820485_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Type or visit: Com ance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: U C
Arrival Time:
❑-#A
--1%
Departure Time: c ) F County: `� Region:?*—
10
Farm Name: �L 2 J,-:1��
. "F�k
V
Owner Email:
Owner Name: L -t A_;6L
l cf-e
f "ev
Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:%rte
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes La -No ❑ NA ❑ NE
❑ Yes
Design Current
❑-#A
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
L lNon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D P.uul
Ca aci
1?0 ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
-_
Turke s
Other
Turkey Poults
Other
Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes La -No ❑ NA ❑ NE
❑ Yes
❑ No
❑-#A
❑ NE
❑ Yes
[:]No
0-19A
ONE
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?
0 Yes 0 No
❑ Yes ffNo
❑ Yes El -No
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facill Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Cg- O NA ❑ NE
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
0 Yes 0 No [3 -NAC -0 NE
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
0 Yes 0-9.I ❑ NA ❑ NE
❑ Yes [iGo r ❑ NA ❑ N E
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 [3 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑.ld"ci_❑ 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 G -go ❑ NA ❑ NE
maintenance or improvement?
Waste_ Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LLf kw ❑ 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 p Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. p Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable L� Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 1.6 -6-co GAJ AL1 fig
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Blq ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[]"7 oCi__❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
lD 1Vo l❑ NA
❑ NE
acres determination'?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�"" 1 NA
❑ NE
18, Is there a lack of properly operating waste application equipment?
❑ Yes
D -Ko f❑ NA
❑ NE
Required Records & Documents
��
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
I -] Yes
GooNA
❑ 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 Trirnsfers ❑ Weather Code
❑ Rainfall ❑Stocking 0 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 rNo
❑ NA [:]NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: 9�L - 41, K5 I jDate of Inspection: / Cy -
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ZO-K-6 [] NA
ONE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
N
❑ 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
Q_Nb—_O NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
C3'56__�[:] NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes Q -Nu --0 NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes E 15__ ] NA ❑ NE
❑ Yes ' [3.N� NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ED -W6 ❑ NA ❑ NE
33. Did the ReviewerlInspector 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 0 NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Date: ! CIS.
2/4/2015

i ype or visa: k,-i-ompuance inspection v vperanon review v structure e,vaivatton V i ecmmical Assistance
Reason for Visit: 't.7 xoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: / Arrival Time: Departure Time: County: Region -/`—
Farm Name: &'L {� Owner Email:
Owner Name: r 4.. k - t1lo, Phone:
Mailing Address: 1
Physical Address:
k 4& .- if
FacilityContact: �f�`�,n lJ,rrr�t- Title: Phone:
Onsite Representative: 1t (� Integrator: Imo1?s
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
11111111ij��i
Swine
Wean to Finish
' Design Carrent
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Cnrrent
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Layer
I
❑ Yes
Dairy Calf
Feeder to Finish
20
Dr 1?oul
Design
Ga aci
Cnrrent
P,o
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Dry Cow
Non -Dairy
Farrow to Finish
[IFNo
I.a ers
❑ NE
of the State other than from a discharge?
Beef Stocker
Gilts
Non -I a ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
t?ther
Turkeys
Turkey Poults
Other
Other
Discharges and Stream_ Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes [q-tdo ❑ NA ❑ NE
❑ Yes ❑ No [2 -NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
[] No
LTN
❑ 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 a past discharge from any part of the operation?
❑ Yes
E3 filo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[IFNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2015 Continued

Facili umber: jDate of Inspection: W
Waste Collection & Treatment
4. 19 storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q -Ne- ❑ 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): t
5. Are there any immediate threats to the integrity of any of the structures observed? 0 Yes [3 -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 [J'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
[J -No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑'No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[]'No
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
[�t"No
❑ NA
❑ NE
Waste Aonlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
dNo
❑ NA
❑ NE
maintenance or improvement?
I 1 _ Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes [2No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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): �✓ +�� b
13. Soil Type(s): w -
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ®'No 0 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 [:]Yes E;a No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Eg-llo
❑ NA
❑ NE
18. 1s there a lack of properly operating waste application equipment?
❑ Yes
[}ado
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[J -No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[�t"No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists E] Design [:]maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [allo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [�J(No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility umber; - yk= jDate of Inspection: 1b vu !
24. Did the facility fail to calibrate waste application equipment as required by the permit? [D Yes EINe ❑ NA ONE
i
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [] f"To ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non -compliance -
26. Did the facility fail 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 Renal 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/]nspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
n Yes
[a -Mo
❑ NA
❑ NE
[] Yes
ETNo
❑ NA
❑ NE
❑ Yes
E]Iqo
❑ NA
❑ NE
0 Yes C3'No ❑ NA ❑ NE
❑ Yes [:a' o ❑ NA ❑ NE
❑ Yes [J No ❑ NA ❑ NE
❑ Yes [ o
❑ Yes [3 -No
❑ Yes Q'No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature: Date: 0q) 2XUUL'*
Page 3 of 3 21412015

Type of Visit: P.empliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: &Routine Q Complaint Q Follow-up a Referral Q Emergency 0 Other O Denied Access
Date of Visit: 9.1 ar-, Arrival Time,-me:Departure Time: �d County: Region:
Farm Nat+V(� l t ✓k'4t � z Owner Email:
Owner Name: b �t CILy"�t .� Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Discharges and Stream IMD2CtS
MDaiGowCalf
aHeifer
D Cow
Non -Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
1. Is any discharge observed from any part of the operation?
Design Currettt
Design CtirrentDesign Current
r= { "
Swine
Capacity Pop...
°Wet Poultry Gap acity Pop
Cattle
Cppaeity Pop.
a. Was the conveyance man-made?
❑ Yes
❑ No
Wean to Finish
�
[Layer
❑ No
Wean to Feeder
❑ NE
Non -Laver
F_
Feeder t0 Finish
_
❑ Yes
Farrow to Wean'&D
2 NA
"�`` t:
�..: es�gn�rCurrent
;. _
❑ Yes
Farrow to Feeder
❑ NA
© Il?oultr;4Ca act[ Po
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Farrow to Finish
❑ NA
Layers
-0'
Gilts
Non -La ers
Boars
Pullets
=;
Turkeys
Other
TurkeyPoults
Other
Others
Discharges and Stream IMD2CtS
MDaiGowCalf
aHeifer
D Cow
Non -Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
1. Is any discharge observed from any part of the operation?
❑ Yes
[�'I o
❑ NA
❑ N F
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[^ �NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
© Yes
❑ No
[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 DWR)
❑ Yes
[] No
2 NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E3 -No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
e'Nfo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4,12f115 Continued

