820724_INSPECTIONS_20171231

NUH I H LAHULINA
Department of Environmental Qual

l ype of visit., U Zoutine
Hance Inspection U Vperation Review tJ btructure :valuation U l ectlnlcal ASslStance
Reason for Visit: O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: [� ] Arrival Time: Departure Time: County: g5�n� Region:r
Farm Name: fla. (C Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: 19A4,zAcfc^el t Title: Phone:
Onsite Representative: (I Integrator:
Certified Operator: l� 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 C•a $city p.
Wean to Finish
Layer
I jNon-Layer
I
I
Dairy Cow
Dai Calf
Wean to Feeder
Feeder to Finish
2 Is$Q v
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Farrow to Finish
D , P,ouIt .
La ers
Ca aci
P,a
Non -Dairy
Beef Stocker
Gilts
Boars
Non -La ers
PuIIets
Beef Feeder
Beef Brood Cow
==
Turke s
Other
Other
v.
'
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 0-N6—_rFNA ❑ N1
[] Yes ❑ No El -KC—❑ NE
❑ Yes ❑ No NF
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [7'No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes � o ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

IFacility Number. jDate of Inspection: Qri
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[] Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): --
5. Are there any immediate threats to the integrity of any of the structures observed?
[] Yes
c.. -lq—o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
Ef No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
reat, notify DWR
7. Do any of the structures need maintenance or improvement?
[] Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[] Yes
[EPIC
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
Duo
❑ 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 10 ❑ 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): cI u 9
13. SoiI Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? [::]Yes E3 loo ❑ 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 [3 N ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
D No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
F3<o'❑ NA
❑ NE
Required Records & Documents
14. Did the facility flail 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
rNo ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall O 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 NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: M -J Z 1 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
1]N`6❑ NA
❑ NE
r
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
�
[3-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 suucture(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
! o ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
2No ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes 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 B<o ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes D-10 ❑ 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 [f N ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes 0 o ❑ 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 Q'No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (rise additional pages as necessary).
k�p / ��"t t a� '!�_��(-�� s(ctc�r,�?�Cc�` ! / ` f ,�,Z 3 ` I
c4� 1(0 -30�- �� 5(
Reviewer/Inspector Name: SM 11DU
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: �� our 1
21412015

ry
epe of v isit: Lgcompitance tnspecuon v uperatton tceview V structure r:vatuanon I ecnntcal Assurance I
ason for Visit: (Routine O Complaint 0 Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit- Arrival Time: [e Departure Time: /tL? County: S ►vI
Farm Name: ['IM''k I�� Owner Email:
Owner Name: N i`���5 Phone:
Mailing Address:
Region: fln
Physical Address:
Facility Contact: 4-"Te t Title: Phone:
Onsite Representative: i t Integrator: S'V t
Certified Operator: I( Certification Number:
Back-up Operator -
Location of Farm: Latitude:
Certification Number:
Longitude:
Design Current Design Cnrre tt Design Cnrrent
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish Layer Dairy Cow
Wean to Feeder on -Layer Dairy Calf
Feeder to Finish �r0It
�� DairyHeifer
Farrow to Wean Design Cnrrent D Cow
�,p'mlth�Eul��l0Farrow to Feede„ D $Foul :il„ Ca ae� P,o IN Non -Dal
Farrow to Finish Layers Beef Stocker
P: n �
Gilts Sri Non -Layers Beef Feeder
Boars 11 Pullets Beef Brood Cow
Turkeys
Other''.i�, Turkey Points
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?
❑Yes 0o❑NA ❑NE
❑ Yes ❑ No ❑ ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes [:]No E[� ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No EfNA ❑ NE
2. Is there evidence of 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 [�fNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Faciflky Number: j 13t jDate of Ins ection• p
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
c�'n10
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
ICI IqA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
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
EJ14o
❑ 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
Q,N
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[a -NV--
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[;L>4cr—
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[--i_ -No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [ ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I 0 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): J' a
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [D'11;ro ❑ 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 io ❑ 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 allo ❑ NA ❑ NE
❑ Yes [a -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
[2-1]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
6 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
EfNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E:fNo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

lFacility Number: Z2 jDate of inspection: -;4-0
Z4. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E� No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
e No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
E]"ko
[] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
<o
❑ NA ❑ NE
Other Issues
28. Did the facility fail to property 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? I f yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [3No ❑ NA ❑ NE
❑ Yes EjNo ❑ NA ❑ NE
❑ Yes [3 No ❑ NA ❑ NE
[:]Yes ❑/ "No [:]NA ❑ NE
❑ Yes EJ'No
❑ Yes �No
❑ Yes Q No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
(refer,to qnestion #)= P y anyadditional recommendations or any other comments.
Use drawings of facilityt better: explain situations (use additional. pages as necessary).
1
ReviewerAnspector Name:
ReviewerAnspector Signature:
Page 3 of 3
0- 30&-- 6� 5 ( -C41
l 'C)v Phone: U o— -i Vr3 334
ELI-Jo Date: (} 1 ec,Q
21412015

& RC Ptv-14
Structure Evaluation Inspection
•
Facility Number: 1), -- 72-1 Date: / fl/te`-K11- /L
r
Time in: / lt° P Time out: l�D0 t
Farm Name: ✓'Y"'-k 3 b Farm 911 address:
Owner Name: Phone
Facility Contact: pier P6 'ts-e�
Onsite Representative: Integrator: lit
Certified Operator: Cert. Number.
Is storage capacity less than adequate? Yes No
If yes is waste level into the structural freeboard? Yes No c�
Was non-compliant level reported to DWR ref POA received. y-ef
Structure: 1 2 3 4 5 / 6
Identifier:
Spillway?
Designed Freeboard (in.): "
Observed Freeboard (in.): C
Are there any immediate threats to the integrity of any of the structures
observed? Yes No
Do any structures lack adequate markers as required by the permit? Yes _ No
Does any part. of the waste management system need repair Yes No
Condition of field's 131
Condition of receiving crop fig'
Comments.:

Il ype or visit: Lde7omraneeinspection V uperation Kev�iew V Structure Evaluation U 1 ecbnical Assistance
Reason for Visit:tine Q Complaint O Follow-up O Referral p Emergency Q Other O Denied Access
Rate of Visit: Arrival Time: r Departure Time: Courtly: MW Region:C
Farm Name: q 3 —ro Owner Email:
Owner ;lame: i l( r--` S 0 VI Phone:
Mailing Address:
Physical Address:
Facility Contact: r-jVi/fc9-'t Title: Phone:
Onsite Representative: i Jnkegrator: tq f5- S - t
Certified Operator: Certification Number: 15 N
Back-up Operator:
Certification Number:
Location of Farm: latitude: Longitude:
Desigtt Current
Design lvtirrersf
benign Current
Swine
Capacity Pop.
yi et Poultry Cap ttv
Cattle# r,.; -
C*apacity Pop. '
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Dairy Heifer
Farrow to WeanDestga,iCu
Farrow to Feeder
rent
D , P,oultr. Ca acityPo
D Cow
Non -Dairy
Farrow to Finish La ers Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullcis
Beef Brood Cow
Turkeys
Other
Turkey Poults
*`
Other
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (11'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 Ea 10 ❑ NA ❑ NE
❑Yes
❑No
�A
❑NF.
❑Yes
QNo
❑-'A
❑NF
[] Yes
❑ No
❑ Yes
�0
❑ Yes
ZfNo
['NNA ❑ NE
❑NA ❑NE
[DNA ❑NE
Page 1 of 3 214112015 Continued

Facili Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Z. N� ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No Q- A ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E; o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
U 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
EfNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[7-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 [ffNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 6No ❑ 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): t/wV% (-&--o
13. Soil Type(s): Q 10 6 0
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Q No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [f No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design 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 ['fr-No 0 NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 21"No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [Z"No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps [] Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [TNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [!�No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes LjTNo
❑NA ❑NE
❑ Weather Code
[:]Sludge Survey
❑ NA ❑ NE
DNA ONE
Page 2 of 3 21412015 Continued

Facili Number: jDateof Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [a -No ❑ NA 0 NE
1
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes E O 0 NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Ca"No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
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 Ef No ❑ NA ❑ NE
❑ Yes [2rNo ❑ NA ❑ NE
❑ Yes EErNo ❑ NA ❑ NE
❑ Yes [/3'-No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
[—]Yes �No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Ck�� Eon"7
i.- 7- 1s
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
-A 851
Phone: 933-JJ v
Date: P1 b�r' A
21412015

type of visit: lolcLompllance inspection CV Vperatton Kevlew U Ntructure Evaluation U lectlnlcal Assistance
Reason for Visit: &*outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: � Arrival Time: 1r� Departure Time: County: Region., rL�
Plh-
Farm Name. l 16G rra n Owner Email:
Owner Name: a, - gea 3-6 Phone:
Mailing Address: IS,' It V G -1
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
flA_'rG- [
It
it
Title:
Sack -up Operator: 16�� o [ w L . cv
Location of Farm:
Latitude:
Phone:
Integrator] Vjq '- fq D
Certification Number: -S
Certification Number: ;0 "S qq j s
Longitude:
Design'Current
Design
Current
1?esign Curreut
Swine; Capacity Pop.
Wet Poultry
Capacity
Pap.
Cattle Capacity Pap.
Wean
I.a er
airy Cow
Wean
Non -La er
airy Calf
Feede
airy Heifer
Farro
MN
Design
Current
D Cow
Farro
D . P,oult .
Ca al i
PAo
Non-DairyFarro
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pallets
Beef Brood Cow
TurkeyIF
Other
TurkeyPoults
Other
Other
Discharees and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[3-Ko—
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance mall -made?
❑ Yes
❑ No
®'lqA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
[I-N'A
[] NE
c. What is the estimated volume that reached waters of the State (gallons)?
d- Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
[:]No
Q' AA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[gNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
glTo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facili Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0_%a_-0 NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes ❑ No [P�A ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes LEkNo ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[3-%
❑ 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 D WR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[D-Ko-
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
L-' 0
❑ 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
[-lo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[]
❑ NA
❑ NE
maintenance or im rovement?
p
11, Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes ]�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): �; U us I9 o r'7, Ahtr
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[9'110
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[:]Yes
C3 N
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
Clk o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[&No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
]o
❑ 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
[;PW
❑ NA
[] NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [�No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [] Weather Code
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes ffNo ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EfNo ❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

It
Facility Number: Date of Inspection: D
�4 Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes qo [] NA NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [A Yes No [] NA NE
the appropriate box(es) below.
[[]'Failure to complete annual sludge survey Failure to develop a POA for sludge Ievels
[] Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? Yes ❑ No NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? Yes No [] NA [] NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
E] Yes
E] 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 the drains exist at the facility? If yes, check the appropriate box below.
Yes
No
NA NE
EJ Application Field [] Lagoon/Storage Pond ❑ Other:
32_ Were any additional problems noted which Cause non-compliance of the permit or CAWMP?
0 Yes
No
❑ NA NE
33. Did the Reviewer/]nspector fail to discuss review/inspection with an on -site representative?
[D Yes
E3 No
❑ NA NE
34. Does the facility require a follow-up visit by the same agency?
Yes
E3No
[] NA 0 NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
C, ,a%, 1-31-0�,
fi t)-k A �[ a S o�'l� w P "^ � A -S soon c.s usS ti� t o
,f
eel �v S L&�S
Reviewer/Inspector Name: _ ]S i
Phone: U Y
Reviewer/inspector Signature:
Page 3 of 3
Date: Il
2/4/20M

