820697_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Divislon of Water Resources
Facility 1`TUrnbe R z— Division of Soil and Water Canservation
OO Other Agency
Type of Visit: erCiMpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: O Departure Time: County: _ Region: �Z1
Farm Name: 9-1i ,& C rr-�--R Aut "— . Irv► -- Owner Email:
Owner Name: _ %p ��{ ��e rt i Z-6 _ Phone:
Mailing Address:
Physical Address:
Facility Contact: _U�nrr;f�r �arr i�%s Title: Phone:
Onsite Representative: S' ,�� Integrator: r
Zyj
Certified Operator: Certification Number: AAsc I
Back-up Operator: Certification Number: a
Location of Farm: Latitude:
Longitude:
Design Currents
Design
Current
Design Current
Swine
Capacity 10 -:
s.
Wet.Poultry
Capacity
Pap.
C►attle Capacity Pop.
Wean to Finish
I
11-ayer
DairyCow
Wean to Feeder
614100'-
Non -La er
I
Dairy Calf
Feeder to Finish
"
--
Dairy Heifer
Farrow to Wean"
.
Design
Gurrent . --DryCow
Farrow to Feeder
Farrow to Finish
9D
. Pohl Ca sc1 Po
I Layers Ii
Nan-Dai
Beef Stocker
Gilts
Non -La ers
I
113eef Feeder
Boars
Pullets
Beef Braod Cow
k s
Turkeys
Other
Turkey Poults
Other
Other
Dischartres and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other.
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes El"No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [D No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

`[Facility Number: - 7 Date of Inspection:
Waste Collection & Treatment
N
4. Is storage capacity (structural plus stonn storage plus heavy rainfall) less than adequate?
❑ Yes
E
❑ 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): a�
Observed Freeboard (in): _yam
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑'I�lo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
Ej n'o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
[] Yes
0 o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�o
❑ 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
2r'�o
D NA
❑ NE
maintenance or improvement?
Waste Application
No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �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 E�No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes En'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
D—No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Er -No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
nNo
❑ NA
❑ NE
the appropriate box.
❑ WUP [I Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E] No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [] Yes E f No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes []. Io ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - 7 Date of Inspection: 6:w— /"
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EK0
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes To
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 ED<
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E3-<o
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 GAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑Yes Ea' o ❑NA ❑NE
❑ Yes [ENo ❑ NA ❑ NE
[:]Yes 2 No ❑ NA ❑ NE
❑ Yes E3-1�o ❑ NA ❑ NE
ED Yes [a No
❑ Yes E5<o
❑ Yes �o
❑ NA ❑ NE
❑ NA ❑ NE
[] NA ❑ NE
Comments (refer to.question #..Explain any YES answers and/or any additionatri ecommendations or any other. comments
Use drawuigs of facility to better. explain situations {use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: �Zy0—
Date:
21412015

t
i ype of visit: teMompliance Inspection V operation Keview V Structure Evaluation U l echnical Assistance
Reason for Visit: outine Q Complaint Q Follow-up O Referral © Emergency Q Other Q Denied Access
Date of Visit: i^ t 7 Arrival Ti rm-e: , O c`� Departure Time: County: Region:
Farm Name: (r Z-Y 1� 40;2 Fd►P Owner Email:
f or
Owner Name: U-0d 6f '4--> a ;' C ) j Phone:
Mailing Address:
Physical Address:
Facility Contact: ar,-/tl r/~J�L?-1 �ls Title: Cpd_i.J Phone:
Onsite Representative: «��� Integrator:
Certified Operator: Certification Number: �3�1
Back-up Operator: V-O d „` i i~ /S Certification Number: t�L��1-
Location of Farm: Latitude:
Longitude:
Design Current Design Current
Design CurrentMA2u1Cr;._aD`aciLMW
Swine Capacity Pop. Wep. Cattle Capacity Pop.
Wean to Finish Layer IDairy Cow
Wean to Feeder fwf Da G,19V I iNon-Layer I Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Dry Cow
D . P,oWt . Ca aci P,aINon-Datry
Layers Beef Stocker
Non -Layers Beef Feeder
Farrow to Finish
Gilts
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 0 No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[:]Yes
[:]No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
[:)Yes
& No
[] NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
X] No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? 0 Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?. -
Designed Freeboard (in):^
Observed Freeboard (in):^
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 property addressed and/or managed through a
waste management or closure plan?
® No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes R No ❑ NA ❑ NE
❑ Yes CNo ❑ 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 ja No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes a3No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes O-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 7-f ►t c� /DEN' /?7 % � r d� i ,60 4,5
13. Soil Type(s): p W
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 3 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?
18. Is there a lack of property operating waste application equipment?
❑ Yes allo ❑ NA ❑ NE
❑ Yes ES�No ❑ NA ❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Q No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [x_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 ,�4 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes 10 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes Eq-No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Facili Number: Date of inspection: /]
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes El No ❑ NA ❑ NE
• 25_ is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes l4 No ❑ NA ❑ NE
the appropriate box(es) below.
El Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
El 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? Cl Yes M No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
tgNo
❑ 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
JZ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
VNo
DNA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
Eg No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
&, No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
C!�No
❑ NA
❑ NE
answers and/or any�addthonal recommendations nr any;othercomments.
Use drawmes of 'aeditvto better ex lExplain setuahans ^' � ' y "` (use�addittonaLna�es as.necessarvL _ °:..: .. �» w-
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date: 6 Z/Li�
21412015

Type of Visit: I-Com"lice Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: outine Q Complaint O Follow-up 0 Referral Q Emergency 0 Other Q Denied Access
Date of Visit: 7 _, Arrival Time:' Departure Time: County:. Region:/ D
FarmName: �Ji Cy rz-1� C7��a�W�� Owner Email:
Owner Name: 1 e) a.►ti 'i r� S Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: 45-awn rf— Phone:
Onsite Representative: ��rt n i-Fi-! l -n—L 21f
Certified Operator: S'ff
Back-up Operator: 7b dOt vaj2
Location of Farm: Latitude:
Integrator: -5'2V'P-"
Certification Number: ,7 '/
Certification Number:
Longitude:
$wine
Design Current
Capacity Pop.
Wet Poultry
Design
Capacity
Current
Pap.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Finish
I
11-ayer
Wean to Feeder
Feeder to Finish
Farrow to Wean
,�
Cp 0v
Non -La er
Design Current
D . i!oui Ca ac' P.o ,
Layers
Dairy Calf
Dai Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Boars
Other
Other
Non -Layers
Pullets
Turke s
Turkey Poults
I 10ther
113eef Feeder
Beef Brood Cow
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 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 ULNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
❑ Yes [] No
❑ Yes Jallo
❑ Yes C3.No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 2/4/2015 Continued

