820698_INSPECTIONS_20171231

NUH 1 H UAHULINA
Department of Environmental Qual

,MS 1 1 � t l Vve- r
a
of Visit: om Hance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
in for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: - ,Z., Arrival Time: 5 Departure Time: County: 5� Region:
Farm Name: _A l f e--t Owner Email:
Owner Name: n Phone:
Mailing Address:
Physical Address:
Facility Contact: v. s X--G —k ( Title:
Onsite Representative: 4�
Certified Operator:. 'J o� $I-
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: & 6 S
Certification Number: t' % 70K
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Vet Poaltry Capacity Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
La er
Non -La er
DairyCow
DairyCalf
Wean to Feeder OD
ra
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Design Current
D , Paul Ca aci P,o
Layers
Da' Heifer
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Farrow to Finish
Gilts
Non -Layers
Boars
Pullets
Beef Brood Cow
Other
HTurke
iurke s
Points
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 water; 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 D WR)
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 E3-7 ❑ NA ❑ NE
❑Yes
[]No
U9A-
❑NE
[:]Yes
[-]No
[],IAA
❑ NE
❑ Yes ❑ No
❑ Yes ®-No
❑ Yes Lim o
[q'<A ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Num er: _ Date of Ins ection: --P_
Waste'Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes NA ❑ NE
a. If yes, is waste level into the structural freeboard? [] Yes ❑ No ❑, XF ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Q_d'6 ❑ 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 [Z.NT-❑ 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 notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
threat,
[l`N�o ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
© 'No ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[3-15-o-- ❑ NA
❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
LJ "'o ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑-N_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): C 13 — 9&� g& -0
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
Q No
❑ NA
❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
LJ 1No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[—]Yes
O No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E�'No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
FTNo
❑ 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
Cl 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
No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E]["No
❑ NA ❑ NE
Page 2 of 3
21412015 Continued

Facility Number; - �� Date of Ins ectiou: �,Kel
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Io ❑ NA ❑ NE
25_ Is the facility out of compliance with permit conditions related to sludge? If Yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in'any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes M-No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes L24o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately,
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31, Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[:]Yes 0:�,<o ❑ NA ❑ NE
[:]Yes rl; o ❑ NA ❑ NE
❑ Yes [5' �o ❑ NA ❑ NE
❑ Yes [TNo ❑ NA ❑ NE
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
[ 'l�o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
L]I�o
❑ NA
❑ NE
Comments (refer to question #) Eapiain,any';YESianswer,slnd/or;any additional recommendadoas or any.other comments.
Use drawiings of facility-to.better egpiatn siti ateons (us�eradditionai pages as necessary}
C o- )
Reviewer/Inspector Name:
Reviewer/Inspector Signatu
Page 3 of 3
DO Phoneq( o- q33-3334
re: MA 4 Date: u-t Lb
21412015

t ype or visit: U FRoutine
fiance Inspection U Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Q Complaint O Follow-up Q Referral Q Emergency O Other O Denied Access
Date of Visit: U� Arrival Time: -� , tJr3 Departure Time: i County: > VT M.
Farm Name: l Owner Email:
Owner Name: t( Phone:
Mailing Address:
Physical Address: _ C-.t w �S 1� 'A''d
Facility Contact: y Title: Phone:
Onsite Representative: t{
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Region: t
Integrator: yl !3��
Certification Number: T L YF'z
Certification Number:
Longitude:
Desrgn Currents Design Current
Design Current
Swine
Cap rty
Wet Youltr:�°
T,
C Cl Popes
Cattle Capacity Pap.
Wean to Finish
_
La er
Dairy Cow
Wean to Feeder
00
;
a er
Dairy Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean1P1
esign Current
Dry Ppult .En!a ao ^�
D Cow
Non -Da
Farrow to Feeder
Farrow to Finish
Layers
Non -Layers
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Turkeys
Beef Brood Co...
C3ther
M
Tur ey Poults
'.
Other
I LOther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge'?
❑ Yes E3-h`o ❑ NA ❑ NE
[:]Yes ❑ No �A ❑ N E
Yes ❑ No NA ❑ NE
❑ Yes
❑ No
[3'NA
❑ NE
[] Yes
E?<o
❑ NA
❑ NE
❑ Yes
�o
❑ NA
❑ NE
Page I of 3
21412015 Continued

Facili Number: n - Date of inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q'flo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [3-NA ❑ NE
Structure f Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed'?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes ETNo ❑ 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 ENo ❑ 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 f:fNo ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes D"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): Y/cJ`i c� C2
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
LJ-'1"o
❑ NA
❑ NE
IS. Does the receiving crop and/or land application site need improvement?
❑ Yes
E3"N' o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
2fgo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
dNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 0No ❑ NA ❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes YKo ❑ 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 0 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 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No [] NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: _ Date of inspection: Ik
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 03" o [DNA ❑ 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i_e., discharge, freeboard problems, over -application)
31. Do subsurface tile. drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
Ig`flo
❑ NA
❑ NE
❑ Yes
I3 o
❑ NA
❑ NE
❑ Yes
[3 o
❑ NA
❑ NE
❑ Yes E3fqo ❑ NA ❑ NE
[] Yes 0<o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 014 ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes FKNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes E3"No ❑ NA ❑ NE
Comments (refer io question #): Eirpla"in any YES answers and/or any additional recommendations or any attar comments.
Ilse drawings ofLfacility to better a lain situations (use gdditianal pages as necessary,).
Ct
elo
Reviewer/Inspector Name: �I I Phone: qly —� 3" 3 3S
e
Reviewer/Inspector Signature: Date:
Page 3 of 3 21411015

KI rc 6 b r'�
— Division of Water Resources
Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1 Arrival Time: Departure Time: County:4 A Region: `-7J
Farm Name: C KcA�-t Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: it
Certified Operator: GU ewLd,
Back-up Operator:
Location of Farm:
Phone:
Title:
Phone:
Integrator:
Certification Number: t g A
Certification Number:
Latitude: Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
iNon-La er
D ioul
Layers
Design
Ca aci
Current
to
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
urke Poults
Other HOther
Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Eq<o ❑ NA ❑ NE
[:]Yes
[—]No
ENA
❑ NE
[:]Yes
[:]No
[?'NA
❑ NE
❑ Yes
[:]No
❑-'KA
❑ NE
❑ Yes
fNo
[_]NA
❑ NE
❑ Yes
dNo
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facili llsmber: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [Et<o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No �QA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:.
Designed Freeboard (in):
Observed Freeboard (in): ��
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[<o
❑ NA
❑ 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
[2 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
[yio
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the perrnit?
❑ Yes
E2'N' 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
Z No
❑ NA
❑ NE
maintenance or improvement?
Waste Aoplication
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 E]"No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
PAN ❑ PAN > 10% or 101bs. [] Total Phosphorus C] 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): YC
13. Soil Type(s): tI f.
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
EfNo
C] 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
C] Yes
E?(No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑'No
[] NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
C�rNo
❑ NA
[] NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[2/No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
C�No
❑ NA
[] NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design [:]Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [ No
❑ 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 Z�N
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑'N
0NA ❑ NE
❑ Weather Code
❑ Sludge Survey
o [] NA ❑ NE
o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