i AS
29
De-S.- j S
Type of Visit: t(fCom iance Inspection O Operation Review O Structure Evaluation O Technical Assistance i
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access I
Date of Visit: Arrival Time: /? V� Departure Time: 0 d ri
County; Region: 20
Farm Name: 0a* g _ 3-6 Owner Email:
Owner Name: L � ry` Phone:
Mailing Address:
Physical Address:
Facility Contact:
104 Title:
�t
Onsite Representative: p
Certified Operator: c a i ! �50.1
Back-up Operator: Qcrs RZ-7- k�-r_'sCK
Phone:
Integrator: r `�' �-
SD
Certification Number. I [ PU
Certification Number:
Location of Farm: latitude: Longitude:
Design Current
Design Current
Deslga Current
Swine Capacity Pop.
Wet Poultry
pacity Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
-
Da Heifer
Farrow to Wean
Design.Current
Dry Cow
Farrow to Feeder
D : PoultrCa
aci 'Pop. _
Non-Dai
Farrow to Finish I
ILayers
I
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
IFullets
Beef Brood Cow
_
Turkeys
Qtlier -
Turkey Poults
Other
Other
jilli
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
EaNd❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[]Yes
[] No
A
❑ NE
b, Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
[:]No
NA ti ❑ NE
2. Is there evidence of a past discharge from any part of the operation?
(:]Yes
*
C3'No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
C] Yes
U o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Wacilitf Number: -I Date of Pas ectio
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? f Yes [ ❑ NA NE
a. If yes, is waste level into the structural freeboard? FE?ees ❑ No E A 0 NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): r
Observed Freeboard (in): j
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes t!QK'o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ®lNo ❑ 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 L.l Xbo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 2r o ❑ NA ❑ N E
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes E3�N° ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes C]rNo ❑ 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
2 ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): F is '1P
13. Soil Type(s): 1/ O (. 7 O 1Fer
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
io
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
FTNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Fg<o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
&No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
��
[9 o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
2<0
❑ 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 D<O
❑ 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 [Z�No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �(No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
0 NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

Racili Number: - Date of Inspection: JI
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [P1V V ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes fo ❑ 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? Q Yes [4Vo ❑ NA ❑ NE
2T Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes �o ❑ NA ❑ NE
❑ Yes 2<o ❑ NA ❑ NE
❑ Yes ETNo ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. [] Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss revicw/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
Reviewer/Inspector Name:
1=J No ❑ NA ❑ NE
['No
❑ NA
❑ NE
C3 No
❑ NA
❑ NE
[fNo
D NA
❑ NE
Reviewer/Inspector Signature:
Page 3 of 3 21412014

of Visit: QjrUompUance Inspection V Operation Review V Structure Evaluation Q Technical Assistance
for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral (D-Efitergency 0 Other 0 Denied Access
Date of Visit: (,�% �, p �Ar 'val Time: 0_ Departure Timer County: S f dA Region: F/
Farm Name: ' 3 1 1 f T� r ` 'c.�savt - Owner Email:
Owner Name: U 1� �1� Sl,csc;tit Ptic" - Phone:
Mailing Address: old 60 J 1 t, Ak, Z IN
Physical Address:
Facility Contact: j (C 44 -CC Mez $O-t Title: Phone:
Onsite Representative: t tr Integrator:y��ratr Li
Certified Operator: 64t(c_ v( 'ate — I 0 Ct 3 U[Certification Number:
W lri"It S
Back-up Operator: Certification Number:
Location of Farm:
Wean to Finish
ME
erWean
to Feeder
LNt--L.
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . $�
La ers
Gilts
Nan-L.
Boars
Pullets
Other
Latitude:
Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure [jEApplication 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)?
Longitude:
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
03-�es ❑No ❑NA ❑N1
Yes ❑ No ❑ NA ❑ Nl
❑ Yes Ca No ❑ NA ❑ NE
0 r
d. Does the discharge bypass the waste management system? (if yes, notify DWR) ❑ Yes o L2 l"❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [DIN ❑ 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 3 214/20I4 Continued

Facill Number: -7 Date of Inspection. p
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [R<o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [rr Qo� ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes tJ o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [t.]<o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
[:)Yes [�J<o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes [7rNo
❑ 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 es D No
❑ NA
❑ NE
maintenance or improvement?
Waste_ Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes To
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. 14
Yes ❑ No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
rl PAN ❑ PAN > l 0% or l0 lbs_ ❑ Total Phosphorus ❑ Failure
to Incorporate Manure/Sludge into
Bare Soil
M ' utside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
ffrNo
0 Yes
El o
[:]Yes
Eg<o
❑ NA [] NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
[�No
❑ NA
❑ NE
❑ Yes
[ENo
❑ NA
[] NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22_ Did the facility fail to install and maintain a rain gauge? ❑ Yes [] No
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

7j�_Y - 1
Farili Number: Inate of Ins echo .
24. Did the facility fail to librate waste application equipment as required by the permit? ❑ Yes
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any Iagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31 _ Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
oq ` ,old
❑ No ❑ NA ❑ NE
r] No ❑ NA ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
[—]No
[DNA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
❑ 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
❑ No
❑ NA
[:]NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).rI
I a --� Ca 6lerj 0-V OL tt/A ILIc I[ 1(`r i e a,tl ow;-1 (,J� c't,e
i `DU C Lcv\ f cS 1- -*e4 '� 1�� Y3 r �� tf -c7 p `^v� it Xa`41 ♦ 1 !J�
�1Qu�re� Ga�t��G. biz
J
wclme-, s L94 4tt-c 9r,
-K e J 4o h cAs u-4 pe-s (t, c ate
6,1T_S5 cl�xy 9--,
P )-T
Reviewer/inspector Name:
0
Reviewer/Inspector Signature:
Page 3 of 3
Phoncl?j — s J y
Date: Da-
2/4l2014

