820432_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

t ype ON visit. V.0's-ompliance Inspection U mperatioo neview v atructure r valuation v t ecnoical Pkssistauce I
Reason for Visit: ErRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
-�
Date of Visit: C Arrival Time: 7o Departure Time: ;70 County: Region:
Farm Name: `Pj G ha < 1 Cur s Owner Email:
4 .
Owner Name: - -TlkaKta- 5L7 Phone:
Mailing Address:
Physical Address:
t
Facility Contact: c. Title:
Onsite Representative: f
Certiified Operator:
Phone:
Integrator:e-S
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Imuacts
1. Is any discharge observed from any part of the operation? ❑ Yes o ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No E:rNA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify- DWR)
Design RMC.
NA
Design
C►urrent
Design Current
Ca act Po
p ty p
Wet P• paltry
Capacity
� Pop,Sirix
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E]NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes No
7toFiiish
1!!Feeder
❑ NE
of the State other than from a discharge?
La er
Dai Cow
er
$S E,
Non -La er
Dai Calf
ish
Dai Heifer
T'°
Design
;I:an
Cufrent
Dry Cow
Farrow to Feeder
D �P,oult .
Ca actp.
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
urke ser
urke PoultsOther
10ther
LIFl1t•tW:a�:lvuyvl:�a�µlns�:lluflyy¢+,Iln;®t
?Irawnagc:t lteaa111t1iL.-IIIS3Yki!tllY�%.ti'.I�Iilxaa
slxau'.".Aiui:
Discharges and Stream Imuacts
1. Is any discharge observed from any part of the operation? ❑ Yes o ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No E:rNA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify- DWR)
❑ Yes ❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes ❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E]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 2/412015 Continued

IFacili Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [g_Ner— ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No � ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ,
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E]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 II 11O
❑ NA
❑ NE
waste management or closure plan?
C'No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
&o
any of the structures need maintenance or improvement?
es E3 Nob
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes [ o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes [�'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
I i _ Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [O -NT ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, 7_n, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑n Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 9,/. a., of -t
13. Soil Type(s): X.-4- r2rj -
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 [2 <o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �VO ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
[:]Yes
ILS 3""
❑ NA
❑ NE
❑ Yes
C'No
❑ NA
❑ NE
❑ Yes No
❑ Yes E No
❑ NA ❑ NE
❑ NA ❑ NE
❑ 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
p Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0�10 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [ No ❑ NA ❑ NE
Page 2 of 3 214/2015 Continued

Facility Number: - Z Date of Ins ection:
24_ Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes +Io ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [0-1 0� ❑ 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 Q -N-6— ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E3 -NU --D 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 ofthe inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Ale— ❑ NA ❑ NE
❑ Yes Imo"”' ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No
❑ Yes T -No
❑ Yes :fNo
❑ NA ❑ NE
❑ NA 0 NE
❑ NA ❑ NE
Comments (refer to question #):'Explaiin any YES answers.and/or any addrfioaal recommendations or any other cominents.
Use;drawings.of facility to,better explain situations (ase additional,pages as aecessary) 'I„'
47
cel( Tr X01_ C
Reviewer/Inspector Name: �� o AlPhone: U t. 3 `33 3
Reviewer/Inspector Signature: Date:
Page 3 of 3 F 21412015

ion of Water Resvurces�
FaeiH Number L = O Division of Soil and Water Conservation
• � Other Agenc}
Type of Visit: i2r1rompliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: G�Routine O Complaint Q Follow-up O Referral Q Emergency 0 Other Q Denied Access
Date of Visit: Arrival Tirtte: Departure Time: County:
Form Name: 6k410 ' ! Owner Email:
Owner Name: /( Phone:
Mailing Address:
Physical Address:
Regionmb%
Facility Contact:7 j f C� L Title: Phone:
Onsite Representative: Integrator: r>c
Certified Operator: - Certification Number: ;2 5XSY
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
e vi c 1 � li s'1 `"T``. r, L'
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes. notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes R-Ndo — ❑ NA ❑ NI-
❑ Yes
llesign Currettt
Swine Capacity Pop.
Zi'et Poultry :.
Design .
Capacity
CuuFrrent ,.
Popti=. =Cattle
[:]No
Design Current
Capacity Pop.
Wean to Finish
La er
O No
[] NA
❑ NE
Dairy Cow
Wean to Feeder i
'ion Laver
-
Dairy Calf
Feeder to Finish
-="�
=
Dairy Heifer
Farrow to Wean
_
C Trent
D Cow
Dry
Farrow to Feeder
Dry f;oult Ca acit
1'0
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
.. .
Other
Turkey Moults
Other
Other
F�
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes. notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes R-Ndo — ❑ NA ❑ NI-
❑ Yes
❑ No
[D- -A
❑ NE
❑ Yes
[:]No
TNA
❑ NE
❑ Yes
❑ No
f NA
❑ NE
[]Yes
[DNo
Q NA
❑ NE
❑ Yes
O No
[] NA
❑ NE
Page 1 of 3 21412015 Continued

[Faci!k Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [P-Ne—O NA ❑ NE
a. If yes, is waste level into the structural freeboard? [] Yes ❑ No [9 ;TA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a1"
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ((].Nn ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management ar 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 4E!rNo [DNA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes []'go [DNA 0 NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Oo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
No
10, Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0
❑ NA
❑ NE
maintenance or improvement?
No
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
[—]Yes
❑ NA
❑ NE
[3 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): - i�[ ✓ �7 (�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
0 Yes
�o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[T Nq
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
+lo
❑ NA
❑ NE
acres determination?
`
17. Does the facility lack adequate acreage for land application?
❑ Yes
[2 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
Rtguired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E5"'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ff No
❑ NA
❑ NE
the appropriate box.
❑WL1P ❑Checklists ❑ Design [:]Maps ❑Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [2'N
❑ Waste Application C] Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis ❑ Waste Transfers
❑ Rainfall E] Stocking E] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [�No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �No
o ❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA [] NE
Page 2 of 3 2/412015 Continued