[Facility Number: - Date of inspection: 7--
/b
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
allo
❑ 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): _ 42Z(I
Observed Freeboard (in): 3 S
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
fia No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
0 No
❑ NA
❑ NE
8. Do any of the structures 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
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
RZ No
❑ NA
❑ NE
maintenance or improvement?
1 I. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes B-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 Cropj Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crap Type(s): f�Y/Yi1�[de� rrCs�'� /st r- f�.r
13. Soil Type(s): f
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes allo ❑ NA ❑ NE
l5. Does the receiving crop and/or land application site need improvement? ❑ Yes [a No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ERNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[] Yes �&No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes rNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes J�] No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists []Design ❑ Maps ❑ Lease Agreements ❑Ocher.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes SINo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes IN N
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �-N
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
o ❑ NA ❑ NE
o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Ins ectian: — 6
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ED-No ❑ NA ❑ NE
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes PSNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes M No [] NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 21 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 Z No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes 0 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 J. No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes O No
❑ NA
❑ NE
33. Did the Reviewer/Tnspector fail to discuss review/inspection with an on -site representative?
❑ Yes M No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency%?
❑ Yes QSNo
❑ NA
❑ NE
el_raw�ngs ofm actlt y to better explain situatEansi(use ad lattonal:,pages,as�necessary} A d f
avp
1g-j' r q'�
7,/f1 r7
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone:T
Date: , _7 �4 %4g
21412015

4 7— U 1 .4--
11t
Type of Visit: ;'Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: e'Routine O Complaint 0 Follow-up O Referral 0 Emergency O Other 0 Denied Access
Date of Visit: ® Arrival Time: F_/_9­77 Departure Time: '. County: �� Region:
Farm Name: _L42 ; 26 y C f'td k �ry �arryu Owner Email: �'
Owner Name: _ "�p ��cyti 1 r-I s Phone:
Mailing Address:
Physical Address:
Facility Contact:
/
Title: _ gP6z.)/2
r-✓ Phone:
Onsite Representative:
Tz`er1,
Integrator: 4113
Certified Operator:
Tr_r7 n i f �r
S�a-`c 1 r-I S
Certification Number:
Back-up Operator: _ 7_0 ol Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop. Wet Poultry
Wean to Finish Layer
Design Current
Capacity Pop.
Design Current
Cattle Capacity Pap.
Dairy Cow
Da' Calf
Wean to Feeder
pt]
Non -La er
Feeder to Finish
D . P,oul
La ers
Design Current
Ca aci P,o
Da' Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Turke s
Other Turkey Poults
Other Other
Discharges and Stream Impacts
i . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify 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 J2,No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
[::]Yes [—]No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ONE
[] NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Facility Number; - Date of Ins ection:
Waste Collection & Treatment
1+ 4. 1s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [] Yes Eig-No
a. If yes, is waste level into the structural freeboard? [:]Yes ❑ No
Identifier:
❑ NA ❑ NE
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 30
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ZNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[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 DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
C!�No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
F;Q No
❑ NA
❑ NE
maintenance or improvement?
Waste Avolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
PAN0
0 NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes JFJNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 109/6 or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Wind/ow [] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): ZrLm_ �-
13. Soil Type(s): Zt 7 l]f�
14. Do the receiving crops differ from those designated in the CAWMP? E Yes ❑ No [] NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes F No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design ar wettable [:]Yes 0 No ❑ NA ❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
18. 1s there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes ®,No ❑ NA ❑ NE
0 Yes [54-No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E,No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
DSNo
❑ 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
[&No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
70 No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

FFacWty Number: Date of Inspection:
h 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes VINo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check [] Yes 1:2 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 J.No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ® No
D NA ❑ NE
Other Issues
28_ Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes EZ No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAW MP?
❑ Yes 25 No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes gNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes CE�No
❑ NA ❑ NE
Comments (refer -to -question #l): Explain any YES answers and/or; any: additional recommendations or any other.comments'_ W ;
Use drawings: of facility to better explain situations (use additionalf pages as necessary).
5
CD41 ac¢�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
.21412011

Type of Visit: 8Tompliance Inspection Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: t3r1fo'utine 0 Complaint 0 Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ; as Departure Time: Dca I County: rS�.� Region:
Farm Name- LU t7naf, tC 'q&' �
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: (- j r �� _ Title: Phone:
Onsite Representative: r-7;:n A -" ^� i � � Integrator:
Certified Operator: 12 n ;NYC CL___-�2h.4-- 14 Certification Number:
Back-up Operator: .—�nr dre rt y f� Certification Number: �#•��}
Location of Farm:
Latitude: Longitude:
Design Current
e Capacity to Finish
r
Design "'Current
La er
Design Current
Dai Cow
to Feeder
P�4
11C3p
Non -La er
Dai Calf
er to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
hk
Designer Current
D . P.oul Ca acity - 1?0
Lavers
DairyHeifer
Cow
Non -Da'
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
-
Otber
Other rE
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
t . 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)?
0 Yes R.No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d" Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any pan 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
[:]Yes No
[:]Yes No
❑NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection: — f
Waste Collection & Treatment
�y 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E&No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2. Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): k
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
RNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
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 DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
&jNo
❑ 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
[gNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 5�[No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10lbs. ❑ 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 Z,_9 Zt Jwd
14. Do the receiving crops differ from those designated in the CAWMP? C] Yes [Z No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes Q No ❑ NA ❑ NE
❑ Yes [D No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
R No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
PNo
❑ 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
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
CR No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

FWeili Number: - Date of Inspection: - 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 5QNo ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [RNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32_ Were any additional problems noted which cause non-compliance of the permit or 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
CgNo
D NA
0 NE
❑ Yes
P, No
❑ NA
❑ NE
❑ Yes
CR No
❑ NA
❑ NE
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes ® No 0 NA ❑ NE
❑ Yes E] No ❑ NA ❑ NE
❑ Yes ® No
[:]Yes No
[:]Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explatn.any YES answers and/or any additional recommendations or any other comments:'
FR_ a
tlse drawioks of facility to better explain situations (use additional pages as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone:
Date: 61Li
21412011
Page 3 of 3

L .
jType of Visit: ¢6 Compliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance I
(Reason for Visit: ekRoutine Q Complaint <D Follow-up Q Referral O Emergency O Other 0 Denied Access 1{
Date of Visit: �-Ead I Arrival Time: ' Departure Time: L County: �_ Region: FIB 0
Farm Name: IlYe4v Ccmk Hog 617fm
Owner Name: T
Mailing Address:
Owner Email:
Phone:
Physical Address:(iriG�:?(li� IiCil �tu
Facility Contact: � ;Q Title: Phone:
Onsite Representative: T & d . _ Integrator: —1
Certified Operator: 0�e/UiKff lP_ls Certification Number: c;03V
Back-up Operator: Certification Number: QQY
Location of Farm: Latitude: Longitude:
Design Current
MSWwiffineCpa�city
Design Current Design Current
I.
Pop.
Wet�PoultryCagactopt Cattle Capacity Pop.
Wean to Finish
La er DairyCow
Wean to Feeder
Non -La er Dai Calf
' "' ` - DairyHeifer
Feeder to Finish
Farrow to Wean
x�w
�g� . C+tirrent Cow
Farrow to Feeder
D , P,oult , � .a act . .0 . Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
look —
TurkeyPoults
ErOther
1F Other
Other
Discharees 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 Ej No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes No
❑ Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 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 �ZNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): a r___
Observed Freeboard (in): 3!9 ^�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes [S'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 MNo
❑ 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 [51'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes CgNo
❑ 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 [RNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes CgNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes [5j 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): !>7 ! S 1I
-
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [5j No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes ER No ❑ 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?
18. Is there a lack of properly operating waste application equipment?
❑Yes ®No ❑NA ❑NE
❑ Yes �R No ❑ NA ❑ NE
Required Records & Documents
19_ Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes FK] No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes IV] 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 1,;0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [:]No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
El NA ❑ NE
Page 2 of 3 21412011 Continued