- ivision of Water Quality
Facility A'ttrnber ®- 0 Division of Soil and Water Conservation
sQ Other Agenney
Type of Visit: Compliance Inspection 0 Operation Review 4 Structure Evaluation p Technical Assistance
Reason for Visit: Q Routine O Complaint O Follow-up O Referral �mergency Q Other O Denied Access
Date of Visit: r ,3 Arrival Time: ', D Departure Time: `. 3 l7 County: Region:
Farm Name: / Z t z-, t f a= lr L .3— (,� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: %��-C�/jer� Title:C4.,4�7 wp/'� Phone:
Onsite Representative:
Integrator:
Certified Operator; f%l,`�j�cy
fir fyjSp+---�
Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
4410
Design Current. a `° °Design Current
Design Current
Swine
Capacity: _Pop. - Wet Poultry Capacity Pop.
Cattle Capaci#y Pop.
Wean to Finish
IT —Layer
I INon-Layer
Dairy Cow
Wean to Feeder
Dairy Calf
Feeder to Finish
- -
Dairy Heifer
Farrow to WeanDesgn
Ctirrent
,.:-,
D . Ponl .Ga act Po
D Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
La ern
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Caw
Turkeys
Other Turkey Poults
Other Other
Discharges and Stream Imoacts
1. Is any discharge observed from any part of the operation? g) Yes ❑ No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field Other:SY
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 Q NA ONE
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) ayes ❑ 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: &L-I Date of Inspection: O—/
— 3
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
gNo
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[]Yes
0 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
jig No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
CA 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
aYes
[:]No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
16. Are there any -required buffers, setbacks, or compliance alternatives that need
[] Yes
❑-No --0
NA
S NE -
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[:]No
❑ NA
� NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
ONE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
aNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
CgNE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
:0 NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
5j NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
EgNE
20. Does the.facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
Eig,NE
the appropriate box.
❑WUP ❑Checklists ❑Design [:]maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA �NE
❑ Waste Application [:)Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA M_NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [:]No ❑ NA IS NE
Page 2 of 3 21412011 Continued

Faciti Number: jDateof Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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 fo NE
❑ NA RINE
❑ NA 54 NE
[] NA DgNE
❑ Yes [] No ❑ NA 54 NE
❑Yes �No []NA ❑NE
[:]Yes EQ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ® NE
❑ Yes [&No
❑ Yes No
Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question f: Explain any YES answers and/or any additional recommendations or any outer comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

Type of Visit: Q•Zroutine,
ante Inspection U Operation Review Q Structure Evaluation U Technical Assistance
Reason for Visit: ()Complaint O Follow-up O Referral D Emergency O Other O Denied Access
Date of Visit: A ITIArrival Time: Departure Time: County: 1 Regio�L-6
Farm Name: L.n4-m_L, ti*_d rvo, .-&,k •S L...--' / Owner Email:
Owner Name: G i 'r- if U`f/� Phone:
Mailing Address:
Physical Address:
Facility Contact: //�� Title: Phone:
Onsite Representative: eta iJ t S �•Integrator: Pd, )r
Certified Operator: �i' Certification Numbe_
?I
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current""
D'es gn Current.
Design Current
Swimemc.pacity
Pvp.WettPoultry
Capacity Pop:
Cattle Capacity Pvp.
to Finish
Layer
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Q'
�`
Dai Heifer
Farrow to Wean;
F-4Wean
D fgnC.
D Cow
Farrow to Feeder
4rrent
, r t y
D , ,'P,oul Ca aci l?o Y :
Non -Dairy
Farrow to FinishX.
Gilts
Layers
Non
Beef Stocker
Beef Feeder
b
-Layers
Boars
Pullets
Beef Brood Cow
11110
Turkeys
Other
Turkey Poults
Other
10ther
Dischar es and Stream Impact
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
[11NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[] No
UfNA
❑ 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
16 NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E6o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
F!�No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

F cili Number: - Date of Ins ection: Jt
fL V
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes lFj�
5 ❑ NA ❑ NE
a_ If yes, is waste level into the structural freeboard? ❑ Yes o ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
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
❑-'{moo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[D.Nu
❑ 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
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
❑ Yes CNo ❑ NA ❑ NE
❑ Yes [] N --❑ NA ❑ NE
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes QdV-
❑ 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): 6'0'r'* `''d�� 1 j5- 60
--r
13. Soil Type(s): rllkMldcaL_4�41t
/�•
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes [3--Ko'
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes e'
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ZNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes 1 V_ .
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes [;pia
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ANo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Q-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
die
❑ 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
F211Ko
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [r -Nrr ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

F.acili plumber: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
2T Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
\ If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑Application Field ❑ Lagoon/Storage Pond ❑ Other:
ED- o ❑ NA ❑ NE
[3�Kb' ❑ NA 0 NE
❑ Yes
U5,No
❑ NA
❑ NE
[:]Yes
[Po
❑ NA
❑ NE
[:]Yes
[ZWo
❑ NA
❑ NE
❑ Yes [D No ❑ NA 0 NE
❑ Yes [j4o ❑ NA ❑ NE
[:]Yes Q5,5o ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Q 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 �lo ❑ NA ❑ NE
Comments (refer to question#): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional panes as necessary).
duJI le _��Vj
If
(,M
Reviewer/Inspector Name:
Io-1-13
S-�Y�12
Phone:
Reviewer/Inspector Signature:
Date:
Page 3 of 3 21412011