Facili Number: - jDate of Ins ection:
24. -Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes Vo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes co ❑ 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 structures) and date of first survey indicating non-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
❑,Icr ❑ 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)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA W MP?
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?
fer to question #): Explain any YES answers and/or any additional
of facility to better explain situations (use additional naaes as neces
CW'� ea-Ir-Ak Ix -3Q, - L5
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
'6t
T
❑ Yes Q4to ❑ NA ❑ NE
❑ Yes Q< ❑ NA ❑ NE
❑ Yes PkNo
❑ Yes dNo
C] Yes L� No
❑ Yes f I No
[:]Yes 777❑"' No
ons or any other
a�
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
comments.
4( Y70'
a 'tfo, �f 3 3-3.33
Phone:
Date:
21V20rs

110s
IType of Visit: compliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance I
Reason for Visit: Cr Routine 0 Complaint O Follow-up 0 Referral 0 Emergency 0 Other O Denied Access
Date of Visit: Arrival Time:(I / ✓ Departure Time: County: Otk
'A v
Farm Name: he, wt -es � c Owner Email:
Owner Name: it ( Phone:
Mailing Address:
Physical Address:
Facility Contact: ;ty`v l� Title:
Onsite Representative: I it
Certified Operator: d
Back-up Operator:
Location of Farm:
Latitude:
Region:( l
Phone:
Integrator: an l `'i
Certification Number: 2 s 2, 5 P,
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?
❑ Yes ❑ NA ❑ NE
[:]Yes ❑No E� 1"t' ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
Design Current
Design
Current
_=- Design Current
Swine
Capacity Pop. Wet Poultry.
Capacity
1'op.
Cattle Capacity Pop.
❑ NE
Wean to Finish
❑ Yes �o
❑ NA
Lader r
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes Vo
Dai Cow
❑ NE
Wean to Feeder
Layer
airy Calf
Feeder to Finish,
airy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
.. , D a ultr
Caaci
Pow.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow ,j
Turkeys
MOther
ITurkey Poults
`-
OtherOther
_ . .--
__-. ......
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 ❑ NA ❑ NE
[:]Yes ❑No E� 1"t' ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[:)Yes ❑ No
[�1A
❑ 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
A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes �o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes Vo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2014 Continued

[Facility Number: tyA jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ge -�o ❑ NA [] NE
a. If yes, is waste level into the structural freeboard? EptT- ❑ 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 [:[14 [] 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 [Y] 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 environm�ZEJ
hreat, notify DWR
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No NA [3 NE
❑ Excessive Ponding ❑ Hydraulic Overload E] Frozen Ground F] Heavy Metals (Cu, Zn, etc.)
F] PAN ❑ PAN � 10% or l0 lbs. ❑ Total Phosphorus C3 Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window _ E] Evidence of Wind Drift ❑ Application Outside of Approved Area
7. Do any of the structures need maintenance or improvement? [:]Yes NA ❑ NE
8. Do any of lite structures lack adequate markers as required by the permit? ❑Yes � ❑ NA [3 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 [:)Yesio ❑ NA E] NE
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? [] YesN ❑ NA [:]NE
15. Does the receiving crop and/or land application site need improvement? Cl Yes��No
❑ 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 ENo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes jj'No
[] NA
❑ NE
Required Records & Documents
14. 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 L"J 1Yo
❑ NA
❑ NE
the appropriate box.
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? [] YesN ❑ NA [:]NE
15. Does the receiving crop and/or land application site need improvement? Cl Yes��No
❑ 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 ENo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes jj'No
[] NA
❑ NE
Required Records & Documents
14. 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 L"J 1Yo
❑ NA
❑ NE
the appropriate box.
❑ WUP El 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
[DRainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 214/2014 Continued

(24
Frscifi Number: - Date of Ins ection:
24" Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes CZ�� DNA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes I P Mloo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [;J�❑ 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?
19-- D tis
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes E2K ❑ NA ❑ NE
❑ Yes � ❑ NA ❑ NE
❑ Yes [R -ND- ❑ NA ❑ NE
❑ Yes CZPW— ❑ NA ❑ NE
❑ Yes
[
[] NA
[] NE
❑ Yes
[�To
❑ NA
[] NE
❑ Yes
E'l<o
❑ NA
❑ NE
Phone:
Date:
2/412014

IM5
Type of Visit: Q Com lance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: outine 0 Complaint Q Follow-up 0 Referral 0 Emergency 0 Other O Denied Access
Date of Visit: Arrival Timer Departure Time: County:
Farm Name: f `ly k" - T--0_ Ut'"Lr Owner Email:
Owner Name: p riha f AThw [� � Phone:
Mailing Address:
Physical Address:
Region �� D
Facility Contact: _Ttkt AA.C4 Title: _ a�N Phone:
Onsite Representative: �{ Integrator: P"�fhy
Certified Operator: l
Certification Number:
Bach -up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream lmnacts
1. Is any discharge observed from any part of the operation? ❑ Yes �— NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [] Yes ❑ No ❑-lq-A [] NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑-NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
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
Design
Current
❑ NE
Design
Current
Design Current
Swine
Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle t:apacity Pop.
Wean to Finish
Layer
I
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
MeRsi
Dry Cow
Non -Dai
Beef Stocker
Beef Feeder
Farrow to Feeder
D . P,oul Ca aci Pio
Farrow to Finish
Layers
Gills
Non -La crs
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream lmnacts
1. Is any discharge observed from any part of the operation? ❑ Yes �— NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [] Yes ❑ No ❑-lq-A [] NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑-NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
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
Q No
[3NA
❑ NE
❑ Yes
[ -No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
.2/412014 Continued

