820430_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Quai

• �Divi'sion of Water3 Resources
Facility Number � - L.�.J OO .Division of Soil and Water Canservatioa
Q Other Agency
=for
Visit:Com��pliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance Visit: 0 ke-utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Aceess
Date of Visit: Arrival Time: Departure Time: :3 County: Region: 7 �`
Farm Name: ;�41wt_ ' Owner Email:
Owner Name: ���r'� yrn _ I Phone:
Mailing Address:
Physical Address:
11 Facility Contact: �l�f Z' lw lam-*/
Onsite Representative: .IIII
Certified Operator: ' ""
Back-up Operator:
Location of Farm:
Title: 60-4flJl1?,a-' Phone:
Integrator: r2'0—" L —
Certification Number:
Latitude:
Certification Number:
Longitude:
Discharges and Stream Impacts
Design .Current:
Design
Current
Design Currrent
Swine
Capaeity Pap
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
pacity Pop. '11`
CaI.
FN
a. Was the conveyance man-made?
[:]Yes
❑No
Wean to Finish
❑ NE
b. Did the discharge reach seaters of the State? (if yes, notify DWR)
❑ Yes
❑ NA
Dai Cow
Wean to Feeder
er
d. Does the discharge bypass the waste management system? (Ifyes, notify DWR)
Dai Calf
Feeder to Finish
�{
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Dai Heifer
Farrow to Wean
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Design
Current
Cow
Farrow to Feeder
of the State other than from a discharge?
D . P,oult ,
Ea aei
Po
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
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Erlqo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes
❑No
❑ NA
❑ NE
b. Did the discharge reach seaters of the State? (if yes, notify DWR)
❑ Yes
[] No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (Ifyes, notify DWR)
[] Yes
[:]No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[D'No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[3 -No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes ETNc ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes 0"No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [] No [j NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
E] No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[3 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
E No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
E o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
dNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
E3<o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
F71'N-o
❑ NA
❑ NE
RJCJ�- /
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: }jam 3�3—c�rsl
Date: 6,
21412015

Facility Number: - q_3T) I Date of Inspection:
❑ Yes
[]rNo
❑ NA
❑ NE
Waste Collection & Treatment
�.
❑ Yes
[l] 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
Ejl�o_
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
the appropriate box.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[,r No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
E] No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E j -&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
EKO
❑ NA
❑ NE
maintenance or improvement?
Waste Application
No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E
❑ NA
[] NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[] Yes
ErNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus 0 Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window% ❑%Evidence of Wind Drift [j�JApplication Outside of Approved Area
�
12. Crop Type(s): �p"n- �1��1� ! T� �X/', L u r- �ZS r--rj
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
EfNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [l] No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[]rNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[l] No
❑ NA
❑ NE
Required Records & Documents
No
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
❑ Yes
E o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [llNo ❑ 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 2/412015 Continued

i
_ - Divi"slon of Water Resources
Facilify Number - �� Devision of Soil and Water Conservation
Q Other Ageney
Type of Visit: O Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: L� Arrival Time: / Departure Time: ,' 3 County: Region:
Farm Name: _ fu -l!5 Y // Owner Email:
Owner Name: '2/ z_ /�(G- Phone:
Mailing Address:
Physical Address:
Facility Contact: .l fG J Title: Phone:
Onsite Representative: Integrator: &Z2' �O_
y�
Certified Operator: Certification Number: r2 7 7
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Desigu
Cnrreot
Design Curren#
Swine . Capacity Pop.
We# Poa[try
Capacity
Pop.
Cattle Capacity Pap.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
IL
I IN2n:LaXer
I
Dairy Calf
Feeder to Finish v --p
-
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . P,oal
Ca aci
P,o
Non -Dai
Farrow to Finish
Layers
I JBeef Stocker
Gilts
Non -Layers
Beef Feeder
Soars
Pullets
Beef Srood Cow
Turkeys
Others
Turkey Poults
Other
Other
D_ ischarses and Stream Impacts
L Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes allo [] NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑No
❑ Yes a No
❑ Yes J,No
❑ NA ❑ NE
[DNA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Con need