IFacWty Number; - Date of Ins ction•�
Waste Collection & Treatment
4_11s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
�A
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�t _
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
EEr1g
❑ 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
[9'111'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
M<o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
B - <o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[ o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[2,1�o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes [E'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 Sane Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12_ Crop Type(s): _ �_,c1`ymj�1�,t, S6 o
13. Soil Type(s): ! V p ?--g _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes � ❑ NA ❑ NE
15_ Does the receiving crop and/or land application site need improvement? ❑ Yes [G]-lqo— ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes t]No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑'No ❑ NA ❑ NE
[:]Yes PTI�o ❑ NA ❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ONo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [],No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes b No
23. If selected, did tlie" facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes C�No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 214/1015 Continued

lFaclUty Number: Date of inspection: ZZ I Lad
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑i . W ❑ NA ❑ NE
2Y Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑-N< ❑ 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 4ai% ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [5'�io ❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes �o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [a -Ko ❑ 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 P48 ❑ 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 E o
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other -
32 .
ther-32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes O No
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative? ❑ Yes E:fNo
34. Does the facility require a follow-up visit by the same agency? ❑ Yes E] No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
. _ (, . -- q #)' x „ . y , y -` or' nye tnments:
omtrnents re er to .nestson' am any answers and/or additional recommendationan got er co r xr I
Use drawings of facility.,4 better explam_situattons (use additional pages as necessary). ��
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
A It
Phone: j
Date:
11412015

B w -1
for Visit: Routine 0
t o ec- [ s Kj7.
0 Follow-up 0 Referral 0 Emergency Q Other 0 Denied Access
Date of Visit: (, , Arrival Time: lj uo Departure Time: County: � Region:
Farm Name: r,CP �+t � 2 Owner Email:
Owner Name: X'1" JW Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
!t
Certified Operator: it
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: - A-6
Certification Number:
Certification Number:
Longitude:
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? (1f yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [jP4T—'F] NA ❑ NE
❑ Yes ❑ No [fg-A [] NE
❑ Yes ❑ No [2-M [] NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No [�NA [] NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [2<o ❑ 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 1 of 3
21412014 Continued
Design Current .y
Design Cur- at
Design C•nrreat
wine
Capacity Pop. Wet Poultry
Capacity Pop.
Cattle Capacity Pap.
inish
Layer
Dai Cow
eeder Non -Layer
Dai Calf
inish
Wean
Feeder
rrFarrow
D . Point .
_ z
Design Current
Ca .aci ., P,_a :_
Dai Heifer
D Cow
Non -Dai
Finish
La ers
Beef Stocker
Non -La ers
Beef Feeder
Boars
I 1pullets
Beef Braod Cow
Othe
Turkeys
I Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (1f yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [jP4T—'F] NA ❑ NE
❑ Yes ❑ No [fg-A [] NE
❑ Yes ❑ No [2-M [] NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No [�NA [] NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [2<o ❑ 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 1 of 3
21412014 Continued

Facili Number: IDate of Inspection:
[] NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
Waste Collection & Treatment
❑ NA
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus [3 Failure to Incorporate Manure/Sludge into
Bare Soil
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Q—Ner' ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
®,#K
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
[:]Yes �o
Identifier:
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ON.
❑ NA
Spillway?:
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ;;]'No
❑ NA
❑ NE
acres determination?
Designed Freeboard (in):
17. Does the facility lack adequate acreage for land application?
❑ Yes R<o
Observed Freeboard (in):
❑ NE
I& Is there a lack of properly operating waste application equipment?
❑ Yes C3<o
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Eg lw
❑ 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
[a<o
0 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
[3<o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[3'go
❑ 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
[g -Ko
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ET<o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes [�Jo
[] NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
[:)Yes [? No
❑ NA
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus [3 Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window- E] Evidence of Wind Drift
E] Application Outside of Approved Area
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
12. Crop Type(s): :D
_ T
21. Does record keeping need improvement? If yes, check the appropriate box below.
13. Soil Type(s): O IZ14—
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes �o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ON.
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ;;]'No
❑ NA
❑ NE
acres determination?
T
17. Does the facility lack adequate acreage for land application?
❑ Yes R<o
❑ NA
❑ NE
I& Is there a lack of properly operating waste application equipment?
❑ Yes C3<o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
ll
E] Yes [�] <o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:)Yes [? No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
[:]Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stacking ❑ 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 ZNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes [?rNo
❑ NA
❑ NE
Page 2 of 3 2/4/2014 Continued