IF%cihty number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [9-10-ASA ❑ 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?
(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?
❑ Yes [9 -No ❑ NA ❑ NE
❑ Yes Er<0 ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ©-o ❑ NA ❑ NE
& Do any of the structures lack adequate markers as required by the permit? ❑ Yes ETNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes E No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E3No ❑ 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): . Ae1_IVlobt c.sc, 0
t3. 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
E(No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�Vo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
YNo
❑ NA
❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
,-�
LTJ
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP 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. 0 Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yeso ❑ NA [:]NE
23. If selected, did the facility fail to install and maintain raiabreakers on irrigation equipment? [:]Yes WNo ❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

44
Faclli Number: - Date of Inspection:Litz I S71
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewerflnspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ No 0 NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
0 Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes [:]No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain. any YES answers and/ovany-additional recommendations or any other comments:
Use drawings of facility to_ b"eater explain situations (use additionalipages as.necessary).
I[- (7-f3
Reviewer/inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
t `1 Phone:
Date: �_i mow
2/4/2 I4

Type of Visit:ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
,��
Reason for Visit: xoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: �=-
Arrival Time:
Departure Time:
County:s�)j� Region: h YJ
Farm Name: I �n p • t—r_ V 14&
Owner Email:
Design Curren_ t
Owner Name: Phone:
Mailing Address:
Physical Address:
�1 G
Facility Contact: --11 DaAk5 Title: Phone:
Onsite Representative: Integrator: rr-c
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (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?
Page 1 of 3
❑ Yes 10 ❑ NA ❑ NE
❑ Yes [:]No NE
❑ Yes [:]No []rl ISA ❑ NE
❑ Yes ❑ No EJ ISA ❑ NE
❑ Yes [ o ❑ NA ❑ NE
❑ Yes 10 ❑ NA ❑ NE
2/4/2011 Condnued
Design Curren_ t
Design Cour ent
Design Current
Swide
Ca a Po
P ..tJ P
Wet Poult .
r5
Ca aci#u 'Por
P P
Cattle Ca aci Po
P ty I►
Wean to Finish
La er
Dai Cow
Wean to Feeder
$
Non -La er
Da' Calf
Feeder to FinishTy
Heifer
Farrow to Wean
gns Current
PGgaep;akcftfAF_o
Cow
Farrow to Feeder
D . I',oul
;
Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Other
Turkey Pouts
Other
Other
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (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?
Page 1 of 3
❑ Yes 10 ❑ NA ❑ NE
❑ Yes [:]No NE
❑ Yes [:]No []rl ISA ❑ NE
❑ Yes ❑ No EJ ISA ❑ NE
❑ Yes [ o ❑ NA ❑ NE
❑ Yes 10 ❑ NA ❑ NE
2/4/2011 Condnued

Facility Number: KL- Date of Ins ectian: AZ Ju.`
14 IT
[0,Xo
❑ NA
Waste Collection & Treatment
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Q o
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
0 Yes
[.-P+I�❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[:]No E3 -KA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
❑ Yes
[ 1 o
❑ NA
Spillway?:
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
Designed Freeboard (in):
❑ NE
Required Records & Documents
Observed Freeboard (in):
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�o ❑ NA
0 NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes
2<0
❑ NA
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
t9'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
hio ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q<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
L;'i"o ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
1+10 ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[3 o ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[0,Xo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Q o
❑ NA
❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
ETINo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ 1 o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
fo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
2<0
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E2,16
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Dar'>o
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 2/4/2011 Continued

Facility Number: jDate of Inspection:
X24. Did the facility fail to calibrate waste application equipment as required by the permit`? ❑ Yes l`_'_7 o ❑ NA ❑ NE
23. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes D NYU ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-comtpliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31 _ Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
[;I -lo
❑ NA
❑ NE
❑ Yes
P–Wo
❑ NA
❑ NE
❑ Yes
L:a�o
❑ NA
❑ NE
❑ Yes [G o ❑ NA ❑ NE
❑ Yes Q. No ❑ NA ❑ NE
❑ Yes M N* o ❑ NA ❑ NE
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 dNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [;3/No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
sc"o.1Gl , Sr t'
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
(13
Phonejt0—
Date:
2/4/2011

rti f ._ . -
U
for Visit: ty4outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County:ts., O
Farm Name: T Li et Jwp f Owner Email: 11111
Farm
Owner Name: 1 O Phone:
Mailing Address:
Physical Address:
Facility Contact: _ '1h 6 �S NA0 itle: _ Cj/ t:zsf _ Phone:
Onsite Representative: (C
Certified Operator:
It
Region n�
Integrator: Pne_dr*e
T
Certification Number: JT2 S J>
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation? ❑ Yes ❑C i o ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [—]Yes ❑No Cg<A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current, ji
'
Capacity Pop'oulry
ean to Finish La er
7F�
DesignGorrent.= Design Current
'�`*r�`
Capacitylop Cattle Capacity Pop.
Dai Cow
L! NA
❑ NE
ean to Feeder
Non -La er
D , P,,oult ,
Design Current
Ca aci leo P. _
Dai Calf
Dai Heifer
Cow
Non -Dairy
eder to Finish
Farrow to Wean
Farrow to Feeder
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
Farrow to Finish
NA
La ers
2. Is there evidence of a past discharge from any part of the operation?
Beef Stocker
[q"N'o
Gilts
Non -La ers
Beef Feeder
[] Yes
FB"N/o
❑ NA
Boars
Pullets
Beef Brood Cow
t,
Other -
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation? ❑ Yes ❑C i o ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [—]Yes ❑No Cg<A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
L! NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[:]No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[q"N'o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
FB"N/o
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 214/1011 Continued

42 12
Facility Number:Date of Inspection: S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): `
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
El No ❑ NA ❑ NE
[j No ❑NA ❑NE
Structure 6
❑ Yes [DXo ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
L!a <0
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
[Z i Wo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
7. Do any of the structures need maintenance or improvement?
❑ Yes
2/No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
L_U'A`o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[Rl�o
❑ NA
❑ NE
maintenance or improvement?
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Waste Application
0 NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
To
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �To ❑ 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): ee_�-kc- 560 CoLIK
13. Soil Type(s): 12 t ( t.e
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[Z i Wo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
]o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
to
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
[�k<o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Ea'K'
0 NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E;jZo
❑ 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 E No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes []�No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