Facility Number: - L' Date of Inspection: r
/
allo
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
M No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
allo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier-
dentifier:Spillway?:Designed
the appropriate box.
Spillway?-
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
DesignedFreeboard (in):
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
allo
❑ NA
Observed Freeboard (in): 3
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i" Rainfall Inspections
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
'E No
❑ NA
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7_ Do any of the structures need maintenance or improvement?
❑ Yes
®No
❑ NA
❑ NE
8. Do anyrof the structures lack adequate markers as required by the permit?
❑ Yes
0 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
2[ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
RLNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Ej No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Accep
table Crop Window
� ❑ Evidence of Wind Drift ❑/Application Outside of Approved Area
12. Crop Type(s): t�/'h� �%(/h Ys*+����1Jr'''✓�6�Q f O u r/s`.-�p�
I3. Soil Type(s),-
14.
ype(s):14. Do the receiving crops differ from those designated in the CAWNIP? ❑ Yes M No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [a No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [S� No ❑ 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
M No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
CR No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAW`MJ? readily available? If yes, check
❑ Yes
[E[ No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
allo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
MNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
'E No
❑ NA
❑ NE
Page 2 of 3
1/4/2015 Continued

Facili Number: - ZD Kate of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check O Yes .+� "" ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance.-
26.
on-compliance:26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ®No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below_
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑Yes ®No [j NA ❑NE
❑ Yes [a No
❑ Yes ® No
❑ Yes ® No
E] NA F] NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pales as necessarv).
aw// '�
Reviewer/Inspector Name: _�t-� — --r.��
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: �.; v- atJ!
2/412015

Type of Visit: (Coroutine
nce Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Q Complaint O Fallow -up O Referral O Emergency 0 Other Q Denied Access
Date of Visit: � Arrival Time: c7 Departure Time: ! D County: Region: � (�
Farm Name: ;;� u .2 � _,rvs— Owner Email:
Owner Name: �,� Y}( //!G _J _ Phone:
Mailing Address:
Physical Address:
Facility Contact: �%/'r' 1)7GL,,h1 Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number: 1919s_31;�>
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
❑ Yes
Design
Cnrreat
Design current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pap.
Wean to Finish
Layer
❑ No
❑ NA
Dairy Cow
Wean to Feeder
Non -La er
I
❑ NA
IDairyCalf
Feeder to Finish X2
❑ Yes
No
❑ NA
1 Dairy Heifer
Farrow to Wean
es
Dry Cow
Farrow to Feeder
D . P.oultr
Ca aci
P,o
Non -Da'
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Broad Cow
-
Turke s
TurkeyPoults
herher
nt
Other
Dischar es and Stream Impacts
. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes Eg,No ❑ NA ❑ NE
❑Yes 0 N 0 N 0 N
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
0 NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3
21412015 Continued A

Facility Number: - 113= Date of Ins ection: — 7 -11 -
Waste
/GWaste Collection & Treatment
`* 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 0 NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
identifier:
Spillway?: q
Designed Freeboard (in):
Observed Freeboard (in): 1
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes RNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
fElNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Jallo
❑ 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
KNo
❑ NA
❑ NE
Waste Avollcation
❑ Waste Transfers
[] Weather
Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ELNo
❑ NA
❑ NE
maintenance or improvement?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ErNo
❑ NA
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes
�- o
❑ NA
❑ NE
❑ Excessive Ponding p 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): Fjo-el �{/ t /j! bre• •
13. Soil Type(s): 'A O
-
14. Do the receiving crops differ from those designated in the CAWMP?
[] Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
®No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[!�No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[4 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
FV
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[-]Yes
0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Pq 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
KNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
[] Weather
Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
.Q No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ErNo
❑ NA
❑ NE
Page 2 of 2/4/2015 Continued I

Number: -1 jDate of Inspection:
id the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
25. Is the facility out of compliance with pennit conditions related to sludge? if yes, check ayes p 0 NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
ONon-compliant sludge levels in any lagoon
List structures) and date of first survey indicating non-compliance: 3%lo _ _16y 9= z
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes N No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes g No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
allo
❑ NA
Q 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
CE� 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
CgNo
[DNA
❑ 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
0 No
E3NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWIVIP?
[:]Yes
Eg No
[DNA
❑ NE
33. Did the Reviewer/lnspector 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
JZ No
[] NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4nars
I

