820702_INSPECTIONS_20171231

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 3 - -O Arrival Time: /:� Departure Time: County: Region: WO
Farm Name: A9Aa' q. NT op '111/ a.,iz -w-a Owner Email:
Owner Name: Ad Ala Inc. Phone: rf/O- _1/ - O /9G
rMailingAddress: .2y90 C6"'4 ?ee./ ��ar A/G .2B3_�g
Physical Address:
Facility Contact: �IL.iL.,g! /a>, "fitle:
Onsite Representative: /4n ...,., Nav I
l
Certified Operator: 11n14aa),_�
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
Phone No: s/a-IrSy6- %f/161
Integrator: Prt n. un, -f><r. al"I
Operator Certification Number: / gyz!z
Back-up Certification Number:
Latitude: =0 =' [= Longitude: =o =,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
I'. ❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the convevance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
J
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: �I
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 EK ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑Yes
❑'1To
El NA
❑NE
❑ Yes
ZNo
❑ NA
❑ NE
12128104 Continued

Facility Number: .? -- 70.Z
Date of Inspection -D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes O 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: _ _ .i
Spillway?: _.40
Designed Freeboard (in): .7e9 31 "
Observed Freeboard (in): 7
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 properly addressed and/or managed
❑ Yes [37No ❑ 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 E No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[31�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
❑'No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
I0. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
QNo
❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
2No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
.2 r.
12. Crop type(s)
13. Soil type(s)
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
0'No
❑ NA ❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ yes
❑ No
❑ NA [a NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
❑ No
❑ NA BNE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
ONO
❑ NA ❑ NE
ffe v.'{wed &-<'.-W
o {' ><'r,eel ooro/ fdi e -se e u� % f
� oe n r r C� v ,'res 3 /. a rrt �l. Z f yav 4o..t
61/oC -1,hth /aatinw O S,4,_,,I- 'fAc Past r wor /E T'e A4,e /le
0,6 "r 44 wO.' am & r m►a.
Reviewer/lns ector Name —2--�� 2/0-� I541
p 11 Q�c., f/rc. _ LarryQ®►�./r. Phone:
Reviewer/Inspector Signature: ,� Date:
12128104 Continued

� • f
Facility Number: 8� Date of Inspectionos-
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes D<O ❑ NA FINE
20. Does the facility fail to have all components of the CAWMP readily available? Ifyes, check ❑ Yes B- o- ❑ NA ❑ NE
the appropirate box. ❑ `zJf ❑ Ch ists ❑ Dull' ❑ Mws` ❑ 9�hcr
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [moo ❑ NA ❑ NE
_2-Iq— Old .3oj Aft- IV. Ir-W-9
❑ "iVastcApplieafien ❑ ❑ ❑ S+o:ysi ❑�iatr ❑ n
elf ❑-94o4:+ ❑ rrcltl- ❑ _ ❑ y an ns ❑ 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?
30Q At the time of the inspection did the facility pose an odor or air quality concern'?
If yes, contact a regional .Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency'?
❑ Yes
B--No
❑ NA
❑ NE
❑ Yes
[a'ivo
❑ NA
❑ NE
❑ Yes
2No
❑ NA
❑ NE
❑ Yes
['io
❑ NA
❑ NE
❑ Yes
2No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
9i E
❑ Yes
D'No
❑ NA
❑ NE
❑ Yes
['No
❑ NA
❑ NE
❑ Yes
[Q"No
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ Yes ffNo ❑ NA ❑ NE
Additional' Comments and/or Drawings: '
,Sa-lole 'ra,
61
12128104

Type of Visit Gr[Dompliance Inspection p Operation Review Q Lagoon Evaluation
Reason for Visit outine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number D a Date of Visit: 'f O Time: I : 45
O Not operational O Below Threshold
(�'�Permitted (�'Eertified [ Conditionally Certified © Registered Date Last Operated or Above Threshold: •••••_.
fit!
Farm Name: ] . - ........_...__ ...�....__...............�...� ..�.�.».............
------_.- �"�-.--------�..BQ....._........_---- ` � �..._�...............- County- .S ,�Xevt
Owner Name:.._m ^ o _ �. _ _ _- •— -- Phone No: --gI T r
Mailing Address:.._
Facility Contact: r "` � .. iD� Title:.. _.Pt.w_n...................................... Phone No: _.
Onsite Representative: !�'�'^1 ry�4kQ W _Integrator; __F—k-111,11
Certified Operator: .,_.._...... .( So..... �a lot _ Operator Certification Number: j'g���
Location of Farts:
LKSwine ❑ poultry ❑ Cattle ❑ Horse Latitude • f 46 Longitude • 4 f°
W_zan to Feeder
er to Finish
G / g c,
S'p
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
r ' ,Number of l,agoous
Layer
�
Dairy
10 Non -Layer I
4o
Non -Dairy
Mcharees & Stream l- meaets
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier• 1 2
❑ Yes 91<o
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
[�Ko
❑ Yes
5314o
❑ Yes 9'NO
Structure 6
............ .....................................
Freeboard (inches): �a
12112103 Continued

+ Facility Number: — o-x
Date of Inspection
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes dNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or [] Yes 21N0
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes [4 o
S. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑ Yes G?Ko
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes MXo
elevation markings?
Waste Application �
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑dQo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes GKo
❑ Excessive Ponding El PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type Cb^S 4 , rW— (Lm~ &bp )
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes allo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes Rf4o
b) Does the facility need a wettable acre determination? ❑ Yes Rf No
c) This facility is pended for a wettable acre determination? ❑ Yes d No
15. Does the receiving crop need improvement? ❑ Yes Gr&o
16. Is there a lack of adequate waste application equipment? ❑ Yes [9,Ko
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below [] Yes [F<o
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes Or/No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes MIN"o
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes 0<0
Air Quality representative immediately.

Facility Number: 9,2 — ?02 Date of Inspection = 1$ ay -
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes [r No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes SINo
23. Doesrecordkeeping need improvement? If yes, check the appro ate box below. ❑ Yes ❑ No
IJ waste Application (] Freeboard B"Waste Analysis Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
0<0
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ERI lo
28. Does facility require a follow-up visit by same agency?
❑ Yes
M41o'
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
&;�iQo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
RrYes
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Gliqo
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
M1410
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
&3'No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
E?No
35, Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
2No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1 " Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

