.`�.FG r w S ......... Phone No: .......................................................................................
Facility Contact:
Mailing Address:
Title:
Phone No:
Onsite Representative: e,%'I,�.q.1..!. 17.jJT T.. r``-^a.................................... Integrator:... ✓ f � 1� { ✓ ✓t'ts ........ .... .............._............../.........................................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
[]Swine []Poultry []Cattle []Horse Latitude O• =, 0" Longitude =• =1 =11
Design Current Design Current Design , Current
_:Swine Capacity Population Poultry Capacity Po notation Cattle capaci Po ulation.;
Wean to Feeder Z $Q ❑ Layer " -. ❑ Dairy -
❑ Feeder to Finish ❑ Non -Layer I ILI Non -Dairy I I-
❑ Farrow to Wean .`
❑ Farrow to Feeder - ❑ Other ..
❑ Farrow to Finish Total Design, Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area lf
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
uisc'narees K n ream lmpac
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ............ .p.........................................................................................
Freeboard (inches): 3 I
5/00
[]Yes ONo
❑ Yes fit ,. No
A
❑ Yes No
A
❑ Yes IgNo
❑ Yes VNo
❑ Yes ,oNo
❑ Yes ONo
Structure 6
Continued on back

0.
Facility Number: 3 1 Date of Inspection B Printed on: 1/9/2001
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes b'No
❑ Yes VNo
❑ Yes ONO
❑ Yes (' No
❑ Yes 2�No
❑ Yes JgNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes RNo
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does thefacility 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?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0;- vi91u(i¢iis:oc d$f►ciencies •were pogo d oh this;visit;-You wits-teb fty uti tui titer • : -: -
:: corres ondeitce: ahotif this visit:::::::: ...............
❑ Yes No
❑ Yes No
❑ Yes )a�No
❑ Yes •07fNo
❑ Yes ONO
❑ Yes IS No
❑ Yes VINO
❑ Yes )9fNo
❑ Yes J8"No
❑ Yes JR No
❑ Yes %No
❑ Yes '-Pd No
❑ Yes ONO
[]Yes ONO
❑ Yes ff No
Be sor-e 4e n,tafe �U1/s eiccovd;.-J �0 toe#41c etcr'¢s 4zs"'Srti, •
Fac:l }�Ttd,rccora(S atre well ikefl'
Hr
Reviewer/InspectorName ..C�prLCt.jct1% J✓/Li'J�; { _f �"�,-�' a•;)?:
Reviewer/InspectorSignature: �;!U X/ Date: 3//,q/O/ 5/00

Facility Number: '3% -2 6q Date of Inspection 3 O 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 VNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes IdNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes IgNo
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 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 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? O Yes %No
5100

of Visit $(Compliance Inspection O Operation Review Q Lagoon Evaluation
for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number .Z Dale of Visit: L.11 -L.L�J Time: 13 D O Printed on: 7/21/2000
Q Not O erational Q Below Threshold
C] Permitted �Xertified ❑ Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .........................
Farm Name: CU j le`� L County:.......D" Zv' po
....................................................................................................t!..............................................................,
OwnerName: ......................... �.........r...... ................................................. Phone No:......................................................................................,
FacilityContact: ..............................................................................Title:................................................................ Phone No:...................................................
MailingAddress: ..................................................................................................................... .
Onsite Representative: ................. _...�.............At................ integrator: ............. 1.1.4.......�.`.......�..�........ Certified Operator: ................................_.•,`'�„_��"`�c�................................................... Operator Certification Number:
Location of Farm:
❑ Swine []Poultry ❑ Cattle ❑ Horse Latitude • �'°° Longitude �• �'°°
Design Current
Swipe Capacity. Population
can to Feeder
_2
❑
Feeder to Finish
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
[]Gilts
❑
Boars
Design Current Design Current
Poultry Capacity Po uI tion Cattle Capacity Po ulation
❑ Layer ❑Dairy
❑ Non -Layer I Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lag--n Area ID Spray Field Area
Holding Ponds / Solid Traps 0 ❑ No Liquid Waste Management System .
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 -matte? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) [I Yes ❑ No
c. If dischar_e 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 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4
❑ Yes No
Structure 5 Structure 6
Identifier:
Freehoard (inches): / /
5100 Y
Continued on back

Facility Number: 3 ( —2(,q I Date of Inspection Printed on: 7/2I/2000
`1 5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
Qpvo
' seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
kCNo
(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
�Wo
8.
Does any pan of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
fjjo
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
t/�
elevation markings?
❑ Yes
o
Waste Application
r
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
o
1.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑Yes
No
12.
Crop type SA."a c / cg; n
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
VNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
KNo
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
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?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'!
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0' iVo v....s. deficiencies were .... dit ... tttis:v.. 7 You ..1..eb ... t..
cofurther
-ries Tideice. tabout:this
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): _
❑ Yes ❑.., NoEl( Yes Z .
El Yes �c,L o
❑ Yes � No
❑ Yes Irro
❑ Yes jallo
❑ Yes No
❑ Yes No
❑ Yes KNo
❑ Yes ro
❑ Yes No
ElYes No
Reviewer/Inspector Name , - -I C U S 5 (16
Reviewer/Inspector Signature: Date: 5100

i
facility Number. —�6 Date of luspection 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 Wor below ❑ Yes
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
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
a
5100