FaciIi uwb r7: JDate of Inspection: ff
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes J]�o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Ea<o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of fast survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes_, f o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [-]Yes Isla ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
Q�lo
❑ 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
Q 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
DIo
❑ 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
[�Io
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
eNo
❑ NA
❑ NE
33. Did the Reviewerdnspector 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
ZNo
❑ NA
❑ NE
y '�,y y
,r d, « �» _ r� r x1er ConllneAts.'
�omroeiits refer to question;#) Expiarn an YES answers and/or an adtlitsonaik ecommendattons or -lot
Use drawings o[ faciUty to betterre plain situations; (ase.addihonalFpages as necessa ,).: ,
394 k -
{1 2X(j
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone: "1 ._] V
Date:
2141207

i YVs / u--oIq.- 1,5
Type of Visit: Q�.Com ante Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral O Emergency 0 Other 0 Denied Access
Date of Visit:
Arrival Timed �11
Departure Time:Y- I --I✓ County: ��
Region: —Av
Farm Name:
Ale,ak __e vv
Owner Email:
Owner Name:
Phone:
Mailing Address:
Physical Address:
Facility Contact: _LG cL ZavkjAti tK Title:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Phone:
Certification Number: 1 0 d 6
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
-Design
Current
Design
Current
Swine Capacity Pop.
WefPoultry"'
"Capacity
Pop.
Cattle `; Capacity
Pop.
-
-
Wean to Finish
La er
Da' Cow
Wean to Feeder
p gtt70
Layer
Da' Calf
Feeder to Finish
-
Da Heifer
Farrow to Wean
- k
"Di ign
Current
D Cow
Farrow to Feeder
D , tPoult ...
Ca aei
P,o P.
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layer
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
TurkeyPoults
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)?
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 Q_K ❑ NA ❑ NE
❑ Yes [-]No
❑ Yes [:]No
❑ Yes
[:]No
❑ Yes
to
[:]Yes
®No
❑ NE
[' ❑ NE
[3"NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [E T o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No E3-NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Ll -
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �❑ NA [] NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes U 'moo ❑ NA ❑ NI:
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
I_=H10
❑ NA
❑ N F.
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q'1Vn
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ErNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2-710 ❑ 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
Z12. Crop Type(s): Cr/ V (• o f
13. Soil Type(s):
6 't(_<_ 'yok k
14. Do the receiving crops differ from those designated in the CA WMP?
❑ Yes
❑.N6
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ED-No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[gNo'
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
L7 go
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2-Ko
❑ NA
❑ NE
ReQuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
[5 o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check
[:]Yes
<o
❑ NA
[] NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps [:]Lease Agreements
❑Other:
21 _ Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ErNC
❑ NA
0 NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall 0 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
'[NNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
(["No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

FaciTi Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes � ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check []Yes []-No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
[] Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [:Ko❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes [No ❑ NA ❑ NE
❑ Yes/'No
❑ Yes ffNo
[:]Yes No
[:)Yes [No
❑ Yes ��40
❑ Yes ZNo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
comments (refer to question 9): Explain any V ES answers5andlor any additional recommendations or; any, other comments: ,
Usexplain situations (use adiiitionai pages as necessary).
1
d4
Reviewer/Inspector Name: F l of jao Phone: �3
f
Reviewer/Inspector Signature: Date: y'
) 1� —
Page 3 of 3 2/4 014

!Type of Visit: ($"Compliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: t_i'Routine 0 Complaint 0 Follow-ue 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visi rG Arrival Time: Departure Timer County: ' Region:
Farm Name: C Owner Email:
Owner Name: U e"' Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: ' Phone:
Onsite Representative: � Integrator:
Certified Operator: Certification Number47 f&2-
Back-up Operator: Certification Number:
Location of Farm:
Latitude.
Longitude:
Design Current a ;x� Design Current a= t
Swine fi Capacity Pop. Wet Poultry Capacity Pap. Cattle'
Wean to Finish Layer Dairy Cow
Wean to Feeder 1 INan-layer Dairy Calf
Design Current
Capacity Pap.
Feeder to Finish »: Dairy Heifer
Farrow to Wean s Design Current Dry Cow
Farrow to Feeder D . Pout C act $o Non-Daill
Farrow to Finish Layers Beef Stocker
Gilts Non -Layers Beef Feeder
Boars Pullets Beef Brood Cow
i� Turke s
AMMI
,>,n- 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)?
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 Q—W6— ❑ NA ❑ NE
❑ Yes
❑ No
E13�;K
❑ NE
❑ Yes
[] No
[ A
❑ NE
❑ Yes [:]No
❑ Yes [Z.M
❑ Yes �o
[3-]TA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

FaciNty Number: - U4 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ONE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA [] NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
b 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
❑-Wo—
❑ 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
I_-1 ' o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[ -lqo
❑ 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
[3'<o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E31<o
❑ NA
❑ NE
maintenance or improvement?
I I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑jb16 ❑ 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): 5G O
13. Soil Type(s): T a 4jj c -�_ _:�_#v&f
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[ t�lQo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[J>o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
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 ET<o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall InspectioWNo
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [—]Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [P,lKo ❑ NA ❑ NE
Page 2 of 3 21417011 Continued

Facili Number: Date of Ins ection: V
9
24. Did the facility fail to calibrate waste application equipment as required by the permit? 0 Yes [t "l o ` ❑ NA D NE
25. is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes E —❑ NA ❑ NE
the appropriate box(es) below.
D 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 [3.� ❑ NA ❑ NE
s
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [44,� NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[j*r—❑ NA
0 NE
and report mortality rates that were higher than [formal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Q..Ncr- ❑ 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
[�I p_ ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
E:VN"6' ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
V<,( ❑ 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 ft Explain any YES answers and/or any additional recommendations or any other ycomments -
Use ai^awtngs'offacilityto better explain situations (use additional pates as necessary).
J�.
cri tJ -D - P�
�c-37 2ar(
Reviewer/Inspector Name:
Phonegv 3
Reviewer/inspector Signature:
Page 3 of 3
.21412011