900 1401 0 4 —1
Facility Number: 12 Ok - Date of Inspection: IfS
24. Did 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 permit conditions related to sludge? If yes, check ❑ Yes [] No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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?
Reviewer/Inspector Name:
Reviewer/Inspector Sigmature:
Page 3 of 3
® :: �_Lf f, fr
r
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes E] No ❑NA E] NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
(-j Yes
n No
n NA
n NE
l ' Phonel I q �
Date:"2141201
a

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: V'Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: �. Arrival Time: Departure Time: 1`M County- '�A VA
Farm Name: Ct\C p t\VIII vnA fkm�? Owner Email:
Owner Name: _��►\t},rvti R p►.t Mt kL,AT 1 Phone:
Mailing Address:
Physical Address:
Facility Contact: t i1 a �pC, q A.I MC 'P t,#aj Title: {fir k Phone:
Onsite Representative: p,mQ Integrator: Nf,54A
Region: FRa
Certified Operator: II ixI.NL Certification Number: 95aSS
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
mat
[:]Yes
[2q No
Design
Current
Design Current
Swine
Capacity .Pop.
Wet.Poultry ..
'Capacity
Pop.
Cattle Capacity Pop.
ANA
Wean to Finish
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
La er
❑ No
NA
Dairy Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Wean to Feeder
EL15W yelq
Non -La er
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
Dairy Calf
❑ No
Feeder to Finish
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
No
jDairy Heifer
❑ NE
Farrow to Wean
❑ Yes
No
Design
Current
Dry Cow
Farrow to Feeder
D P,oult .
Ca aci
P,o P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
turkeys
Other
Turke Po Its
Other I 10ther
Discharees and Stream Imnacts
1. Is any discharge observed from any part of the operation?
[:]Yes
[2q No
[] NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes
❑ No
ANA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
No
r] 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 2/4/2011 Continued

Facility Number: -LA12 Date of Inspection: t I:) -
Waste CoUeetion & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Cfl No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes M No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 1l�
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No [] NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes 0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 46 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures .need maintenance or improvement? ❑ Yes ® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes M No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes EQ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes M No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes W No
[DNA
[] NE
p Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN a 10% or 10 lbs. E3Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. CropType(s): Rar_
13. Soil Type(s): P� V Q
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes M No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [@ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes ® No
[:]Yes ® No
[:]Yes ® No
[:]Yes [g No
❑WUP El Checklists [:]Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes rh No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall El Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes � No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Ej No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
F] NA C] NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA] NE
Page 2 of 3 21412011 Continued

Facili Number; - Date of Inspection: l-¢ 1 1
24. Did 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 permit conditions related to sludge? If yes, check ❑ Yes Z] No ❑ NA ❑ NE
the appropriate box(es) below.
Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ®No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes m 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:
❑ Yes ® No ❑ NA ❑ NE
❑ Yes �] No ❑ NA ❑ NE
❑ Yes NJ No ❑ NA ❑ NE
0 Yes Ug No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 6Q 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
Reviewer/Inspector Signature:
Page 3 of 3
Date: t"L I I 1 �
2/4/2UII

A
Type of Visit: 42rCompliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: (!)1outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: [y ;� Arrival Time: D: rip I Departure Time: ' D a County: �crRegion:
Farm Name: f/! I ,I Owner Email:
Owner Name: G9 rn --o /%T� /�1Gti _ Phone:
Mailing Address:
Physical Address:
Facility Contact: 7h&EZ&d6 Title: �.r�h z Phone:
Onsite Representative: �srzF integrator: 'a�
Certified Operator: �v_ Certification Number:��?�
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?
❑ Yes
® No
❑ NA
❑ NE
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other:
Design Curreet
x
Design
Current
Design Current
Swine
Capacity Pap.
Wet Poultry
Capacity
Pop
CattleCapacity Pop.
Wean to Finish
❑ N
La cr
_
Dairy Cow
Wean to Feeder'
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
Non -La er
[] No
❑ NA
Dairy Calf
Feeder to Finish-'-
❑ Yes
w �"
❑ NA
❑ NE
Dai Heifer
Farrow to Wean
No
_
��
l;n
Currents
D Cow
Farrow to Feeder
Farrow to Finish
� Drr Po.iiltry Ca aci Po -
Layers
Non -Dairy
Beef Stocker
Gilts
Boars
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
_.
MINUM
Turkeys
nOth7er
�� Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ N
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[] No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
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?
Paige I of 3 2/4/2011 Continued

Facili Number: - Date of Inspection:
❑ Yes
&No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
6?,No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
SNo
❑ 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):
5. Are there any immediate threats to the integrity of any of the structures observed?
[—]Yes
M 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
Q 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?
0 Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
25 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Pg 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 /Windo'w ❑ Evidence of Wind Drift [:]Application Outside of Approved Area
12. Crop Type(s): A,' o d !3r /Ayeric fir/ : //,� 42 -
13. Soil Type(s): -A ti"5 /Aa
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes tgNo [DNA ❑ 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
&No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
6?,No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
12�No
❑ NA
❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
2g No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists p Design ❑ Maps p Lease Agreements ❑Other:
21. Does record keeping need improvement'? If yes, check the appropriate box below. ❑ Yes �g No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [Q No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? D Yes ff] No ❑ NA ❑ NE
Page 2 of 3 214/2011 Continued

Facifi Number: 222== - Date of Inspection: G 3 O l/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No
25. Is the facility out of compliance with permii conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(cs) below.
❑ Failure to complete annual sludge survey E] Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA E3 NE
❑ NA ❑ NE
❑ NA ❑ NE
F] NA F] NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
,] No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[0 No
❑ NA
❑ NE
❑ Yes
®No
❑ NA
❑ NE
❑Yes
JKNo
❑NA
❑NE
Reviewer/inspector Signature:
Page 3 of 3
Date: 3