r
Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Ernergency Notification O Other ❑ Denied Access
L Facility- Number Date of Visit: �� Time: %aQ
IQ Not O erational Below Tbreshold
M Permitted QI Certified Q Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: 0 t? /¢ Countv., A an q
Owner !dame: �avla/ Pttone No: 1d-S6 �� aI `G
�taiiingAddress: __ o�U0 Chr1►[T�t �COd /1TD�1 � ,32�
Facility Contact- Title: Phone No:
Onsite Representative: Art gm ✓ Aylor- Integrator: e ftr/dM J•T�JIId�f�'�
Certified Operator. Wet vlar Operator Certification Number:
Location of Farm:
IM Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude z 0 " Longitude 0 1
Design
Swine Capacity
Current
Po ulatioi
❑ Wean to Feeder
Ig Feeder to Finish
Farrowto Wean
❑ Farrow• to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons
Holding Ponds / Solid Traps
Design Current Design Current
Poultry capacity Population Cattle Ca ackv Population
❑ Laver I I I ED Dairy
❑ Non -Laver Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Discharees & Stream Impacts
l . Is anv discharge observed from any part of the operation?
L I Subsurface Drains Present JILI Lagoon Area JLl Spray 1
❑ No u rid Waste Management Sysfem
Discharge originated at: ❑ Laeoon ❑ Sprav Field ❑ Other
a. If discharge is observed_ was the conveyance man-made?
6_ If discharge is observed. did it reach Water of the State? (If yes. notify DWQ)
c. if discharge is observed. what is the estimated flow in ealimin?
d. Does discharge bypass a lagoon system? (if ves. notif}• DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
WA - a Coligrtion & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Sauce e? Structure 3 Structure 4 Structure 5
Identifier:
�
Freeboard (inches): 3,3a _—
❑ Yes ER No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
RI No
❑ Yes
EJ� No
❑ Yes
(5No
Structure 6
05/03/0I Continued

r
Facilih' Number: � —7O�
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not proper]}' addressed and/or managed through a waste management or
closure plan?
(if any of questions 46 was answered yes, and the situation poses an
immediate public health or environmental threat; notify DWQ)
7. Do any of the structures need maintenance/improvement?
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate. gained markers with required maximum and minimum liquid level
elevation markings?
❑ Yes ®No
❑ Yes 06 No
❑ Yes W No
❑ Yes 14 No
❑ Yes f9 No
Waste Application
10_ are there any buffers that need maintenanceiimprovement?
❑ Yes
JrNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
UUNo
12. Crop type !�{& / Ryc ay
13. Do the receiving crops d`ifffer`wi�os
th those designated in the Certified Animal Waste Management Plan (CAVVMP)?
❑ Yes
[V No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
Wf No
b) Does the facility need a gettable acre detmm-iination?
❑ Yes
M No
c) This facility is pended for a wettable acre determination?
0 Yes
No
15. Does the receiving crop need improvement?
❑ Yes
No
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
RRe uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
WLNo
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
JRO No
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
21 rail to notify- regional DWQ of emergence situations as required by General Permit?
(ie' discharge, freeboard problems. over application) ❑ Yes ® No
23. Did RenzewerAnspector fail to discuss review/inspection ,"zth on -site representative? ❑ Yes ® No
24. Does facility require a follow-up visit by same agency? ❑ Yes MNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes RNo
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit`
Comments (re%r Eo gnestitiii: 'Ezplsiii stay i'ES'aQswes andlarany atiy ether e6htmm�._;
yrernaemend'atians.ar
Use drawittgs of facsltry to better erpiain sling_ ttas. (use addihotaal pages as nersssary` )= _❑Field Cop,.- ❑ Final *totes �--
e_
�n R: wr J-Y,
Revlewerlfns ector Name , ..� . •( :: ` �. 'i,Y.
p »+e i F.:S l is wi5: aKs �?fan-AdD . a..T Z1_­i^_
Reviewer/Inspector Signature: Date: Id — ]'
05103101 Continued

r
._ .. - 1_. ._ -I 1 _
Type of Visit *0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit _-Q Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Timer Departure Time: County: t
Farm Name: Arrh 6hv Nov Or Owner Email:
Owner Name: t n" Phone:
Mailing Address:
Region: L�a -
Physical Address: 1 I
Facility Contact: �! + k1 Title: � /_?;_�'/_ _ Phone No: SqE7q 03 lC
Onsite Representative: J N 1 fr' Integrator: / 4j!:
Certified Operator: fin_ `&q A Operator Certification Number: A1IA lgqlT
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = I = " Longitude: 0 ° = 1 = v
Design
Swine Capacity
Current
Population
Design GurrenI Design Current
Wet Poul#ry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy Cow
❑ Non -Laver ❑ Dairy Calf
❑ Wean to Finish
Wean to Feeder
FFeeder to Finish 1 &Iao'
❑ Dai Heifer
Dry Poultry ❑ D Cow
❑ Non -Dairy
❑ Layers
❑ Beef Stocker
❑Non -La ers
❑ Pullets ❑ Beef Feeder
❑ Beef Brood Cowl
❑ Turkeys
❑ Turkey Poults
Other I I Number of Structures:
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other 10
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
NNo
❑ 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
0 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
N No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

f
�
Date of Inspection
Facility Number. —
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
2No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Stntcture 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (iu): --
Observed Freeboard (in): q _
5_ Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA ❑ NIE
(it/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
lj� 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
JR No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
IN 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?
% aste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
P�No ❑ NA ❑ NE
maintenancelimprovement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
NNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes VNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
IR No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'[] Yes
CRNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
&No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
)�] 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 �S-. 'f k ^' f EPA Phone(1133 3_WK
Reviewer/Inspector Signature: Date:
�' 12128104 C Onturued

Facility Number: <9 3,— 70,11 Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes a No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check [:]Yes V No ❑ NA ❑ NE
the appropirate box_ ❑ WDP ❑ Checklists
❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes � No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
❑ Yes
W No
❑ NA
❑ NE
❑ Yes
❑ No
®'NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
tR No
❑ NA
❑ NE
❑ Yes
S No
❑ NA
❑ NE
❑ Yes
❑ No
tR NA
❑ NE
❑ Yes
9No
❑ NA
❑ NE
❑ Yes
[[No
❑ NA
❑ NE
❑ Yes
h No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 2INo ❑ NA ❑ NE
❑ Yes ETNo ❑ NA ❑ NE
I5 , Al (s Prcj, r,reI ay-��L� oafta 7, VeV f�df CAW
-Co'jq, t1iijef f 1406kOcto-if roatj biltc -rvd� no� 167
foilsJ i!!)
6&-d too
Page 3 of 3 12128104

M
• Facility No.S a"7D)- Farm Name b0% Date $ ,J +tcl
Permit ,✓ COC .X OIC_ NPDES (Rainbreaker PLAT Annual Cert )
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft& %
Liquid Trt. Zone ft
Calibration Date
Fesign Flow�.�_---�-
Soil Test Date 6-i C r
pH Fields 7.�L-7. !
Lime Needed 0
Lime Applied JOtC;tYf
Cu ✓ Zn
Needs P (�
Crop Yield v�
Wettable Acres
WUP J�
Weekly Freeboard ✓
Rainfall >1"
1 in Inspections
120 min Inspections
Weather Codes
Transfer Sheets h Vt
RAIN -GAUGE t�
Dead or incinerator
Waste Analysis Date
Pull/Field
Pull/Field
Soil
crop
RYE
PAN
Max Rate
Ma`x� Amt
kj
/��Wiipndow
hop
sG
5 D
SP -
a
0 SD
a
s�
s
fv
I-
.T
7
Verify PHONE NUMBERS and affiliations
Date last WUP FRO S11 C( I Date last WUP at farm
FRO or Farm Records
old
Lagoon #
Top Dike
("Ir.'s
Stop Pump
6a 5T
Start Pump
j . qT
App. Hardware