.\
Facility '.tlurnber: T I Date of Inspection:
!�2
��++
<o
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E5<
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[] Yes
[3-Koo
[] NA ❑ NE
the appropriate box(es) below.
29. At the time of the inspection did the facility pose an odor or air quality concern?
Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
[j No
❑ NA
❑ Non-compliant sludge levels in any lagoon
If yes, contact a regional Air Quality representative immediately.
List structure(s) and date of first survey indicating non-compliance:
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
B<
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[ to
❑ NA ❑ NE
Other Issues
��++
<o
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
ER
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[j No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
/
[901gO
[] 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
[3-
❑ 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
[A4o
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[ffN
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[] Yes
[El"No
❑ NA
❑ NE
Comments (refer to question #. Explain any YES answers and/or any additional recoramendateons.or any other coinrrtents. ' .:
Use drawings of facility to better explain situations (use additional vaQes as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
OCT 1L(
Phone:
-3 3 -5 3 3q
Date: gfba_
1/4/2014

n
]Type of Visit: CKompliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: 04outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
i Nim
Date of Visit: Arrival Timer Departure Time:County: C Region:
Farm Name: L ) h r44 jot LLIL��_ ��`�' � Owner Email:
Owner Name: - Phone:
Mailing Address: �6 ! V — _
Physical Address -
Facility
Facility Contact: Rlcft,4 W t {`�� Title: Phone:
Ousite Representative: Integrator: A43
Certified Operator: jt Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
❑ No
Design
Current
Design Current
Swine Capacity A.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Finish
La er
Dai Cow
Feeder
Non -La er
Dai Calf
o Finish d
-
Dai Heifer
o Wean
Design
Current
D Cow
o Feeder
U
DD . P,oW
Ca aci
P,aaci P,a
Non -Dai
to Finish
La ers
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Turkeys
rno
Turke Poults
erL
Other
Discharges and Stream Impacts
Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page I of 3
❑ Yes [Die' [] NA ❑ NE
❑ Yes
❑ No
[rI A
❑ NE
❑ Yes
❑ No
[;J 1 A
❑ NE
[:]Yes ❑ No [l"'NA ❑ NE
❑ Yes [�ia ❑ NA ❑ NE
❑ Yes F5No ❑ NA ❑ NE
21412014 Cohdnued

Facility Number: is 97 _�5 Date of Inspection: Y2%Z2�ou
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 [D -NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a -y
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �fNo [DNA ❑ 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 El"No
[] NA
❑ NE
waste management or closure plan?
14. Do the receiving crops differ from Kose designated in the CAWMP?
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 �o
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [3&o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[:]Yes
4. Does any part of the waste management system other than the waste structures require [:]Yes Q ' -No
❑ NA
❑ NE
maintenance or improvement?
Waste Aaolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes []KNo
❑ NA
❑ NE
maintenance or improvement?
�To
❑ NA
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [R/No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ NA
❑ NE
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
[410
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
❑ NE
12. Crop Type(s): (�
13. Soil Type(s): i
14. Do the receiving crops differ from Kose designated in the CAWMP?
❑ Yes
[[ to
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
G<o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[:]Yes
UJ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�To
❑ NA
❑ NE
IS. is there a lack of properly operating waste application equipment?
❑ Yes
E!I o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[410
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
To
❑ 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 [�Ko
❑ 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 elNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ETNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
0 NA ❑ NE
[]NA ❑NE
Page 2 of 3 2/4/2014 Continued

]FaciDt
y Number: IDate of Inspection:
`e 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [BAo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [-1 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 fust survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [E-1go ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [�io ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[] Yes C,_jXo ❑ NA ❑ NE
❑ Yes E]Xo ❑ NA ❑ NE
❑ Yes B<o ❑ NA ❑ NE
❑ Yes 21% ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes 4�!J'No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss revicw/inspection with an on-site representative?
[:]Yes jf�No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes C
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommenda_ tions or,any other comments:
;:
Use drawings of facility to better explain situations (use additional pages as necessary).
Gal,b��9� o�< 13
Reviewer/Inspector Name:
�& 'V1_
Reviewer/Inspector Signature:
Page 3 of 3
Phone: YAA —M
Date: A10
2141ZO14

P., .. f .s -,%
(Si m s' d,7UeL is 60
Mston of Water Quality
Facilit;YNutitl7er - Division of Soil and Water Conservation
z Outer Agency
Type of Visit;om lane Inspection Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: ( Routine Q Complaint 0 Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: �.� County:
Farm Name: t ��C — Owner Email:
Owner Name: y�e,.�—� �)+j��� Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:�Phone:
Onsite Representative: - T Integrator: '9"4), L 7
Certified Operator: Certification Number: ` f'08'�
Region
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish.
Wean to Feeder
Design Current=
Capacity -
Wet Poultry
Jayer
Non -Layer
Design Ciirrerit Design Current
' Cap c��P p� C•attie Capacity Pop.
Dai Cow
Dai Calf
Feeder to Finish
D . Poult ,
--
Design
`'Ca�ac'i
"
Current
Po
Dai Heifer
Cow
Non -Da'
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Non -La ers
Beef Stocker
Beef Feeder
Gilts
Boars
(-
Pullets
Turkeys
Beef Brood Cow
Outer
Other
-
Turkey Poults
Other
Discharges and Stream Impact
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d, Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes E�Nw ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes [] No [] NA ❑ NE
[:]Yes ❑ No
❑ Yes ❑.Ko
❑ Yes [4— o
❑ NA [] NE
❑NA ❑NE
[DNA ❑ NE
Page I of 3 2/4/2011 Continued

a
[:]Yes
NA
❑ NE
Facility Number: jDate of Ins ection: '%
Waste Collection & Treatment
❑ Yes
�o
❑ NA
❑ NE
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
❑ NA
Identifier:
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑-tqo
❑ NA
Spillway?:
the appropriate box.
Designed Freeboard (in):
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
Observed Freeboard (in):
21. Does record keeping need improvement? If yes, check the appropriate box below.
0 Yes
S445—
❑ NA
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.)
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
[].lib
❑ NA
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[? o
❑ NA
❑ NE
waste management or closure plan?
Page 2 of 3
2/4/2071 Continued
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?
es❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑Yes
N
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
L J.Xo"
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑,Ada
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes i_y"6❑ 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): �3 &&'K"
13. Soil Type(s): C;�_
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [G].3ale-- ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [3-Ncr ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[:]Yes
NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
z--�
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
EJ [N '
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑-tqo
❑ 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.
0 Yes
S445—
❑ 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
a Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
[].lib
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0<
❑ NA
❑ NE
Page 2 of 3
2/4/2071 Continued