Type of Visit 8Mompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine Q Complaint Q Fallow up 0 Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: Q 00 Departure Time:i? t7 County: Region: IZ O
Farm Name: � a-4 I �aria?S Owner Email:
Owner Name; ©_W IZa. /Ve Thar Phone:
Mailing Address:
Physical Address:
Facility Contact -JA c �f!� Title: C.t/n r Phone No:
Onsite Representative: �, _ _ Integrator: r'rn
10,
Certified Operator: Operator Certification Number -
Back -up Operator: Back-up Certification Number:
Location of Farm: Latitude: 1=1 o F-1, Ell" Longitude: =] o El' ❑ u
Design C*urrent
Swine FTVacI–Anupglation
Design Current
Wet Poultry Capacity Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ No
❑ Dai Cow
II
® Wean to Feeder q691
❑Non -La cr
Q Dai Calf
❑ Feeder to Finish
❑ NE
❑ Dairy Heifer
❑ Farrow to Wean IDry
Poaltr�°
❑ Dry Cow
❑ Farrow to Feeder
ULNo
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
Turkey Poults
❑ Other
Number of 5truetures:
Discharees & 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? (Ifyes. notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes LINo ❑ NA EINE
❑ Yes
❑ No
[INA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
0 -No
❑ NA
❑ NE
❑ Yes
ULNo
❑ NA
❑ NE
Page I of 3 12/28/04 Continued

Facility Number: — Date of Inspection �9` O
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 ERNo
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
El NA EINE
Structure 6
Identifier:
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
®-No
❑ NA ❑ NE
Spillway?:
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
Designed Freeboard (in): 9- _
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Applicatioon Outside of Area
Observed Freeboard (in): trR 19,
Crop type(s) ...$�� Q
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
Do the receiving crops differ from those designated in the CAW MP? ❑ Yes
P No
❑ NA ❑ NE
15.
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
® No
❑ NA
❑ NE
through a waste management or closure plan?
❑ NA ❑ NE
IT
Does the facility lack adequate acreage for land application? ❑ Yes
KNo
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
1�j No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[RNo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
12 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
J4No
❑ NA
❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
®-No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Applicatioon Outside of Area
12.
Crop type(s) ...$�� Q
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAW MP? ❑ Yes
P No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
JO No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
JZ No
❑ NA ❑ NE
IT
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
Ba -No
❑ NA ❑ NE
Comments (refer to question #}: Explain any YES answers and/or any recommendations.6r any other comments I,—
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name ,. _ � Phone:
Reviewer/Inspector Signature: Date: fob aZ9`" /D
1-1/-a/uq Lannnuea

Facility Number: — Date of Inspection
Required Records & Documents
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes � No El NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E&No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑Maps El Other
2l. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E,No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
allo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
R No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E,No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ER No
❑ NA
❑ NE
27.
Did the facility fail to secure a pbosphorus loss assessment (PLAT) certification?
❑ Yes
MNo
❑ NA
❑ NE
Otherlssues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
R No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
JRNo
❑ 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
D4 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
4190
❑ 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
C&No
❑ NA
❑ NE
12128104

Type of Visit U�C&nepliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 60outine 0 Complaint 0 Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ®Arrival Time: .'f%`]! Departure Time: �Ga County: Region: /i d
Farm Name: Owner Email:
Owner Name: c �C ��!? / Phone:
Mailing Address:
Physical Address:
Facility Contact: �fk.,j" 49 6k ge P! Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number -
Back -up Certification Number:
Location of Farm: Latitude: = e =I ="
Longitude: = ° = I 0
Discharges &: Stream Impacts
1. is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes. notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 10 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
Design Current
Design) Current
Design Current
Swine Capacity Population
Wet. Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Laver
El Dairy Cow
Wean to Feeder D
Non -Layer
❑ No
❑Dai Calf
❑ Feeder to Finish
❑ NA
❑ Dairy Heifer
❑ Farrow to Wean
Dry Pouf,
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
El Farrow to Finish
❑ Layers
❑ Beef Stucker
❑ Gilts
❑ Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
El Beef Brood Coy
❑ Turke s
Other .
❑ Turke Poults
❑ Other
❑ Other INumber
of Structures:
NAMEMANK40,
Discharges &: Stream Impacts
1. is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes. notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 10 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE .
❑ Yes
No
❑ NA
❑ NE;
0
12128104 Continued

r Facili Number: %
h' Q� — Date of Inspection
Waste Collection & Treatment
Reviewer/Inspector Signature: Date: ir•��
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
XNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Stntcture l Stnteture 2 Stnicture 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard 60: 1
Observed Freeboard (in): /
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
(XNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
[2�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 thr t notify DWQ
7. Do any of the structures need maintenance or improvement?
0 Yes
0❑
NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
N No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
L ,NO
❑ NA
❑ NE
maintenance or improvement?
Waste Allplicalion
10. Are there any required buffets, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance/improvement?
1 L Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% 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) nn,
13. Soil type(s) /T U _E
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �&No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 5�No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes X'� No ❑ NA ❑ NE
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 F�LNo ❑ 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):
Reviewertinspector Name Phone:
Reviewer/Inspector Signature: Date: ir•��
12122/04 Connnuea

t Facility Number: — S' Date of Inspectian
ftuquired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes rV1 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes X No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E; -No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 124 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
UZNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
UitNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[,RNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
5kNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
XNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
2.No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PS No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ZI 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
allo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspeetor fail to discuss review/inspection with an on-site representative?
❑ Yes
LN No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[XNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128/04