IMS_7vj 71a4f06
Type of Visit O Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit )@ Routine O complaint O Follow up O Referral O Emergency O tither ❑ Denied Access
Date of Visit Q Arrival Time: Departure Time: County: Region:
Farm Name: n`�l 6A U _ aY ! � � 4 �. Owner Entail:
Owner Name: ' V Phone:
Mailing Address: z4qX CheaJ, a kf1rh a� g
Physical Address:
Facility Contact: Title:
Onsite Representative: ar'
Certified Operator: (oshe in n
Back-up Operator:
Location of Farm:
J�.y.PhoneNo:
�T7 Integrator: 11.9M_
Operator Certification Number:A" 1R ` L!�
Back-up Certification Number:
Latitude: Q o Q I= u Longitude: D 0 D 1 D u
Desigwx_ Current.
DestgaCurrent
Design Current
Swine
Capacity Populahon. "
Wet Poultry
C p city Popetlat�on
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ Wean to Feeder
❑Nan -La er
❑Dai Calf
Feeder to Finish
i - -' " -
❑ Dairy Heifer
Farrow to Wean
�`
❑ Dry Cow
❑ Non-DaiTy
❑ Farrow to Feeder ` -' '" -
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
-- ❑ Pullets
❑ Turkeys
❑ Beef Brood Co
❑
❑Turkey Puuets
.E
Number Structures:
Other
❑Other
of
Discharged & 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?
I Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page ]of 3
❑ Yes ;KNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
D? No
❑ NA"
❑ NE
❑ Yes
�Rj No
❑ NA
❑ NE
12129104 Continued
a

` FaciWy Number: a- Date of Inspection L7 BON
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes CgNo ❑ 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: 0 i d New
Spillway?:
Designed Freeboard (in): I Q.5
Observed Freeboard (in): 1 _
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[NCNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
MNo
❑ 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
NNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
9No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
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
t"No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
allo
❑ 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 Croup Window ❑ Evidence of Wind Drift ❑ Application Outside of Area ���
r f y
I
12. Crop types) At kL lT4-f
G d,s �'Dn %tO11�
C/7d, �. S0�°Da
I
.
13. Soil type(s) N/i i N&Aif
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
IgNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
CRNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
19 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
91 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
54 No
❑ NA
❑ NE
io better, e
Reviewer/Inspector Name ZDAWLi Phone: [Q lO1 3imX
Reviewer/Inspector Signature: Date: (�rJQI bA
Page 2 of 3 12128104 Continued

Facility Number: 3a. —7 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JR No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes CRNo ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists [3 Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes to No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ No
&NA
❑ NE
❑ Yes
UNo
❑ NA
❑ NE
❑ Yes
t'No
❑ NA
❑ NE
❑ Yes
29 No
O NA
❑ NE
❑ Yes
❑ No
[ WA
❑ NE
❑ Yes
CB:No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
krNo
❑ NA
❑ NE
❑ Yes
krNo
❑ NA
❑ NE
❑ Yes
kNo
❑ NA
❑ NE
❑ Yes
XrNo
❑ NA
❑ NE
Addif�onal:Comments"and/or Drawings: ""=�
3 y,..
7, A-Cew bcresrob of old 1gem . A/CW I & h a rJ00d
oi-'be % ��Pd - sera y i� , i t m 111,ei- c� !`h A4Agd 0 f � rDW (r0 fS
r ff �-a 11 �-i med'la�
i l
@Lsoji svrv�y wa�dole in a+ao�, 1v�rt beo{ole aukiLf -Call,
34, Ca I b'a*01 h, -e I i%I a0�o8 ,
3'. SA/dam'rVrveo, db?e in eca007,
6 ood look f-darn-r .
Page 3 of 3 12128104

'Facility No. k- 0-A, Farm Name
Permit COC �� OIC
...Pp . Type Design Current
FB Drops
ft•�'
Date
NPDES (Rainbreaker
PLAT Annual Cert )
Freeboard
1
2
3
4
5
6
7
Design
RIMS
Observed in
Sludge Survey Date Perm Liquid ft
s
Sludge De th(ft)
4,2
IJ1l, � rlJJ
; Calibration Date
Design Width
E WT-�-MIMM
Soil Test Date g Q ! TObd#1'P o' .fop Yield
pH Fields OK e•s-y g .N S Wettable Acres-"
Lime Neede WUP
Cu Zn IV Rain Gauge
Needs P 410_ Weekly Freeboard
Rainfall >1"
1 in Inspections ✓
120 min inspections
Weather Codes
Transfer Sheets
Waste- -
r� ,,rr�:►;
�r��r�r�r�
SIDE
-,._
•
r
Pull/Field Soil Crop Pan Window
3
1

- * Q2 Division of Water Quality
Facility Number _ `7QU0 Division of Soil and Water Conservation
ei other Agency Q
IP
Type of Visit lacompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint 0 IFo11ow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of visit: Arrival Time: Departure Time: E==County: -�W Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Ousite Representative:
Certified Operator -
Back -up Operator:
Location of Farm:
swine
❑ Wean to Finish
t❑ Wean to Feeder
ceder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
77
Other
❑ Other
Design Current
Capacity Population
FQ-fm_� 'rl CG Phone:
I
PX Phnnp Nn-
Operator Certification Number:
' Back-up Certification Number:
Latitude: o ='
= " Longitude: = o
DesW-
Wet Poultry Capaci
layer
Non -Layer
Dry Poultry
Current
y Population Cattle
❑ La ers
❑ Non -La ers
❑ Pullets
❑ Turke s
❑ TurkeyPoints
❑ Other
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Co
Number of Structures'..::'[
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2_ Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes KNo ❑ NA ❑ NE
❑ Yes ❑ No NA
❑ N E
❑ Yes
❑ No NA
❑ NE
❑NoNA
ONE
El Yes
❑ Yes
o ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
12128104 Continued

Facility Number: YQ—ZD
Date of Inspection 7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: e_
Spillway?:
Designed Freeboard (in): Z
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
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
Wo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes y�ao ❑ NA ❑ NE
11 _ Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes "�MNo ❑ 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 E] Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
f-1
6
r o1 S
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes '�&No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes'io
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes :i4 No
❑ NA
❑ NE
17. Does the facility Iack adequate acreage for land application?
❑ Yes -10
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 'C�No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers. and/or any recommendations or any other comments
.Use drawings of facility to better explain situations. (yse additional pages as necessary): x �:
Reviewer/Inspector Name L C
ReviewerAnspector Signature:
Phone:
Date:
N
Page 2 of 3
12128/04 Continued