Facility Number: - Dlate of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [(blo- ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes [Z. e ❑ 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
&'1166-
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
C3>W-
0 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 ar air quality concern?
[:]Yes
❑NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30_ Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
E Alts
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
E] Yes
/
LEIXo
❑ NA
[] NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
la
❑ 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?
El Yes
❑ NA
❑ NE
Comments (refer to question #)::Explain any YES answers and/or. any additional recommendations orweny$other�commeats_ i; f
Use.drawings of facility.to better explain situations (use additional pages as necessary).
C-104 I �, i1iuu .15
S (Jcj�_'14 13
;o-qaci� l9
e N-oL (�5 a 1N`
Reviewer/Inspector Name. t PholAo
Reviewer/Inspector Signature: Date: (.
Page 3 of 3 2/4/2011

Fri o5t ivi"sign of Water Quality
Facility Natnlber V - 4$,S O Division of Soil andWater Conservation
O (?cher Agency
Type of Visit: &Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine Q Complaint ( Follow-up O Referral a Emergency 0 Other O Denied Access
Date of Visit: Arrival Time: Departure Time: 111 'ff;! County:Region: r
Farm Name; �:.11�� �7€.S�c1� Owner Email:
Owner Name; _1" A , �' � �� _ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: pwnTA Phone:
Onsite Representative: s � UVOIJ P Integrator: Mkir,la)Rpw
IF
Certified Operator: Certification Number:
Back-up Operator: Certification Number;
Location of Farm:
Latitude:
Longitude:
Dische es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: p Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2_ Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [Z No ❑ NA ❑ NF
❑ Yes i❑ No ❑ NA ❑ NE
❑ Yes ❑ No [] NA ❑ NE
[:]Yes [:]No
[] Yes [V]"No
[] Yes [TNo
❑ NA ❑ NE
E] NA C3 NE
❑ NA ❑ NE
Page I of 3 214/2411 Continued
m
Dgn Current''` `�,, . � � ° � Design
I
Current
Design Current
Swine
cj"., Po - .et Poult : �-
CaEliCapa
p ry city
Pop
_
Cattle Capacity Pop.
YW
Wean to Finish
I ILayer
Dairy Cow
Wean to Feeder
Iffi INon-Layer I
Dai Calf
Feeder to Finish
LxM3Q — m
- =
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , Poul Ca achy
1?0 -
Non -Dairy
Farrow to Finish
Lavers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
- Pullets
Beef Brood Cow
Turkeys
O#her
Turkey Poults
Other
Other
Dische es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: p Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2_ Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [Z No ❑ NA ❑ NF
❑ Yes i❑ No ❑ NA ❑ NE
❑ Yes ❑ No [] NA ❑ NE
[:]Yes [:]No
[] Yes [V]"No
[] Yes [TNo
❑ NA ❑ NE
E] NA C3 NE
❑ NA ❑ NE
Page I of 3 214/2411 Continued

,i
Facili Number: - LABS -Date of Inspection: 1d
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes C3 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?:
❑ Ycs
E(No
❑ NA
❑ NE
Designed Freeboard (in): C�
❑ Yes
C"No
❑ NA
❑ NE
Observed Freeboard (in):
❑ Yes
00
[g No
❑ NA
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
CD�No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not property addressed and/or managed through a
❑ Yes
[g"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
Ej-No
❑ NA
❑ NE
R. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q�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 [D610 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes Eg,& ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [L[-iYo ❑ 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): qn5
13. Soil Type(s): ups(' .
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 [fNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes gNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Ycs
E(No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
C"No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
00
[g No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yesr❑i
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:)Yes ffNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [3 Stocking [] Crop Yield ❑ 120 Minute inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 1 'No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
DNA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
PAA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: $ - 4 g,5 IDate of Inspection: 0 Q
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 6]�No ❑ NA
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E3'No ❑ NA
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, aver -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Application Field ❑ Lagoon/Storage Pond M Other:
❑ NE
NE
❑ Yes
�No
❑ NA
❑ NE
[:]Yes
©'No
❑ NA
❑ NE
❑ Yes
[215o
❑ NA
❑ NE
❑ Yes 52"No ❑ NA ❑ NE
❑ Yes U2'No [] NA ❑ NE
❑ Yes 0* -No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [DAo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes QlNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [3"No ❑ NA ❑ NE
Comments (refer td question I#) -Explain any YES answeirs'and/or.any additional recommendations or any wage'" oti►`'inents.
M—
lUse drawings of fbetter explain situations (use additional pages�as necessary).
�'Cxs?_ WP6 AMCLn &XO,?'5.bvj\A past
Ca"Q`E o� r. s, tVo sQ Rp►-1 iS�R a'{% -t -N }ppK O'C"C� '(C4 AO[)sL44-
�i�• V�1hZ� l���A itriS NEu+ C{tiC
VO&v, w�tl ro><Ec>
o "A -Is.
'.AQ\1
'ft C.c�n�fa,vt� wott�.-.�
©�. se�os� baw�
s�crs
a4'-cam+1a l-,P�oorl
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
S.
Phone: 9J0.191) &f6l
Date: 1 ej Ia9 1 1 c�
214/2011

n I- I
Type of Visit: t9 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 1$� Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:+� Arrival Time: j ; j � Departure Time: County: �Q� a Region:
Farm Name: N+1fT"C� dL uye tk * --� Owner Email:
Owner Name: A it VYhi} 696 _ Phone:
Mailing Address:
Physical Address: }6-71) kfA0A Weekr PL Net-bl C
Facility Contact: RjafA 411-LMN f j Title: _ Phone:
Onsite Representative: PCS C�I�l l�t�_ integrator:
Certified Operator: PiCh A %► ?, � _ Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes. notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes D No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
ine k max,
Design Cssrrent:;
Capacity a Papr .Wet Poultry
D�ign� CtirrenY
Capac�ty�Pop. i
Design C+urrent
Cattle Capacity Pop.
❑ NA
❑ NE
[:]Yes
[B No
Wean to Finish
Layer
Dai Cow
Wean t0 Feeder
Non -La er
,� _
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
''
Des! Current
D Cow
Farrow to Feeder
Farrow to Finish
«.
D -P_oul_ . '=r a aett�.Po
Layers
Non -Dairy
Beef Stacker
Gilts
Non -La era
Beef Feeder
Boars°
Pullets"
Beef Brood Cow
Turkeys
R
Uther
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes. notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes D No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
to No
❑ NA
❑ NE
[:]Yes
[B No
❑ NA
❑ NE
Page 1 of 3 2/4/2011 Continued