• Facili'Number: $ - Date of Inspection:
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 6Q-No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
2& 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.
❑ AppIication Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ® NA ❑ NE
❑ Yes ®' No ❑ NA ❑ NE
❑ Yes 15 ' No ❑ NA ❑ NE
❑ Yes C'No ❑ NA ❑ NE
❑ Yes
allo
❑ NA
❑ NE
[:]Yes
Jallo
❑ NA
❑ NE
❑ Yes
[RNo
❑ NA
❑ NE
❑ Yes
FUN.
[:3 NA
❑ NE
Comments (refer to question f: Explain any YES answers and/or any additional recommendations or any other comments ' ;,
AfM � �f
Use drawings of facility to.better explain situations (use additional pages as necessary). �"
as's� �x'a, u�rtil ao�y,
�mt, fi�,la��4 �PtD�r in9�slhe�,
Onlr pret.+vrce, s iW
Reviewer/inspector Name: 'JoLU1 schnfifc Phone: 11 0-l IlIZ t
Reviewer/Inspector Signature:
Page 3 of 3
Date: Nav iaaoU
4/2011

-Lagoon Name. S for'.s illwa .
1
2
3
4
5
B
7.
Design Freeboard:l.Last. Recorded in
Observed freeboard::::
Sludge Surve . Date!-':
Slud a Depth! ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment�Volulne if> 0.45
Date out of compliance/ PO ?:
LtAIETT-7ri;oFIFAI ]U wArrm.rdI�
-Actual Flow
Design Diari-
. I I R 1 -
r S#
hS i'--_---
Soil Test Date C Crop Yield 6t amll a01 a. Transfer Sheets
pH Fields j Wettable Acres RAIN GAUGE
Lime Needed! Q $ .% 41 UP ✓ Dead box or incinerator
Lime Applied , Weekly Freeboard ✓ Mortality Records
Cu-I -L*1n- 1 in Inspections :, Check Lists
i :.CW 120 min Insp. ✓ Storm Water
Needs S (S-I425)
Needs P`.i1'6)Cf Weather Codes
pal
Verify PHONE NUMBERS and affiliations
Date last WUP FRO 44jblb j FRO or Farm Records
Date last WUP at farm) Lagoon #
App. Hardware ' Top Dike 47'}`
Stop Pumps 3
I :,� Start Pump biz
Conversion- Cu-13000=108 Ib/ac; Zn-I 3000= 213 lb/ac 3

elms �1 51a� tra,
Type of Visit: 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 0 Denied Access
Date of Visit: [ - iAg1 1] Arrival Time:
7T' Departure Time: j �C /�}, County: Region:
Farm Name: YV'P! Y� U 0- ri ! Fil Owner Email:
Owner Name: �Q/1 j P (S Phone:
Mailing Address: �g Q MG N911 l 0 , Pw h)/V
Physical Address:
Facility Contact: Tf)dd V0ArTitle: nrvnq- Phone:
Onsite Representative:
Certified Operator: zenn i-i�n( DCh►Qls
ovrho
Back-up Operator:
Location of Farm:
Latitude:
Integrator: M"_G
Certification Number: oQ Ss 1
Certification Number: 0)0)5%
Longitude:
Jill
Design Current -Design Current
Capacity
Design Current
Caacity Pop. Wet�Poultry Pap
Cattle
Capacity Pop.
Dai Cow
Finish
La er
rrFarrow
Feeder
Q
Nan -La eri
Calf
Finish
Dai Heifer
o Wean
"` Design Current
Cow
o Feeder
D", aPoult%y` Ca aci. Pao .
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
I Beef Feeder
Boars
Pullets
jBeef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes Wo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
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
❑ Yes No
❑ Yes V<No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - pate of lns ection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. if yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?: _
Designed Freeboard (in): Q42
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
tZ No ❑ NA ❑ NE
[]No ❑ NA ❑ NE
Structure 6
❑ Yes RNo ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
CKNo
❑ 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
R No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
allo
❑ 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
N'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
R No
❑ NA
❑ NE
maintenance or improvement?
11 _ Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
U'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): k
13. Soil Type(s):Caf i —5me /27
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
CR No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
1>—a No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
J�j No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�Rj No
❑ NA
❑ NE
IS. Is there a lack of properly operating waste application equipment?
❑ Yes
CRNo
❑ NA
❑ NE
Required Records & Documents
19_ Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
CR No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
(3 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 allo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes rX No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
NA ❑ NE
Page 2 of 3 21412011 Continued

11 Faci lity Number: - Q Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [RNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [' No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes allo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No !&a NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes j No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application) TT''
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
Qjj�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
CRNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[]Yes
No
❑ NA
❑ NE
Comments (refer to question #} Explain any YES answers and/or any additional-recoinmendations or any other o—Mi6ent`s�.
Use drawl of facility to better explain situations (use additional pages as necessary).
N� WO(k Dn (S©Q S J )Qgoch ,
15, Limes 1 ej� 1peagnbo 3/Y fo, /atve
Vvi` (I ne,-j Ca 11 bAuh --);' f , SI B e svve hreidola,
Q_ C_1eAa-+ dole- loYry:iar oidlot
�S on �7 - once s'6� s1 !) I A y
a olc'� ) Of pof
Fol m-Fi ddl Gnd lewd - 1/) f v$ 9o'zt Shole,
Reviewer/Inspector Name: oM SrJ7f e1P Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3 24120111

Facility No. gad Farm Name Y�y �(� Date
Permit COC ✓ OIC_ NPDES (Rain breaker PLAT Annual Cert Daily Pipe )
FB Dro s
Lagoon Name, S forspillway
1
2
3
4
5
6
7
Design Freeboard 1 Last Recorded in
Observed freeboard
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA7
70rfi
Soil Test Date j
pH Fields
Lime Needed
Lime Applied
Cu-1 '\/ Zn-I ,!
Needs S (S-1<25) ✓
Neeas v
Waste E
- 60 Day
+ 60 Da!
N f1b110C
1 510r' V 10g'� r)"4f%
Crg94 -p Yield
Wettable Acres
WUP
Weekly Freeboard *.
1 in Inspections
120 min Insp.
K11
-1 000f *Transfer Sheets
RAIN GAUGE
Dead box or incinerator
Mortality Records
Check Lists
Storm Water
Verify PHONE NUMBERS and affiliations
Date last WUP FRO 3( FRO or Farm Records
Date last WUP at farm (�fp p3 Lagoon #
App. Hardware K-o a 51 Top Dike
Stop Pump
Start Pump
Conversion- Cu-1 3000= 108 Iblac, Zn-I 3000= 213 Iblac
I