Type of Visit: om liance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral Q Emergency 0 Other 0 Denied Access
Date of Visit: e Urrival Time: Departure Time: County: rµ % Regionf�ffi—
Farm Name: �dl f-� afv�"l 3 Owner Email:
Owner Name: tJ i '1' Phone:
Mailing Address:
Physical Address:
Facility Contact: i ,, �ltit Spvt Title:
Onsite Representative: i
Certified Operator:
Back-up Operator:
0
Phone:
Integrator: nf
Certification Number: 1 b
Certification Number:
Location of Farm: Latitude: Longitude:
D� Current - ` ry Capa�� CPa ens CHR gnu `
ME :,
Swine Ca act Pap. Wet Poult
_ Ap��s�� 6 p' le
Wean to Finish La er Dairy Cow
Design Current
Capacity Pop.
Wears to Feeder
I
lNon-jAyer
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
- ` Dairy Heifer
Destgn fCu Tent Dry Coin
Dry P,ault , Ca acityl?a Non-Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
Boars
'
Other s-:.
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes Q,Z'd"o ❑ NA ❑ NE
❑ Yes
❑ No
EtrNA
0 NE
❑ Yes
[—]No
Eq A
[:] NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No [3 NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes [�To ❑ 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

L
Facili Number: - Date of —inspection: e(
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Oft ❑ NA ❑ NE
a_ if yes, is waste level into the structural freeboard? ❑ Yes 0,Ko ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑'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 c�r<o` ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or enyironmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [�o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [—]Yes [_ No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [d No ❑ NA ❑ NE
maintenance or improvement?
Waste Avolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes P-o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2 ""' ❑ 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): J—rSeLk-e f !J to-
13. Soil Type(s): yl/ e 60 j
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 EKo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes E3 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
IS. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps 0 Lease Agreements
[:]Yes
gNo
❑ NA
❑ NE
❑ Yes
�o
❑ NA
❑ NE
❑ Yes
Egl o
❑ NA
❑ NE
[:)Yes
to
❑ NA
❑ NE
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 14_�o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 10
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Ins ectioa
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 El"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 fo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [DKo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 1;?"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 Lo, ❑ 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 [allo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes [; No ❑ NA ❑ NE
El Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [E�Ko ❑ NA ❑ NE
33_ Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes P3<o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ YesFl"No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Photit:' — 3
Date ac 1,9
21412011

of visit: (ytuompliance inspecuon t_j operation xevtew t,J structure LVatuatron V 1 ecuntcal Assistance
in for Visit: O Routine Q Complaint 0 Follow-up O Referral Q Emergency Q Other Q Denied Access
Date of Visit: j0 II Arrival Time: I O&S-S A✓'% Departure Time: / p q/'I County-ZAm IJ
Farm Name: l) (� �� �'Z(Zy,�� 3 - U Owner Email:
Owner Name: QM\\'f VVkf jz_C<� Phone:
Mailing Address:
Region: FRO
Physical Address:
Facility Contact:it.5ot� Title: �pRt�>�� Phone;
Onsite Representative: AM - Integrator: %A��' {5%wo
Certified Operator: �� �s=�£€ZSan Certification Number: ! q86�5
Back-up Operator:
Location of Farm:
Certification Number:
Latitude- Longitude:
Design Current Design Current _ Design Current
Swine " Capacity Pop. Wet Poultry Capacity Pop Cattle Capacity Pop.
Wean to Finish
Layer
Daig Cow
Wean to Feeder
Non -Layer
Dai Calf
Feeder to Finish
%%o
1200
Dai Heifer
Farrow to Wean
_
r Design @urrent
eCa aci P,o
Cow
Farrow to Feeder
Non -Dairy
Layers
Beef Stocker
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
-
Turkeys
-
nther
Turkey Poults
Other
lacl
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes ❑ No ff NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No a 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 [yNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes dNo ❑ NA ❑ NE
of the State other than from a discharge?
1 Page 1 of 3 214/2011 Continued

Facility Number: IDate of Inspection:10111PYL-
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
Identifier.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
*1
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?
dNo ❑ NA ❑ NE
]]/No ❑ NA ❑ NE
Structure 6
❑ Yes
allo
❑ NA
❑ NE
[—]Yes
EdNo
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
["No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
&XNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[I No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [[�No (DNA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10°/Q 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
1
12. Crop Type(s): 0 e.'R tg\ Vn 'R Kpa ' ��f ��ut Ir1 t G' �
13. Soil Type(s): KU A C7t7 i� s 4 t f['
14. Do the receiving crops differ from those designated in the CAWMP? [] Yes M No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 4No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [fNo ❑ 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 [j No ❑ NA ❑ NE
[—]Yes [�ANo ❑ NA ❑ NE
Re uired 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 [vI 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 [2(No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [] Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [] Yes [j No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Ej No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Faeili Number: Date of inspection: jQ 111 t;L,
24. Did the facility fail to calibrate waste application equipment as required by the permit? 0 Yes ❑ No ff NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [] No MIA ❑ 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? 0 Yes ❑ No O NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No [INA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31, Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoor/Storage Pond ❑ Other:
❑ Yes ❑ No Q(NA ❑ NE
[:]Yes ❑ No [i:j/NA ❑ NE
❑ Yes ❑ No [jKNA ❑ NE
❑ Yes ❑ No ZNA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ff NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ No G�`NA , ❑ NE
34. Does the facility require a follow-up visit by the same agency? 0 Yes ❑ No &rNA ❑ NE
F
ents (refer to question #): Explain soy YES answers and/or any additional recommendations or any other comments.
awings of facility to better explain situations (use additional pages as necessary).
r MOS 46 bc. Ca�.p[v4-1cm s,n 0 .'
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