Facili , Number: - Date of Inspection:
❑ Yes
allo
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
[-No
❑ NA
❑ NE
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
❑ NA
Identifier:
the appropriate box.
Spillway?:
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
EJ Other:
Designed Freeboard (in): 12
2l. Does record keeping need improvement? If yes. check the appropriate box below.
❑ Yes
RNo
❑ NA
Observed Freeboard (in)-
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield D 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
U No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
❑No
ONA
6. Are there structures on-site which are not properly addressed and/or managed through a
ayes
❑ 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
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
Maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? I f yes, check the appropriate box below. ❑ Yes 2 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift 0 Application Outside of Approved Area
12. Crop Type(s). -,, &nva .
13. Soil Type(s): W#dA7/h t5 1��(
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes rRNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ayes tff NO ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes aNe ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
allo
❑ NA
❑ NE
18, Is there a lack of properly operating waste application equipment?
❑ Yes
[-No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily avai[able?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
EJ Other:
2l. Does record keeping need improvement? If yes. check the appropriate box below.
❑ Yes
RNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield D 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
[] Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
W No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
❑No
ONA
[] NE
Page 2 of 3
21412011 Continued

- Facile Number: - Liss
Date of ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ER No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [�kNo ❑ 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
[RNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
aNA
❑ NE
Other Issues
28. Did the facility fail to property dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal'?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30_ Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface lile drains exist at the facility? tf yes, check the appropriate box below. ❑ Yes ld No ❑ NA ❑ NE
❑ Application Field p Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes CR 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/orany additional recommendatransxarl'any�i - er
* comMentS..
Use drawings of facility to better'explain situations (use addittunal_pages as necessary).
60,srna)) old )a 0o, AtAc+ 0 ac-tr%t 1a9C*, l� hos- be&) eaf&OK ��1 7
�aae.. r� c o, 1 a o 14 w aJ sari y►-h*0700-r'h
-m so f e },ci�e b bei*) dowt) a,d re 64 If -, -Rtd6d hoT a mew cert�wYe
o�—(ooe!je 04, Yvo k ri l q �ve ble acfdr,
1St PL%f- Co"lrof F'�Jyffl4r
a0u -fo r)WW lid oOi-h tr ea, or
V l +fi,eoin 'Ili -� jJ ea- �/�to
�y c�ro� - ch -evaroa-ho.7 t t_ de fqdA��.
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: %.--q3—_V 3 {0q'
Date: Y417
J011

Facility No. SD�-L&5-^Farm NameDate
Permit COC OIC NPDES (Rainbreaker PLAT Annual Cert )
Pop. Design Current
Type
FB
Dro s
Lagoon 1 2 3 4 5 6 7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft ,
Ratio Sludge to Treatment Volume
Design Width
Soil Test Date
pH Fields
Lime Needed
Lime Applied
Cu -1 ✓Zn -I'
Needs P
N ew' WOW Roi � ItT- )
Wettable Acres
WUP
Weekly Freeboard ✓
1 in Inspections
120 min Insp.
Weather Codes
Crop Yield Transfer Sheets
Waste Analysis Date
- 60 Da
+ 60 Da
N Amt Ib11000 Gal
H
RAIN GAUGE
Dead box or incinerator
Mortality Records
• ..
M
� r
' r F&'%![4arZ,
LET i � i.! .�
,• R -11;%M
IM,>�
Verify PHONE NUMBERS and affiliationsjp�j
Date last WUP FRO Date last WUP at farm 0 t /App.�Iardware
FRO or Farm Records
Lagoon #
Top Dike 50$
Stop Pump
Start Pump
Conversion- Cu -1 3000 108 Ib/ac; Zn -I 3000- 213 lb/ac
w(

DIKS !)Illphp
Type of Visit OcCompliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit RRoutine Q Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ®n Arrival Time:
'ted Departure Time: �. County: Region: �R-P
Farm Name: r_.!i!!t_�L�{ tvf'sXK� Owner Email:
OwnerName: Tvh Q _ _.__ - _ Phone:
Mailing Address:
Physical Address:
Facility Contact: .R' I'VhTtlPI(. Title: N#A174EC Phone NJC qM-1Wr
Onsite Representative: �r j Integrator: p
Certified Operator: I�iU ,TYJtti 1�''�F ti T7 C[OE_ Operator Certification Number: �7
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: E=10 ET
=" Longitude: =° =' 0
Design Curren#
Swine Capacity Population
Design Current
Wet Poultry Cepacii , Population
Current
_ Cattle opulation
"eanniv
❑ NA
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Da Calf
&Feeder to Finish m0
-
❑ Dairy Heifer
❑ Farrow to Wean
lDty Poultry -
❑ Dry Cow
❑ Farrow to Feeder
❑ NA
El Non -Dai
Farrow to Finish
❑ ers
ElBeef Stocker
❑ Gilts
El❑ N .a ers
❑ Beef Feeder
❑ Boars
Pullets
El Pullets
❑ Beef Brood Co
❑ NE
❑ Turke s
❑ Yes
Other
❑ Other111EFOther
❑ Turkey Poults
I
Dumber of Structures:
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
5No
Discharges A Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
Wo
❑ 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
5? No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
5No
❑ NA
❑ NE
other than from a discharge?
Page ! of 3
12128/04
Continued