I-f
Vf
Type of Visit: ompliance 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: ,' t7 Departure Time: ; y- County: •�� Region: c�
Farm Name: d w e,. -r,n 4* x f Owner Email:
Owner Name: « G',,r �d�y ~' _ Phone:
Mailing Address:
Physical Address: /
Facility Contact: _ , � iW � Title: _7 . ���G� Phone:
Onsite Representative:
Certified Operator: 70-Z "Z31 1 /,74.,n�eM
Back-up Operator:
Location of Farm:
Integrator:
Certification Number: f �0G
Certification Number:
Latitude: Longitude:
Design
Current „ ,Design
Current
`� �� Design Current
a
Swine
Capacity
Pop. Wet Poult1:Capacity
ry
Pop.
Cattle Capacity Fop.
Wean to Finish
L ILayer
Dairy Cow
Wean to Feeder
I jNon-Layer I
Dairy Calf
Feeder to Finish
Farrow to Wean
f:n;..
=Design
Current
Dairy Heifer
Dry Cow
Farrow to Feeder
D in i�Ca aci
P,o
Non -Dairy
Farrow to Finish
Gilts
Layers
Non -Layers
Beef Stocker
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
`L
Other
Turkey Poults
Other
Other
Discharges and Stream Im acts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes [:]No
❑ Yes [] No
❑ Yes [] No
❑ Yes [] No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page l of 3 21412011 Continued

VI
Facili Number: - U JDateof Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 5�t 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): 1 —
Observed Freeboard (in): 3
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 S No ❑ NA []NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes CR 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?
I I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Eg-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): Ap", �
13. Soil Type(s): d 0
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes O 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
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes 0 No
[:]Yes ® No
❑ Yes ® No
❑ Yes [Z-No
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �Q 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 RNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes l] No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
0 Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of [tts ection: --/7— 0
24. Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes P No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes allo
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 M No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
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?
❑ NA ❑ NE
❑ NA ❑ NE
DNA ❑ NE
❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes [0 No ❑ NA ❑ NE
❑ Yes
El No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question:_# Explain any YES answers and/or any additional recommendations or any outer comments.
Use drawings ofiacility, to better=eyplain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: IrJ - Z 3 DD
Date: _ 5 / ]-- 3
2/4/20if

qhg
1AFL
(Type of Visit: t) Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access Il
Date of Visit: 1. 4 t= Arrival Time: � Departure Time: L[Llao ftM I County: r� Region: ro
Farm Name: UN rt CA taA L FAiken 2 Owner Email:
Owner name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: C Qqk w Z 0,� Title: Phone:
Onsite Representative: �AM�e integrator: 1At]R0h3 &UA]
Certified Operator: ck-09. I nknp" Certification Number:
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design
Current
Design Current
Design Onrrent
Swine 1 Capacity
Pop.
WetPuultry Capactty Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder NULiC'!'{{)
Non -La er
DairyCalf
Feeder to Finish
'Current
Dairyheifer
Farrow to Wean
`�
Design
Cow
Farrow to Feeder
Dr lPoultr�
Ca ac.j y P■o
Non -Dal
Beef Stocker
Farrow to Finish
La ers
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
w
Turkeys
Qthe.r
TurkeyPoults
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 ratan -made?
b. Did the discharge reach waters of the State? (if yes, notify D WQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes �o ❑ NA ❑ NE
❑ Yes
❑ No
[i/NA
❑ NE
❑ Yes
❑ No
52"NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [:]Yes ❑ No [�NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes E:rNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes eNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: - — Date of inspection: t
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? []Yes E�'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ErNA ❑ NE
Structure I
Identifier: 41
Spillway?:
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Designed Freeboard (in): ,g,
Observed Freeboard (in): a%
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes R] No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ❑ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [gNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes W(No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9_ Does any part of the waste management system other than the waste structures require ❑ Yes E] No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Ej No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes Ej 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): a,
13. Soil Type(s): 1r, r
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes [;TNo ❑ 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 E/ 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 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0 No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
8"'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
NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
6Z No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [:]No F�rNA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: '� -Loq Date of Inspection; q177112
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑Yes
� No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
EeNo
❑ 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 fait provide documentation of an actively certified operator in charge?
❑ Yes
6ZNo
❑ NA ❑ NE
27. Did the facility tail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[]/No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
624Vo
❑ 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
EO/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
UNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[]r4No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[L�No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[dNo
❑ NA
❑ NE
mmeitts� refer to uestion Ex lam an YES answers and/or an additEonal recomutendations or an other cam
i (.q 9)= P Y Y tyi6en"ts.
F
drawings.oifacility to better explain situations (use additional pages as necessary).
=
Reviewer/Inspector Name-
Reviewer/Inspector Signature:
Page 3 of 3
E1DS Phone: %i -• d:6-6 gS j
Date: 4 n 1 ')L
21412011

ms -7/15-/11
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (BrIautine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: / % Arrival Time: Departure Time: g�� Countv:� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: &1/22:r�t rL.i lGMf' Title: Phone:
Onsite Representative: Integrator: 06
Certified Operator: Certification Number: Q
4
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design
Current
Design Current Design Current
Swine Capacity
Pop.
Wet Poultry .Capacity Pop. C*attle Capacity Pop.
qyF 'aleki I _ _
Wean to Finish
Layer Dairy Cow
Non -La er iry Calf
Wean to Feeder
Feeder to Finish
Dairy Heifer
Farrow to Wean
.. „ . Design Current Dry Cow
Farrow to Feeder
D . Poultry i _.: Ca aci P,o . Non-Dai
Farrow to Finish
Layers Beef Stocker
Non -Layers Beef Feeder
Pullets 113eef Brood Cow
Gilts
Boars
Turkeys
Other
TurkeV Poults
Other
Other
Discharges and Stream Impacts ��
1. Is any discharge observed from any part of the operation? ❑ EYes [ �o ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man -trade? ❑ Yes ❑ No [jrNA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ) ❑ Yes ❑ No E3'<A ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes [] No U 1 A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [2**r4o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [—]Yes 2r<o ❑ NA ❑ NE
of the State other than from a discharge?
Page l of 3 21412011 Continued