7ilS 1' ( MS I ak j I l3
Type of Visit: IR Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ®'.Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 151 .1.� Arrival Time: r jp Departure Time:j p1_'� County:
Farm Name:T,rj If A Ry rlrq WGwe" _ Owner Email:
Owner Name: Dinl Iton Phone:
Mailing Address:
Physical Address: Q�b WO//
ie Fel'
Region: tR Q
y� ,
Facility Contact: 1p o i � 'v%vf41 Title: Phone:
Onsite Representative: Ronniter hjx& Integrator:
Certified Operator: R jr rq WZ?/mr; Certification Number: c1g713
Back-up Operator:
Location of Farm:
Latitude:
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? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 5?No ❑ NA ❑ NE
❑ Yes
DnCUrrentl Design Crurrent
"k`�`
Design CurrenVAt
Swore
Ca aciti o et Poultry CapacityPopj
P P
Cattle Capacity Pop
[] NA
r r g -
❑ Yes
Wean to Finish
a er
Dai Cow
Wean to Feeder
" ]Non -Layer
Dai Calf
Feeder to Finish
Farrow to Wean
m Design Current
9
Dai Heifer
D Caw
Farrow to Feeder
D , .P,oul "� Ca ael P,a .
Non -Dai
Farrow to Finish
w Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
AW 'k ....,-
Turkeys
�`
�...
Other.
°' TurkeyPoults
}.:.�:._..� ._�-��
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 5?No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
[] NA
❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page 1 of 3
❑Yes
[:]No
E) NA
E] NE
[:]Yes
[2 No
❑ NA
❑ NE
❑ Yes
ER No
❑ NA
❑ NE
2/4/1011 Continued ti

Facili Number: - Date of Inspection: (O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes D§ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes f5i 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 JR 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 R1 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes tg No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
®'NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
9. Does any part of the waste management system other than the waste structures
require ❑ Yes JR No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
❑ Yes
U1 No
❑ NANE
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes JS No
❑ NA
❑ NE
maintenance or improvement?
i
/
Required Records & Documents
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. tR Yes ❑ No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload [] Frozen Ground
[] Heavy Metals (Cu, Zn, etc.)
❑ No
❑ NA
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ failure to Incorporate Manure/Sludge into
Bare Soil
❑ Yes
'] Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
❑ NE
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Fk] No
❑ NA
❑ NE
15_ Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
®'NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
0 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
U1 No
❑ NANE
18. Is there a lack of properly operating waste application equipment?
❑Yes
No
❑ NA
i
/
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
grYes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
C'No
D 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. EW Yes ❑ No
�] Waste Application ❑ Weekly Freeboard RWaste 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 U No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [:]No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
g] NA ONE
Page 2 of 3 2/4/2011 Continued

Facili Number: jDate of Inspection: 1011,5
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ® Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: aQ�Q
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 10 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ® NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [53 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 (B 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
E] NA
E] NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
g No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
JZ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[Z No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA
❑ NE
Comments (refer,to;question #): Explain any YES answers and/or any additional recommendatioonior'aan'yFoth6. comments
Use drawings of tarifit y to better explain situations (use additional pages as necessary). =. ,
15, Sorbs dole- b '40,44
, <vq c Belot. bsio-e), -P63e. mai 1 cop &;)O �Gvialys)1 �
f i & r n
19, z0a, VV1 m015
a+� '06 6 '1+ 4cq+SCA . Ofct�0�, fl-eaye. F��i� � rtD(Vdi.
all, So beds YVO e- s /r� tc Ua+ fi� -�l
y e- eid of e cro vQow bu4 �e1�I4 We,
'NegeN '
cro e s(&) -%)im
a ar i 4 )-g f�
� ► %hp co f& c of el {ors o, T Ra v, wo)�_> avk s ej Ure to o A ssOnly o, e_
�NO� ��, �� ��13 �y i4h wn5' isy 4fir ha th t`s 361 ar �
Nehce_ l �t` D>aaor3-w a
� �
out 4o can _wh�l _ oybe4jj- i� Y;ae. )M,540
aje!�- b94LV --
Srna! 9�1n�
g�
a, ;� sa111Ira
6F
X71 £l dor. �e� `fid- _
f�ls3 ra�,�Sl� �'7U I►o �F �l Mbo,i� Ffa 'S�i�IC
`VVaUj(v hia N I�eve)s tee_ stt I n&ma i, % r + I�
was 'C s Eem'd Joan sc�»e �n�,9°" PTt,�'�,tl sur_ 630
C olesalx-er>dt-+'l todtw u�
Reviewer/Inspeetbbr Name: -
Reviewer/Inspector Signature:
Page 3 of 3
Phone: % -9 33 300
Date:: f I a a o 13
2/4/2011