Facility Number: S5 —qw Date of Inspection i
N No
❑ NA
❑ NE
Waste Collection & Treatment
SNo
❑ NA
EINE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ERNo
[--INA
❑.NE
a. If yes, is waste level into tate 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 (RNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
KYes 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 (J"No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes (SNo ❑ 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 9No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes KNo ❑ NA ❑ NE
maintenance/improvement? i
11. Is there evidence of incorrect application? If yes, check the appropriate box below. Wes RNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ [hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ FAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
ipOutside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) S'[2��G, }v/11�P/ .,
13. Soil type(s)
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 2No ❑ 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
SNo
❑ NA
EINE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
J"No
❑ NA
❑ NE
- ` r - '�.fw' ^!
Comments refer to neshota+ 4 rs'aadlor am ..(r�yeco xda iO
Use drawings of foe o bet#eexplatnsn*(see ^�` 4�ns or auy other comments.
ly ..__ r, i additional a es as recess
�:R.is
A.
308 - k -e(
Reviewer/Inspector NameS Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 'J 12128104 Continued

ft
Facility Number: — Date of Inspection I
Renuired 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 appropirate box.
❑ WUP El Checklists ❑Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.Yes XNo ❑ NA EINE
IQ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 ° Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
25_ Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss reviewlinspection with an on-site representative?
33_ Does facility require a follow-up visit by same agency?
❑ Yes
NTio
❑ NA
❑ NE
❑ Yes
❑ No
NMA
❑ NE
❑ Yes
5'No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
t'No
❑ NA
❑ NE
❑ Yes
❑ No
UNA
❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes B -No ❑ NA ❑ NE
❑ Yes W No [INA ❑ NE
Additional-C.ommen 6ian"W60D` wings
34,
e w
t)1I VV And yses 3ocJ_ [ u, o, n,j (� o days corn& aialys
C)qcv, C9h b —" . a-ld-sl4e swe d ft b Rain mr,) Q. w y o,
�` `
Pa �rIvork not bockr1L7
l V/\,1L , V itl IJ-' Sly' •1� t
Sm it r a ©a, egg o(K ve 1,2 CaP�°d hrrs n'o� l'PCp, r��� wage �n may ,
Page 3 of 3 12/28/04

FadilityNo. �a�_ _ t{� Farm Name ► f �u - Date
Permit COC OIC_ NPDES (Rainbreaker PLAT Annual Cert)
Pop. Design Current FB
Type Drops
Lagoon 1 2 3 4 5 6 7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
Li uid Trt. Zone ft
Ratio Sludge to Treatment Volume
– i .f' �I M
Calibration Date 'c, 2 3 4 5 6 7 8
Design Flow
Actual Flow
Design Width
Actual Width
Soil Test Date 6 X10 Wettable Acres RAIN GAUGE
pH Fields WUP Dead box or incinerator
Lime Needed_ Weekly Freeboard Mortality Records
Lime Applied 1 in Inspections
Cu -I Zn -1 ✓ 120 min Insp.
Needs P -Q_ Weather Codes
Crop Yield . Transfer Sheets
Waste Analysis Date MPT, �Wv
•
i
Puffield Soil Crop Acres PAN Window Max Rate Max Amt
loo -S rs
214
I KA too Se -A
Verify PHONE NUMBERS and affiliations
Date last WUP FRODate last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu -I 3000= 108 Ib/ac; Zn -I 3000= 213 Ib/ac
�q q
App. Hardware

✓ !Um -5 11-2-3- 2,00 9
Q MIVision of Water Quality
15TE-MURN,umber 82 �~� Dlvisinil and Water Conservation
0 Other An of Sogency
Type of VisitCom
[lance Inspection
O Operation Review 0 Structure Evaluation
O Technical Assistance
Reason for Visit
Routine O Complaint
O Follow up O Referral O Emergency
O Other ❑ Denied Access
Date of Visit: //-%7-O 9 Arrival Time: f/.� ,.� Departure Time: County: 5g=45otJ Region: f %W
Farm Name: _h fe-1 L�y� �a �/� z Owner Email:
Owner Name: L- ._ b.lfnr 44,c.i'Cl _ Phone:
Mailing Address:
Physical Address:
Facility Contact: _ R1G c-44 OL`17 4 Oct Title: Q rr- 1e9&hv.v S Sanf Phone No:
Onsite Representative: R"q kA &A7-Ie_I d Integrator: 114ilv4 N cg - LS *-6 Ui til
Certified Operator: &"Aed B. 614; Operator Certification Number: �� 3
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0' 0 ' 0" Longitude: [_—] o E:D ' 0
Design Current
Design Current
Design Current
Swine Capacity papulation
Wet Poultry C►opacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dai Calf
Feeder to Finish
❑ Dai Heifer
❑ Farrow to Wean
Dry poultry
❑ D Cow
❑ Farrow to Feeder
❑ NE
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
[] Boars
❑ Pullets
❑ Beef Brood CoA I
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑Turke s
❑ No
F6�0
❑ Other
Number of Structures:
er
a -5o
❑ NA
Disci & Stream ImpActs
1. Is any discharge observed from any part of the operation?
❑ Yes
[]'No No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
ETF4A
❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
❑ Yes
❑ No
D'5A
❑ 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
Ef _N A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
a -5o
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
f3,iqo
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

12. Crop type(s) W l N `KY 4"Ar t }tkeaA,
13. Soil type(s) AJOL
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Ngo ❑ NA
El NE
Facility Number: — 5 Date of Inspection
❑ Yes
�
[TNo ❑ NA
❑ NE
Waste Collection & Treatment
❑ YesN'o
No
El NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[T
❑ 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: Zu 41
Ir
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 36
5. Are there any immediate threats to the integrity of any of the structures observed'?
❑ Yes
8-156
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
E3 -5o
❑ 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 environmentalthreat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
IJ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
l-7ivo
❑ 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
,.,
L�'hlo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[I Yes
�,�
o
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
[I,-
Yes
, ,�
l_�vo
❑ 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(s) W l N `KY 4"Ar t }tkeaA,
13. Soil type(s) AJOL
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Ngo ❑ NA
El NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�
[TNo ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ YesN'o
❑ NA
El NE
17. Does the facility lack adequate acreage for land application?
El Yes
L�N��o [:1 NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
E] Yes
B o ❑ NA
❑ NE
N * �-y `._ r'M y,2 -i°.
Comments (refer to questlorr'#): 'Ei*olatn'any YES answers andlor any recommendations ar if& C6 ber comments
Use drawings of facility to better explaro situations. (use additional pages as necessary)y
^" D4"'6 G" zoo 5` r
Reviewertinspector Name I Rte�w 1 Phone. 9l0,�33,33DQ
Reviewer/inspector Signature: l — Date: 7-2o-0-9-
12128104
912/28/04 Continued