Type of Visit: ® Compliance Inspection aOperation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 11 i!
Arrival Time: 1 "i' o" �n I
Departure Time:
County: Region: P—
Farm Name: ci a , —�)
y, Arch -,j - 6
Owner Email:
Owner Name: _ {� �� �� j 4 r7 -SCE10 Phone:
Mailing Address: )`A C:1 .f} Sc_l,c-I WI P si o Ci` c +»� t �c•C� �.-� t'1 `1 t`
Physical Address:
Facility Contact: S-1� Z 1 1 iZ Sc? :V Title: rA a ni a?A.'1 okc v 'Z Phone:
Onsite Representative. j �y. 1k k Pt f I izsc, _ Integrator: M
Certified Operator: {i,� � � Zf"SL+:J Certification Number: `S �
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude -
Swine Capacrty Pop.
Desgn�Current
6px Ni�
Wet Poultry�Capae�ty Pap.
La er
en
Design Current
Cattle Capacity Pop.
Dai Cow
Wean to Finish
Wean to Feeder
Non -La cr
Dai Calf
Feeder to Finish
�a
}':�.
i4/d� i ie�A.r��
.0 DesignCurrenf
D , P,oult Ca eci .. ePo
DairyHeifer
Farrow to Wean
Farrow to Feeder
D Cow
Non-Da'try
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
fJther „ ' .wxR.4TurkeX
Other
Turkeys
Poults
Other
Dischar es and Stream Im acts
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 M No ❑ NA ❑ NE
❑ Yes
0 No
[!n NA
❑ NE
❑ Yes
❑ No
M NA
❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes
❑ No
0� 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
gI No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: -_72 U jDate of Inspection: j/ ,
C ;1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[K] No
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
® No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:.
Spillway?:
Designed Freeboard (in): jril
Observed Freeboard (in): a
5. Are there any immediate threats to the integrity of any of the structures observed?
Yes
K] 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
[K] No
❑ NA
[] NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7_ Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
© NE
8_ Do any of the structures lack adequate markets 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 M 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): `) Z�tAv Du }AA-q �L tIF Ha` , 5 to ol1 Q a-3 rl C S
13. Soil Type(s): tV �f A t It;; _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment'.?
Reguired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
[] Yes E(] No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes E� No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑other: jjb
21. Does record keeping need improvement? If yes, check the appropriate box below. �] Yes [V o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis M 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 M No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: - -7oL4 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
®No []NA ❑NE
® No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑Yes No ❑NA ❑NE
❑ Yes K] No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes [g No ❑ NA ❑ NE
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[6 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
M 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
® No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
t7j Crr�1� b2i���S� �7.� i3,�3► J ��U'�
(1t1er.�7►tS�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
-L� 4 L 1 � . •��{L 1 �`7
Phone: 1
Date:
2/4/2o 1

_,
A
Type of Visit (H'Compliance inspection Q Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit outine Q Complaint O Follow up O Referral 0 Emergency O Other ❑ Denied Access
Date of Visit:Arrival Time: a Departure Time: County: 1�'�5�`� Region:
Faun Name: rou'tc.� 3— Owner Email:
Owner Name: Cr Phone:
Mailing Address:
Physical Address: l
Facility Contact: m i trj 111le:
Onsite Representative: :5.0" -4 _
Certified Operator: �y
Back-up Operator:
Phone No:
1 ntegrator:/y%P�Z 4
Operator Certification Number:
Back-up Certification Number:
Location of Farm: latitude: = o = f = tl Longitude: = o = I 0
Design Current
Swine Capacity Population
Design Current
Wet Poultry Capacity Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer
❑ Dairy Calf
eeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dr) Poultry
❑ Dry Cow
❑ Farrow to Feeder
El
Farrow to Finish
La❑
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ Turkey Pou Its
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
❑ Yes
allo
❑ 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)
El Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of past discharge from any pan of the operation?
❑ Yes
[&No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
C.No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: — Date of inspection —S®- ID
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? []Yes ®.No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): cz'� %
Observed Freeboard (in): 2-2 T
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [&No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed []Yes ERNo ❑ 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
® No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4_ Does any part of the waste management system other than the waste structures require
❑ Yes
ER[ No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
®.No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
®-No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift/ ❑ Application Outside of Area
12. Croptype(s) FrsGu %r/ �c %ovrr4-��d
13. Soil typc(s) Na/,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
MNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[ o
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
EN, No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
QNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[allo
❑ NA ❑ NE
raP: tea.. f.Jrw Ja S-?J—
Reviewer/inspector Name ,,� _ „� Phone: /0- 7 33Dc;l
Reviewer/Inspector Signature: Date: O?o/a

Facility Number, Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. [&Yes ❑ No ❑ NA ❑ NE
Cl Waste Application ❑ Weekly Freeboard ❑ Waste Analysis EDSoil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fait to install and maintain a rain gauge?
'es
0 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[&No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
®.No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
(.No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ®,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
KNo
❑ 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
RNo
❑ 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
[RNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
9LNo
❑ NA
❑ NE
12128✓04