Facility Number: - Date of In ection: Xa4
ZA
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0<0 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No &I'1gA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):^
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed? [] Yes 2< ❑ 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 Io ❑ 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 [t�fo
❑ 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 E3'Vo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
l0. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes vo
❑ NA
❑ NE
maintenance or improvement?
1 l . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Fo
❑ 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): bn_r'11 tf�0_ [ LL a2� _
13. Soil Type(s): k us
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 2 o ❑ 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 52< ❑ 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?
Reauired Records & Documents
❑ Yes [ No ❑ NA ❑ NE
❑ Yes [D""o ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
figKo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Q Ko
❑ NA
❑ NE
the appropriate box.
0 WUP ❑Checklists []Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
vns
❑ Rainfall [3 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall InspectiSludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakets on irrigation equipment? ❑ Yes ❑ No 2'NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: XCA, - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Io ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? if yes, check the appropriate box below.
El 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
[ 30
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
EKE
❑ Yes
B<o
[DNA
❑ NE
❑ Yes K3 No ❑ NA ❑ NE
❑ Yes [✓ <o ❑ NA ❑ NE
❑ Ycs Cgollo ❑ NA ❑ NE
[—]Yes
io
❑ NA
❑ NE
[:]Yes
g o
DNA
❑ NE
Yes
0-lo—
❑ NA
❑ NE
g.'fer,to question # ): Explain any YES answers and/or any additional recommendations or any outer comments L v g
Use bra tn. ..
of facility tosbetfer explain situations, (use additional pages, as necessary). ,,-
�.�
CIJA U h-e-
OAS 11JCxcty4j_-" 61 -got is
(-at '.
Ct�v�C-
Reviewedinspector N
Reviewer/Inspector
Page 3 of 3
Phone: 91Z6_)-AL,3
Date: %
412d11

r
Type of Visit *Compliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: e
Arrival Time: Qg;CQ_a Departure Time: Z{ iM County: S Region:
Farm Name:Al (r6tM Owner Email
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: 'Pll aij a Title:
G
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
integrator
Operator Certification Number: 9 f 176 y
Back-up Certification Number:
Location of Farm: " Latitude: e [__1 1 0 i/ Longitude: = ° = 6 = u
Design C►urrent
Design Current
Design C►urrenE
Swine Capacity Population
Wet Pltry CapacityouPopulation
C*attic
Capacity Population
❑ Wean to Finish
❑ Layer I I❑Dai
Cow
Wean to Feeder
10 Non -Layer
I
Feeder to Finish
Dry Poultry
-
El Layers
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
ElFarrow to Wean
ElFarrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑Nan -La Non -Layers
❑ Pullets
❑ Beef Feeder
❑ Beef Brood Co
❑ Boars
❑ Turkeys
Other
❑ Turkey Poults
❑Other
Number of Structures:
❑ Other
Discharses & 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 No ❑NA El NE
❑ Yes
❑ No
09NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
PNA
❑ NE
❑ Yes
❑ No
❑ Yes
V No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
Page ! of 3
12128104 Continued

r- Facility Number:
Date of Inspection I10 I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in).
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes T No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
[,N?NA ❑ NE
Structure 6
❑ NE
❑ Yes
P No
❑ NA
❑ Yes
Pallo
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
F,
t
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require (] Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes Pa No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window❑Evidence of Wind Drift ElApplication Outside ofyArea
12. Crop type(s) ( rt+' oJ11 6rdl6L , � L - �-O
13.
Soil type(s)-_VOL —110
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[P No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
[PNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
V No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
Wo
❑ NA
❑ NE
Explain any.YES
etter explain situations�'(i
Reviewer/Inspector Name_ Phone /0 rsf�
Reviewer/Inspector Signature: Date: ZL fo
Page 2 of 3 12128104 Continued

Facility Number: ZEM
Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No Q�NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes FNo ElNA ❑NE
ElWaste Application ElWeekly Freeboard ElWaste Analysis [ISoil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[P No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
&A
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JP No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
PNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
O&NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[�'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
ONo
❑ 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
[�PNo
❑ 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
[?TNo
❑ NA
❑ NE
Page 3 of 3 12128104

Dion of Water Quality
Foci tyty Number �j �9� Q Division of Soil and Water Conservation
0 Otber Agency
Type of Visit 0 Compliance Inspection 0 operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: � Arrival Time: �rC�" Departure Time: jD 7 dt� County: Region:
Farm Name: a _h Owner Email:
Owner Name: 24, felm cann jnn06.16 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
�f
Onsite Representative: �`,,�_
Certified Operator: U�h `-�
Phone No:
Integrator: —eybk'o uc � J
I
Operator Certification Number:?�
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = 1 = {! Longitude: = o = I = u
I
Design Current
Design Current
Design
Current
Swine @opacity Population
Wet Poultry C►opacity Population
Cattle C►apacity
Population
❑ Wean to Finish ❑ La er
❑ Dai Cow
Wean to Feeder 00
❑ Non -Layer
❑ Dai Calf
Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
Dry poultry
❑ D Cow
❑ Farrow to Feeder
❑ Layers
❑ Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
Gilts
❑ Non -La ers
❑ Beef Feeder
PBoars
❑ Pullets
❑ Beef Brood Cowl
❑ Turkeys
Qtl
❑ Other I
❑ Turkey Pouets
❑ Other
Number o€ Structures:
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
[ No
`
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made`!
❑ Yes
No
❑ 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
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
`� No
❑ NA
❑ NE
other than from a discharge?
11/18104
Continued

Facility Number: JU7Date 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 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 294
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
t�No
Cl 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
0
❑ 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
LfPNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
'T
❑ NA
[INE
(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
0 No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) Qas42J
13.
Soil type(s) K
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
1�No ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
1� No ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
[P No ❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
CpNo ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
ZNo ❑ NA
❑ NE
Use drawtn somments �oi facility question
better xp lain�any YES answers and/or an recommendat,ons organ other corm eats.
s
��"
g fer to 4 ) tarn situations. (use additional pages as necessary)` y t
TL
Reviewer/Inspector Name ' ' Phone: Gb
3
Reviewer/Inspector Signature: Date: O Z/ Q
12128104 Continued

�y
R
Facility Number: Date of Inspection
Renuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n El maps ❑Other
❑ Yes
Wo
❑ NA
❑ NE
❑ Yes
�RNo
❑ NA
❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes *io ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
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?
❑ Yes
EJPNo
❑ NA
❑ NE
❑ Yes
1PNo
❑ NA
❑ NE
❑ Yes
�j No
❑ NA
❑ NE
❑ Yes
1P No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
WNo
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes [PNo ❑ NA ❑ NE
❑ Yes
1�No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
12128104