Type of Visit Compliance Inspection Q Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up Q Referral O Emergency O Other ❑ Denied Access
Date of Visit: 14 Eg"Arrival Time: .5( Departure Time: .' County Region: {r-�—
Farm Name: G Ex, L j Owner Email:
Owner Name: /na Phone:
Mailing Address:
Physical Address:
Facility Contact: ?_L; % Title:
Onsite Representative:
Certified Operator: J�e-
Back-up Operator:
Phone No:
integrator;
Operator Certification Number -
Back -up Certification Number:
Location of Farm: Latitude: =0 =6 0 Longitude: =10=1 = u
Design CurrentDesign
SR�ne Capacity° Population
Current
.'
�Ve-tPouCaptyLP�opultian
Design Current
Cattle Capacity Population
❑ NA
❑ Wean to Finish
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
❑ La er
❑Dai Cow
Wean to Feeder
-Laer
❑Dai Calf
Feeder to Finish
❑ No
Dai Heifer
❑ Farrow to Wean
Dry poultry
❑ D Cow
❑ Farrow to Feeder
❑ NA
❑ Non -Dairy
❑ Farrow to Finish
❑Lavers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
10 Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Ca
-
❑ Tunce s
❑ Yes
Uther
Elrurkey Poults
❑ NE
❑ Other
❑ Other
Nurrilser of Structures: O
❑ NA
❑ NE
other than from a discharge?
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
®.No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NF.
2, is there evidence of a past discharge from any part of the operation?
❑ Yes
Egq�o
❑ 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
12128/04
Continued

' Facility Number: Date of Inspection
[0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
1 Waste Collection & Treatment
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
M 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): „ /9
Observed Freeboard (in): b
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[N 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
jA No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
® Yes
❑ No
❑ NA
❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[,No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
®.No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
54 No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [Z No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) ". i4_12 i ,n s �^a. �-
13. Soil type(s) f ► "3 Z ;KZX —
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
[0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
No
❑ NA
❑ 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
RNo
❑ NA
❑ NE
Comments (refer to question #):Lhxplainfany YES answers and/or any recommendations or any other comments.
Use draRME of facility to better explain situations. (use additional pages as necessary):
T
Reviewer/Inspector Name ,�r � y B -� ° , v Phone• g/D�Z 33 d
Reviewer/Inspector Signature:
Date:. pC�
Page 2 of 3 12/28/04 Continued

i Facility Number: — Date of Inspection
3
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ®, No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ®,No ❑ NA ❑ NE
the appropirate box. ❑ W Dp ❑ Checklists ❑ Design E3 Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes ®.No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis Cl Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. If selected. did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
f4 No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
qNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
14 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ 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
® No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[K 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
IS 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
R No
❑ NA
❑ NE
33, Does facility require a follow-up visit by same agency?
❑ Yes
EKNo
❑ NA
❑ NE
Comments and/or Drawings:
12/28104

Division of Water Quality G �%
Facility Number O Division of Soil and Water Conservation
0 Other Agency
Type of VisitCC�ommpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit �0'Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: �i7 t7 Departure Time: i County: Region: f=9'�y
Farm Name: arm Owner Email:
Owner Name: Zh 014*1a %%%G �� i L Phone:
Mailing Address:
Physical Address:
Facility Contact: t7w'o moi` Title:
Onsite Representative: _5;re_�
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
U Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Other
❑ Other
Phone No.
Integrator:
Operator Certification Number:���s� _
Back-up Certification Number:
Latitude: = o =I
= " Longitude: =0=4
o=4 =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
E-1
La er
-T Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkevs
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design `Cdr'rent
Capacity Population
I,
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Ca
Number of Structures: Eil:
b. Did the discharge reach waters of the State? (I f yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes C�JNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
EJ Yes
El No
El NA
El NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
V .No
❑ NA
❑ NE
❑ Yes
IM -No
❑ NA
❑ NE
12/28/04 Continued

1
Facility Number: — 3 Date of inspection
Waste Collection & Treatment
Reviewer/Inspector Name �-e �- Phone: 2/jr2= a 3 L
Reviewer/Inspector Signature: Date:
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate`?
❑ Yes
[9No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA EINE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): g
Observed Freeboard (in): 3/
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[2 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
BNo
❑ 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
9No
❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
M No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA ❑ NE
maintenance/improvement?
11- Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
0 No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
Crop
12. Crop type(s) , atnC miler ZQP nt �r� /11: IX -7 AV 4Z
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
C,No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
M No
El NA El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
® No
❑ NA ❑ NE
IT Does the facility lack adequate acreage for land application`?
❑ Yes
19 No
❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name �-e �- Phone: 2/jr2= a 3 L
Reviewer/Inspector Signature: Date:
12/28/04 Continued

a
1r�+' Facility Number:
— ,3 Date of Inspection %
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 10 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 ❑ Checklists ❑ Design [:]Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. C1 Yes ❑ No ❑ NA ❑ NE
5 -Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
N No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
(N 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
[R No
❑ 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-comp]iance of the permit or CAWMP?
❑ Yes
13 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
0 Yes
(4 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
.® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
9 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12/28/04

Type of Visit 8-eompliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit I31T&utine Q Complaint Q Follow up Q Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: p(i )Arrival Time: / D Departure Time: Wo ; Up County: Region: 6S
�L ___Farm Name: FQ_Owner Email:
Owner Name: G Nek
• L Phone:
Mailing Address: Gc n Z2 �2� �ryr�/�r-� /V
Physical Address: p[
Facility Contact: 7_A Avs? a. s /W %%%/ /nay -4itle:
Onsite Representative: _ Certified Operator:
Operator: 5-- -
Back-up Operator:
Phone No:
Integrator:/�rs/It7.G
Operator Certification Number: ol'�
Back-up Certification Number:
Location of Farm: Latitude: =' ❑ ' = Longitude: ❑ ° =
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Design Current
- � � �-s � Design Current
Design Current
Swine
Capacity Population
�'Ve�t Poutry,Cap achy Population
Cattle Capacity Population
to Finish I
I
er
❑ Yes
® No
�I ❑ Dairy Cow
❑ NE
aWean
Wean to Feeder
❑ Yes
n -La er
❑ NA
❑ NE
❑ Dairy Calf
❑ Feeder to Finish
Dairy Heifer
❑ Farrow to Wean
['No
+� '
❑ Dry Cow
❑ Farrow to Feeder
❑ Yes
® No
❑ Non -Dai
El Farrow to Finish
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ i avers
ElBeef Stocker
❑ Gilts
❑ NE
E] Non -La ers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
w�
=
❑ Turkeys
:>
Ot e V
�� =
❑ Turkey Poults
❑ Other
❑ Other I
_
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation'?
❑ Yes
56 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
❑ Yes
® No
❑ NA
❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
❑ Yes
LONo
❑ 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
® No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
J4 No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