1
•
Type of Visit (O'Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 016utine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: �rrival Time: Departure Time: County: ��� Region:
Farm Name: (oG �� �� 3_ _ Owner Email:
Owner Name: i �� �T�fj �` Phone:
Mailing Address:
Physical Address:
-7 a
Facility Contact: 1617141av he '1 a Title: Phone No:
Onsite Representative: Integrator: e2gtm4, 37— 1 .o
Certified Operator: 5— Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [= a = t = u Longitude: [� o = t = At
Design rents
21
lgn � urgent..
Design C•nrren#
Swine
.apacity Population
paK!i y4 operation
CattEe Capacity Population
❑ Wean to Finish
❑ La er
❑Dai Caw
❑ Wean to Feeder
❑Non -Laver
❑Dai Calf
Feeder to Finish(7�
��gg
❑Dai Heifer
ElFarrow to Wean
Pon,��
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -La ers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turkeys
Other
Ex=
❑ Turkey Poults
❑ Other
❑OtherI
Number:ai Structures: LO
Discharges & Stream Im acts
I - Is any discharge observed from any part of the operation?
❑ Yes
CA No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
29 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
1@ No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

Facility Number: � — Date of Inspection �l
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
C&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
J@ 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
0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
J9 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
91 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need -Yes
-No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. Yes
❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload - ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
9Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) A2 VeL!sogaL,i
13. Soil type(s) /�p`,
/0
14. Do the receiving crops differ from those designated in the CAWMP?
E] Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
© Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
'® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
S No
❑ NA
❑ NE
/v r,�-r /fus N 5 r'r pt r-t— be ckcyr-d. Z
�I•GI Cd4 9 t iUe a � � � �Ui 6eLJOW ./01) t'-G, 7V Afra.1'�' 9)C/
Reviewer/ins ectorName Phone:33c`�7C�
P - = 1
Reviewerfinspector Signature: Date: /�--- ---�
rage a o) .s rZi160ivl# c.ornurnuru

r
` Facility Number: — Date of Inspection
Reguired Records & Documents
19. Did the facility fail to have 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 @ No ❑ NA ❑ NE
the appropiate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. dEL Yes ❑ No ❑ NA ❑ NE
'® Waste Application aWeekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections K 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
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
S No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® 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
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
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
Yes
❑ No
❑ NA
❑ NE
AdditionatCommeiits and%or Dta in s-
%(7"
7
nt of r D Inc �i'o F4
oYn ✓1'^r��R � � M �
7 ' a C-r�y� i�✓'rr�r
0"' l " ��- % �Q' ..r C Dls"l �-- � n yr�`.'�c.--�e"
re
7a i
L; J,
Page s 01 s 12,28/04

L
ivision of Water Quality
Facility Number `� 0 Division of Soil and Water Conservation s�
D Other Agency
Type of Visit Z$6 Piiance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Orkoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �j Arrival Time: �� Departure Time: ; County: 4T— Region:
Farm Name: f Jam, IK rcx�k f�a/jpYl3 3—� Owner Email:
Owner Name: J5 i x 6-Phone:
Mailing Address:
Physical Address:
Facility Contact: �i i' I Y (4- Title:
Onsite Representative: <Ar�
Certified Operator: 1<r_ C
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
Latitude:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
0 Longitude: 00 0 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Lavers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: E/0
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 (f No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑Yes
®No
❑NA
El NE
❑Yes
[No
❑NA
❑NE
12128104 Continued

Facility Number: Date of Inspection —
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? ❑ Yes 9 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): % f
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [RNo ❑ 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 [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 EgNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes M No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_)
❑ PAN ❑ PAN > 10% or l0 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(s1 I—e4,eaih-
13_
Soil type(s) &ni
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑ No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18.
is there a lack of properly operating waste application equipment?
❑ Yes
❑ 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. (use additional pages as necessary):
ricedeOFyou r re c&a5
Reviewer/Inspector Name A-e- phone %pY3�
Reviewerfinspector Signature: Date: e"
l L/LO/UY 9.vnit""ru

Facility Number: — Date of Inspection 7
Required Records & Docutttents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Z Yes JeNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes A No ❑ NA ❑ NE
the appropirate box. ❑ WUP 0 Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Rbo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ AnuuaI Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
D9 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[9 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
O No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[$ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
®,No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
04 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
PZNo
❑ NA
❑ NE
General Permit? (ief discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
,® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
0 No
❑ NA
❑ NE
[Additional Comments and/or Drawings:
12178104

x
Type of Visit �C,ommppliance inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit adroutine Q Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Ti Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: C� -f���� Phone:
Mailing Address:
Physical Address:
Facility Contact: r Title: Phone No:
Onsite Representative: _
Certified Operator: S�1
Back-up Operator:
Integrator -
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [=] e ❑ ' [� " Longitude: ❑ ° ❑ t = u
Design
Swine Capacity
Current Design Curietit
Population Wet 1'nultry Capachy Population
Design Current
(Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ DairyCow
II
❑ Wean to Feeder
❑Non -La er
❑ DairyCalf
91 Feeder to Finish
' ' - v
' ❑ DairyHeifer
❑ Farrow to Wean
> `
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
" ' _-°
El Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
Non -La ers
ElBeef Feeder
P171 Boars
❑Pullets
' ❑ Beef Brood Co wl
_
❑ Turkeys
Other
❑ Other
; ❑Turke Poults
❑ OtherN_
s
` ' tuber of Structures:
Olt,
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
A No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[:]No
❑ NA
❑ NE
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[]No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ER No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
K.No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

4
Facility 1Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
❑ Yes
RNo ❑ NA ❑ NE
a_ If yes, is waste level into the structural freeboard?
❑ Yes
(9 No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[RNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
J@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
KNo ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
J29 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
JMN No ❑ 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)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
RNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
n No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Z�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
UsIPIA
dr
eawings: of facility to better explain situations. (use additional pages ask necessary): ` '�- •:
Reviewer/Inspector Name Phone:
Reviewer/inspector Signature: V Date:
Page 2 of 3 12128104 Continued