Facility No. TD-Lho�Farm Name T1 4 Date
Permit COC OIC NPDES (Rainbreaker PLAT Annual Cert Daily Pipe )
FB Dro s
Lagoon Name, S forspillway 1 2 3 4 5 6 7
Design Freeboard / Last Recorded in 3 l3
Observed freeboard
Sludge Survey Date
Sludge Depth ft
Li uid Trt. Zone ft 3
Ratio Sludge to Treatment Volume if> 0.45
Date o,4t of compliance/ POA?
l -4l3eZ717. "-
910 -M -m- MOW
Or
Ar/ %
�� R• + � if ! _-
--SCD
Verify PHONE NUMBERS and affiliations
Date last WUP FRO 5 119 10Y FRO or Farm Records
Date last WUP at farma jjq j[), Lagoon #
App. Hardware Top Dike W.?
R Stop Pump qt,q
JJr3) Start Pump q+0
Conversion- Cu -1 3000= 108 lb/ac; Zn -I 3000= 213 Ib/ac
C
Soil Test Date
Crop Yield V
Transfer Sheets
pH Fields
Wettable Acres
Actual Flow
Lime Needed
WUP `-�'"
Design _
Lime Applied
Weekly Freeboard
Actual®®-��---
a .-�_�---�
Cu -I Zn-I--��----��----��
1 in Inspections
910 -M -m- MOW
Or
Ar/ %
�� R• + � if ! _-
--SCD
Verify PHONE NUMBERS and affiliations
Date last WUP FRO 5 119 10Y FRO or Farm Records
Date last WUP at farma jjq j[), Lagoon #
App. Hardware Top Dike W.?
R Stop Pump qt,q
JJr3) Start Pump q+0
Conversion- Cu -1 3000= 108 lb/ac; Zn -I 3000= 213 Ib/ac
C
Soil Test Date
Crop Yield V
Transfer Sheets
pH Fields
Wettable Acres
RAIN GAUGE
Lime Needed
WUP `-�'"
Dead box or incinerator
Lime Applied
Weekly Freeboard
Mortality Records
Cu -I Zn-I--��----��----��
1 in Inspections
Check Lists
Needs S (S-1<25)
120 min Insp.
Storm Water
Needs P �`. (
Weather Cordes
910 -M -m- MOW
Or
Ar/ %
�� R• + � if ! _-
--SCD
Verify PHONE NUMBERS and affiliations
Date last WUP FRO 5 119 10Y FRO or Farm Records
Date last WUP at farma jjq j[), Lagoon #
App. Hardware Top Dike W.?
R Stop Pump qt,q
JJr3) Start Pump q+0
Conversion- Cu -1 3000= 108 lb/ac; Zn -I 3000= 213 Ib/ac
C

o
�
v
95
s�
PX5
�
J

(Type of Visit: Q Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ( I Arrival Time: Departure Time: 9 :S County: tOW Region: /-120
Farm Name: 1 t A PA Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: L• a r(eo Title:
Onsite Representative: I
Certified Operator:
Back-up Operator:
IT
Phone:
Integrator: �it`C�L9,Q1►�[s
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
�I
SwmMilli!
ql Desi n
g
R
C creat
momDgn
Current
Design Current
e
Capacity
Pop
Wei
Poultry
--.t
Capp �
Pop.
C*attle C+apatity Pop.
Wean to Finish
Layer
iry Cow
Wean to Feeder
I
INon-Layer
I
ai Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
D , P,ou1
Design
Ca act
Current
P,a
D Cow
Non -Dairy
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
- Turke s
Other
''
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: p Structure [] Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
[:]Yes [ No
❑ Yes No
NA ❑ NE
❑NA❑N-E
❑NA ❑NE
Page I of 3 2/4/2011 Continued

t Facie Number: WE Date of Ins ection:/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ YesNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes n No P NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ YesNo ❑ 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 �!3 No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate Public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
� No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ YesNo
Ep
E]NA
❑ NE
{not applicable to roofed pits, dry stacks, and/or wet stacks}
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E�a No
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ YesNo
tp
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 00 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 jr ❑ Evidence oof, Wind Drift ❑ Application Outside of Approved Area 6"k 'k
OLO-sw
12. Crop Type(s):�M'.-et "C'5
13. Soil Type(s): A
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes DO No ❑ NA E] NE
I5. Does the receiving crop and/or land application site need improvement? ❑ Yes [P No [DNA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes P No ❑ NA [:]NE
acres determination? T
17. Does the facility lack adequate acreage for land application?
❑ Yes
Og No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q9 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box_
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ YesNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Tra sfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes � No ❑ NA ❑ NE
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [D No ❑ NA ❑ NE
Page 2 of 3 2/417011 Continued

h f
Facility Number: Z - Date of Inspection: zo&2_
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes � No ❑ NA ❑ NE
25_ Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [A 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 fist survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes Q No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [] Yes [A No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Cg No ❑ NA ❑ NE
❑ Yes 5M No ❑ NA ❑ NE
❑ Yes [d No ❑ NA ❑ NE
❑ Yes M No [] NA ❑ NE
❑ Yes No
❑ Yes No
[:]Yes [�)No
[DNA ❑ NE
E] NA C—] NE
❑ NA ❑ NE
ReviewerlInspector Signature: Date: 1 Z
Page 3 of 3 21412011

Type of visit P Compliance Inspection U Operation Review U Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral a Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time:1;�M1 Departure Time: County: 5 0-'J_ Region: Fft
Farm Namc: ►4A_ _ Owner Email:
nn II
Owner Name: ,•_•_ Ap lt,>% + i&Qwre Phone:
Mailing Address:
Physical Address:
Facility Contact: lac ' ` -A tJaW#-e-`VTitle:
1f
Onsite Representative:
U
Certified Operator:
Back-up Operator:
Phone No:
p
Integrator- T ATG ,
V g a� t
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0O 06 = Longitude: =° 01 =16
Design Current
Swine Capacity Population
Design Current
Vein,ointry Capaeity Population
Design Current
Cattle C+apacity Population
❑ Wean to Finish
❑ Layer
❑ Dai Cow
❑ Wean to Feeder
❑ Non -La er
❑ Da' Calf
Feeder to Finish 2(a
a. Was the conveyance man-made?
❑Dai Heifer
El Farrow to Wean
Dry Poultry -
❑ D Cow
❑ Farrow to Feeder
❑ Yes
❑Non -Dai
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -La ers
10 Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowl I
❑ No
❑ Turkeys
❑ NE
Other
Turke Points❑
No
Other
�[J]
Other
Number of Structures:
[]Yes
No
❑ NA
Discharees & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
[, No
I
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
P NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
IP NA
❑ NE
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
❑ Yes
❑ No
®NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes]
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
[]Yes
No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

Facility Number: a -4;0 Date of Inspection Z� f
Soil type(s) ,
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�FNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
�NA [INE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
Spillway?:
No
❑ NA
❑ NE
Designed Freeboard (in):
Does the facility lack adequate acreage for land application?
❑ Yes
No
Observed Freeboard (in): 7 Z �
❑ NE
18.
Is there a lack of properly operating waste application equipment?
5. Are there any immediate threats to the integrity of any of the structures observed?❑yes
® No
ekq 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
FRNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
�No
El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
E,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
[] Ym
P No
[INA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes�]
No
[__1NA [INE
maintenance/improvement?
I
11. Is there evidence of incorrect application'? If yes, check the appropriate box below.
❑ Yes
f�g No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
plication Outside of Area
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑7p",
S if ��uG�L(
12. Crop type(s)
13.
Soil type(s) ,
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15,
Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
No fir, l^
Reviewer/Inspector Name — --- T--- ----- � Phone: �1it) -Lr 33 3 300
Reviewer/Inspector Signature: AAMO,4yz Date: [ L511 I
Page 2 of 3 12128/04 continued

Facility Number: Date of Inspection L ZS i
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes EWNo ❑ 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 El maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 53 No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
§9 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P.No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[jNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
""'No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
14 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
[INo
❑ 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
lMNo
[j NA
El NE
33.
Does facility require a follow-up visit by same agency`?
❑ Yes
El NA
El NE
Additional Comments and/or Drawings:
Page 3 of 3 12/28/04