Facility Number: 82 — ' Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes
L7 No
❑ NA
❑ NE
❑ Yes
E3 No
❑ NA
❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
o ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and 1" Rain Inspections,
Code
❑Weather
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[:INA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
j'N�o ❑ NA
L:__01
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
<0 NA
❑ NE
25. Did the facili fail to conduct a slud a surve as uired b the ermit?
facility g Y � Y P
❑ Yes
LJ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
io [--INA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Flo ❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ YesNo El NA El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document El 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 ffN ❑ 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 [:1 NA [INE
33. Does facility require a follow-up visit by same agency? El Yes ❑ NA ❑ NE
12128/04

Type of Visit�mp fiance Inspection Q Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint Q Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: ,'pp' Departure Time: County: V� Region��`Z
Farm Name: /�,..A; 4;4,,z-- y, 7; Owner Email:
Owner Name: %f���� /� Phone:
Mailing Address:
Physical Address:
Facility Contact: x- Title:
Onsite Representative: A integrator:
Certified Operator: tom.•-��
Back-up Operator:
Phone No: 9,/6- /,;Z/g
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =]' =' ❑ « Longitude: =0=6
o❑6 = ,s
Design
Nt�
snrrent
❑ NA
Capacity Popu�on
"FORean
Wet Aoapaci�tyPopulation�
Cattle' �' '�_ Capacity Population
❑ Lacr
a. Was the conveyance man-made?
❑ Dai Cow
❑ No
❑Non -La er
❑ NE
❑ Dairy Calf
Feeder to Finish lPa
❑ No
- {
El Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ Da Cow
❑ Farrow to Feeder
❑ La ers
"` - -
❑ Nan -Dai
❑ Farrow to Finish
on -Layers ers
2. Is there evidence of a past discharge from any part of the operation?
❑ Beef Stocker
❑ Gilts
❑ NA
❑ NE
❑Beef Feeder
❑ Boars
❑ Pullets
❑ NA
❑ Beef Brood Cow
other than from a discharge?
❑ Turke s
Ulher
❑ Turkey Points
12/28/04
Continued
❑ Other
❑ Other
Numberof Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ELNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
[INA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
EINE
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
M_No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
RNo
❑ NA
❑ NE
other than from a discharge?
Page ] of 3
12/28/04
Continued
. -A

Facility Number: V— Date of Inspection f�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): l�
Observed Freeboard (in): L`
❑ Yes 9 No ❑ NA ❑ NE
❑ Yes ❑ No [INA ❑NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
JZ 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
M No ❑ NA ❑ NE
through a waste management or closure plan?
® No
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? la, Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ NE
9. Does any part of the waste management system other than the waste structures require (] Yes
�SNo ❑ NA ❑ NE
maintenance or improvement?
❑ NE
Waste Application
❑ Yes
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
® No ❑ NA ❑ NE
maintenancelimprovement?
18. Is there a lack of properly operating waste application equipment?
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.)
❑ NE
❑ 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) GU i .t7`pr firm
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
®No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
®.No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[KNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E No
❑ NA
❑ NE
.i.�r>�-ay.,i�1!1w'=,`C—:-a`k4'��r�.r�i�_:� �. s;.�`� r-.-• ti_ . �';'eS..::�+31+1��€s's'-- '/;u T 3�
fi=mDv� S�la.�% �Pcx'j �, � �� 1�� v1, -z_- � �_5Td- Z 51�
w
Reviewer/Inspector Name ter, . ` Phone: ` .10 X33 �-3a�
Reviewer/Inspector Signature: Date: %'i /77a��
t uge L Oj s �.vnsanucu

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 fallo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 10yes ❑ No ❑ NA ❑ NE
Dr -Waste Application ❑ Weekly Freeboard ❑ Waste Analysis JO.Soit Analysis ❑ Waste Transfers ❑ Annual Certification
Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
RNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
KA
El NA
El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
19 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
t4 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes 0 No ❑ NA ❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
54No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[:]Yes
No
❑ NA
EINE
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
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
54 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
CA No
❑ NA
❑ NE
Addetional Comrrtents actd/or DrawingsN
AL
11
Page 3 of 3 12/28/04

Type of VisitCoo�mpliance
Inspection
0 Operation Review O Structure Evaluation
0 Technical Assistance
Reason for Visit
O' outine O Complaint
0 Follow up Q Referral Q Emergency
Q Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region: ' 1�
Farm Name: t� L,� �� dY.57Df� Owner Email:
Owner Name:• L ' �� i ��i r f' Phone:
Mailing Address:
Physical Address:
Facility Contact: �� Title:
Onsite Representative: Sdt,A --f
Certified Operator: ,S -
Back -up Operator:
Phone No:
Integrator: „�✓�
Operator Certification Number: Jzf�1 _5
Back-up Certification Number:
Location of Farm: Latitude: F-10 =' 0 Longitude: a o =' = w
�_ Design Current
Design, Current
Design Current
Swine ;y7p Capacity Population
Wei Poultry Gapit�1'opulation
Cattle CapacityPopulation
❑Wean to Finish
❑ La er
❑ Dairy Cow
❑ an to Feeder
❑Non -La er
❑ Dairy Calf
Feeder to Finish 00
_ t
0 Dairy Heifer
❑ Farrow to Wean�rxJ
�y
❑ Da Cow
❑ Farrow to Feeder
Dry PoulttY �a��+ � ��,�_:;
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stacker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
El Beef Brood Co
2. Is there evidence of a past discharge from any part of the operation?
❑ Turkeys
allo
Other
❑ Turkey Points
,
❑ Other
❑ Other
�y
N 6er of Structures:
❑ NE
other than from a discharge?
-urn
Discharees & Stream Impacts
I . Is any discharge observed from any part of the operation?
❑ Yes
PKNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
ti No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
R 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
EINE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
allo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
® No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128.104
Continued

Facility Number: — 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 I Structure 2 Structure 3 Structure 4
❑ Yes LN No ❑ NA ❑ NE
❑ Yes ZINo ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
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Spillway?:
Designed Freeboard (in): 12
14. Do the receiving crops differ from those designated in the CAWMP?
Observed Freeboard (in): a (p
RNo
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
E9 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ Yes
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
O.No ❑ NA ❑ NE
through a waste management or closure plan?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
M No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
L4No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
M No
9. Does any part of the waste management system other than the waste structures require ❑ Yes
N No ❑ NA ❑ NE
maintenance or improvement?
❑ Yes
Waste Application
❑ NA
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[21 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
(KNo ❑ 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) �r�.c4 AGt4l/'
13. Soil type(s)
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T
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
IRNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
J9 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
M No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Z No
❑ NA
❑ NE
Comments:(refer to'question ft Explain any YES answers and/or any recommendations or any other comments' • 17. L
Use drawings of facility to better explain situations. (use additiona[.pages as necessary).
Ll ni'�vRe,- �-
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Reviewer/Inspector Name ��� p Phone:
Reviewerfinspector Signature: Date:
Page 2 of 12/28/04 Continued

Facility Number: j� —IWSr Date of Inspection $r�cs�� 6
Required 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 CAWNIP readily available? If yes, check ❑ yes H No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps p El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. CKYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections KWeatherCode
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
12 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
ONo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
X No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
9No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
0 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
[:INA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[9 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
ZNo
❑ 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
D&No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
J,No
❑ NA
❑ NE
Additional Comments,and/or Drawings:
T
Page 3 of 3 12/28/04

Facilitv Number Date of Visit: g D Time: U
=Not erational 0 Below Threshold
ff,Permitted entified O Conditionaliv Certified © Registered Date Last Operated or Above Threshold
Farm Name: 44te1vtSlyk $ Count.
Owner Name: � ��r �i Phone No:
Bailin=_address: 1 (O7t7 KC+�Qn wtG1Ct ��. /1�[w'1vr► �+��� /�C o1�3(s�o..
FacilitV Contact: a " 4it. d l Title: Owner Phone No:
Onsite Representative: Ridt, C L.A. cid Integrator: /",
Certited Operator: ! ' L�d Operator Certification Number: 9J3
Location of Farm:
wine E3Poultry ElCattle ❑ Horse Latitude 0' = 0" Longitude
Design Current
Swine Capacity Papulation
❑ Wean Feeder
DT-fe—der to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons
Hoiding Ponds i Solid Traps
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Laver ❑ Da'
❑ Non -Laver I 1E1 Non -Dairy°
❑ Other
Total Design Capacity
Total SSLW
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
No Liquid Waste
Discharae originated at: ❑ Lagoon ❑ Spray Field ❑ Other
Present ULJ Lasoon Area
a. If discharge is obsen>ed, was the conveyance man-made?
h. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated floes• in eal/min?
d. Does discharge bypass a lagoon system" (if yes, notif.' DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2
Identifier:
Freeboard (inches):
05103/01
❑ yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 3 Structure 4 Structure 3 Structure 6
Continued

Facility Number: — 5 Date of Inspection F 31,54A
5. Are there any immediate threats to the integrity of any of the structures observed? (icl 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 �,��
closure plan? ❑ Yes Leo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes 11,Ko-^
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 0'No
9. Do any stuetures lack adequate, gauged markers with required maximum and minimum liquid level ,�, _�
elevation markings? ❑ Yes Leo
Waste Applie ltjgn
10. Are there any buffers that need maintenance/improvement? ❑ Yes ID"No
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
W-tvo
l2. Crop type SoetbGa•,5 , tjeAt
❑ Yes
No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
_
❑ Yes
L'i'No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ TC
b) Does the facility need a wettable acre determination?
❑ Yes
0 <0
c) This facility is pended for a wettable acre determination?
El Yes
[2 o
15. Does the receiving crop need improvement?
❑ Yes
[��
16_ Is there a lack of adequate waste application equipment?
El Yes
01ro
Rhe uireclRecords & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
t8. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
,,��,, ����
(ie/ WUP, checklists, design, maps, etc.)
El Yes
[9- o
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
yh, g.
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
El Yes
21- Did the facility fail to have a actively certified operator in charge?
El Yes
,E _Nom
Lgivo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
No
(iet discharge, freeboard problems, over application)
23. Did Reviewer/lnspector fail to discuss review/inspection with on-site representative?
❑ Yes
13 o
24. Does facility require a follow-up visit by same agency?
❑ Yes
EKo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
BN -0-11,
Q No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
.i16* SJ�.4�v�:i�lY•iFOe 'Mt �'VR. .__ ^ e :..
Cowmen refcrto.,quesdon #)Eipiain ally YES answers and/or any recommendations or snv.:other cotnrnerit�s.iT},
643
iise drawings oGfacility to,better explain srtdations: (use 8rlilitional necessary):
pages'as teld Copy
El Final Notes
Doti r't "S j /i I c e C. 0 c .
t
Reviewer/inspector Name F
Reviewer/Inspector Signature: Date:
O3 � o
05103/01
Continued

Facility Number: 9A — Date of Inspection o
Odor J§sues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
34. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanenthemporary cover?
❑ Yes [9<0
9 o—
ElYes Gtvo
❑ Yes OK,—
❑ Yes
E
❑ Yes
Ly,�"9vo
❑ Yes
Fa oo
❑ Yes
05103/01