I C.
0
t ype of visit: U Compliance Inspection f) Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: I$k Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Arrival Time: R=s
Departure Time:
County:���
Farm Name:Miy
Cteek `T3ca
r/rf t
Owner Email:
Owner Name: ��(�
�Q J� L��
Phone:
Mailing Address:
Region:
Em—
Physical Address: _� kL r ePow-bat)
Facility Contact: 0 Title: w/jC Phone:
i
On site Representative: d Integrator:
Certified Operator: J �An r l Certification Number: S
Back-up Operator: Todd— ho j els Certification Number: o �
Location of Farm:
Latitude:
Longitude:
1111111 jig
Design�zCurrent
Des�gnCurrent
- Design Current
Swine Capacity Pop.
Wet Poultry Caaci� Po
p ty�, �;
Cattle Ca aci Po
p ty p•
..
Wean to Finish
La er
Dairy Cow
Wean to Feeder 6400
n-La er I
airy Calf
Feeder to Finish
-'s ' ,eta
airy Heifer
Farrow to Wean
�- Design'Current
rr
D Cow
Farrow to Feeder
D . P,oul Ca aci S Po
Non -Dairy
Farrow to Finish
Gilts
Boars
...:,: _ ......, ,1.
Layers
Non -Layers
Pullets
Turkeys
Beef Stocker
Beef Feeder
Beef Brood Cow
tither
Turkey Poults
Other
Other
Dischar gs 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)?
❑ Yes f'No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
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
❑ Yes No
Yes [:]No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page l of 3
21412011 Continued

Fac'li Number: a. - Date of Ins ection:
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:
Spillway?:
Designed Freeboard (in): �3--
Observed Freeboard (in):—`
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes CK 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 Callo ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
® Yes ❑ No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes No ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes tg 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
KSL
❑ 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 Types): Copa,iO tRn1eL $ pGitYr sl?1Qi (/rFil�t Dom$ S
!A--pppr11ovv�ed
t
,rrt�i�t . It'd1Ta7Q/
13. Soil Type(s): �Q A f1l A% Wt, A golk jpgx S&t >ti6A
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? Yes 0 No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes V9 No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:)Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
Page 2 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
ZjNA ❑NE
21412011 Continued

Facili Number:2k- Date of las ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes to -No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structures) 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 QRNA ❑ NE
Other Issues
2& Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes El No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes F0 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. 0 Yes W 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 K No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes CK No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 13rNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations orrany other, comments."
Use drawings of facility to better explain situations (use additional pates as necessary).
5Mme, m o/e As IM-4-) c©w fA below darn hi - n6fPv--fA( 11/
aRIes, Soil is vvash)�7 e
0-fa4� bot lqoa-� W i
f �cn h a �1- a 1� f PQ � l ;s , n Drk aceP
S' �d lei d id plot` fande o� �mnt
�4 h►or Ino1� � i ri, d'h �A W � � S� ,� �-
d �vr�a of a� o ���'�y , s1�d� was s�r�do2 07 0
�Jl � -h hl �� � . e
10 -GeV
5 we chi �'` � i p� U°� � �C c cv�� e �'
tm i�sr- ofire" Sl �dy� �a0Perrvor and d
WeA MA+41,� *n ad-J ocd r�cmc�c
Reviewer/Inspector Name
&arlo pplo, )ajJ40KPe-
so;1 t� 'fog 1aj
Reviewer/Inspector Signature:
Page 3 of 3
Date: ,TV.lt? aLr1)611
21412011

Facility No. Fam1 Name _N� q� Date
T /
Permit COC OIC ✓ NPDES (Rain breaker
PLAT Annual Cert )
---
La oon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
Li uid Trt. Zone ft
Ratio Sludge to Treatment Volume
­11,afta a srrcr
Calibration Date
1,esign Flow
Design Wi Ali
Actual Width
Soil Test Date �Q Wettable Acres Vol" RAIN GAUGE
pH Fields WUP Dead box or incinerator
Lime Needed �lo� Weekly Freeboard Mortality Records
Lime Applied- 1 / 1 in Inspections
Cu-I \/ Z - 120 min Insp.
Needs P ND�r Weather Codes
Crop Yield Transfer Sheets
. 000
,
J
Pull/Field
.
.
MIT.,
Verify PHONE NUMBERS and affiliations
Date last WUP FRO JgJ03 Date last WUP at farm
) qq� (-ff� 1
FRO or Farm Records 30
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-1 3000= 108 Ib/ac; Zn-I 3000= 213 Ib/ac
App. Hardware
hid k0- -5I ud yr P451 -
See bocLt

10,3Acno*h
if 114010 F-,a �A �S

n
Type of Visit (9 Compliance inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine Q Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: � Arrival Time- �Departure Time: � County: Samsamoso, Region: FRO
Farm Name: WPA&
I Cfn l�Cd _ Owner Email:
t
Owner Name: _ �� � ,_h lam_ Phone: --�.���� �QQ
Mailing Address: l t or+'ad W� �G.f�^
Physical Address:
Facility Contact: Title: NAO— Phone No:
y, �
OBsite Representative: Integrator: t l� I?
Certified Operator: -jf (1AA- oon Operator Certification Number: QQ5 l
Back-up Operator: CIAO% I D41_e�[_ _ Back-up Certification Number: a S5-
Location of Farm: Latitude: ° a Longitude: °
Design Currenfi
Design Curren!
Design Current
Swine C►opacity Population
Wei Poultry Capacity Population
Cattle Capacity Population
❑Wean to Finish
❑Layer
❑ Da Cow
Wean to Feeder 0
❑Nan La er
❑ Da Calf
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
_._.
I)ry�Poutlry
❑ La ers
❑Non -La ers
❑ Pullets
❑ Turkeys
❑ Dairy"eifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Cow
.
Other
❑ Other
❑Turke Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes -RNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
El Yes
[I No
❑NA
❑NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
09:j to
❑ NA
❑ NE
[]Yes
1KNo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number:. — Date of Inspection 11V_S�J_LLZI
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Wo ❑ 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). a �
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes V 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 JP -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 puhlic health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes Nallo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �ZNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes I)_i'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ja No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes N No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 1 O 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) CflladPaia I kVh 6 ArAw Shmi i Gi ,
13. Soil type(s) 1F flnf iA, i.S wag t khr "`9 I k 1.0 i W nAr
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
14 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
1�3 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
P7 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
CgNo
❑ NA
❑ NE '
�Comm&ifi (refer to question'#) ExpWjViiny-YES answers and/or any:recommendations or any other comaien&
Use dtawrngs of facility, to better explain situations. (use additional pages as necessary):'
IReviewer/Inspector Name Phone: l� �-33 I
Reviewer/Inspector Signature: Date: c Oct o a an
12128104 Continued

t Facility Number: a Date of Inspection w (
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? lfyes, check ❑ Yes rffNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 'Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes No
❑ NA
[INE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
No
DJ:NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
54 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No '*Q NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
BNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
J�allo
' ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
VNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
2fNo
❑ NA
❑ NE
AddQ61 Comments and/or Drawings;
You %t po
a �
Goa$ Cover 0n
� y I
weff MOPA— 4 441
Hiui_+ ,1sf9raieddow,, - rye P%40
Page 3 of 3 12178104