Division of Water Quality J
Facility Number �9� O Division of Soil and Water Conservation
F. W Other Agency
I ype of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 49 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: F011fMok. Departure Time: t� Q aH" County: —W Region: FiPy
Farm Name: Ly, ca, n -Im Owner Email:
Owner Name les, Ca'rlQcto Phone:
Mailing Address:
Physical Address:
Facility Contact: A&A Title: Phone No:
Onsite Representative: N Integrator: a✓,� +fit` ;iV/H S
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 00 [=, a « Longitude: ❑° =. =
Design , Current
„
a Design
- Design Currents
Current
Somme Ca aci Po ulation
p ty p
t3. CCattleM�
We# Poult apacity
T_,..
Ca aci
Populatton� _ p ty
Po ulation
p
❑ an to Finish
JE3 Laver
[] Dairy Cow
Wean to Feeder
2FM
JE3 Non -La er
❑ Dairy Calf
❑ Feeder to Finish
- ���"''
DairyHeifer
❑ Farrow to Wean
��� _
Dry Poultry
" [] D Cow
❑ Farrow to Feeder
"
- [] Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
Beef Brood Cowl
❑ Turke s
Older
El Turkey Pou Its
❑ Other
ther
�'�'�� IVumber'of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
fU No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
FNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
99 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
[ PNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[ No
{�
[I NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
El NE
other than from a discharge?
Page I of 3
12128104
Continued

Date of Inspection �OJP.J
Facility Number: Oa i7 g
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 ElNE
PNA
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 cture 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ yes
)] No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
OkNo ❑ 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?
KYes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
*No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
R 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/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
,l No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Drift` ❑ Application Outside
of Area
\Wind
12. Crop types} l D�fr 101q �SS NL 1x s►'�i7 � �1 r
13. Soil type(s) J
ghytS
r WL4&.
—CIA
_
14. Do the receiving crops differ from those designated in the CAWMP?
ElYes
R No
[I 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?❑ Yes
0No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ONo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
MNo
❑ NA
❑ NE
�p+tio %ov► tt�.rtu[
Cjjt,J11r't4, 07
Reviewer/lnspector Name Phone: 3V19O
Reviewer/lnspector Signature: Date: 1191241M
Page 2 of 3 121128104 Continued
Reviewer/lnspector Name Phone: 3V19O
Reviewer/lnspector Signature: Date: 1191241M
Page 2 of 3 121128104 Continued

l
r �
Facility Number: — Date of Inspection/ImLolfl
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes PVo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes VjNo ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists ❑Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ 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 V No ❑ NA ❑ NE
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
N,+,,J No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
0 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
F9 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
A No
❑ NA
❑ NE
29,
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
01 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
ODNo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
19No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
AdditiunahComments and/or Drawls `s ,: °
�1 �► W4 P 1 «rt 6� t�li,l �iR h 1�1A s
16_0 a 7�'
1, 4Qf tJ �i� lGt� b �-, a,-ep-S
Page 3 of 3 12/28/04

Division of Water Quality
11 Facility Number 0 Division of Soil and Water Conservation
- 0 Other Agency 11
j
. I -
Date of Visit: i Icy Arrival Time: Departure Time: a-` f County: S W%) Region: FYW
Farm Name: 4o? Owner Email:
Owner Name: A f-4, Phone:
Mailing Address:
Physical Address:
Facility Contact: � ��4 , Title: Phone No:
Onsite Representative: u Integrator: MU/sAV
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of FaTM:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Latitude: =' =' =" Longitude: ❑ ° =' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
9-GCD I L5jo I 1E1 Non -La et
Dry Poultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Pouets
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a, Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (I f 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'?
❑ �'es VNo ❑NA ❑ NE
❑ Yes ❑ No ONA
❑ NE
❑ Yes ❑ No NA
❑ N1
❑ Yes ❑ No NA
❑ NE
❑ Yes 1P No ❑ NA
❑ NI
❑ Yes �9 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
QjNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
J@ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3l
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
VO 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
IQ No
❑ NA ❑ NE
through a waste management or closure plan?
If any of Questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E�No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
RNa
❑ 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 ElEvidenceof Wind Drift F— Application Outside of Area
12, Crop type(s) uAq�L), SwG,.a m ovt &,_
t
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
TNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ro No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
10 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ffl No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: 8
W f 3,3 30
Reviewer/Inspector Signature: Date: /� �%
12128104 Conunued

Facility Number: — Date of Inspection
Re uired_Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ONo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EbNo ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes V07'No [INA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes P No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 9) No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E3No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�9No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
El Yes
[UNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
PNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
19 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
& No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
01 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
19No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
OgNo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Type of Visit Q Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit ®Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑Denied Access
Date of Visit: Mj Q Arrival Time: ( �, Od Departure Time: ,00Vftj County: M cvl Region:
Farm Name: Owner Email:
Owner Name: _ 1�Qf1 CQinnct C4(— Phone:
Mailing Address:
Physical Address:
Facility Contact: ` Title: 0 L,-Ivyp. Phone NO:
Onsite Representative: A fainCavNnac4v Integrator: ! V f (it" — &e, n
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 =1 = u Longitude: 0 o i = «
Swine
Design Current
Capacity Population
Wet Poultry
Design
Capacity
Current Design Current
Population Cattle Capacity Population
❑ Wean to Finish
640—
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
El Dairy Calf
El Feeder to Finish
__ya_M .
:_.;-::'n ❑Dai Hei fer
Dry
❑ Cow
ElNon-Dairy
❑ Layers
El Beef Stocker
❑ Non -Layers
El Beef Feeder
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other;
❑ Other
❑ TurkeyPoults
❑ Other
u
Number of Structres:
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Soars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑Yes
$ No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑Application Field El 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)
[I 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?
El Yes
X No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑Yes
XNo
❑ NA
❑ NE
other than from a discharge'?
Page 1 of 3
I2/28/04
Continued

1
Facility Number: —(q
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
❑NA El NE
El NA El NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: M _
Designed Freeboard (in):
Jf
Observed Freeboard (in):
❑ Yes A
No
❑ Yes ❑No
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 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes %No ❑ NA ❑ NE
maintenance/improvement?
I t . Is there evidence of incorrect application? If yes, check the appropriate box below_ ❑ Yes )6No ❑ 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) 1_ %-fl L d% urn4 . G,"r, t ro t,n
r
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
JKNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
9No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
J9 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
W No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
JKNo
❑ NA
❑ NE
Uicr TC�C'Y�1 �Ll'YI �r r "
Reviewer/Inspector Name i ,. u a , ` fit�c ` L� S Phone:
Reviewer/inspector Signature: Date:
Pave 2 of3 U 72/2R/Od Continued