Facility Number I
Date of Inspection
Time of Inspection
E3 Permitted Certified a Conditionally Certified 13 Registered C
FarmName: ..............................1............ ........ ........................................................
Owner Name:
Facility Contact:
Title:
County:
Phone No:
24 hr. (hh:mm)
Date Last Operated:
Phone No:
MailingAddress: ............ .....................................................................................
Onsite Representative: G �Q,t C.......................................................... Integrator:.......L_K.\ i^ .... ........................ ................................................
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
Latitude =• 01 =•, 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 gaVmin?
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 4No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 5f No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes EXNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ..............................................................................................................................................................................................................[..w'.......
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes o
seepage, etc.)
3/23/99 Continued on back

` Facility Number.3 1X H Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
1
12. Crop type !41-\ . %7-el
13. Do the receiving crops differ tw th 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?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes 4 No
❑ Yes �rNo
❑ Yes �j No
❑ Yes &No
❑ Yes KNo
❑ Yes QrNo
❑ Yes O No
❑ Yes NrNo
❑ Yes ONo
❑ Yes kNo
❑ Yes [�No
❑ Yes RNo
❑ Yes �(No
❑ Yes )VNo
❑ Yes No
❑ Yes No
❑ Yes �'No
❑ Yes KNo
❑ Yes 4No
❑ Yes ®'No
[I Yes 'E ` No
3/23/99

Facility Number: Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge allor below ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes yJ 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 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 No
e
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes PtNo
3/23/99

❑ Division of Soil and Water Conservation ❑ Other Agency
0 Division of Water Quality
I® Routine O ComDlaint O Follow-uD of DNVO inspection O Follow-uD of DSWC review O Other I
Facility Number
3 Date of Inspection I Llt Ilk I
M..M
Time of Inspection L, 0 D 24 hr. (hh:mm)
0 Registered m Certified ❑ Applied for Permit 0 Permitted JE3 Not Operational � Date Last Operated:
Nam
e: ante:........;Pm....V4........:�l
.............................................................................. County:... tL aN............................ ............... .......................
Owner Name:.....' .... E.,41i4 .......... a'1+.5............................................. Phone No:.. q1Q,.: .S.�d!
Facility Contact: ....V ...........:I.t1k.......................... Title: .... I.Y.lyytp�{t...................................... Phone No:
Mailing Address: ... U...X_.Za`..................................................................................hfi�t:IN7.I�t..�1G...............................................ZB�ls7f..........
OnsiteRepresentative:..... 1........its.i.S....................................................... Integrator:....................................................................
Certified Operator................................................................................................................ Operator Certification Number :.......... I...05 m.........
Location of Farm:
Latitude =• =' =" Longitude =• =' 0"
Design, ;Current Design"', Current P Design'; CurrenE
Swme,- Capacity Population,, : Poultry-_,., Capacity: Population Cattle _ Capa`city Population '
a�
Wean to Feeder 2 - ❑Layer_, ❑ Dairy '
❑ Feeder to Finish I0 Non -Layer I ,❑ - Non -Dairy
❑ Farrow to Wean
§ _ ❑ Farrow to Feeder ❑Other r `_ , ,..
❑ Farrow to Finish `Total Design Capacity,,Q
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons! Holdtng;Ponds '0. ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
s„ ❑ No Liquid Waste Management System
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 _al/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes [A No
❑ Yes V No
❑ Yes d No
❑ Yes El No
601
T
❑ Yes No
❑ Yes ❑ No
❑ Yes 0 No
❑ Yes W No
❑ Yes No
❑ Yes No
Continued on back

Facility Number: 3
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Laeoons.tioldin2 Ponds. Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure l Structure 2 Structure 3 Structure 4
Identifier:
Freeboard(f):............ 1.1.1Z .....................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
Structure 5
❑ Yes 11 No
❑ Yes 10 No
Structure 6
❑ Yes [p No
❑ Yes [B No
12. Do any of the structures need maintenance/improvement? - W 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 WNW, or runoff entering waters of the State, notify DWQ)
15. Crop type.......DLYAJI.................................................................... 5�r'J... yl;Li� ........................... _.............. ...............................................................
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
P 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?
9Yes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
®No
22.
Does record keeping need improvement?
91 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
MNo
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
IN No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
❑ No
p, No violationsor deficiencies were noted during this.visit'. You wilt receive,no furth&.
correspondence about this:visit.
'Z- gkckfir)t_ o�- 45ooi, ak'4 wa(l &6A be wwod,
11— I%%Q)tVck([ 5.�r%4 records ot. s �e • IP_R—� •t t RR-2 forms 'Wj to uced '1a d
W0.5k r+���Cbflllh owcti rh•Hr'Og¢h �OadV✓.
7/25/97
Reviewer/Inspector Name �`r
Reviewer/Inspector Signature: A& _ /'. // Date:

IQ Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection ! 47
Facility Number I u
Time of Inspection 3: Sv
24 hr. (hh:mm)
Farm Status: ❑ Registered ❑ Applied for Permit
Total Time (in fraction of hours
(ex:1.25 for 1 hr 15 min)) Spent on Review
0 Certified ❑ Permitted
or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:
.... — .... ...... _....—....—_.._ ....—....— ..... __..... �_.. �._.—_..__.......... —._._ .....
Farm Name:—..c—...:.... — .... — .......... --—....__....—.._—...._
..__ County:
Land Owner Name: ..-AVg1Mf..._ 1'rn jl....Y-1.,ow.__......_..... _..... Phone No: [g.lo�..� `L. I I I...._.....Y.... __...._..
Facility Conctact:..... Lynt1.._._ni.................... ..
Title: .SLdC4(4b..PPYSQ._. Phone No:.�1(Q�.Z$q-211„(__.
Mailing Address:6o_lc_..( ...
Onsite Representative:..... .+ .. �.�Ill �.ILI["
Integrator: _..... MW4
Certified Operator: ..... _.... .......... ...... .............. ...... _.............
............... ............ Operator Certification Number:._, k5l) ,
Location of Farm:
Latitude =•=' =" Longitude 0• =' =6
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 gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes ® No
❑ Yes
MNo
❑ Yes
NA
CR No
❑ Yes
®No
❑ Yes 19No
❑ Yes RNo
❑ Yes 0 No
Continued on back

Facility Number: ...
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes [)d 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 Holdino Ponds)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
02 No
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
10.
Is seepage observed from any of the structures?
❑ Yes
OD No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
P No
12.
Do any of the structures need maintenance/improvement?
Iff 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 ......... GClY1LI9R..,.............. .......... ._...... _...._......_SYt I. _........ ..gX.Adtn.._..
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
R No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
® No
18.
Does the receiving crop need improvement?
IR 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?
Ep Yes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
99 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?
jid Yes
❑ No
.oa,uac�w,ticicr w yuesnon s/ _ xpiam any its answers and/or any recommendations or any, other c6mments a — use
drawings of facility.to better ex'plazn sitiiafions (use addrttoiial.pages as necessary) , -�.
Iz- lc-ooK &,taus s►.ov1d 6e mowed, gees OK aru- u,a(l of (ay9eons s�.oufd be ��� doah- Q
18 CO"s crap sWa 6_ lwt d rov or filltd under aid wtrx for
srnu,(I 0r 11A oam� dir.
+�'X G.tl - tt1 f l 11
sZ. "54(- LA_'("t-A'Oh plan N trmiiS1vtt� � TAy h's-ttitj Th1k �ttc(ds of [Xt}n `�pv.
Z4. k �P of � sp" AAA ShOVO 6e �n � A(wx. 5tt2W recfird_s I5lwu(J be-
V_q� by roAvv&/V'w1 I aiJ rfr(J 4t-s l I
Reviewer/Inspector Name =
Reviewer/Inspector Signature:
Date:
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires Immediate Attention:
Facility No. 31 - Z (,4
DIVISION OF ENVIRONMENTAL MANAGEMENT
• ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 1995
Time: 13t5
Farm Name/Owner: 6J2,-4)4A-
Mailing Address: 1 y -),-7 & K C. ;61, _
County: Ll < <`-
Integrator. ON"14
On Site Representative:
Physical AddressA ocati
Phone:
wr°S2 oos- ;2 w ht S• dl it
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: 3(,0" &,t ien4 Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: >j ' o � ' 5 10 " Longitude: -71 �� 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) �r No Actual Freeboard: - L4—Ft. '0 Inches
• Was any seepage observed from the lagoon(s)? Yes oreo) Was any erosion observed? Yes or
Is adequate land available for spray? Des No Is the cover crop adequate? Co or No
Crop(s) being utilized: ; L,� S pa,.��{a1 o ,l at a_& R-k P , 1 R't w�
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings9 lQ or No
100 Feet from Wells? & 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 orq
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other vv
similar man-made devices? Yes o& If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applid,'���
spray irrigated on specific acreage with cover crop)? Yes or No 7&' 071t f� l
Additional Comments: b _ C c v PAK- o U,
• -,� L-w9e,t —
Inspector Name
Si a ure
cc: Facility Assessment Unit Use Attachments if Needed.