Facility No!$c_�_Farm Namey �f( Date
Permit rl COC OIC! NPDES (Rainbreaker
PLAT Annual Cert )
---
� MM ME
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date 'A lAcr
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
Q.. Ali 1
Design
—Actual Width
Soil Test Datechvcl�&U Wettable Acres RAIN GAUGE
pH Fields C WUP Dead box or incinerator
Lime Needed Weekly Freeboard ✓ Mortality Records
Lime Applied 1 in Inspections ✓
Cu-I _jZ Zn-1 u_� 120 min Insp.
Needs P Weather Codes
Crop Yield Transfer Sheets
Pull/Field
Soil
Crop
Acres
PAN
Window
Max Rate
Max Amt
NuAt
d r
-
�IT
.,
nn
Y
^�
F V v
0,
tJ
Verify PHONE NUMBERS and affiliations
Date last WUP FROG j, Date last WUP at m yri
w� OPOVA. ((;, ) 13"" rvj; 1
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump'�5's
Start Pump ,4 &
Conversion- Cu-1 3000= 108 Iblac; Zn-I 3000= 213 Iblac
App. Hardware Aoe 1

Type of Visit ®CCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit §kRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �,,�� Arrival Time: 1�0,1P11 Departure Time: �.� County: Region:,526
Farm Name: i fin? Owner Email:
�hh Owner Name: T�O� OOA; 1 Phone:
Mailing Address: t I 0 3! did
Physical Address:
Facility Contact: 1La ID D% ! S Title: lJW11$^ Phone No:
Onsite Representative: TDAL Q�1i Integrator: �}
Certified Operator: .a-pnn l�7 _ f �� Operator Certification Number: a�` 'AW'`
Back-up Operator: Owl-er T Back-up Certification Number: 0a53-0
Location of Farm: Latitude: = o = 1 = v Longitude: = o = , = "
Design,- Current
Swine Capaty_ Population Wet Poultry
Design Current Design Current
C►apacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
Wean to Feeder
QP2
1 ❑ Non -Layer I
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
n
Number of Structures:
❑ Feeder to Finish
❑ Farrow to Wean
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Turkeys
10 Turkey Poults
JEI Other
't e
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�9No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ffNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
21"No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

1
Facility NumberSja, —6q Date of Inspection Uhcj
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?
Stricture l Structure 2 Stnicture 3 Strlc11fri 4
❑ Yes �QNo ❑ NA ❑ NE
❑Yes ❑No [I NA ❑NE
Strueture 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
)i5No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
CKNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑Yes
No
❑ NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
rsNo
❑ 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) & M'IdDL 4kya PA(c.Sd1w` 24"y� t 6 os —AlQZ-e—
_
_ —
13. Soil type(s) Nam., b_ 11f&1 Q 1"-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
D 'No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�RNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
El Yes
CR No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Cg`No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[�yNo
❑ 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):
I
'�
Reviewer/inspector Name Pbone: Y A'r 3
Reviewerllnspector Signature: Date: a
v ruralvr c.onan"ea

15%
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
);rNo
❑ NA
❑ NE
❑ Yes
)S No
❑ NA
❑ NE
❑ Yes
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 V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
❑ Yes
IR No
❑ NA'
❑ NE
❑ Yes
A No
PS NA
❑ NE
❑ Yes
79 No
❑ NA
❑ NE
❑ Yes
LI No
❑ NA
❑ NE
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
❑ No
�? NA
❑ NE
❑ Yes 'RNo ❑ NA ❑ NE
❑ Yes
0 No
❑ NA
❑ NE
Cl Yes
%[ No
❑ NA
❑ NE
❑ Yes
V No
❑ NA
❑ NE
❑ Yes
%No
❑ NA
❑ NE
❑ Yes XNo ❑ NA ❑ NE
Limes f�ebaooq ,
�I�� arm rna[� do�•l �-Iv a b `'. C�rr��� �a��ed -Fo Ma^k-e, har
�• tr `v,� hit �a1�ed o 11-1�e- rva .
6) A reood o Egad � d IS �y ,J %
vg n'�f-n?a'1l��°�C
TOM) ohd r�cArdr �'
Far, h aS. PEPS ,
12128104

Facility No. Farm Name WAd CleDate ktlo
Permit L-,-,' COC OIC^ NPDES (Rain breaker PLAT Annual Cert)
Po . T e Des!n Current
■ter
Lagoon
1
2
3
4
5
6
.7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
�p
Sludge Depth ft & %
3.Z
Liquid Trt. Zone ft
3
Calibration Date
160M
2
3
4
5
6
7
8
Design Flow
141-
Actual Flow
t500
Design Width
0
Actual Width
'a
3
Soil Test Datel6%l
pH Fields ✓
Lime Needed n—
Lime Appl
Cu Zn
Needs P ,
il f
poCrop Yield 6raw-,�
Wettable Acres
WUP
Weekly Freeboard ✓
Rainfall >1"
1 in Inspections
120 min Inspections ✓
Weather Codes
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
of ..
96 Field
Soil
Crop
RYE
PAN
Window
Max Rate
Max Amt
--
0?0
4�p
I
N
30
—o
�i
3
1
qD
_
W _
Verify PHONE NUMBS S and affiliations
Date last WUP FRO Vo,3 Date last WUP at farm 6�C9— App. Hardware
FRO or Farm Records
Lagoon #
Top Dike q-,)- I
Stop Pump 4),t)
Start Pump
� r3
40) vMfr,-ev-

. � nrMr D-vJ oal jglaff--
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: �� County: SP2 f Region:
Farm Name: W. G ok i@ DWni Owner Email:
r
Owner Name:�D� __ 1 iA�C Phone: Mailing Address: 1a`ao 11611111, 119- 31
Physical Address: nn I /1
Facility Contact: TiW d.J& !ta S Title: �1 �'V/1�/'' Phone No:
OnsiteRepresentative: Integrator: N y"tuloli*r1
Certified Operator: 3eMiAl)_ Vali��f Operator Certification Number:tshaa1SS'
Back-up Operator: �J &h l e U Back-up Certification Number: A aa3's6
Location of Farm: Latitude: = o = ` = Longitude: = ° = ` "
N16,0001-afionWet'P
- rtolpfirirrV All
esign
a --
@urrent Design Current
wine
ult
-THYj Capacity
PopulatlonN Cattle Capacity Population
VILE er
❑ DairyCow
'❑ Non -Layer
„ ❑ DairyCalf
�� ❑ DairyHeifer
'�
❑ D Cow
vDryPonit
❑ Non -Dairy
❑ Layers
❑ Beef Stocker
❑Non -La Non -Layers
El Beef Feeder
El Pullets
Beef
❑ Brood Co
Y ❑ Turkeys
Other
❑ Other
�F ❑ Turke Poults
4 ❑
�Numher Structures:
Other
of
❑ Wean to Finish
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑Gilts
❑ Boars
Discharges &Stream Impacts
1. is any discharge observed from any pan of the operation?
❑Yes
JN No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑Application Field ❑Other
a. Was the conveyance man-made'?
El Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (]Eyes, notify DWQ)
❑Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑Yes
CffNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑Yes
JErNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

It
Facility Number: OOX — Date of Inspection Q
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes IN No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): afo
Observed Freeboard (in): 't '
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
KNo
❑ NA ❑ NE
Oel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
CS No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
IgNo
❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
N 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
�TNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
$'No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? I f yes, check the appropriate box below. ❑ Yes
9No
❑ 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) lLb� � Bpfm r/P,0j Vi,o I, M f I
13.
Soil type(s)Wa B 1 V No A IS
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ZNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
9 No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
jK No
❑ NA
❑ NE
17,
Does the facility lack adequate acreage for land application?
❑ Yes
19 No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
12dNo
❑ NA
❑ NE
Reviewer/Inspector Name 120" SCAVGIek Phonet y33-3,3�OX � 33
Reviewer/Inspector Signature: Date: Q �S
- -a -- - 1 ' _ -