Facility Number: Date of Inspection -1107
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes lt�No ❑ NA ❑ NE
the appropriate box. ❑ W`Up ❑ Checklists ❑ Desig
n El Maps [I Other
21 _ Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes '51No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soii Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes *No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No �NA [I NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes GrNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes o
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes 4 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
�kA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes No
❑ 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 o
ElNA
[_3NE
33. Does facility require a follow-up visit by same agency?
ElYes kNo
❑ NA
❑ NE
Additional. Comments and/or Drawings:
-*
CcD ✓e-c. yd 5.
Page 3 of 3 12178104

(�
Facility No.� d' Time In �OOTime Out
1'JV! F O,.r rn5 y,Lu Integrator �%�✓ '71
o Owner Site Rep iy
Operator .11 � No.
Back-up
CQC
No.
Circle: &era-ly or NPOES
Wn log
Design
Current
Design
Current
Wean -Feed
Farrow - Feed
Wean - Finish
Farrow - Finish
Feed, Finis
Gilts / Boars
Farrow - can
Others
FREEBOARD: Design c,? 7' �" Observed
Slijuya 5unrey Calibration!GPM 5 b c
Crop Yield Waste Transf
Rain Gauge Rain Breaker
Soil Test PLAT Wettable Acres L�
Weekly Freeboard Daily Rainfall 1-in Inspections
Spray/Freeboard Drop
Weather Codes
120 min Inspections
Waste Analysis: o[ j 0--Q
Date Nitrogen (N)
Q�
Date Nitrogen (N)
Pull/Field Soil Crop Pan Window
S V
10
r --

Type of Visit IS Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit V Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑Denied Access
Date of Visit: Z Cho Arrival Time: � �Q'1 Departure Time: County: Region: KS) �_
Farm Name: n fYls Owner Email:
Owner Name: AL" nYl U4 ,,,, nn Phone: '}
Mailing Address: Ul't�l ►V-% 11 O(83.2 X
Physical Address: Q 64 _ �bddlrl_
Facility Contact: 72�me-- Title: 0Yl Phone No: 91a J9(D - --) `i 0 3_
OnsiteRepresentative: J� g P�rL°-hrl-�LkM' i� �� �{ Inte rator:
Certified Operator: n`� �b71 ' " �{ Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: F--I O [� t [� it Longitude: M ° E], 0 u
an !1`ate (kc ier
��i7v
crt
Swine
Design Current"
Caacity Poulatt
� "" �
We# oultry
Design Current- Elift
Capacity Pouatran Capacity Population
❑ Dairy Cow
❑ Wean to Finish
❑ Layer
El
Wean to Feeder
Discharges &Stream Impacts
. Is any discharge observed from any part of the operation?
El Yes
A7No
❑ NA
❑ NE
Discharge originated at: El Structure El Application Field ❑Other
a. Was the conveyance man-made!
[-I Yes
❑ No
ANA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
❑ No
t�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)
El Yes
❑ No
J�PNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
R No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
1� No
❑ NA
❑ NE
other than from a discharge?
Page 1 of
12/28/04
Continued

4 •
Facility Number: — Date of Inspection Ola
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes NNo ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes ❑ No UNA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 1 Z
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes Wo ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes 0 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 14 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 C] Yes P:No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �;lNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes XNo ❑ 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) & IMt&& (C)1kT_C
13. Soil type(s) Qo,
14. Do the receiving crops differ from those designated in the CAWMP? Yes ❑ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes RNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 9 No ❑ NA ❑ NE
IT 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 14 No ❑ NA ❑ NE
hue or C Wv'r , tje'ver kk+s `
PA1VWd tm WeV 3 . A/I craps OkE same as CA rump &I ttVs
Wh-cr-f- LOOLS-Le.. ; s a p l y d.
Hw
ReviewerlInspector Name]] Phone: l o T�3 3
Reviewer/Inspector Signature:
Page 2 oJ-f
Date:
12128104 Continued

Facility Number: 'Z — 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 $SNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
� ❑ Maps
p ❑Other
21, Does record keeping need improvement'? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [:]Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
4No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[XNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Ovo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
�4 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
KNo
[:1 NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Wo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
PNo
❑ 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
Xlo
❑ 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
ONo
❑ 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
Mo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
Ulo
❑ NA
❑ NE
Addtteod0f, draments and/or Drawings:-;',*"
o4
(2jcx�
12128104

Pz
Type of Visit: V Comp' nce Inspection O Operation Review O Structure Evaluation O 'Technical Assistance
Reason for Visit: '"tine O Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: / Arrival Time: p ; OD Departure Time: ; t] c7 County: S Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: j�to'f 11 f.y %lJ f p/" Title: Qcu es rr'' Phone:
Onsite Representative: Sac-_ Integrator:
Certified Operator: �; GK.� Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current Design Current
Pop. Cattle Capacity Pop.
Da' Cow
Wean to FeederFINon-Layer
I) . R551W,..i
La ersBeef
Design
Da' Calf
Da' Heifer
Current Cow
Non-Da'Farrow
Stocker
Feeder to Finish
Farrow to Wean
f
Farrow to Feeder
to Finish
Gilts
Non -La eBeef
Feeder
Boars
PulletsBeef
Brood Cow
Turke s
Other Turke P
Other Other
Discharses 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?
00,
❑Yes No ❑NA ❑NE
❑ Yes ❑ No DNA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
�No
❑ NA
❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
Page I of 3 21412015 Continued

"1 lFacifity Number: [Date of inspection: --/
Waste Collection & Treatment
. 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: -L J _ �'j 7- 0i
Spillway?: _
Designed Freeboard (in): /
Observed Freeboard (in): �' ld ��.5 7
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?
ONo ❑NA ❑NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes E]'14 ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes E]rNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [3-Ko ❑ 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 dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Aipplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ff/No ❑ NA ❑ NE
maintenance or improvement?
11. 1s there evidence of incorrect land application? Ifyes, check the appropriate box below. ❑ Yes dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs. ❑ 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): B-e-I.4xcle
13. Soil Type(s): zaaz ! l�,•� f e „:, ..
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [�No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [�J'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?
[-]Yes D-I o ❑ NA ❑ NE
[:]Yes dNo [DNA ❑ NE
Required Records & Documents
19. Did
No
the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[3
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[—]Yes
[3rNo
❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[3`�o
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Ej No
❑ 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:
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 0 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [Z No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �o ❑ NA 0 NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes []"No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [�J`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
E 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
G_ o
❑ NA
❑ NE
❑ Application Field ❑ Lagoort/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[�`No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
EfNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[/]"No
❑ NA
0 NE
k., a on ft Explain any YES answers and/or any additional recommendations or: any otherscomments:
£�
ius6diawlnig'g,of facilrueto better explain situations (use additional pales as necessary): ___ `
Reviewer/Inspector Name:
Reviewer/Inspector Signatut
Page 3 of 3
Phone:
Date:
21412015