iFacility Number: Date of Inspection
Waste Collection & Treatment
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
(RNo
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): f
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[&INo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
ER 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
5jNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
��yy
ILEI No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop
7 Window ❑Evidence of Wind Drift ElApplication Outside of Area
j!OL
12. Crop type(s) eA
y(r�
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes R1No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes XNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application'? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA ❑ NE
�No El NA El NE
RNo ❑ 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):
&gip fssrVV_
ReviewerAnspector Name 5 7_ev y- 4:, t-wj'� Phone: /17-- 33 33 oZ
Reviewer/Inspector Signature: Date: o (¢
Page 2 of 3 12/28/04 Continued

.'
Facility Number: Date of Inspection
Rewired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes EffNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design El Maps ❑ Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes C,No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes R 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 M No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes to No ❑ NA ❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
JK No
❑ NA
❑ NE
'kNo
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[KNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Dq No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
W 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
'tet` 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
2JNo
❑ 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
KNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
WNo
❑ NA
❑ NE
Additional'.Commenis and/or Drawings:
T
Page 3 of 3 12128/04

: W Division of ,*'ater Quadrit�...k;
IFactlttyyNum C 8a y3,� O Division of Soil and Water Conscrtattan
1 _ e
OM1. 0 Other Agency
Type of Visit • Compliance Inspection Q Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine 0 Complaint O Follow up O Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: 14 130,1�j Arrival Time: Departure Time: County: Sa— sow Region: P iZo
Farm Name: Owner Email:
Owner Name: _ J, �► d r» a i2 a 4. Phone: Qq__
t a) S-4 7 G 2 y A
Mailing Address: 1 0 age 5 li 0" J...r 5_
Physical Address: w 002- 2A (r
Facilitv Contact: Title: Phone No:
Onsite Representative: ��e w..����� -_P�± a �� Integrator: &e' A +421 t
Certified Operator: T rhG PL, Q`. 4 Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o =I = tl Longitude: =o=[ o❑
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
El Wean to Finish I ❑ Layer
® Wean to Feeder S po 1 5 d/ f ❑ Non-Layet
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Lavers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges!SL Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dail
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of -the State? (If yes, notify DWTQ)
c. What is the estimated volume that reached waters ofthc State (gallons)?
d. Does discharge bypass the waste management system? (Ifves. notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes %No [:INA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
14 No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
12/28/04
Continued

Facility umber: ?j-
Dateof 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
Identifier:
Spillway?: / 7—
Designed
~Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
El Yes R)No [:1 NA El NE
❑ Yes 51 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? DO Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures 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 pari of the waste management system other than the waste structures require ❑ Yes 9LNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [Sd No ❑ NA ❑ NE
maintenance/improvement?
IL Is there evidence of incorrect application'? If yes, check the appropriate box below. ❑ Yes ®No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) Qe D S - sr.
I
7— t�0it�%�t�G '� lr�D� QC %els IS %dJ ,,k*We_
�}
13. Soil type(s)
Reviewer/Inspector Signature: Date:
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�9 No
[]NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
f�p No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination %❑
Yes
5 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[39 No
❑ NA
❑ NE
18- is there a lack of properly operating waste application equipment?
❑ Yes
O No
❑ NA
❑ NE
Comments (refer'to question #): - Explain any YES answers and/or anyrecommeadatians or any other comments:
Use drawings of facility to better explain situations. (use additional pages as necessary): 4
7— t�0it�%�t�G '� lr�D� QC %els IS %dJ ,,k*We_
Reviewer/Inspector Name L. % Phone:
Reviewer/Inspector Signature: Date:
12/18/04 Continued

Facility Number:t/1TX I Date of Inspection /la aY
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
Required Records & Documents
® NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
W 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 ❑ Checklists ❑ Design El Maps El Other
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
21. Does record keeping need improvement? If yes, check the appropriate box below.
[% Yes
❑ No
❑ NA ❑ NE
qWaste Application R3 Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
[:]Annual Certification
❑ Rainfall ❑ Stocking E� Crop Yield ® 120 Minute Inspections ® Monthly and I"
Rain Inspections ❑
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ® NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
0 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
[id No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
® NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
1�@ No
❑ NA
❑ NE
29.
Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑ Yes
Mi 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
[P No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[� No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Additional Comments and/or Drawings
l
G S LL't V o `� Ga. 1 b b -a_0 N.- dAv_ L b't f� cs'1 66.(
e21- %3c7in -f-c K t cypra.icdL -�e ,n..s a -S CC• «ew,t�=Q w,.'�
$02- AZO,
12/28104