Facility Number: ga — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes IgNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 'S No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 5rNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes CkNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No J'NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[]Yes
ERNo
❑ 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
Wo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
t9NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
MNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2 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
ERNo
❑ 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
IgNo
❑ 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
tgNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
9No
❑ NA
❑ NE
7.A ws ►gall bo-erb a, Walls s hh'j* fill It).
(6, p leap pint m a-�& fo a & " 1 nitre fl poh1d 1lo lq).
7
yas�
13 )ed o -his fa <
Sot'1 S✓ive LSr�t l
StYd es��e
PI.8&e p ojt �cta-dry hay c�fPali�-�►� year.
Recv(nn q reard r ai 1l W4 fa be Vert 3Ye s-
Page 3 of 3 12128104

Facility No. Farm Name
Permit COC ✓
OIC "11�
Date Ogig- l or
NPDES (Rainbreaker PLAT Annual Cert )
--i
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in 41
Sludge Survey Date Perm Liquid (ft)
Sludge Depth (ft)a
6
Calibration Date
Design Width
Actual Width
Soil Test Date 10
pH Fields
Lime Needed ✓
Lime Applied
Cu ✓ Zn
Needs P
Crop Yield ~C'ja�—^at
ekleoL
Wettable Acres _ ✓ 31.�j`�`
WUP
RAIN GAUGE
Weekly Freeboard ✓
Rainfall >1" ✓
1 in Inspections
120 min Inspections L/
Weather Codes
Transfer Sheets
AFIL
Uff
Waste Analysis
. � �.
Date of last Waste Plan in FRO 711410j Date of last Waste Pian at farm(�Q11"'App. Hardware I6r= 1 U
TIT
-Mn
rIW.
11�09M
INK
,f� r �-
-6lfv�
-M►T
I
• .
--
Vern�`` phone numbers and affiliations 101
Vj

Division of Water Quality
Facility Number Q Division of Soil and Water Conservation t
O Other Agency t 2 4
Type of Visit *Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 0 Arrival Time: Ioasool- I Departure Time. County. Region: 1—'f�- V
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Ias Phone:
Facility Contact: trod-4— t Title: Phone No:
� rn
Onsite Representative: t Integrator:
Certified Operator: ,n Operator Certification Number -
Back -up Operator: E i Sly Back-up Certification Number: '
Location of Farm: Latitude: o =, = Longitude: ❑o =,
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
Wean to Feeder DU
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other ,
❑ Laver
❑ on -Layer
Dry Poultry
❑ Layers
❑ Non -Lavers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impact
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)
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures; IT
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes %No ❑ NA ❑ N E
❑ Yes
❑ No
�] NA
❑ NE
❑ Yes
❑ No
I NA
❑ NE
❑ Yes
❑ No
FQ NA
❑ NE
❑ Yes
4No
❑ NA
❑ NE
❑ Yes
'A No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 7_6
Observed Freeboard (in): `t
5. Are there any immediate threats to the integrity of any of the structures observed'?
❑ Yes
No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[P No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[�LNo
❑ 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
A No
❑ NA ❑ NE
maintenance or improvement?
Waste Anttlication
I0. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Wo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
RNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ FaiIure 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 {KNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes '�&No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes [A 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):
f
Reviewer/inspector Name / N Arm Phone: t]
3 33cr�
Reviewer/Inspector Signature: Date: A/ aY z,/ Zr u-7
12128104 Continued

Facility Number: 7 — Date of Inspection I l Z! O
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check (] Yes No ❑ NA ❑ NE
the appropiate box.
❑ WUP El Checklists 0 Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1XNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes XNo ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ;INA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[I NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
4;�No
Wo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
NA
❑ NE
Other Issues
/
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
?LNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
527No
❑ 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
O No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
Ii No
❑ NA
❑ NE
Additional Comments and/or Drawings:
V&ft ojms tz�Y1 -+a P a.t� ns� 4t S-ly n 4
axl& PkI trv�
72128104

Faci}ity'No, Time InTime Out Date
Farm Name Integrator
Owner Site Rep
Operator 0 L,0ZQj No.
Back-up No.
COC Circle: CGener1l or NPDES
C
Desi n
Current
Design
Current
can -Feed
Farrow - Feed
3��fth
Farrow- Finish
Feed - Finish
Gilts 1 Boars
Farrow - Wean
Others
FREEBOARD: Design t�
Sludge Survey
Crop Yield
Rain Gauge
Soil Test Wettable Acres
Weekly Freeboard Daily Rainfall
Spray/Freeboard Drop
Weather Codes 120 min Inspections
Waste Analysis:
Date Nitrogen (N)
Z_ z
Pull/Field
Ic
Observed
Calibration/GPM b� l c qD
Waste Transfers
Rain Breaker"~- l �'a
PLAT
1-in Inspections
12�1
Date Nitrogen (N) ��-
0 111 o cQ
AA D
Pan Window
O - C-)

FactLty Number
OrDlvlsion of Water Quality
Q Division of'Soil and Water Conservation F
OttierAgency`
Type of Visit 'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 01�outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /(n p Arrival Time: Z, j 0 Departure Time: County: Region: F-"
Farm Name: W 1 tLk- Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address: �C'1'r �►_1
Facility Contact L Title:
Onsite Representative: ~� , ��
Certified Operator:C hlr_ks io(4r C&(�y 11 L
Sack -up Operator: t �1t "'F I S
Location of Farm:
Phone No: Lo 3 ' 47&C
Integrator
Operator Certification Number:-J
Back-up Certification Number: �� 1
Latitude: ❑ o ❑ ❑ u Longitude: = ° = ❑
Design
Current
Design Current
Swine ;._
;::Capacity
Population
Wet Poultry Capacity Population_ C
Wean to Finish
JE1 Layer
❑
Wean to Feeder
�
M
❑ Non -La er
El
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
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?
tittle S `-�
DaipL Cow
DaipL Calf
Dairy Heifer
Ll Beef Feeder
❑ Beef Brood Cow
Number of Structures: I ► P.
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 No ❑ NA ❑ NE
❑ Yes
❑ No
10 NA
❑ NE
❑ Yes
❑ No _,8%NA
❑ NE
VINA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number:,_0 7.Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�4 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
' 6@ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: l
Spillway?: ~—
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
hoNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
$yNo ❑ 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
PNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
RNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No ❑ NA ❑ NE
maintenance or improvement?
Waste Applicadon
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
AVNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
�LNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 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) aga MG C S _. ,
13. Soil type(s) Wal m 1 V bX �CA k ,
v'
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
UNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17_ Does the facility lack adequate acreage for land application?
❑ Yes
%No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
W No
❑ NA
❑ NE
Comments (refer to question,{{): Explain any YES answers and/or any recommendations or any other�comments `
1L1se drawings of facilitylo better explain situations. (use additional pages as necessary):
Ftw 6 rt spds
d,C, ,
C3Y1 Ern? n�(�htg 011, �Or and rt Seed 0.�
Reviewer/Inspector Name ,S�K //A/ TON Phone:7'/0
Reviewer/Inspector Signature:�aL Date: tCT
rage -, of s 111Z&U4 c.onnnuea
I i's�,`c�e , �IGrl�finl �� n2T