Facility Number: — Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ,KNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ,Q No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JUNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
P[No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
t� No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EINo
❑ 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
KNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
allo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
JK[No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
f o 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
VkNo
❑ 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
J,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
PQ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

® Division of Water Quality
Fic
>tLtty'N�mber �oZ 0 Division or Soil and Water Conservation.
0 Other Agency
' t�r•�. .x��
Type of Visit @ Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
i
L>
Date of Visit; I a/%DlOS Arrival Time: Departure Time: County: SQ++.-use! + Region:
Farm Name: - i�a. IC j�i r�.���-, 3'�o Owner Email:
Owner Name: 13 11 5o .r la . Pe %� r v Phone: %+O�_ e�� G 3 a'i' -
Mailing Address: 3 tE , t-J i� WYG�G�, - sel oNam-
Physical Address: %yf�
Facility Contact:
Title:
Onsite Representative: 1?zk,_
Certified Operator: /Y7•-%c _213' cry o td
Back-up Operator:
Phone No:
Integrator: 16L,j-- .4,4A an: 94-4., X. r�
Operator Certification Number: f F/ frG 's—
Back-up Certification Number:
Location of Farm: Latitude: 0 0 ❑ I = 46 Longitude: = o = 6 =
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
i ❑ Non -La et
❑
Wean to Finish
❑
Wean to Feeder
Feeder to Finish
2 Yic,
? 3n&
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
IDTurkey Pou Its!
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at_ ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Da Cow
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood Cow
b. Did the discharge reach waters of the State? (If yes. notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
)Number of Structures: =�
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [4 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[29 No
❑ NA
❑ NE
[:]Yes M No ❑ NA ❑ NE
12128104 Continued

Facility Number: '7,;Iy Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): __ _,27 6
Observed Freeboard (in): 3 i ,d
❑ Yes M No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
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 [N 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 W No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes iZ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s) tier,., 2 p _ c►rar.r4 SG . 6S. i050u�za..�,
Wi
_
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[9No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination' El Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
m No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® 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. (use additional pages as necessary):
Reviewer/Inspector Nameo i Phone:
Reviewer/Inspector Signature: Date:
�/ ! 12128104 Continued

Facility Number: Date of Inspection a OTCT
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the approprrate box. ❑ WDP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking �j Crop Yield ® 120 Minute Inspections © Monthly and I " Rain Inspections ® Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
© No
❑ NA
❑ NE
23_
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
LA Yes
❑ No
&NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
® NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P0 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
Q) No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
© No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
[] Yes
® No
❑ NA
❑ NE
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12178104

3
of Visit 000ompliance Inspection O Operation Review O Lagoon Evaluation
IReason for Visit (J4outine p Complaint O Follow up O Emergency Notification O Other © Denied Access
Facility Number Date of Visit: s o Time: . S
O Not Operational O Below Threshold
M*ermitted Ml(fertified 13 Conditionally Certified © Registered Date Last Operated or Above Threshold:
Y- _I r1
Farm Name • 1f� .0 �� • "`r'� I ... � ----- County. - .. � .. -- -----------------
Owner Named �� . ,t�l1i ................... Phone No:... ........ _. _ . .... ,,QQ J I
Mailing Address:... - - - - ..... W !2... .... �!...�a.--- ".ii'�
?'�. _._. r_WW
Facility Contact: f � t� �/y..... ........ Title: _...1 ........ .... Phone No: -
Onsite .�Representative-
• r !�..........................._........................................................ Integrator:.. ....L............� � ...... .................
Certified Operator:. 1 .......Gt40/ ..................__ Operator Certification Number:
Location of Farm:
.wine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 44 Longitude • 4 "
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes M"iio
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) El Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2- Is there evidence of past discharge from any part of the operation? ❑ Yes [r No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Ea'Ro
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Erf o
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...................................................... _........................
Freeboard (inches): 470
.12112103 Continued

Facility Number: — (j Dale of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes [10
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/iinprovement? [:]Yes &No
S. Does any part of the waste management system other than waste structures require maintenancelimprovement? [:]Yes 93'/,_/No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes Ej No
elevation markings?
Waste ADDlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes �YNNo
11. Is there evidence of over application? If yes, check the appropriate box below. El Yes Lf No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Gr/ound� ❑ Copper and/or Zinc
12. Crop type . �f �i qt'4. �. , %ttJ�/lf . �o►tG v�� . t ,`
13. Do the receiving crops differ with those ddignated in the Certified Anifnal Waste Management flan (CAWMP)? ❑ Yes GI NO
14, a) Does the facility lack adequate acreage for land application? ❑ Yes E 2,No
b) Does the facility need a wettable acre determination? ❑ Yes [(No
c) This facility is pended for a wettable acre determination? ❑ Yes RfNo
15. Does the receiving crop need improvement? ❑ Yes 92"No
16. Is there a lack of adequate waste application equipment? ❑ Yes ✓(No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes
[f No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes
&lo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes
DKo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? Hyes. contact a regional ❑ Yes
E?(' o
Air Quality representative immediately.
Comments (ielfer io gceestioa lf}Explarn any YES a ers attJor grey reoommctatciabtor off[ aap,tber cominents.�-
jUse drawings of sty to /better explas srtrrlat�ans.�(te adeLttatva! pages s aesressary)'ie`Id Copy O Final Notes
k
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: O
12112103 l Continued

Facility Number: — Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes [RNo
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 W41ro
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0'90'
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
QONo
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
No
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
RfNo
28.
Does facility require a follow-up visit by same agency?
❑ Yes
[lio
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[i?No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) M4es ❑ No
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Biro
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes M-90-
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes GWO_
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes 131<0
❑ Stocking Form ❑ Crap Yield Form [] Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
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