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 ❑ Denied Access
Facility Number
Date of Visit; Time:
.3
not O erationa! 0 Below Threshold
Mfermitted �ertified 0 Conditionally Certified ❑ Registered Date Cast Operated or Above Threshold:
Farm Name: r P r County: •S gi &nese n F� D
Owner Name: TAe c 1n/Cn" „ AC /04 0 , � Phone No: �1 � � S� � G ��iy
Mailing Address: Sys// &,III Rd Sa 41JI)
cell T
Facility Contact: TAimr,- %2..-, 111rNAJ Title: Phone No: ClP-2/2- '1023
Onsite Representative: I1'e&"058G•, _ 1''1L�iurL _ _ Integrator:
Certified Operator: 7-4 c», s Operator Certification Number;
Location of Farm:
Q -Swine ❑Poultry El Cattle ©Horse Latitude �' �� t,J Longitude �' �•
Design Current
Swine ran*eitv Pnnntatinn
0-W, can to Feeder 3 300
❑ Feeder to Finish
❑ Farrow to'Wean
❑ Farrow- to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons
Holding Ponds / Solid Traps
Design Current Design Current
Poultry Capacity Population Cattle Ca achy Population
❑ Laver I IED
Dairy
❑ Non -Laver Non -Dain
❑ Other
Total Design Capacity
Total SSLW
Di charges & Stream Impacts
1. Is any discharge observed from any part of the operation?
ILl Subsurface Drains Prese2LJjLJ Lagoon area JLJ S n
❑ No Liquid Was-te Management Svstem
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man -trade?
b. If discharge is observed, did it reach Rater of the State? (If yes. notifv D`YQ)
c. if discharge is observed, what is the estimated flow in eallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes 2190
❑ Yes E No
❑ Yes 2'�o
❑ Yes ['Ifo
❑ Yes 0'�I0
❑ Yes [' NO
❑ Yes ET'No
Structure 1 Structure 2 Structure 3 Structure 4 Structure ; Structure 6
Identifier: L
Freeboard (inches):
05/03/01 Continued

VP
Facility Number — J/32
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes �fo
❑ Yes S 0
❑ Yes D o
❑ Yes 9<o
❑ Yes [1Go
❑ Yes 0'11-o
11.
Is there evidenceof over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
CIN -012.
18.
Crop hype &-M A, FPSe_ I,C _.
5 A0., v �%olt nap 1 �. CMr. /►?cPs;/ �as p/e„f {e i',<
Advse 5 ,,, a /l l e a/ k a� � 0 � r 7r.',t//E
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
0'+Io
14,
a) Docs the facility lack adequate acreage for land application?
❑ Yes
RITo
20.
b) Does the facility need a wettable acre determination?
❑ Yes
❑<o
21.
c) This facility is pended for a wettable acre determination?
❑ Yes
0<0
15.
Does the receiving crop need improvement?
❑ Yes
Q No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
,,
t�tvom
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
S<o
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
5 A0., v �%olt nap 1 �. CMr. /►?cPs;/ �as p/e„f {e i',<
Advse 5 ,,, a /l l e a/ k a� � 0 � r 7r.',t//E
(ie/ WU�checklists esigrL a�etc.)
❑ Yes
{--�,
❑1K0
19-
Does record keeping need improvement? (ie/ irrigation, freeboard, wase analysis & soil sample reports)
❑ Yes
9�0
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
2&
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
�o
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
Qvo
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
[`-•]'No
24.
Does facility require a follow-up visit by same agency?
❑ YesOX0
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
PIC
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
�mm (refer, to"quesUoe #�� Ezpiatn�any YESransrters andlor:aey recomme-e�d �tto�s or�any_other comment
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Reviewer/Inspector Name/Yf� G ,. r
Reviewer/Inspector Signature: Date: •2
05103101
Continued

C a
Facility Number 3
Date of Visit: - 6-03 Time:
rO Not Operational 0 Below Threshold
Permitted 13 Certified 0 Conditionally Certified ❑ Registered Date Last Operated or Above Threshold:
Farm Name: �[ C Gl r•� ! i/7S County: X1110�'t
Owner Name: Ka /'(G f ilc� (/ _ Phone No: 56 7— 6 ?j/�
Mailing Address: L ►om] /r('
Facility Contact: KGt y %�r�h/'t/
G• 1 Title: Phone No:
Onsite Representative: �� rl1R P1cs7141e-
p c,l Integrator: ,^
Certified Operator: 1/G PXQ► _ Operator Certification Number: rias$
Location of Farm:
OR Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 0 u Longitude
Design -
Current Iksign
Current,- Desegn Current
- C ach
`acrtv
Po ula
..CattleSwine
Pa "-' Ga acitf ,.P i7latYon..'.
❑ Layer
Dairy
s= ❑Non -Layer
t-:
❑ Non -Dairy #
T
- -
❑ Other
'Total
Design CapaciEty
:Tetif§s
Number of Lagoons _ ;: ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area ]
Holdtitg,Ponds! Solid :-=�
❑ No Liquid Waste Management System - -..
-. _...
Wean to Feeder 00
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑Farrow to Finish
❑ Gilts
❑ Boars
Discharges &Stream Impacts
1. Is any discharge observed from any pan of the operation?
Discharge originated at: ❑Lagoon ❑Spray Field El Other
a. if discharge is observ
ed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State? (If yes. notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge fr
om 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? El Spillway
Structure 1 Structure Z Structure 3 Structure 4 Structure 5
Freeboard (
inches):
OS/03/OI
El Yes 20
Identifier:
No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes R]
No
❑Yes ®No
❑ Yes ®No
Structure 6
Continued

w
Facility number: o) —113
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage. etc.)
6- Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure pian?
(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?
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stu aures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type 1gT ✓c& , -.f,*417 a . at
13- Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fait to have Certificate of Coverage & General Permit or other Permit readily available?
1$- Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22 Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes Q No
❑ Yes W3 No
❑ Yes No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes R1 No
❑ Yes 10 No
[IYes No
❑ Yes No
EDYes LK No
❑ Yes (B No
ElYes ® No
ElYes [B No
❑ Yes RI No
❑ Yes Ud No
ElYes ® No
❑ Yes Up No
(ie/ discharge, freeboard problems, over application) ❑ Yes (A No
23- Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑ Yes ® No
24. Does facility require a follow-up visit by same agency? ❑ Yes ® No
25. Were any additional problems noted which cause noncompliance of the Certified AR'MP? ❑ Yes f No
Q No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit
Comments (greter to.questtQri #) Explain any YES atts�ers a Wor-any reeonmtendatmns or any other coenmtrits T µ w
-. W
Use drawtn s,af fitcili#y to better a=plain Sit�Yat�totis._(an addtiaonai pages as necessary):� 0 Meld Conv ❑ Final Notes
Reviewer/Inspector Name
Signature:
O5103101
Date:
Continued