Facility Number: Date of Inspection o f
Reguired Records & Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑ maps
p El other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �(No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes""KNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[:]No
lA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
1es
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Wo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
59tNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
�WA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
IgNo
❑ 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
Oo
❑ 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
W 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?
ElYes
N No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
J�Vo
❑ NA
❑ NE
Additional Commen`fsland/or Drawii;!gs: ;::�.� �• ;:
ra�-or SaM les
mow "s4c. CL V"r
AO
fOt �� QXl ,is �p D 6_V f_ Q n d
Ol
KQn�
C. _MMe.n.4 COL
V
evo(L6 3 - Mono k 5 .
Cam. [ ram. Pc
Cu, i� Q�Dr W rt�iI►1 r
2-1 f'"e'e LS
Page 3 of 3 12128104

Facility No. � Time In 1,h `i Time Out (� Date
10 4 o�
Farm Name ii Integrator i_= ' V_
Owner a C, C , . x a 5 _ Site Rep
Operator
VM81
Back-up No. -
COC Circle: �ralor NPDES
Design
Current
Design
Current
Wean —
(o It O(3
Farrow — Feed
Wea — nish
Farrow — Finish
Feed — Finish
Gilts I Boars
Farrow — Wean
Others
FREEBOARD: Design
Sludge Survey
Crop Yield
-aU Observed
Calibration/GPM
Waste Transfers
Rain Gauge/ Rain Breaker _
Soil Test ✓ PLAT Wettable Acres
Weekly Freeboard L-wily Rainfall 1-in Inspections
Spray/Freeboard Drop
Weather Codes 120 min Inspections
Waste Analysis:
Date Nitrogen (N)
+ 10111 ) , Co
Ct
Date Nitrogen (N)
0<
Pull/Field
Soil
Crop
Pan
Window
tL
'
t
�OC.•
r - OC
., C
S
- — 4
,--

Division of Water Quality j
Fat�iity Number �!� ` - - fo �i`7 0 Dn�ision of Sail and Water Gonsen�ation
Q Other Agency
Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit P Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
,104"
Date of Visit: Arrival Time: Departure Time: County: S "' Region: 020—
Farm Name: cc Owner Email:
Owner Name: l Phone: /,C - -C& 7 S
Mailing Address: _ �,? C _ 1�c2r��r�_Gt c _ Av1rX L J1, ' AIC
Physical Address:
Facility Contact: -r,, dw /,,7,. alc; ,.,A Title:
Onsite Representative: _ Tccq_
Certified Operator: _ - /S
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number: 02 SGo
Back-up Certification Number:
Location of Farm: Latitude: ❑ 0 0 i 0 Longitude: ❑ ° ❑ 1 ❑
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
ElLayer
Ot? !c D ❑ Non -La et
❑ Wean to Finish
01Vrean to Feeder
El Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
ElLayers
ElNon-Layers
El Pullets
❑ Turke s
El Turkey Poults
El Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation`?
Discharge originated at: El Structure ❑ Application Field El Other
a. Was the conveyance man-made`?
Design Current
Cattle Capacity" Population
ElDai Cow
El Dairy Calf
i
❑ DairyHeifei
El Dry Coup
ElNan-Dai
El Beef Stocker
❑ Beef Feeder
i
El Beef Brood Co
j
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
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 ET�o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
0-Ko
❑ NA
❑ NE
❑ Yes
O'fJo
❑ NA
❑ NE
12128104 Continued

Facility Number. Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 9- 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?: r7 0
Designed Freeboard (in): .;P- C. "
Observed Freeboard (in): .3q
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0-i�o
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
allo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
allo
❑ 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
ElO Yes
�
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
�No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn,
etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Dri#i ❑ Application Outside of Area
Q- r!a S"v
/
12- Crop type(s)
13. Soil type(s) L,/,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
BNo
[INA ElNE
15. Does the receiving crop and/or land application site need improvement?
ElE Yes
►�o
❑ 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
❑ No
❑ NA U-NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑<oo
❑ NA ❑ NE
ICOMts (refer,to question;#Explain ante YES answers. and/orian }ecommendahon s ora�ny�o1.
thtcommen
)Use drawings ofataer[ity tobettereapiaun) atlons:'(use °additional pages as necessary
Jco', . C�C���✓ � C c ! r c !c 14 S,Jr, cc +'r aC•-<,
Reviewer/Inspector Name
If. g Phone: /C- Lfri4 30
Reviewer/Inspector Signature: Date: Y-l.� 5'
12128104 Continued

• Itrar;� - L `1 7
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? O Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0-5o ❑ NA ❑ NE
the appropirate box. ❑ W� ❑ Checjs� ❑ � �ps� De ❑ Ma ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. D-Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekl Freeboard ❑ Waste Analysis ❑ seg 4nalysis ❑ W=te-TTansfars ❑ A=ual-Eertificatiou
y 0 I()"f
all ['Stocking 01C field 0-120 Minute Inspections El-Wonthly and 1" Rain Inspections ❑4eather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
D i o
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
0-l'd'E
❑ Yes
❑ No
❑ NA
Q&
❑ Yes
❑ No
❑ NA
9-KE
❑ Yes
L�t1vo
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑-NE
❑ Yes Q�o ❑ NA ❑ NE
❑ Yes Q'No ❑ NA ❑ NE
❑ Yes 0-fio ❑ NA ❑ NE
❑ Yes 9&o ❑ NA ❑ NE
❑ Yes
❑-io
❑ NA
❑ NE
❑ Yes
[I"No
❑ NA
❑ NE
!T A1. LfI,ria`_C h.n'5s hC: _ tleC `-vl ��.5 /7cL✓ Cvc ✓,�eU /�1C1`/►1•fi
X4spe�.f�,� �„r� c.1eGlc
'94, 11e,r;e"'d .)o ftie /Ie Pefn,,'r� ce^�� ��•ns cr:'fC fYt,', �en%c/s
09
1tEv� {�opf— wezlClyiC�`�CpiGA G��C��-Il /Gfi�/!TG[��/ Cr�� •r�,`E/!f iC%/MS
i» rri n ✓i f i rt S�J G G
%
a's cf"' r
�u•r,'a1�S , s kPef,;'+�g r�ac!' G�ur�s �- c
s7uG�C� n9 I`ec.C"r% S
1
A' c - Fe rn) ,
12128104

Facility Dumber G y Irate or Visit: Time: D
10 Not O erational 0 Below Threshold
Permitted GI -Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold.•
Farm Name: W" ' / /L jeee% &r ns County- SaR0
Owner Name: Da a, a/��f _ ` Phone No: 9 d ' 7 ~ S41 S_
Mailing Address: HOW1001a 29319
Facility Contact: 1 o d Title: Phone No:
Onsite Representative: _L2r1,/ 10Gtrr %ck Integrator: _ M� 13r wI _
Certified Operator: iodr.( QGn : e�s_ Operator Certification Number: ,..2-2 DSO
Location of Farm:
Q'i wine '❑ Poultry ❑ Cattle ❑ Horse Latitude ' " Longitude 0'
Discharges & Stream impacts
l . Is any discharge observed from any part of the operation? ❑ Yes �fo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 9<0
b_ If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ yes
c. if discharge is observed, what is the estimated flow in gal/ruin?
d_ Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes E34go
2, Is there evidence of past discharge from any part of the operation?
❑ Yes 01jo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �10
Waste Loiection & Treatment ,--,
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 0 =vo
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
3
05103101 Continued