t
ype of vtsu: tfyc,orupit inspection snspecon V uperahon xevtew V structure evaluation V .} cat
Reason for Visit: outine 0Complaint Q Follow-up O Referral O Emergency Q Other Q Denied Access
Date of Visit: f,— _j Arrival Time: Departure Time: r _ Q County: Region:
Farm Name: Aw Owner Email:
Owner Name: _ice Phone:
Mailing Address:
Physical Address:
Facility Contact: 16-fYI D
Title: d2j: j7 Phone:
Onsite Representative.
p ^� � Integrator: /
Certified Operator: Certification Number: /1P"*�A _
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
--�Desigtt-7Current
Design
Cjr,rent
Design
Current
Swine
.=Capaty, _Pop.
Wet Poultry .
Capacity
p.
Cattle Capacity
Pop.
.. ...
Wean to Finish
La er
DairyCow
Wean to Feeder
Non- -a er
DairyCalf
Feeder to Finish
s�jf
DairyHeifer
Farrow to Wean
"'..: Design
Current
Cow
Farrow to Feeder
D . l;oultri' . `Ca
aci
Pao .
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Farrow to Finish
La ers
Gilts
Nan -La ers
Boars
Pullets
PTurke
therTurkeoints
KOOther
s
Other
Discharges and Stream imuacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑Structure ❑Application Field
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 2§-No ❑ NA ❑ NE
[] Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [] Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑Yes � No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑Yes RNo ❑ NA ❑ NE
of the Stake other than from a discharge?
Page I of 3 2/4/20I5 Continued
Assistance
Reason

Facili Number: Z2.--74 jDate of inspection: G
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
O 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: 0149( J"
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
allo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
[:]Yes
MNo
❑ NA
❑ WE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Ug.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
,jNo
❑ NA
❑ N E
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E�_No
0 NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [ENo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): V� �
13. Soil Type(s): ,U a `` A.' 0
I4. 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 UNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes fYo D NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
KNo
❑ NA
❑ NE
1 S. 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
Z_No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
F�J_No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
allo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
RNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
allo
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

FaciliNumber: - Date of Ins ection: — 3— f;7
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes rallo ❑ NA ❑ NE
•� 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 12g.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
[n No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
F1No
❑ NA
❑ NE
❑ Yes E�]_No ❑ NA ❑ NE
❑ Yes C- No ❑ NA ❑ NE
❑ Yes &jNo ❑ 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
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
ZfNo
❑ NA
❑ NE
Commegts,(refer to g iesstion #} Egpiain any YES ans d/ any addrhona! recommendatEons'or any°other comments: f
Use drawingsaafpfaci ta. better. etplam sttuationD laddihonal pages as necessary. `
f
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone:
Date:
21412015

�
Type of visit: "Compliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: &Ifoutinc O Complaint Q Follow-up O Referral Q Emergency Q Other O Denied Access it
Date of Visit: L Arrival Time: Q ; p C Departure Time: : /j— County: _vim Region:
Farm Name: Owner Email:
Owner Name: J¢/�! �pr� 00S -47ne". Phone:
Mailing Address:
Physical Address:
Facility Contact: l ,pr ' Title: 012-W `fir
Onsite Representative: ��� ` Integrator:
Phone:
Certified Operator:— Certification Number:
Back-up Operator:
Location of Farm; Latitude;
Certification Number:
Longitude:
Design Current
Swir►e Capacity Pop.
Wean to Finish
Design Current
Wet Pouitry Capacity Pop.
La er
Design Current
Cattte Capacity Pop,
Dairy Cow
Wean to Feeder
]Non -Layer
Dairy Calf
Feeder to Finish
Design Current
D . Q.oult , Ca aci Po
Lavers
Non -La ers
Pullets
Turkeys
Turkey Poults
Other
Da' Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
Non-Dai
Beef Stocker
Gilts
Beef Feeder
Boars
Beef Brood Cow
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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Eg No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes Q No
[] Yes (KNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page ] of 3 21412015 Continued

.' Facili Number: = D Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[allo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: C/l c� L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): r ��
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
allo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[allo
[DNA
0 NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
j!j No
DNA
❑ NE
maintenance or improvement?
Waste Applicatlon
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
[allo
D NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): xpv rr rr—� r
13. Soil Type(s): 2WIrle- IT'cx
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes B No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
2 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
[R 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 [K No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Eallo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [] Yes [allo
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: IDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ISNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes jBjNo
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 RNo
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
❑NA ❑NE
❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes [a No ❑ NA ❑ NE
❑ Yes M_No ❑ NA ❑ NE
❑ Yes E-No
❑ Yes 2LNo
❑ Yes allo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments refrwto nestton Explain any answers:' ! recommendations.orany other comments:`
Use drawvrngs [if [aci>ty to better -ex lam sttnahans use additional, a es as n
( q xp andlor any addttwona
1? { / P g essary)... r a,
f A a 4
aAj �' uJ -,filjav--r_ No F-waQ. AU),
Reviewer/Inspector Name: uy Phone: /O-JL330D
Reviewer/Inspector Signature: _ _ Date:
Page 3 of 3 21412015

type of visit: (_-C:omphance inspection U Operation Review (.) Structure Evaluation Q Technical Assistance
Reason for Visit: CrRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: c7 Departure Time: .' Dd County:: Region:
Farm Name: Owner Email:
Owner Name: 21 40 rc r Phone:
Mailing Address:
Physical Address:
Facility Contact: &n�,4 Z:! �- Title: CV" e-"— Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish Layer Dairy Cow
Wean to Feedcr
Nan -La er Da Calf
Feeder to Finish
v
Da' Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current Cow
D . P.oul Ca aci P,o Non-Dairy
Layers Beef Stocker
Gilts
Won -Lavers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other TtAey Poults
Other Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 allo ❑ NA ❑ NE
[:]Yes ❑ No
[:]Yes [:)No
❑ Yes [:]No
[]Yes [g No
❑ Yes t4 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 21412014 Condnued

'� Facrli Number:2Z2 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 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): % `27
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
lMNo
❑ 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
Vj No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4fi 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
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Cj�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus 0 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): / oGrC St'?rcI / "10),`f -
13. Soil Type(s): 2. ct
14_ Do the receiving crops differ from those designated in the CAWMP? 0 Yes [allo ❑ 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?
❑ Yes � No ❑ NA ❑ NE
❑ Yes [2 No 0 NA ❑ NE
Rewired 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 ON 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 S No ❑ NA 0 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 P° No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes R No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