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I
J/j z A
Q Arrival Time: : 11 l^4 Departure Time: t{.:/ County: PSOr Region:
Farm Name: 1 r I ple r-ar V_A ` RQ I r1 dA - Lk)afrttn Owner Email:
1:9Owner Name: ��Ir1_7`t� Warren Phone:
Mailing Address:
Physical Address:
Facility Contact: g0omt-2 t4ly-cP n Title: Phone No:
Onsite Representative: �{ Integrator: Tres !at
Certified Operator: PonY1fe A 0-00'P Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0 =1
= Longitude: = o = d =61
Finish
E"o
es*'je&
an try
❑ La er
u r =r I In ti lffl#Desi n Curation
Capacity P pu n Cattle Capacity Populrent
W.
Q491❑ Dai Cow
ean to Feeder
❑ NE
III[— er
❑ Dai Caif
Feeder to Finish
A li
5' r ' ❑ Dai Heifer
❑ Farrow to Wean
❑ NE
D ` `Poult
�'``�*'��`
`.'� ❑ D Cow
❑ Farrow to Feeder
(PNA
❑ NE
El Non -Dairy
❑ Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
❑ Yes
❑ Non -Layers
❑ Beef Feeder
El Boars
2. Is there evidence of a past discharge from any part of the operation?
❑Pullets
Beef Brood
El Beef Co
._- �
_ ...,
❑ Turke s
❑ Yes
Other Y
❑ Turkev Poults
❑ NE
❑ Other
_ _... .
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
El Yes
?NA
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
�3 NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
(PNA
❑ 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
INA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
PNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Wo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

Facility Number: — 3D Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes & ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No qg�qA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: f
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �y
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ YesNo ❑ NA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes "ITINo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes P No ❑ NA ❑ NE
S_ Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ?3 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E Vo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ yes 4 No [:INA ❑NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes to No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of�Acceptable
�Crop _Window ❑ Evidence of Wind Drift Application �Outsiidde of Area
�t n
12. Crop types) t--�L'i.S`IQ,I kr" SS � } &,. 61A . W , S M < C4[i�,!/+ DM
13. Soil type(s) k Ik--%1114
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[@ No
❑ NA
❑ N£
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
*filo
❑ NA
❑ NE
Reviewer/I;nspectorName Phone: `7/U�S'35C
Reviewer/Inspector Signature: Date:
Page 2 of 3 12/28/04 Continued

Facility Number: Date of Inspection "
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No
ElNA E]NE
the appropriate box. ElWUp El Checklists Design ❑Maps ❑Other
Checklists
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes O'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes t6No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes [FNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 1PNo ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes [PNo ❑ NA ❑ NE
26_ Did the facility fail to have an actively certified operator in charge? ❑ Yes Wo ❑ NA ❑ NE
2T Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes fallo ❑ NA ❑ NE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑Yeso
No
❑NA
NA
[I
El Yes
No
❑NA
❑NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
El Yes
p&No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12/28/04
Page 3 of 3 12/28/04

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: ' lk County: Region: 'T pV
Farm Name: _ „ fes. 1- rVI Owner Email:
Owner Name: or) rl l Lkh —czn r7 Phone:
Mailing Address: 6 VJ0. r1Dq I�'�'' o + /VC a0 �Al2 �'
{i
Physical Address:
Facility Contact: P—OVI Y1 t rry) Title: Phone No:
Onsite Representative: Integrator: p`QS
Certified Operator: t
Back-up Operator:
Operator Certification Number--
� �'
Back-up Certification Number:
Location of Farm: Latitude: =' =' =" Longitude: 0 ° =' =
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Design Current:..
Designb Current
Design Current
Swine
Capacity Population Wet Youltt7
Capity F Poptrlation
Cattle Capacity Population
❑ Wean to Finish
❑ La er
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ NE
❑ Dairy Calf
Feeder to Finish
j
El Dairy Heifer
❑ Farrow to Wean
" -
Dry P©ult
*': A
❑ D Cow
❑ Farrow to Feeder
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ NE
❑ Beef Stocker
❑ Gilts
❑Non -La ers
❑ NA
❑ Beef Feeder
❑ Boars
❑Pullets
O No
❑ Beef Brood Co
-_
❑ Turkeys
Other
❑ Turkey Poults
Page I of 3
12/28/04
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
0 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
0 NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
(R 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
[6 NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
§Z No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
O No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