'a4100
wsly
•yS

Facility Number: — 7
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
S. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancerunprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground [:ICopper and/or Zinc
12. Crop type ,6ermuA/Gi � r'! lkt. Sni&ll G.&.'n 4vcrsPgel
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes ErNlo
❑ Yes O No
❑ Yes E314
❑ Yes 01 o
❑ Yes BNo
❑ Yes B'fio
❑ Yes 01I 0
❑ Yes
❑ Yes [ !o
❑ Yes B1Go
❑ Yes [moo
❑ Yes [allo
❑ Yes M.N6'
❑ Yes ❑ No
❑ Yes io
❑ Yes [31fo—
❑ Yes 94o
Final Notes
,Dah:e,IS 4&,s ahole /,'-e Ao ee,11-U Ao
k
Has sPrbYed dot u.rea15 ma•%►��.►a.,�
c_
0c,c/� ,6
r+i0v s�Opc of � s IO o /
9 a� `{O conrlro� br�s%t,
Reviewer/Inspector Name lh sr k n .� - . �" b� r .
Reviewer/Inspector Signature: Date: 7' •p
12112103 Continued

Facility Number: ' q Date of .Inspection �O
Required Records & Document%
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
Ekl
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ W%JP,chmktfists d ,etc.)
❑Yes
EW
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[; PKo
❑ ❑.weebe ❑ ❑Via'
5-II 9 A..5 3 -$ 7 a,s /0• :74--'7 1.y
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
EJ.No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
®wo—
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
�,✓
(ie/ discharge, freeboard problems, over application)
❑
�o
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ONo
28. Does facility require a follow-up visit by same agency?
❑ Yes
9No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[!Wo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
G-Ko
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

h A F❑ DSWC Animal Feedlot Operation Review
g�DWQAnimalFeedlot
-0k Operation Site Inspection t
Q-
Routine O Complaint O Follow-up of ❑ VO insuection O Follow-up of l?SWC review O Other
Facility lumber
Date of Inspection 1 7
Z
Time of Inspection : d 24 hr. (hh:mm)
17 Registered ® Certified © Applied for Permit [3 Permitted 113 Not Operational Date Last Operated: ..........................
Farm Name:......,�y,%.., c�i�..-- �P�EeK...., ��. '�°. s�- � ............. I....... County:..........:Sf3................................................... o .sa.�
Owner Name: / %4/ .��7— r �~
..............�.�.�......,,�.r9..!.✓..1..:<4,#" ...........................................Phone \'o: 1. ...�,?.��t.J.....�
Facility Contact: ..........v..,Pf� %,��✓•/.r....... ... Phone No: ...........
.•... ... / ..... Title: ........................................
Mailing Address: 7 D J, v' /� / l p.................................. ..........................
!? .......:..�.�.+M..�F2........� ...j .W.4 , t�l .,, ., �r....a > .. lit ....
Onsite Representative: ........ 74�/ . , Integrator ..2._v....w..._e r /.✓.o
..,6p_................
Certified Operatorz..............�✓ i r-.�. .........--......-----.........---....... p I.. 919........_..
...-......�.�. _..�.//,9.•'�X�j�� /� .__. Operator >C�ertiR>ration Number,_..
Location of Farm: ��rr* .59���6a�sg ,t`A/� 9 .?V2 /j'�.z�'� fg �✓r�'�A ��/�
.......................... ..................................................%./...........`.....9........-..�..........._....................................../.f...........(.......A...........
_._9..d_...�....��xs:✓.�>�f./._."/�"...I.1�:7.�[^llr!'�./!P.f�.�a.._�. !.'.:.../......(!Y!�J
Latitude ` =` «
Design Current
Swine Capacity Population
® Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Longitude
Design' 'Current .. Design . Current...;
Poultry. . Capacity. Population y Cattle Capacity- Population.,.
❑ Layer ❑ Dairy
❑ Non -Layer 10 Non -Dairy,
❑ Other
Total Design Capacity .
Total SSLW
Nuinber1'of Lagoons / Holding.Ponds ❑ Subsurface Drains Present ❑lagoon Area ❑ Spray Field Area
❑ No Liquid Waste Management Svstem
General
1. Are there any buffers that need mainienancelimprovemen(') ❑ Yes 10 No
2. Is any discharge observed from any part of the operation? El Yes O No
Discharge ori-inated at: ❑ Lagoon ❑ Spray Field ElOther
a. If discharge is observed. was the conveyance man-made? ❑ Yes No
b. I f discharge is observed, did it reach Surface Water? tlf yes. notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gallrrtin? _ &A
d. Dues discharge bypass a lagoon system? (If yes, notify DWQ) El Yes brNo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes No
i
4- Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes Wo
5. Does any part of the waste management system (other than lagoons/holding ponds) require El Yes IR No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes IR No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes /W No
7/25/97 Continued on back

1
Facility Number: 52 — zrS%
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,Holdine Pands, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure ? Structure 3 Structure 4
❑ Yes X No
❑ Yes $6 No
Structure 5 Structure 6
identifier:
Freeboard(ft):......-3�r..................................................................................................................................................................................
10. Is seepage observed from any of the structures? El Yes � No
l I. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes ® No
12. Do any of the structures need maintenance/improvement? Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markets?
❑ Yes
N No
_Waste Application
14. Is there physical evidence of over application? _
❑ Yes
® No
(If in excess of WMPP,, or runoff entering waters of the State, notify DWQ)
15. Crop type f!u*.sry ... (1ilsit4 ...�.1�!!./v.............................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
O[No
17, Does the facility have a lack of adequate acreage for land application?
❑ Yes
KNo
18. Does the receiving crop need improvement?
Yes
❑ No
19. is there a lack of available waste application equipment?
❑ Yes
J] No
20. Does facility require a follow-up visit by same agency?
❑ Yes
IN No
21. Did Reviewer/Inspector fail to discuss reviewfinspection with on -site representative?
❑ Yes
No
22. Does record keeping need improvement?
❑ 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
No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
9No
No.violations:or deficiencies.were-n6ted-duiing' this .'visit You:WiH i&ei've:ito-ftiriher::
: 0&t spotidehce 64out this:visit:•
t3,<::: x`, agA99+r �,• # Y 3G,. --7;w �;Corr s (refer to$qu hon #'Alip XnSES'- Rf- ioranyc0 o ex^rsF3K'i
commextts;� r� ; gk
[3se drSwiii s n� use add►tional is as necessa � ' g olf faetlrty�to better Explain�sitttabo �( P ges, �'}
2`�. ��
,�xx�
pop
7/251 7
^` .. ' i �+.'.' h x, �4i+ ...,. F ..;Ze 3Y �. 4.fi'a'•�t 5 �l)
Reviewer/laspector Name ;x
Reviewer/Inspector Signature: Date: /� 2a> 97