FaciliNumber: - DInspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes D,No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [0 No ❑ NA ❑ NE
the appropriate box(es) below.
[] Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [] Yes 2 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes MA No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
[]NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Z,No
❑ NA
❑ NE
Comments (refer to;question #): Explain any YES answers and/or any additional recommendations•or any other comments. -
Use deawinks facility to better explain situations (use additional napes as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 22IL5�3 _IUO D
Date: S7__ ';;'
21412011

I ype of visit: C2 rComptiance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: t / Arrival Time: Departure Time: p; Coun �� Region: � (7
Farm Name: r7 V
4_1 #Owner Email:
Owner Name: rvIlms c. Phone:
Mailing Address:
Physical Address:
Facility Contact: 4.17 'T d Title: 6LW1; e1— Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
!� !Design Current
�Destgn�Current t
Design CurrentSwineCapacity
..
Pop Wet Pauli11jfCapacity Pop ; x Cattle
Capacity Pop.
Wean to Finish FLayer Dai Cow
Wean to Feeder Non -La er " DairyCalf
Pi Feeder to Finish ire f a [DairyHeifer
Farrow to Wean IDesignsCui rent D Cow
Farrow to Feeder .
rarD , P.oul Ca ace Po 4Mr Non -Daily
Farrow to Finish Layers r Beef Stocker
_
Gilts Non -Layers Beef Feeder
Boars Pullets Beef Brood Cow
Turkeys -
Other = Turkey Poults
Other Other
Discharges and Stream Impacts
1, is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes jo No ❑ NA ❑ NE
[:]Yes [:]No
[:]Yes [:]No
❑ NA ❑ NE
❑ 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 No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - p Date of Ins ection: /K
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [g 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: Q pal f+ -w
Spillway?:
Designed Freeboard (in): I
Observed Freeboard (in): q —
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes KNo
❑ 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 M No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [XLNo
❑ NA
ONE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes CKNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 101/a or 10 lbs. 0 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 Types): -r�lil b I Oars �c� / l'i'1'r i'+ /
i
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No Q NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes E,No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [R 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
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 [allo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [] Waste Transfers
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ®. No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Eig-No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection: l
_ 24. Did the facility fail to calibrate waste application equipment as required by the permit? 0 Yes C,No
r
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes �Z No
the appropriate box(es) below,
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 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
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [,,21 No ❑ NA ❑ NE
❑ Yes [,No ❑ NA ❑ NE
❑ Yes ENO ❑ NA ❑ NE
[Yes [—]No ❑ NA ❑ NE
❑ Yes
®No
❑ NA
❑ NE
❑ Yes
[�LNo
❑ NA'
❑ NE
❑ Yes
No
❑ NA
❑ NE
Coniments'(rifer_to question:#): Explain any YES answers and/or any additional -recommendations or any, otlterfcotnments.
UO-dia&in: j-!s_';'oFr&ciHty to better explainsituations (use additional oat:es as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: _ 2:20- 33 33 0
Date: / z/
21412011

10W,113 0NS OVS
Type of Visit: & Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: QRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: � Arrival Time: a ; q0 P1 I Departure Time:®' h County.S( Region:r
Farm Name: my Nay ta- *-I Q- 4 k, Owner Email:
Owner Name: Mt-' ' 61X 'Nov I(r F (w 1�4 Phone:
Mailing Address:
Physical Address: S L C
Facility Contact: AyTtl1Qny Novla, Title: w Phone:
Onsite Representative: '}it !hyQy�Q/" Integrator: �tk
Certified Operator:01-Y )JOY10- Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
^� Design Current T ` TCurrent
Design CetrrenI
DDesign
Pop.Poultry" PAC Pap.
Swinei4
Cattle Capacity Pop.
W 'Capacity
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
t }'"
"?�•
DairyHeifer
ti
A.."': fi Design CurrentDry
Cow
Farrow to Wean
1) , P,oult �Ca aCi f;o
-Dairy
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars Pullets
Turkeys
Other elv, : - urkSj Poults
Other ether
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 W No ❑ NA ❑ NE
❑ Yes [] No ❑ NA [] NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
[] Yes
to No
❑ NA
❑ NE
[] Yes
RNo
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facili Number: 10,1 [Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
F>gj 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: O` L6\j Uley (a)
---
Spillway?:
Designed
Designed Freeboard (in): ! !-_
Observed Freeboard (in): si
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
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
J�d No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
U 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
C' No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[!a No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
C5j'No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
� No
❑ NA
NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
P No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
� No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
CR 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 tR No
❑ Waste Application ❑ Weekly Freeboard []Waste Analysis ❑ Soil Analysis 0 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 fS No
23. If selected, did the facility fait to install and maintain rainbreakers on irrigation equipment? [:]Yes [:]No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
CK NA ❑ NE
Page 2 of 3 21412011 Continued

7oa. t
facility Number: a -tW I Date of Inspection:
24_ Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes [RNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes [R No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes [0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No [52 NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes [,;a No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes [$ No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes CR 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.
CKYes ❑ No ❑ NA ❑ NE
El Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes fig No ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes 1A No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Eg No ❑ NA ❑ NE
Comments (referto question ft Explain any YES answers and/or any additional recommendationsor any other commentsW"
Use drawings of facility to better explain situations (use additional pages as necessary).,.
y, broth -i,eld a,
7, Rj w� war s f �a j 11 s#v►�1 r �rad�r>rJ bpi- h�il f n C.'�o be sp� J �d a , �,r�)gr,
741 -e1rat,j # 4f etdj�
ivy' yvd r i/)fv ffg� , i4 H4C- ref la4 ' ��Ils -5, Neir hmk Pla, wor
Reviewer/inspector Name:
ReviewerlInspector Signature:
Page 3 of 3
Phone: qI-q13-33120 leff-Ift)
Date: (LjI q,,)0(3 _
21412011

Facility No. 12: -Farm Name A� 1v� Date .
Permit, lt::::� COC OIC� NPDES (Rainbreaker PLAT Annual Cert Daily Pipe )
4140 qj(413=11.300W
Lagoon Name, S forspillway
1
2
3
4
5-
6
7
Design Freeboard / Last Recorded in
Observed freeboard
Sludge SurveyDate
-Sludge Depth ft
Li uid Trt. Zone ft
Ratio Sludge to Treatment Volume if> 0.45
�`•
Date out of compliance/ POA?
,IT
16-ATA ie'71►� ia"�ftb7� W.tr.L'+Si/.iWW'
. . f . ALM
01
LSi;%Ni
PjsAin r _
'
Soil Test Test Date 31 d 3 4 Ia 0 X
Crop Yield
Transfer Sheets
pH Fields
Wettable Acres
RAIN RAIN GAUGE'
Lime Needed �_
WUP
Dead box or incinerator
Lime Applied
Weekly Freeboard ✓
Mortality Records
Cu-I Zn-1
1 in Inspections i
Check Lists
_
Needs S (5-1<25)
120 min Insp. ✓
Storm Water
Needs P ~
Weather Codes
Waste Date
z
:.
z
:.
..
..
Chats G�i
Verify PHONE NUMBERS
and affiliations
Date last WUP FRO 5 r!d
Date last WUP at farm
)qg FRO or Farm Records
Lagoon ## 3`,,45-
}
App. Hardware
Top Dike
.7
Stop Pump
Start Pump
Bo,t(
V$
0,51-
(p4,Qr
li-7-11
;.00
Conversion- Cu-I 3000=
108 Ib/ac; Zn-I 3000= 213 Ib/ac