13.
Soil IN111046
Facility Number: Date of Inspection —�
Waste Collection & Treatment
type(s)
J
�/0� 7 r>3
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 0 No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
N NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
15.
Does the receiving crop and/or land application site need improvement?
Spillway?:
�No
❑ NA
Designed Freeboard (in):
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
Observed Freeboard (in): w
CK No
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
NNo
❑ NA
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes No
❑ NA ❑ NE
through a waste management or closure plan?
04 No
❑ NA
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 24No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes ,® No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes INNo
❑ NA EINE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 91 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes ERNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I4 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
i2. Cro e s /t')Lfr�
P type(s) () Q [ C9" ^1^ ay,,sf�.�l z 5e�r�
, Ja�
13.
Soil IN111046
s
type(s)
J
�/0� 7 r>3
ReviewerlInspector Signature: Date:
. a
14.
Do the receiving crops differ from those designated in the CA WMP?
❑ 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
CK No
❑ NA
❑ NE
17.
does the facility lack adequate acreage for land application?
❑ Yes
NNo
❑ NA
❑ NI?
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
04 No
❑ NA
❑ NE
Comments (refer= to question #):, Explain any YES answers and/or any recommendations or any other comments
13se drawings - facility. to better explain'situationsJ.Nse additional pages as necessary): p;
s
Reviewer/Inspector Name µ Phone:
J
�/0� 7 r>3
ReviewerlInspector Signature: Date:
. a
Page 2 of 3 12/28/04 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes $5 No ❑ NA ❑ NE
the appropirate box_ ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 9� Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall P Stocking ..Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
CgNo
❑ NA
❑ NE
23.
1f selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
F No
❑ NA
EINE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
(� No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[A No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
RNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 /tours and/or document
❑ Yes
10 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
'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
[P No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[�No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
AddttiohR1Comments°and/6r>DrawtnQQs
C`r-°f 1%",e FaYwr ° '\HJA 4-v Mr, UjowrtVI
o —5 o0 .
12/28/04

� - 3
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other 0 Denied Access
Facility Number Date of visit: W aY Time:�o
Not operational 0 Below Threshold
M Permitted 0 Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: Tri jaj County: 5 G -112 S
Owner Dame: Q o r r 14 w .t - _� ti Phone No:
Mailing Address: d"7( W 3f -Z
Facility Contact: Title: Phone No:
Onsite Representative: nn Integrator: Proms a� S. Certified Operator: Operator: � n__q—_�-r J Operator Certification Number-
Location104-
Location of Farm: oo'7 ' G i� - �a.-r
M Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' " Longitude ' 1
DesigttCurrent
Swine ; _:Caaeity Pb ulation
❑ Wean to Feeder 1
® Feeder to Finish _I_ld tlb
❑
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Other
�'Gurrent_ Des
Population
.,Cattle - CanaetR Poi nliitaon.7
M -®LM
Discharges R Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes [Q No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed. was the conveyance man-made? ❑yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes. notify DWQ)
c. if discharge is observed. what is the estimated flow in gal/min?
d. Does discharge b}pass a lagoon system? (if yes. notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection 8• 'Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure
Identifier:
�E
Freeboard (inches): __..
❑ Yes ❑ No
A-714
❑ Yes ❑ No
❑ Yes ® No
❑ Yes M No
[3 Yes 1 ] No
Structure 6
05/03/01 Continued

lFacility.Number: 6a — q37o Date of Inspection S u/bY
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 1'7'1 No
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or ❑ Yes ® No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes M No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes [4 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes Jj No
elevation markings?
Waste Aamlication
10. Are there any buffers that need maintenancelimprovement? ❑ Yes rOi No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Excessive —Ponding ❑ PAN ❑ Hydraulic
ydraulic Overload ❑ Frozen Ground O ❑v Copper
opper. and/or Zinc
12. Crop tyle Ow rd�.�-in J4, c.G .; {
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a wettable acre determination? ❑ Yes 1[� No
c) This facility is pended for a wettable acre determination? ❑ Yes `f' No
15. Does the receiving crop need improvement? ❑ Yes [M No
16. Is there a lack of adequate waste application equipment? ❑ Yes [�L`No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ YesNo
liquid level of lagoon or storage pond with no agitation? 1 '
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes] No
Air Quality representative immediately.
Field Conv ❑ Final Notes
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Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
12/12/03 i/ / Continued