Facility Number. Date of Inspection 1 1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ N-9--
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 ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
OWaste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
AA No
ElNA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
0 NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Wo
❑ NA *NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
TitNo❑
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
A NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
( No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes]
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 L Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
O 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
_ i No
❑ NA
❑ NE
Page 3 of 3 12128104

r
J
Type of Visit 9 Compliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine O Complaint 0 Follow up 0 Referral . Q Emergency 0 Other ❑ Denied Access
Date of Visit: / JL` Arrival 'Time: Departure Time: County: -5er Region:
Farm Name: ,Xrl 4 C r? 4 4 d :., Fei,- i _ Owner Email:
Owner Name: Phone:
Mailing Address: 3 y f c) : �' __ i �r _ �- /." k, , Al
Physical Address:
Facility Contact: 41 1 Title: Phone No:
Onsite Representative: A/(4 Lunxjt.IT_ Integrator:
Certified Operator: _ el ae n —_ �urtnN' y Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Back-up Certification Number:
Latitude: 0 0 = I = Longitude: = n = & = u
Design Current Design Current
y Po
pulation Wet Poultry CapacityPopulation
❑ Layer
f ❑ Non -La et
Dry Poultry -
ElLayers
ElNon-Layers
❑ Pullets
ElTurkeys
❑ TurkeyPuultsl
I
❑ Other
Other
❑ Other Ji
—-
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ DairyCow
El Dairy Calf
❑ DairyHeifei
❑ D Cow
ElNon-Dairy
El Beef Stocker
El Beef Feeder
El Beef Brood Co
Number of Structures:
b_ Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0- o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
D<o
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
12128104 Continued

r 1
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): _ „ z 4 f
Observed Freeboard (in): Z L7 "
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ONo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed ❑ Yes DNo ❑ 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
[xNo
❑ 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 Applieation
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
9 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
M-f1 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 Area
150 sv
pp
12. Crop type(s) _9 - tYr^
13. Soil type(s) J70 G
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
[�lo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
❑ No
❑ NA ONE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination;❑ Yes
❑ No
❑ NA [ E
17. Does the facility lack adequate acreage for land application? ❑ Yes
❑ No
❑ NA D NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
["No
❑ NA ❑ NE
f!,
1 , I !e` J !
�'S� LG.��+tiud [ �-� .✓�,,"I( 1/'r' �]�!✓� cr,^Pti C:, CJ.tC y,�lt �•� !G'!)•t';!1+ �.�;
ector Name`"
p.114
fPhone:
Reviewer/ins ` 0 173
Reviewer/Irtspector5ignature: Date:
12128104 Continued

r 1
Facility Number: 4 — Date of Inspection D!`f
Required Records & Documents ,��,,�
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Lid'No ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
Q es
❑ No
❑ NA
❑ NE
the appropiratc box. �-
+T WUP ❑ checklists ❑ Design"' ❑ Mapsr❑ O�
21.
Does record keeping need improvement? If yes, check the appropriate box below.
�es
❑ No
❑ NA
❑ NE
3-� ,�.� ,-7-7 � I -I
❑ waste Applimtierr- D4eekly Freeboard ❑ ❑ Seil,An*9is- ❑ Waste
T-r�
❑
ainfall �Stocking ❑ Crop Yield [:1l40-kflMureFTn—s—peMmns ❑'onthly and V
Rain Inspections ❑ Vlteafhef4Pede-
22.
Did the facility fail to install and maintain a rain gauge?
EKes
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑-NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
91'E
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ONo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
;2-1�o
❑ 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
Ofio
❑ 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
O'Ro
❑ 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
0&o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[allo
❑ NA
❑ NE
'.Drawings ,_
.f. V, Need T-e? Ues c- c•t6o,-e,,ef 7 �'•`i''a �a rr l C. y 0" 7 /e ve l' 4 '/
I Cr•� >Gr��` _� c:�{�i{5+ Lind 1 •� �c:."i r•/ls�'Cct, cJF7S /ClcGs�i
�C kc? r/O S
recta,-Jj C>,r �, le (1/od- mil,,zr s) /[FJ c'ts,ec/ C, yee'
r' /C.f �yrnls
t9. /0/,1ase P /Gr e a [ i• p F y/r a
s�,?• ,Flc'tryc r`ns7ic11 UnC/ /r►�1,� ��,,� tt �tt,'n yac�c�4'.
J t
12128104

V
11�.�_..-r...-':._� :��,-:::�.,:-:Y:_-�::•:...u�'3_iEi.��.c3s:'_ �-b�.:�w'n-q'.��.:-�,��.,.._ ._-:..:. ..._ s. :�:--=-- � _i.'t._=..,_ _:,ter-_,..M•._�.',:�z-..__'.. -��_II
Type of Visit 0 Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit 0 Routine Q Complaint Q Follow up Q Emergency Notificatiun 0 Other ❑ Denied Access
Date of Visit: y - �� Time: O' 30
Facilin� Number
Not
,..,� Operational Below Thresholdj
E3
Permitted Certified 13 ConditionaIh. Certified �] Registered Date Last Operated or Above Threshold
Farm Name: Allen County: _5 O
Owner Name: _-Al/ro ca 4A u01 Phone No: 9i0- S_9 - Sli (o
MailincAddress: Q/ DZzfe !goad C/.'7 A A l�/(_ .7$�a
Facility- Contact: Ae.. 6e",04 Title: Phone No:
Onsite Representative: -/ lle}, Cann evG(i./ _ integrator: 141 e 4)e 12 wh
Certified Operator: ti Ile rt o n n 44 Operator Certification Number:
Location of Farm:
E wine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �' �� Longitude
Design Current
Swine (-an A+i , Pnnn1"t
law,ean to Feeder
1 .26 yo
.2 3 as
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Ca adty Population
❑ Laver ❑ Dairy ❑ Non -Laver❑ Non-Dain,
❑ Other
Total Design Capacity~�
Total SSLW
Number of Lagoons _I I ILJ Subsurface Drains Presenl.__JILJ L.a oon Area JU Spray Field .Area
Holding Ponds /Solid Traps ILI No Liquid waste Management Svstem
Discharges 8 Stream impacts
1. Is any discharge observed from any pan of the operation?
❑ Yes DiTo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If dischar�!e is observed, was the conveyance man-made? ❑ Yes ❑ No
b_ If discharge is obsen-ed, did it reach Water of the State? (if yes, notifi, DWQ) ❑ Yes ❑ No
c. If discharge is observed. what is the estimated flow in eal/min?
d. Does discharge by a lagoon system? (]f yes, notify DWQ) ❑ Yes ElNo
2. Is there evidence of past discharge from any pan of the operation? ❑ Yes
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ yes 0,00
WasteCollection 8 Treatment
4. Is storage capacity (freeboard plus stoma storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): S ��
05103101 Continued