V(,t st Loy A :- 5� of 5
ayrJC9,41-= ?o,7
Gi)
6.% 6fuej
€ft,re-kill t �n
(A-�-J se y
"a►� Dalian
o, a q)�.
ti-pals
5, ) $
C�Jojo

Jvs AIltS g1101(x
Type of Visit: i$ Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 8 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 19= Arrival Time:[j_)',5Mtj I Departure Time: 0,30County: .�ON �'� Region: _
Farm Name:. (;
Owner Name: PA& F1/Mr
Owner Email:
Phone:
Mailing Address:
Physical Address: c�` L( � r.' 1 I 1(�)
Facility Contact: _ f,�Y' Title: ©►V/t _ Phone:
Onsite Representati
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator: H— 13 _
Certification Number: 119y / Y
Certification Number:
Longitude:
Design
Current :
Desi gn Current
Swtne Ca a
P t3'
-,DestgnCurrent
Poy et Poult Ca act
P•W p F ty . Pop.
@attle Capacity Pap.
,
�ry
ILayer
=
Daig Cow
Wean to Finish
Wean to Feeder
Non -La er
Daig Calf
Feeder to Finish
;.
Dai Heifer
Farrow to Wean
ti
k DesignCurrent
Dry Cow
Non -Dairy
Farrow to Feeder
D , P.ouly"Ca aci P,a
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
C. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes No [] NA ❑ NE
❑ Yes
❑ No
[] NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes 4� No
Yes CR`No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: New
Spillway?: ON
Designed Freeboard (in): iq4RVI al
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.)
Structure 5
t�37No ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 6
❑ Yes allo ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �TNo
❑ 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 to No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes N No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes C'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes tR No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes '5j"No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs_ ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Z No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
S No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
12 No
❑ NA
❑ NE
acres determination?
17_ Does the facility lack adequate acreage for land application?
❑ Yes
tR No
❑ NA
❑ NE
I S. Is there a lack of properly operating waste application equipment?
❑ Yes
53'No
❑ NA
❑ NE
Required Records & Documents
19_ Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
to No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[5j 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
ta No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
®No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
C9 NA
❑ NE
Page 2 of 3
i
2/4/2011 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Cg No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 51-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.
tK Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
�R No
❑ NA
❑ NE
❑ Yes
❑ No
CR NA
❑ NE
❑ Yes
Ca No
❑ NA
❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes W No ❑ NA ❑ NE
a Yes ❑ No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
allo
❑ NA
❑ NE
33. Did the Revi4er/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
®' No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[-]Yes
C?"No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers;and/orany additional recommendations or any other cotiim6—ii-
Use'drawings:of facility #o better explain situations.(use additional pages as necessary). _
7, Co&L �a), cow o/i both 1ajo9,Lrr,
I y, N i 11et fariveclefois roal We a a-&1 have t7 er8-bvi f Llfld
` x�-hem oui'el7leFlan c� le6� for (Sal7mel, w-e.
1 S� P eaj e, chec4 a, n?ej or �0*alh
) 4. 1 Cofret . &ie_ I PP- a bl+ j Al 1 W Q PlIp 61a e .
o@q, Ybif 1 N4 Wit bcol ai -HII ye6r,
Go& _f �141) _Gelds ,q. rewds ei* ocr nckt, abo,-e:
Gemf1� M,11 1 i ate r be- f/`(-jA `MI'S ill � ��� j6ii� ryf I n6ei�( ry� plan
Reviewer/Inspector Name: 5
Reviewer/Inspector Signature: %A6� , L,
Page 3 of 3
Phone: qiatia LAY)
)
Date:,590f DO f :4,
21412011

+ Facility No. ';_COCA Farm Name � ►\161 11/e��(Ji Date
Permit °<,,,�COC OIC_ NPDES (Rainbreaker PLAT Annual Cert Daily Pipe )
J
Lagoon Name, S forspillway
1
2
3
4
5
6
7
Design Freeboard 1 Last Recorded in
Observed freeboard
; ►
Sludge Survey Date
6
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA?
W[fAk .dmAIIA 1
Calibration Date
Design Flow (gpm)
Actual Flow
��-----
I
Soil Test Date }I� j
VCrop Yie d
Transfer Sheets
pH Fields
Wettable Acres
RAIN GAUGE
Lime Needed 1
WUP ✓�
Dead box or incinerator
Lime Applied.ME
Weekly Freeboard -�
Mortality Records
Cu-I Zn I
1 in Inspections L;
Check Lists
Needs S (S-I<25)
120 min Insp.
Storm Water
Needs P i .i W a
Weather Codes
_ ! -
`.7iLMoir,
mmmrku-
i rLJIMIFM=
--
111 Gal)
• 1
-.
..
..
r`
T
Verify PHONE NUMBF�RS and affiliations016,
Date last WUP FRO 51i� FRO or Farm Records Ril r
Date last WUP at farms Lagoon #
App. Hardware Top Dike S4,5 b� �T • ��
Stop Pump '53, UJ ss
Start Pump .� a,3 ()4'IT [r] `63
Conversion- Cu-1 3000= 108 Ib/ac; Zn-I 3000= 213 Iblac Nil "Z3

e or Visit: *gr(;ompliance Inspection V Operation Review O Structure Evaluation U Technical Assistance I
Reason for Visit: ® Routine O Complaint 0 Follow-up O Referral O Emergency O Other , Q Denied Access
Date of Visit: Arrival Time: �` Departure Time:`"-"'``-"-t CountyRegion: F&
Farm Name:
Owner Name: j4
Mailing Address:
Physical Address: Q91 VAVA' -9- 0- , CTAf n
Owner Email:
Phone:
Facility Contact: AAMV Wlulrr Title: Dhip/_ Phone:
Onsite Representative: , Integrator:$
Certified Operator: (�y o- Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
DesignC rentAl
Desig�Curr�ent Design Current
Swine C+apac�ty op+Wet Poultry Capacity" Pop Cattle Capacity Pap.
Wean to Finish Layer Dairy Cow
Wean to Feeder Non -La er ::3
I jDairyCalf
?C Feeder to Finish,A
IDairyHeifer
Farrow to Wean` £4 Design "C r er nt' Dry Cow
Farrow to Feeder ,D -Dai ry
Farrow to Finish Layers Beef Stocker
Gifts ^,Y. Non -Layers Beef Feeder
Boars Pullets Beef Brood Cow
Turkeys
Other Turkey Poults
Other Other
Discharges and Stream Impacts
1. 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 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
tg No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
F?S[ No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[5j 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: QIJL AJ-P kol
Spillway?:
Designed Freeboard (in): qrs `DD
Observed Freeboard (in): �p
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
140 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
53 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
U[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
UNo
❑ NA
❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[�j No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
5g 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):
P rIc
Sd
13. Soil Type(s): wet D'
AF
14. Do the receiving crops differ from those designated in the CA MP?
❑ Yes
9 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EP-No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
MNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
MNo
E NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
CK No
A
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
1p No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[,;jj 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 5[ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No KI NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - 70 Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes J�a No [] NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No Q 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.
ER 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 f�a No ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes W No ❑ NA ❑ NE
fB Yes ❑ No ❑ NA ❑ NE
❑ Yes VN No
❑ Yes RNo
❑ Yes IVrNo
LCW
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments,( q #}: p y and/or any additional recommendations or.:any°other cohi mfi
Use drain
ws of facility to better explain situations s (use add g ttiona�'pag-es as necessary).
i, 04e_7jd le. doio -(-eld_ a in low s f �
Hill I& is �'-ed acrajJ road_ wh,'c{ hop nef bepn st1wct
�i 6dj vvef f- ( 10A win 1-cr f Mor-e-N&1 I -bl /acre,
= S 1 ud9e ��,trf7o-, _k vyar� a (r11��.J V i i )Ol
y.
�r �oV& lccyovl cote
Vvellmah-6�4-potm)JOod -�etW_r Cft[do�, 401AI Vocd I-ee-0-d-f
Namtic, Setoy� cjrhp d w -f0 riea-lmr,
Celda- 4�a-f- sv 1 nod o0 � ha b�,P,, pazf� ,�,J�al� b't � �l �redu
r
Reviewer/Inspector Name: f
* .,
Reviewer/Inspector Signature:
Page 3 of 3
Phone: [phone] D ' ipgI
Date: p1
/4/201I

Facility No. o Farm Name Anh a,, W, I (Y Date
Permit t% COC --*"' OIC NPDES (Rainbrea
M.
F-i[�L--
PLAT Annual Cert )
Actual
Soil.Test Date 71aa r
Wettable Acres RAIN GAUGE
pH Fields
WUP Dead box or incinerator
Lime Needed
Weekly Freeboard Mortality Records
-
Lime Applie I j`r%C4
1 in Inspections �-
Cu-I Zn-i �-
120 min Insp.
Needs P No
Weather Codes
Cann Yiplrl
Trnncfar Shaafc E n
'
FrW'SMMW�
.�
..
WOR01.
A
A7JQi;�
I
Verify PHONE NUMBERS and affiliations
Date last WUP FRO�1%�C� �/� Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 30 0= 108 Ib/ac; Zn-I 3000= 213 lb/ac
��-ha�+�
App. Hardware

If�,
ylka) ��laJ It.-
!y M - 5f 11 (6 n �sv, env

' roks av io�a�lfr�
Type of Visit Wompliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ($Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Q I Arrival Time: ® Departure Time: County: SMIP—S61 Region: 80
Farm Name: AnAA&q Wt f A-1 � �, Owner Email:
Owner Name: � " �Il Qw f Q" EQ!ms Inc- Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: ��'f1'P/- Phone No: 7 03 (-
Onsite Representative: ow ov � Integrator:.,,,.._
Certified Operator: Gf
1-enn Ivan fa- Operator Certification Number: lS T 11f
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o =' =" Longitude: [= ° = d =
Design @urrent
Swine Capacity Population
Wet Poultry
Design
Capacity
Current. Design Current
Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑Dai Cow
❑ Wean to Feeder I
I
❑ Non -Layer 1
❑ Daia Calf
Feeder to Finish
Dry Poultry
❑ Daia Heifer
❑ Dry Cow
ElNon-Dairy
El Beef Stocker
El Beef Feeder
❑ Beef Brood Co
plumber of Structures:
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
El Layers
❑ Gilts
❑Non -La ers
❑ Pullets
u
❑ Boars
❑ Turke s
Other
❑ Turke Poults
❑ Other
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ structure ❑ Application Field ❑ Other
a. Was the convevance 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 IRNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
ONE
❑Yes
El No
❑ Yes
[RNo
❑ NA
❑ NE
❑ Yes
C'No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number:Qa — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes $j 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): g _ q3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
ERNo ❑ 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 DW¢
7. Do any of the structures need maintenance or improvement? [a Yes
❑ No ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
M No ❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
J'No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
-10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
IRNo ❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[RNo ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 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) L-40l'ta k t5N4 - r1ay 4 r#S" We _,�M4J bM�j J)V_&StW C&A &fLd
13. Soil type(s) koleni&-15 Noff oI k I s `
v
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
W No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
JaYes
[:]No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
�9 No
❑ NA
❑ NE
17. Does the facility Lack adequate acreage for land application?
❑ Yes
'2 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
JR No
❑ NA
❑ NE
leg, 5
Reviewer/Inspector Name 1, S�� 1►1 1i Phone: 1 y� f33
lfevi4ver/Inspector Signature: Date:
,.r a 12128104 Continued

Facility Number: $a, — � Date of Inspection ]0 d n
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ERNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes CTIo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 5'No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No 1�kNA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ISNo
❑ 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
N No
WNA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
C9NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
19 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
10 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
0 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
KNo
❑ 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
KNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Wo
❑ NA
❑ NE
M ,
Additional .Comments and/or Drawings: z �. •
1 k-efp yvoi �Or on bare-s eats on old_ I a�' . 1Vew l a` you,
Ple�e, s �, f y � old:��r�h ,
15. �I eoje 11�ne_ G ralf ' eUs
hay- good cove-,
V e v -�otc-ed o it com pt b l A cn s Ne . 41 R A , vil @ 010 ,
Rye can ve
Wei I mamv hek -ealn 4t9oa_ recall- s.
Page 3 of 3 12128104

NA
Facility No. /$a. -� Farm Name d a spate Q �a �D
Permit ✓ COC ✓ OIC NPDES (Rainbreaker PLAT Annual Cert }
I it UsmEM.'�
�if�L• Ir'L��r•i.�-
iir�f.(C� L �
ss U/751 aOfy
-Lagoon
1
2
v3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
WIN R -Design
��----
Width
Vp
Soil Test Date
pH Fields
Lime Needed
Lime Applied
Cu-I LI
Needs P
Crop Yield
Wettable Acres_
WUP
Weekly Freeboard
1 in Inspections
120 min Insp.
Weather Codes
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
Mortality Records
Waste Analysis Date
• - -
sx�■c
���
��
I �
Verify PHONE NUMBERS and affiliations I
Date last WUP FRO Date last WUP at farm -7 100o
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Iblac; Zn-I 3000= 213 Iblac
App. Hardware