Facility Number: 8;2 — t S j( Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [INo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes D-No
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes GNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑No
9. Do any sluctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes G-No
Waste Anolication
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11, Is there evidence of over application? ❑ Excessive Ponding [ AN ❑ Hydraulic Overload B-Ves ❑ No
12. Crop type Qer, v4 " � 4 IG ,'n
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? Des ❑ No
14, a) Does the facility lack adequate acreage for land application? ❑ Yes B No
b) Does the facility need a wettable acre determination? ❑ Yes Q-No
e) This facility❑ Yes [�3V0
is pended for a wettable acre determination?
15. Does the receiving crop need improvement? 911' s ❑ No
16, Is there a lack of adequate waste application equipment? ❑ Yes ❑-No
Renuired Records & Documents
IT
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
B-No
18,
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
ONO
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
ONO
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[9-mo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
[9-9
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
❑ No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[ two
24,
Does facility require a follow-up visit by same agency?
❑ Yes
0-No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
E1440
0 No violations or deficiencies were noted during this visit- You will receive no further correspondence about this visit.
= _ ,
ie-omments,,(refer tdtquestroni#) ' Eiplsin tunyWES answers and/onrecommendations oi� any uther..comments.. ,�• �,
r�x f w ; ,rye �. . r
Use drawings of facility to1better,ertplain sttuatioiis: (use addihoo_AVH_ necessary)
zeld Copy ❑Final Notes
_
Q V ( Sfa> v�S,�tJ {arm. sty �, �e+5v�} o1G G /eFBrre, �f �rpr, 547 wn,?0'
Z✓Gt�rr. /'lr, CGnnac7Y fu.h��r/ ivasle d_,k7[I on a lC.a/v/ luSJC iu/�1!S�)lwos YA tit
!�/ji. 7L/�inr.e 1&-71161 /L.76/`1 /,yX A /
r1&.7G/6s
/ f
?� a� 8( ) a D , 4 9F) Gnd �lr� Gnu G/ 1�of /v /an
Mr, Co•+n,Jr z+oej C'0#0o r"n h"S [.vasl/r
1no� II/1avPJ
u �Pc�ih E S c°C"A
Reviewer/inspector Name
Reviewer/Inspector Signature: Date:
05103101
i
Continued

e
Facility Number: V 2 Date of Inspection I ZT//'Oy
Odor Issues
26, Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
28, is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ❑ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ❑ No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ❑ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Col`7tan was /o/,nle' el :) lasf y--ar 6.f was re — c,ve-W
km
be fore WOS4 weL1,Pr L_.as A1110!, ee/ o /fan s o
yd,hg /o Se
I �', r/AnYi aGi}/ GS �O/Gly S Td S/d �u y 4 r '!
Eve ects f
05103101

11 '
'V
= hRx4 � � _ µt -. .i � e'_ ��c=� c FL •_�.i. Asa... � k � X .. F. : 4.. v'-'�+.•�
ji
Type of Visit Q! Compliance Inspection 0 Operation Review O Lagoon Evaluation
Reason for Visit ® Routine 0 Complaint Q Follow up 0 Emergency Notification Q Other ❑ Denied Access
I Facility *Number _ _ I Date of � icit: /-c,T/-4y Time:
1 10 Not Operational 0 Below Threshold
Permitted ❑ Certified 0 Conditionally Certified ❑ Registered Date Last Operated or above Threshold:
Farm Name: !¢ �r &nxad Counn: �a 4SV'17
Owner ?Name: 4 Ile P7 t r��6t . _ Phone No:
Mailing Address:
Facility Contact: / Title: Phone No:
Onsite Representative: A'lle4 f�Ari/lcrdsr � Integrator:
Certified Operator: Ali{ 6t4,1la�3` Operator Certification Number:
Location of Farm:
®Swine ❑ Poultry ❑ Cattle ❑ Horse Lat-nude ' 9 �- Longitude 0' �-
Design Current
Swine C'9n2rity Pnnnlsitinn
® Wean to Feeder
.24 O
❑ Feeder to Finish
❑ Farrow to A eau
❑ Farrow to Feeder
Farrowto
❑ Gilts
�] Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Laver I FUNon-Dain-
Da'
❑ Non -Laver
❑ Other
Total Resign Capacity
Total SSLW
Number of Lagoons i t ❑ Subsurface Drains Present H❑ Laeoon area J❑ Spray Field Area
Holding Ponds /Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [R No
Dischame ori--inated at: ❑ Lagoon ❑ Srsray Field ❑ Other
a. if discharge is obsen-ed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is obsen-ed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed what is the estimated flow in pal/min?
d. Does discharge bypass a lagoon system? (if yes. notify DWQ) ❑ Yes ❑ No
2_ Is there evidence of past discharge from any pan of the operation? ❑Yes 10 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes FrNo
Waste QLI&tjon & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes W No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (irtcbes): 7 rl
05103101 Continued

Facility Number: g,dl -k Date of Inspection
S. Are there any immediate threats to the integrity of any of the structures observed? (ic/ 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 maintenancelimprovement?
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes Q No
❑ Yes JZ No
❑ Yes No
❑ Yes No
❑ Yes 10 No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes No
12. Crop type 6=!2k7 % se rrhd'k
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes Qa No
14, a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes El No
c) This facility is pended for a wettable acre determination? ❑ Yes W No
I S. Does the receiving crop need improvement? ❑ Yes 10 No
16, Is there a lack of adequate waste application equipment? ❑ Yes V1 No
Reguired Records & Dgeuments
17, Fail to have Certificate of Coverage & General Permit or other Permit readily available? ® Yes ❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ WUP, checklists, design, maps, etc.) ❑ Yes Of No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes M No
20, Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes WNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes R No
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ®No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes 51 No
24. Does facility require a follow-up visit by same agency? ❑ Yes K No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ®-No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer:tosgnesti n# E plam•iinyYES answers azEd/or'arty recomm°`eodations`or any other'commer�Ls: F
{ ;� V _
Use dr_ awiugs ufafaciirty to better ezplara,stirtations (use*ddittopal pages?as necessary). ' ❑ Field Con v ❑ Fina�Notes
4 cmpy a-f- -t,e &r4 -rta,-Ft kw nol etmadaYe - aeu 146
oIC +Ae Co 6e I[ep-f�
Reviewer/InspectorNamex.:F_
Reviewer/Inspector Signature: — Date:
05103101 Continued

❑ Division of Soil and Water Conservation ❑ Other Agency
® Division of Water Quality
e Routine Q Complaint Q Follow-up of D%VQ inspection O Follow-uE of DSWC review O Other
Date of Inspection
Facility Number S/
Time of Inspection 24 hr. (hh:mm)
M Registered E3 Certified .0 Applied for Permit ©permitted 0 Not O erational Date Last Operated:
Farm Nante: Countv:....................................................
OwnerName: �,!` �! .... Phone No:.......................................................................................
........... ...................... ..... .............
Facility Contact: ...............................................---- •............, Title ............................. ........ Phone
...... . ........................... No: ...,...........................----....----.........
c
Maihng Address:...... �.7s 1�.....1�J ��r. .....C� �� .... ?R�� ...L.../!...... '�,,r ...�U . e .......................
Onsite Representative: ............ IntegraEor:........_._..!�f%/ ....... ...-Y_.... _.... _...... � .,.... _..
Certified Operator;-_---...- .............._.....__.....___....
Location of farm:
Operator Certification Number--.. ............ .. _r...
C
C
Latitude 0 9 94 Longitude ` 0° 44
. R Design Current" Fir „Desiggn Current"x Design s Currein#
Swute Capacity P©pulattan Pont'ry Capacity Population Cattle Capst�ty Population
x �_
❑ Wean to Feeder
❑ Layer ❑ Dairy
uJ, ® Feeder to Finish
I0 Non -Dairy
❑ Farrow to Wean
ElFarrow to Feeder
❑ Other
- ❑ Farrow to Finish
"'.psi` r
z Total Design Capaetty,
- ❑ Gilts`
r: ;
❑ Boars
NtimbeirYof Lagoons f, Bolding Ponds. ❑ Subsurface Drains Present HE] Lagoon Area ❑Spray Field Area
No Liquid Waste Management System
F S: lie4 yy3 jh. b ..:.�wx r Ynt. r k&ro0 .ti4' air''
Genera
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field El Other
a. if discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Surface. Water! (if yes, notify DWQ)
c- If discharge is observed, what is the estimated floe: in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lazoons/holding ponds) require
maintenance/improvement?
5. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7_ Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes 91 No
❑ Yes ONo
❑ Yes l5No
❑ Yes XNo
AM�
❑ Yes fV No
'ffYes ❑ No
❑ Yes ID No
❑ Yes M No
❑ Yes &] No
❑ Yes ❑ No
Continued on back

r =�v
Facility Number: QZ-
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons.11olding Ponds plush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure t Structure 3 Structure 3 Structure 4
No
�7 No
Structure 5 Structure 6
Identifier:
r .0�
Freeboard (ft)K +..�...................
10. Is seepage observed from any of the structures? ❑ Yes ;9 No
It. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ........................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Pernvtted Facilities OnI
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
13 No.violations or defieiencies.wer'e noted,durin ' this:visit.- You:will receive i<o ftiritier ::
CyfresOhdence Ah:out this:visit;• : � .
ayes ❑ No
Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
g,� , �/ .� �� �lA�6pai..d.✓.lf ii� • �tlD /� 4�'� �,�+ririE`r .s/,fie/ ©�
7/25/97 H
Reviewer/Inspector Name
Reviewer/Inspector Signature: ' Date: IZ= / s- 77

10 Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSNVC review O Other
Facility Number
Date of Inspection
2
Time of Inspection J 24 hr. (hb:mm)
Total Time (in fraction of hours
Farts Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for I hr 15 min)) Spent on Review
6Certified ❑ Permitted or Inspection (includes travel and processing)
❑ Not
Operational Date Last Operated; ... _._.....
Farm name:
Land Owner Name:
Facility Conctact:
Mailing Address:
Onsite Representative:..._. .., �. I�!�... _... . _ ....... _ .. � .._
Certified Operator:
Location of Farm:
County:---�IV ) .. _`.._./� ... _.
Phone No: _L!../0� Jam_—��..
.....�.._. _...._ Phone No: _...__ .. ....
Integrator:
Operator Certification Number: .... ._.......
._....
Latitude • 4 k Longitude • 4 "
Type of Operation and Design Capacity
� °DeS gR "ciiiWRt ,, ''l)esrgri Current > r a a ])esign Currei]t Q p
�...,p , ziA -PORT ,� t '� c - �C$ttleµga:''nY b
. �. ,:,,: •..k... ,'Ca pa o tilation° ". n _' �: Ca achy Po ulatioR.::0 3; :,Ca sci [ o ulatroa
g Wean to Feeder '0&rir
❑Feeder to Finish
Farrow to Wean
a < ar
Farrow to Feeder
TOta1D@5tgn Capacity
Farrow to Finish
es
��.,,.,..>_ .gym ..m.,. � {r� yTOtai ►7174��'T � �.v 'F'p-'�`.e�� r`�'�a�i
' ❑ Other
*�f-•-a<s�
e.
t
��x��4 ❑ D
E[]Nin-Eaver
- ❑Non -Da'
"F��'3�� s?a"�'s" �r,� eR ✓-� � �F;:.+c�
I•luml er 6 Lagoons/ Holding Ponds. ❑ Subsurface Drains Present
i �e n Yw ❑ Lagoon Area Spray Field Area
Genera!
I . Are there any buffers that need maintenance/improvement? ❑ Yes V No
2. Is any discharge observed from any part of the operation? ❑ Yes B 'No
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water`? (If yes, notify DWQ) ❑ Yes �] No
c. If discharge is obsen'ed, what is the estimated flow in gal/min?
d- Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes MNo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ yes KNo
4/30/97 maintenance/improvement? Continued on back

Facility Number: -fir
S. Are there lagoons or storage ponds on site which need to be properly closed?
Structur (La oohs Holdi Pond_c Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
. 9 f L3 �-
Freeboard (ft)................................. ... ................................ .......... ....................
10. Is seepage observed from any of the structures?
I I. Is erosion, or any other threats to the integrity of any of the structures observed"
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
Structure 5
13, Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14- Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15- Crop type l . Ore�,J -
16- Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss reviewhnspection with on -site representative?
22. Does record keeping need improvement?
0
For Certified or Perntitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit'?
0 No.violitions or de dencies were.noted dtir:itig this visit.- .Mott will receive no further
correspondence about this.visit_
❑ Yes KNo
❑ Yes Wo
Structure 6
..............................
Yes ❑ No
❑ Yes e&No
Yes ❑ No
❑ Yes K No
❑ Yes 19No
❑ Yes - Wo
❑ Yes V No
effl Yes ❑ No
❑ Yes N No
❑ Yes ® No
❑ Yes iR No
❑ Yes [�tNo
❑ Yes_ �d No
❑ Yes N No
❑ Yes CR No
Comments (refer to question'#): ExpUah" any YES aiiswers acid/or aiy 1.recom-mendattons t r any;t ether catnmetits.'°
Use drawings of factttty;tic'bette' eatplarn`sttdkion.. (use adrl�tiuoal "ages as:netessaiy) .....
N ��.rr�A�';4� 0'OP/.c,.�p. cq.✓ Z/Q/e ~/ ,qs .�.o�vr��••,� �/ �L/� "` 2 r v�
4,1e: 4o� AS A4 l.1oeEAt- / pf}"rA-) 7/25/97 yr
Reviewer/inspector Name
. N4
Reviewer/Inspector Signature: Date: