820499_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 011 outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: F County: YA tIL11 Regionf�
Farm Name: ��`"'r�`^-j-g�"-✓�� '1✓ ��- �+ s ���./1 -„ Owner Email:
�I L
Owner Name: Phone:
Mailing Address:
Physical Address:
�, � 11 ^ ( f
Facility Contact: `e � �vtc
Onsite Representative: ~ t
Certified Operator:
Back-up Operator:
Location of Farm:
Title: Phone:
Integrator: P— 4S,
Certification Number: 1 1 3 it{
Latitude:
Certification Number:
Longitude:
Elm
Design Current
Design
Current
Design Current
Swine
Eapaeity Pop.
Wet Poultry
Capacity
Pop.
Cattle
Capacity Pop.
IF•
k iR�fl
�Ik Illl��k
Wl,e,fll'Illiliw
Weto Finish
Layer
airy Cow
Wean to Feeder
_
Nan -La er
airy Calf
Feeder to Finish
k i.
DairyHeifer
Farrow to Wean
Design,
Current
D Cow
Farrow to Feeder
D . Poult .
Ca aci
1'0
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
:..
Turkeys
, a+
t]ther
Turkey Poults
Other
I
10ther
•
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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 [Cq-NV❑ NA ❑ NE
❑ Yes
❑ No
ETNA
❑ NE
[]Yes
❑ No
Eq A
❑ NE
❑ Yes
❑ No
[]DNA
❑ NE
❑ Yes
[2-No
❑ NA
❑ NE
❑ Yes
to
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facift Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes � ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No qE'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
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
0 Yes
0'i�o ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
8-15p ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
0-10 ❑ 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
NA
❑ NE
maintenance or improvement?
Waste Apytication
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
Cf -Vb ❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? 1f yes, check the appropriate box below. ❑ Yes l 2,<o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ FrozedGround ❑ 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 ❑ Evidenc8e� of Wind
ind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): AA'
13. Soil Type(s): Ur' p,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Q No ❑ NA ❑ NE
15. Does the receiving crop and/or Iand application site need improvement? ❑ Yes �o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [2-No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[:fNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑i "No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[I -No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
allo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps D Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [dN
❑ Waste Application El Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes- dN
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [IN
o ❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
o ❑ NA ❑ NE
o [] NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [&No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3'Po
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 Ej-No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [o
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?
24. 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.
36. 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 orthe permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
[] Yes [3-No ❑ NA ❑ NE
❑ Yes [r 'n% ❑ NA ❑ NE
[:]Yes E3�o [DNA ❑ NE
❑ Yes ❑'Ao ❑ NA ❑ NE
❑ Yes
[ No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
�10
❑ NA
❑ NE
Comments (refer to questtvti #)-.--EyprlatnYES answers attd/ar. any additional recommendations or-amy�eather comments. -
e drawin Usgs of'facfLtyta betterezplamrsitaatsons,, (use addltional pagesras'necessary
CV
( ( 3 '�5I
Reviewer/Inspector Name:
Reviewer/Inspector 5igna
Page 3 of 3
t� Phon offb—
lure: Date: lc f 8
21412015

Type of Visit: ompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: C>Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: lip TG{ Arrival Time: Departure Time: 01 P County: Region:
Farm Name: �.f4. .� J_i �ls Owner Email:
Owner Name: Selr✓'r�h a_ri+�lS Phone:
Mailing Address:
Physical Address:
Facility Contact: S fl C-(A(,!< t I -r'(5 Title: Phone:
Onsite Representative: r Integrator: 15 A,
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Gnrrent
,,
Design Current
Swine
Capacity Pop.
Wet Pouttry
Capacity
Pop:
Cattle '`
Capaeity Pnp.
Wean to Finish
La erMain
Dai Cow
Wean to Feeder
-Layer
Dai Calf
Feeder to Finish
i'
Dai Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D ,P,aul# .
Caaci
Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Nan -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other.
Turkey Poults
Other
Other
s
Discharges and Stream Impacts
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
�A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[3-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)
0 Yes
❑ No
[�NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Lio
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
6-N o
❑ NA
❑ NE
of the State other than from a discharge?
Paige I of 21412015 Continued

IFacikty Number: - Date of inspection: 'Z 0 -_
1-7
Waste Collection & Treatment
4. Is_storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E3_We--❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[c]-lsd'Sf ❑ 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
Lq-"'o ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
E7rNo ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[E'lTo ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[2-Na ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�o ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [� No ❑ NA
❑ 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): 06y (3 Fe s C r.P, 5 G C) lu]``
13. Soil: Type(s):
p GA
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ NE
❑Yes
[9-Ko
DNA
❑NE
❑ Yes
[9-Fo
❑ NA
❑ NE
❑ Yes
[D-No
❑ NA
❑ NE
❑ Yes [ 4 `o ❑ NA ❑ NE
D Yes ❑�o ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
El"No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? Ifyes, check
[:]Yes
G '�o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists 0 Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[] Yes
EJ N
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
�No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
[T No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Racili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[3-1 oo ❑ NA
❑ NE
25. �s the facility out of compliance with permit conditions related to sludge? If yes, check
Yes
o ❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
to E3NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
0 No ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
ErKo
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ NA
❑ NE
permit? (i.e_, discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[3'lTo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[TNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
dNo
❑ NA
❑ NE
Comments -(re erl#o gnestlon Explain auyIYES answers;and/or,anyoaddctioigal recommendations r,'any,otber 6nWj f&'
k• � ,piety ' exa_MP �_ a'. a _ I, 1, _ H�lnin {IIPLi I
Iti— F u, II
Use drawings of faccicty to i�etterexpla�n scfuagoUs {use addrtional'pages as necessary):.
Reviewer/Inspector Name:
ReviewerAnspector Signature: k 11
Page 3 of 3
Phone:1.1c) -13�-_
Date: Z� 4
21412015

G I. MS - a � �4 U( 1 6
IType of Visit: V Com Inspection O Operation Review 0 Structure Evaluation O Technical Assistance J
Reason for Visit: Qzoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency O Other O Denied Access II
Date of Visit:j Arrival Time: Departure Time: ' c7 County: Region: F zab
Farm Name: �� 0'vl! I S Owner Email:
c
Owner Name: gk'n""-d AL Phone:
• - r
Mailing Address:
Physical Address:
Facility Contact: -511 er/k C&Z Jrl Title: Phone:
Onsite Representative: f Integrator: . A44
Certified Operator: q Certification Number: 1 -?
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
`
Design Cnrrent;;,,
Design C►urrent
Design Current
Swine
D2Ci Pop.
Wct Pauttry
Capacih Fop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
cr
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Drv`P.,ptxlf" *`;`
Ca acitvPo" .
Non-Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
n _ Turke s
Other
.. . ,
Turke Poults
Other
Other
4
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Er<o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[ INA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
[3'9A
❑ 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
0 No
❑f<A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
a Yes
[210
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
L2�No
❑ NA
[] NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

aimi Number: - Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [g�tf❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [J'INA ❑ 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
jj-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
2-No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7_ Do any of the structures need maintenance or improvement?
❑ Yes
ED-No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
QrNo
❑ 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
[3'Ro
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[3No
❑ NA
❑ NE
maintenance or improvement?
I I . Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes ff No ❑ NA 0 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 Tylers): i kI ! l V -
I3. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Q o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes CNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes E:fNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ENo ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
Required Records & Documents f
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [�'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check 0 Yes 0 No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes []'No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [TNo
23. If selected, did the facility fail to install and maintain rainbreakcrs on irrigation equipment? ❑ Yes [/(No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: -Zt I Date of Inspection:
ve
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:)Yes Q o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes [ o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey El 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 [g"lffo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes [H-Wo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes C!fNo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[—]Yes E No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes [fNo ❑ NA [D NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[]'1Q6
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
CNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
allo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
❑fNo
❑ NA
❑ NE
Comments (refer to question #): Explain- any YES answers and/or any additional recommendations or any other. cammeuM
Use drawings of facility to better explain..situations (use additional pages as necessary).
0(1� -)-,Ar0^ c0—�?—(t
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Cl
4
Phone: � 1
Date:
21412011

A
(Type of Visit: Ql::ompliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: (30R/outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Arrival Time: 4 S
Departure Time: tU�.
County: `�►+t s�✓t
Farris Name:
S' e
�� `t
Owner Email:
Owner Name:
e-^�c�
D6A (.'et f
_ Phone:
Mailing Address:
Physical Address:
' / c
Facility Contact: Ccc l C{ l e S Title:
Onsite Representative:
1
Certified Operator:
Region: f"T'ZZ
Phone:
Integrator: S-U ()%
Certification Number: l l ? r
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Popitry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
DairyCalf
Wean to Feeder
on -Layer
Feeder to Finish
Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr. P,onl
Layers
Design
Ca aci
Current
P,o
D Cow
Non-D '
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turks s
Other TurkSy Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 l2l"o ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
[} NN
❑ NE
[:]Yes
❑ No
[]"9A
❑ NE
[:]Yes
[] No
❑ NA
❑ NE
❑ Yes
f:j No
❑ NA
❑ NE
Page I of 3 21412014 Continued

Facility Number: - jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Ea< ❑ NAB❑ NE
❑ No MIKA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): J 0 _�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
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 DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
Ej a"u
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑-1fo'
❑ 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
[ -Koo'
0 NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yeses
❑ NA
❑ NE
maintenance or improvement?
11, Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑'�1or
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 109%, or I0 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
Cd D
12. Crop Type(s):
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[. oo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ YesFI-No
❑ 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
E No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E'Co❑
NA
[] NE
REquired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
0 NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[D,<o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall inspections ❑ Sludge Survey
2Z. Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
❑ 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
21412014 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Q-1VQ ❑ 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 0 NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes GKo 0 NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
D o 0 NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
To ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
io ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
lQ 1Vo 0 NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
dNo ❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[;]IN. ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E2fNo ❑ NA
❑ NE
mments (refer to -question #):Explain any YES:auswers and/or any;additional recommendations ar ny other comments
F
e drawings of facility to better explain situations (use additional paces as necessary).
, =
.
'�A
�- '-4
Reviewer/Inspector Name: %` 1 Phone: ,) 3
Reviewer/Inspector Signature: Date:
Page 3 of 3 2/4/20l

(Type of Visit: (4R6hIpliance inspection O Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine O Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: County:_ Region:
Farm Name: egral It 04 .e i Owner Email:
Owner Name: t ( Phone:
Mailing Address:
Physical Address:
Facility Contact: S k,116 EI`Oi _. (S_ Title: Phone:
Onsite Representative: Integrator:
Certified Operator: [ l Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current. r
Design Current
Design Current
Swine
Capartt} Pop -
Wet Poultry
Capactt�Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
Layer
Non -La er
Dairy Cow
Dai CalElEf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
_
Dry P,nul
Ca aci
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
`
Beef Feeder
Boars
Pullets
Beef Brood Cow
: p
Turke s
Dtber
Turkey Poults
"
r�
Other
r—tOther
Diseharees 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 span -made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes E1.900 NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
[:]Yes
[:]No
E3<A
❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
[—]No
[34A
❑ NE
[—]Yes
[]7No
❑ NA
❑ NE
[:]Yes
To
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facili Number: Date of Ins ection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No 0 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
[i-go—❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[:]Yes
[3'No ~❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental th eat, 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
9-�'D ❑ 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
ffNo ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable C�r/o�p, Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): !g G 0
13. Soil Type(s): J
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
NA
�No
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
t__J "o ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[: No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[31Z
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall 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
L...1'`'
❑ 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 21412011 Continued

Facility 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 [ g ❑ 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 R<O
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes UNo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA C] NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the [—]Yes NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[] Yes
Na
[DNA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[T N
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
C] No
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspcctor Signature:
Page 3 of 3
21412014

Para
a
Type of Visit: CJCompliance Inspection 0 Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: CYRoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: `y County Region: 'Feb_
Farm Name: cQkekyO Ekam-, T Owner Email:
Owner Name: �� F NCt x AT-Na AS Phone:
Mailing Address:
Physical Address:
Facility Contact: ��
1LVLs>t_ VJ pr�,'%lS Title:
,mot Phone:
Onsite Representative:
Integrator: &Rn 'T .5(nT+lam
Certified Operator:
c l� ERgI �t\1 \S
_ Certification Number: i
S3%L`
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
besign -Current
�`4•.
Design
Ctti rent
Design Current
Swine
Capacity Pop.
x,a,WetiPoultry
Capacity
Pop..
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
QL05 ICADRO
on -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean'
Dry Cow
Farrow to Feeder
It ,
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Pullets
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes dNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
}
❑ Yes ❑ No
❑ Yes dNo
[:]Yes E/No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Pagel of 1/4/20II Continued

r4
Facili Number: 5<- y R Date of Inspection: Ci t a —
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 [g'14o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: 3 5,fnA
Spillway?:
Designed Freeboard (in): j R 1' R ! 4
Observed Freeboard (in): �� o� 5
_
5. Are there any immediate threats to the integrity of any of the structures observed?
Edyes
❑ 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
[oyes
E4
❑ 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
ErNo
[] NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
2'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
[dNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[S#o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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) 'VEu-y� VknAUP,E I lzl� Urnr%0— QnT\,jPA L "e kkf, [�LR4\uCI1
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
G]�No
❑ NA
❑ NE
El/Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes &3"No ❑ NA ❑ NE
[—]Yes [Delqo ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
❑ Yes [D*o ❑ NA [] NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Quo
❑ 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 [No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
[J,NA ❑ NE
Page 2 of 3
21412011 Continued

Facili Number: $ �9g Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes [O"No [] NA NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check Yes E3�'No NA [] NE
the appropriate box(es) below.
E] Failure to complete annual sludge survey Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31 _ Do subsurface We drains exist at the facility? if yes, check the appropriate box below.
El Application Field ❑ Lagoon/Storage Fond ❑ 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
[�fNo
[] NA
❑ NE
Yes
[—]No
grNA
❑ NE
Yes
M No
NA
❑ NE
Yes 2 No ❑ NA ❑ NE
0 Yes E3'No [] NA F] NE
El Yes [vrNo Q NA [] NE
❑ Yes allo
[] Yes [ZNo
❑ Yes [20'No
NA NE
NA NE
NA [] NE
Comments -(refer to question #): Explain any YES answers and/or®;any additional recommendations or atly otherleonim"ents.
-_
iise drawings of.facility�to. better.eaplain situations (use additionalgpages:as.necessary.).
4
rs w[z
4d aK on [CvR fi�i �a~ti0 `or,�Rn�� APwun4 AL.L LF*cJ«r�5•
Ce 5�
(I S, Cca t��s r,s� �o wn cZtZ an w sYE A
4, Gcoo RQCaczD-S
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
phone: c11t�-3o�tflaS
Date:
2/4/2011

.M
Type of Visit: 18f Compliance Inspection Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: O Routine O Complaint O Fallow -up Q Referral () Emergency O Other Q Denied Access
Date of Visit: �� Arrival Time:
>� Departure Time: [Q; S County: S pjQ�
Farm Name: J Q Vail p is 1 (JIM Owner Email:
Owner Name: h�-� 1 Dpn )`e- IS Phone:
Mailing Address:
Physical Address:
Facility Contact:
i an 4311els f—
S�,I b�z
Title: ©jyl�Q� _ Phone:
Onsite Representative: I oI d(� Integrator: Fr - /3 4h
Certified Operator: S h fo l Dail -etc _ Certification Number: 1531Y
Region: Ego
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
can to Feeder
Design Current
Capaci
4-7 ptrQ
La er
-La er
Design
Current
Design Current
le Capacity Pop.
Dairy Cow
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
D :. P,oul
Design
Ca a.c.ih
Curr`ent
P,4.: -
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
Boars
wT
Other.
Turke s
Turke Puults
Other
Other
Discharaes and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes. notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ® No ❑ NA ❑ NE
[]Yes []No ❑ NA NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes [] No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes CK No ❑ NA 0 NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Ej No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

'S'Number: jDate of Inspection:
,Ste Collection & Treatment
!Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ Yes
C' No
❑ No
❑ NA
❑ NA
❑ NE
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: a LQr4 as S�
Spillway?: bi _T�
Designed Freeboard (in :
Observed Freeboard (in): Ll 91-
5. Are there any immediate threats to the integrity of any of the structures observed?
[—]Yes
ER 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
f2 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
®'Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
CoNo
❑ 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
[gNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
WU] No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Typc(s): iLdSe t Sd� rtil I ►V� �CU�V111
13. Soil TYpe(s): TDiSiI&-( _ w an Is, Y o b-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
O No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application'?
❑ Yes
[RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
CWNo
❑ 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. [R Yes ❑ No ❑ NA , ❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [ o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rambreakers on irrigation equipment? ❑ Yes ❑ No ID NA ❑ NE
Page 2 of 3 21412011 Continued

Pacilitv'Number: a. - Lfqq
Date of Inspection: ay
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
f5�No ❑ NA ❑ NE
No ❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
['NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
CJ:No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
Yes
M No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately_
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
P No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
C@'No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
W No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
J'No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
®'No
❑ NA
❑ NE
Comments (refer to question#) Explain an}.YES answers and/or any additional recommendations or any ottiercommentsr=
Use drawings of facility to better,gkplain situations. (use additional pages as necessary) :- ,,, _. , k
r F'� j UJh OJ�- rwf sloes fi all ��� . Olds lee Cs10fJa`e1nj 0X&'A4 e,
_ 4PI wh `�6�,f� War sea, � y Goad ryas f
h
UU % wedt 11
la) 't
Phase ram- �e� 1 � eac�i C�n� cycles wl�'6 Crt�s ty'l! 6e �l I"y1
�s� slr;�e war JeOMJ,04- 31)-3///)// fft to oa-1 ) a,,d srea� bye ca�ffl�P.
904m)jJa,� a�p��� , M&dj rve--e_Chft+ec�_ o4d_ Pectivr -(� 14k eye&1AC-ev�n
f)014, The carA W&T CVt Q 46V ►ya ks ,a, aid -the- ski We good �Qlc�Cov�-a
*or+ 510 0oo allot of wars fP� oU� abo� g � �t°<
{ 9 3 ,9� 5o aC�efdn s,d� 11 hvowe�/.
�►i11 nth *D cep me -,did e_rv�� C13A�� krr /¢ c�ld�r $e
`9 %' �` °! I) el f, b/�
`For fx�.s it, afa8-, �� oar`�C % Pd1e�h . ._ .
Reviewer/Inspector Name: •-1 om '( o-
Reviewer/Inspector Signature: %020-� � _�
Page 3 of 3
Phone: q - 300 (A()F
Date. Doll
114120l l

Facility No. (a"-q Farm Name Sh'eq i nOl i -e[f
Permit `Z COC l� OIC
Date
NPDES (Rain breaker PLAT Annual Cert )
FB
Drops
i
aolno a
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone (ft),
Ratio Sludge to Treatment Volume
Design
i��-------.
ActualDesign
1�%'--�----
Width
Soil Test Date la I(p
Wettable Acres RAIN GAUGE
pH Fields
WUP Dead box or incinerator
Lime Needed .02—
Weekly Freeboard Mortality Records
Lime Applied
1 in Inspections
Cu-1 Zn-I t.,e—
120 min Insp.
Needs P 0
��iorn
Weather Codes
CrOD Yield
Transfer Sheets
t
Pull/Field
Soil
Crop
Acres
PAN
Window
Max Rate
Max Amt
130
w,4
20/4o
Verify PHONE NUMBERS and affiliations
SiCI$k3
Date last WUP FRO Date last WUP at farm
App_
Hardware
FRO or Farm Records 5h j
Qbf R
30
Top Dike
31 -7
4:7- I&VI
+ $
Stop Pump
3 1
ly toe
Start Pump
Conversion- Cu-I 3000= 108 Iblac; Zn-1 3000= 213 1b/ac
J
c3 14
3 a1
3h,
2a �oadj

3�
l�
3)ii
5•a
'T
I.LWAeefr
ay
q-) o�
-7" Wae
q?X saj-o 1509s®
jq1
1 OS00c_
w*4�# 'Ary'K
��G �h1t1
13�1

0IM-3 ns 10 40lro
Type of Visit 9 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 01I , 4] Arrival Time: Departure Time: I T,NEANKOUnty: J Region: F RA
r
I
Farm Name: Sh L41 Q/1yel Owner Email:
Owner Name: _ Shy i _ c Phone:
Mailing Address:
Physical Address:
Facility Contact: hfl' 1 No; e.l S Title: Gyp P/ Phone No: o) I+& S715
Onsite Representative: 's h-e/al D041 -el S _ Integrator: _FJ11A+ Sm14-h
Certified Operator: Shfr _ NO
Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 e = , = if Longitude: E__1 ° ❑ I ❑ u
Design Current
Design Current
Design Curren
Swine111111111110apacity Population
Wet Potiltry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
Wean to Feeder
❑ Non -Layer
❑ DairyCalf
e
❑ Feder to Finish
❑ DairyHeifer
❑ Farrow to Wean
Di:y Poultry
❑ D Cow
El Farrow to Feeder
❑ Non-Dai ry
Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
❑ Non -La ers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowl
I
❑ Turkeys
Other
❑Turkex Poults
Number of Structures:
❑ Other
❑ Other
ZZ
Discharges & 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 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?
JR Yes ❑ No ❑ NA ❑ NE
Yes
❑ No
❑ NA
❑ NE
❑ Yes
tR No
❑ NA
❑ NE
❑NA
ONE
SYes
❑Ne
❑ Yes
ffNo
❑ NA
❑ NE
❑ Yes
M�No
[:]NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: g —
Date of Inspection
Waste Colleetion & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
$kNo
❑ 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?:
1
Designed Freeboard (in):
Observed Freeboard (in): a a�
_
5. Are there any immediate threats to the integrity of any of the structures observed'?
❑ Yes
UNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
El NA ❑ NE
through a waste management or closure plan?
'SkNa
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
Wo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
J�jNo
❑ 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
[�kNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
5�No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
C'No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[--]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
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
15kNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?
❑ Yes
ial No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
U No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
NNo
❑ NA
❑ NE
&mments (refer to question #j Explain —any —YES answer's and/or any recommendanons or any other i:om iients �
Use drawings`at laci6ty to better explain situations. (use.additional pages as necess ky)
> 1
IReviewer/Inspector Name I JOAV .-" Phone, — 33 a tE
ReviewerAnspector Signature: Date: 60+15 a m ��

Facility Number: $ a — Date of Inspection U.LL=
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [9:No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Desig
n El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [N�No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste "Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes JRNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No EJ-NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
I'No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
fRNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
E+Io
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
JNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
5jrNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
tgNo
❑ 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
1,jd"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
D?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
MNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
WYes
❑ No
❑ NA
❑ NE
onal ensAdditim�tor Draw_tn s
1r in Of' CV, P fi0r7-Pizb 101� ,-"D befj0)t41,_ A4 AP, Pradvc.� I b r✓ �ri�n,f
A,
N9 4-now, Plrvse_ Aix lvitm tl bo d s omd_ cal j whei R is d me . D
S )D 2
al i 1 e�L -b Crfa- be 1 ow 141
7r D 0) u rye— M o1Y.41
j
oiaPA.- c i� of /aj� has net-
94 n� aslbd0lS[
,
A/L 300? 1 0
33a doh*UP -Vo CW( on -bg,) k co U1 k►O
vrnm fHw
Page 3 of 3 12128104

Facility No. _Farm Name
Permit ✓ COC
A&I va?l-eG Date lalo-Itp
OIC� NPDES (Rainbreaker PLAT Annual Cert )
FB
Drops
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
IQ I HOC
Sludge Depth ft
V10,
Li uid Trt. Zone ft
Ratio Sludge to Treatment Volume
'L A s MG aPRD4- I D 131) DO
E-l"161 MANE
Design Flow
• M-12Design
Width
Actual Wid-th
I<I�a
Sail Test Date Wettable Acres RAIN GAUGE
pH Fields l� WUP I Dead box or incinerator �
Lime Needed Ah Weekly Freeboard ✓ Mortality Records
Lime Applied 1 in Inspections
Cu-I ✓Zn-I .. 120 min Insp.
Needs P _�� Weather Codes
Crop Yield w�ansfer Sheets h 1 Tk
M fl
r ,
Ip1'.
�
RAIN r.
Pull/Field
Soil
Crop
Acres
PAN
Window
Max Rate
Max Amt
0-
'. a
Yi
qi, Lr41kdIr
S��
3
vin
QO
Verify PHONE NUMBERS and affiliations
Date last WUP FRO I I I a 1 O Y Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Iblac; Zn-I 3000= 213 Iblac
App. Hardware 1-1�iiCljel-
art'4r�ug1- av, 3YS

R
Type of Visit 'Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit IrRoutine O Complaint Q Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: ® Arrival Time: ; S Q Departure Time: , Q County: _5Region: FT90
Farm Name: S ` l Owner Email:
Owner Name: J� �Q�}I P ___ Phone:
Mailing Address:
Physical Address:
Facilitv Contact: Jh"I Doh1 els Title: (iJ n*- Phone No:
Onsite Representative: 9)JQ ! _han I f— I C — _ Integrator:
Certified Operator: 5�&Q I An l fl Operator Certification Number: K31 Y
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = [ It ❑ i, Longitude: E__1 ° 1 = w
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Non -La er
Dry Poultry
❑ La ers
❑ DairyCow
❑ Dai Calf
0_DajjyHeifer
❑ Dg Cow
❑ Non -Dairy
!EaWean
to Feeder o`7
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
El Stocker
Gilts
Gilts
❑ Non -Layers
Pullets
❑ Turkevs
❑ Beef Feeder
❑ Beef Brood Co
PE01 Boars
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures U
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 JRNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
[I Yes
;DNo
El NA
[:1 NE
❑ Yes
$No
❑ NA
❑ NE
12128104
Continuer'

Facility Number: Fa —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I S i t 2 ru urc 3 Structure 4
Identifier: e
Spillway?:
Designed Freeboard (in): a 1
Observed Freeboard (in): 3
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 ;R No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure '; Structure 6
❑ Yes Wo ❑ NA ❑ NE
❑ Yes Dj No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or env ental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes JE No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet stacks) ❑Yes No El NA El NE
9. Does any part of the waste management system other than the waste structures require ❑ Yes J�j No ❑ NA ❑ NE
maintenance or improvement?
Waste AU},1lication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �WNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes Wo ❑ 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 g of Wind Drift ❑ Application Outside of Area
12. Crop tyPe(s)P,Jf4Uip0]Tg� '_ h'1�1r}�nns„Q I 'S�rnrn 14nn-al
13. Soil type(s) YVAha ,, 16i snag- —rh PS 1
v
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
t'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
IRNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'![:] Yes
A 'No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
$�No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
AL
Reviewer/Inspector Name ��SCHV IE j� Phone: 435,WXXW
Reviewer/Inspector Signature: Date: -,7
121281#4 v Continued

Facility Number: — Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes CRNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes '�kNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ DesignMaps -
❑ ap El
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes IgNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
[]Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 'a No ❑ NA - ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No QjkNA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
X 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
tgNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
C NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ANo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ 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
RNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
KNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
RNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
JffNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
L5i Lime_v)kV_ Av,1 aoq- t rn, /acre_
N 040n " �1�O ws—fA 4 r `tD S M4110 1 a 0111.5 i � 1!1 0�
� a � cal � �'�' � �.9
tm1*a;hP al- �ft4'9, I'&et
Reajc- mow &-cAvp boobri jnj) -e I eray7 ba,4rr —`Perm f 4®oIC,ew-04
-
Fow a. recondr I n Joadt jhafe_ ofi',e�^-'h a, at~r n oin4 aba e .
IW8104

Wi
Facility No.go-Yq!l Farm Name Date
Permit 11' COC ✓ OIC_ NPDES (Rainbreaker PLAT Annual Cert )
Pop. Type Desi n Current
��----�
Observed - - .. _ .
Sludge = Sury Date Lg'�
----
Sludge Depth (ft) & %
W&I
'—d-a-1-ibration Date
Design Fl•
--�---
Design Width
Soil Test Date$M1
pH Fields
Lime Needed
Lime Applied fT&)I -c.
Cu ✓ Zn ✓
Needs P _�
Crop Yield
Wettable Acres
WUP I
Weekly Freeboard +/
Rainfall >1" ✓
1 in Inspections
120 min Inspections
Weather Codes
Transfer Sheets
RAIN
ead bo or incinerator -•/
waste Analysis Date
MOM
-mull
PulUFileld
Soil
CropRYE
PAN
Window
Max Rate
Max Arnt
_N
S
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
A.r)
Ap . Hardware W��

Type of Visit lb Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit (5iRoutine O Complaint O Follow up O Referral O Emergency O other ❑ Denied Access
Date of Visit: Arrival Time: MAD Ai Departure Time: 8 ' —W-Wi County: Region: J V _
Farm Name:{ 1 U �%�llh _ Owner Email:
t
Owner Name: ShfT'lt I Phone: _.
r
Maiting Address: 4 ,h✓.-a
Physical Address:
as38s
Facility Contact: s leU _ Title: Ow—fl r Phone No:
Onsite Representative: (�Integrator:`
Certified Operator: Shwa l _ 00A I �,� Operator Certification Number:► 1 8 I q3 j
Back-up Operator:
Location of Farm -
Back -up Certification Number:
Latitude: E1c=]= u Longitude: 0°= S= N
MOM
Design Current
Swine Capacity Population
❑ Wean to Finish
`Design Current
Wet Poultry:: -Capacity Population
❑ La er
Design Current
Cattle Capacity Population
❑ Da Cow
Wean to Feeder
Non -La er
❑ DairyCalf
❑ Feeder to Finish
El Dairy Heifer
❑ Farrow to Wean
k ..
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
-
❑ Nan-Dai
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑..Beef Brood Cow
El Turkeys
Outer
❑ Other
ElTurkey Points
❑ Other
Number at Structures: I U
Dischart=_es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page l of 3
❑ Yes 5'No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
CkNo
❑ NA
❑ NE
❑ Yes
& No
❑ NA
❑ NE
12128104 Continued -

Date of Inspection
Facility Number:% —
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
'RNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
PNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: a -Small z-Ltge
Designed Freeboard (in):
Observed Freeboard (in): , �� 3 37
5, Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
5kNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
ayes
❑ 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
5'No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
P 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
[1 Yes
ERNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[RNo ❑ 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 I0 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) EclCve- P03-6e. '. Yvin-Ifl-
A'nnya r. J✓Mn#- t_-t, lU7✓Q1
13. Soil type(s) 1V4A,11., ' i 0isr bt- E) -
U �
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
EkNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Ckyes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
E;kNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
KNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
KNo
❑ NA
❑ NE
Reviewer/Inspector Name ! S ""'` T ' PhoneCW 3
Reviewer/Inspector Signature: r Date: g
Page 2 of 3 U 12128104 Continued

Facility Nurnber:'s — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [;No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropiate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes CRNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stacking ❑ 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
CRNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
[RNA
❑ NE
24,
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Gi No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
HNo
❑ NA
❑ NE
27,
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
15kNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
(EtNNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
9No
❑ 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
RNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31,
Did the facility fail to notify the regional office of emergency situations as required by
[] Yes
P'No
❑ NA
❑ NL'-
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
DkNo
❑ NA
❑ NF
33.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo
❑ NA
❑ NE
Addtt�COrttellts
15, �%S '�i0 l 6 ,e Sn -( eedr -1-71 Is Ca j
n n� -b r real re(t�dr 3 ea�.
N$ql n6i Cory;
�L,omqOl n,.al ]_'` h1 s Yea- 1°, 'S'01ka)i � DD tin' J60d),
Page 3 of 3 12128.104

Facility No. col-- q4 Farm Name'slyY,l ! D061 1,,6 Date O q I ll l M
Permit COC LI/ OIC_ NPDES (Rainbreaker PLAT Annual Cert }
Pop -Type Desi n Current FS Drops
-Design freeboard
*bserved freeboard
�7 .. - . - .
Date
Design Flow�
ActualCalibration
Soil Test Date .3131
pH Fields L.
Lime Needed .o
Lime Applied I1
Cu ✓ in
Needs P
Crop Yield
Wettable Acres
WUP f
RAIN GAUGE
Weekly Freeboard ✓
Rainfall ?1"
40 -41
1 in Inspections
120 min Inspections J1
Weather Codes ✓
Transfer Sheets
F944vt4e
F-Mrs A4/s?ff anon (
Date of of last Waste Plan in FRO Date of last Waste Plan at farm App. Hardware HA — 8,0
Pull/Field Soil Crop RYE PAN Window
f
9e?
Verify phone numbers and affiliations

IType of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 'Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I ! (!'I 1cT71 Arrival Time: Departure Time: ®County: Region:
Farm Name: Owner Email:
QN
Owner Name: GL Phone: _
Mailing Address:
Physical Address:
Facility Contact: VNU�5 Title: —'
Onsite Representative: Q
Certified Operator: L5
Back-up Operator:
Phone
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = a =' = Longitude: ❑ a =' =
Design Current
Design Current
Design
Current
Swine
C*apacity Pop�latton
Wet Poultry
Capacity Population
Cattle Capacity
Population
Finish
❑ La er
❑ DairyCow
o Feeder
❑Non -La er
❑ DairyCalf
to Finish
_ _
❑ DairyHeifer `
to Wean
rcilts
¢ ' '
❑ D Cow
to Feeder " "
❑ Non -Dairy
to Finish
❑ Layers
❑ Beef Stocker
❑Non -Layers
❑ Beef Feeder
El Pullets
❑ Beef Brood Co
- _
❑ Turkeys
-
Other
❑Turke Puults
❑ Other
❑ Other
Number of Structures:
e a
Discharges &Stream Impacts
1 _ Is any discharge observed from any part of the operation?
❑ Yes Vo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes ❑ No
E)IZiA
❑ NE
b_ Did the discharge reach waters of the State'! (I f yes, notify DWQ)
❑ Yes ❑ No
N 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
C *A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes tgNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes ❑ No
[ANA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number:
Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: ( _ .41)
❑ Yes [ No
❑ Yes No
Structure 5
❑ NA ❑ NE
[I NA El NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes PNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [a No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [5jNo ❑ 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 rb No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA Cl NE
maintenance/improvement?
11, Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes L�No ❑ NA ❑ NF
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop types) V�4
13. Soil type(s) � �r,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 1§No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes tallo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes �;No ❑ NA ❑ NE
'Comments (refer to question #): Explain,any YES answers and/or any recommendations or#any, otherlcomments:
Used-rowmgs`of facility to better explain situations..(use'additional pages as necessary) It r'
SOr.
1W
Reviewer/Inspector Named Phone: j b
Reviewer/Inspector Signature: Date: q Z7
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes INo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 'KNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps El Other
21 _ Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )�INo ❑ 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
Wo
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
'ONA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
r]� No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
/�<No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
'�ZNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
XNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes]
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
VrNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
)-No
❑ NA
❑ NE
Additional Comments and/or Drawings:.
c6 j r l 1)1 v
axy'_6_'V�LMV�A -�V_t_4 � 4(�M' 1
Page 3 of 3 1212VO4

Facility. No. a ! Time In Time Out _ Date
Farm Name Integrator _ '
Owner Site Rep
Operator No.
Back-up No.
COC Circle: G al or NPDES
Des1 n
Current
Design
Current
an - Fg
Farrow - Feed
Wean - Finish
Farrow - Finish
Feed - Finish
Gilts 1 Boars
Farrow - Wean
Others
FREEBOARD: Design
Sludge Survey
Crop Yield
Rain Gauge
Soil Test
Wettable Acres
Weekly Freeboard
Daily Rainfall
Spray/Freeboard Drop
Weather Codes
120 min Inspections _
Waste Analysis:
Date
Nitrogen (N)
Observed
Calibration/GPM
Waste Transfers
Rain Breaker
PLAT
1-in Inspections
Date Nitrogen (N)
Pull/Field Soil Crop Pan Window
_ n

j Type of Visit '-* Compliance inspection Q Operation Review Q Structure Evaluation Q Technics! Assistance
IReason for Visit & Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑Denied Access
Date of Visit: u u Arrival Time: Z C3lo ''Deprarture Time: � County:
Farm Name: S �L��
,f a \}�+�Yl i-�1 g —_,.,vq) Owner Email:
Owner Name- GA �1�\��I A Phone: _
Mailing Address:
Physical Address:
Region:
Facility Contact: .� uLX "I �s`Q l� Title: G �-� Phone No:
Onsite Representative: y Integrator: 1
Certified Operator: �� Operator Certification Number: } �'
P P
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 e = A = 6i Longitude: 0 ° = & = N
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry t±apacitti Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ DairyCow
r2pycan to Feeder a
❑ Non -Layer
❑ DairyCalf
❑ Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Dn Poultr;N. - _ -
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl I
other
❑ Other
Humber of Structures:
❑ La ers
❑ Non -Lavers
❑ Pullets
❑ Turkeys
El Turkey Points
❑ Other
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
❑ Yes
rUNo
El NA
❑ NE
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
❑ Yes
❑ No
0 NA
[I NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
�NA
El 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
Q5NA
El NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Z)No
❑ NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
�!o
El NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes * No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No � NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Z 3
Spillway?: n i I YY1ot.V Ltz_lr { Yn 4Ij _
Designed Freeboard (in): + Q-1 t C�ye 0.V,
tj
Observed Freeboard (in): .23
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes] No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) ((
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
Waste Apnlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes %No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of 1 r 1
Acceptable Crop Window
❑ Evidence of Wind
� Drift El Application Outside of Area
12. Crop type(s) 1' ��e- . lI � j1L kAk
13.
Soil type(s) L.JIJOL� 1 ir\
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
RNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
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
q No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any
Use drawingsiof facility to better explain. situations. (use additional'pages as'necessary)-
CMIX >RlL� twat [Z'
Tfo ftw +j t41Q3 �GS`�trlc.
Reviewer/inspector Name [ t IS71 �,E fv --- l phone: C H 01'33 J �66
Reviewer/Inspector Signature: aE�t, Date: L
Page 2 of 3 12128104 Continued

Facility Number: — Date of InspectionIN I bi ON
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Alo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes JJJ ❑ NA ❑ NE
the appropriate box.
❑ Wl3P ❑Checklists El Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes **ImNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes 'Io ❑ NA ❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No *A ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ❑ No ❑ NA)4NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes XNo ❑ NA ❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes X No ❑ NA ❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes [:]No IN NA ❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
9410
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
II `"'
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
)Q
❑ 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
P%No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ANo
❑ NA
❑ NE
Additional Comments and/or Drawings
j�ee� -ko c66y-, (P Sl ��e Sur �� 4-o k on S4 , •
U 6 r 0- , a�• t�lec�L 6�
wne� ,P lo.v�s �o r ff tt-111-we- " rL S'p f Y).
Page 3 of 3 12128104

FaciEity No. 4� � 1 Time In a Time Out Date 19
Farm Name 1 1' Yv�- Integrator
Owner Site Rep
Operator �7�Y1� ti _ - No. l 3
Back-up
COC
M
Circle: General or NPOES
Design
Current
Design
Current
can — F
'7
Farrow -- Feed
Wean — Finish
Farrow — Finish
Feed — Finish
Gilts / Boars
Farrow —wean
Others
FREEBOARD: Design
Sludge Survey
Iv,O
Observed
Calibration/GPM LD
Crop Yield Waste Transfers - -
Rain Gauge Rain Breaker
Soil Test to
�jk PLAT -7'—, / Wettable Acres
Weekly Freeboard Daily Rainfall _- V 1-in Inspections
Spray/Freeboard Drop
Weather Codes
120 min Inspections
Waste Analysis:
Date Nitrogen (N) Date Nitrogen (N)
6
o i b. I
t a12� 7
Pull/Field Soil Crop Pan Window
Q Q iX So
sur
R r

.--- 4n's -
a_rl�
TYPe of Visit 4 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: �Departure Time: County: + SGh Region: a
Farm Name: �� e v I I .. / s f i g .rt Owner Email:
Owner Name:—*4end ,I��/� �'r s - - Phone:
Mailing Address: jo`12 7 / a y fad ��G .`r p ,�. �r..� a Y., _V,p-7 X-C—
Physical Address:
Facility Contact: .:5Z-lect Z11 ,,.,'eA Title: e�- Phone No:
Onsite Representative: --=Iel•4 L 1af-.r+v 4 Integrator:
Certified Operator: 6kerc. f RMDa rz ` S Operator Certification Number: Ab 3/
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o =' 0 Longitude: 0 0 [= t = At
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Design- Current Design Current
Capacity- Population Wet Poultry Capacity Population
❑ Layer
?4/�j �Sl3 Q� �� ❑ Non -La ei Ln
lU Farrow to Feeder 1 11
Other
❑ Other - - - — — -- .
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stockei
❑
Beef Feeder
❑
Beef BroodCowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ❑U<o ❑ NA ❑ NE
❑Yes
❑No
DNA
ONE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
M'<o
❑ NA
❑ NE
❑ Yes
LKNo
❑ NA
❑ NE
IW8104 Continued

r
Facility Number: Gj Dale of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Lg'Na ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes.. check ❑ Yes U No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes BIN'* ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall, ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge'?
❑ Yes
QIlqo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[Blo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�o
❑ 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
2<o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Eg<
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[j�No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EYNo
❑ 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
Eg"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
[YNo
❑ 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
UNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�o
❑ NA
❑ NE
AddttYonai Commentsand/orDrswu gs,� a
12128104

Facility Number: Date of Inspection®
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes UIo C] NA ❑ NE
a. if yes, is waste level into the structural fireeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Q'No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) ,�
6. Are there structures on -site which are not properly addressed and/or managed ElL7 Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
Lt-f NIo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑Yes
❑ 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
EXo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
5j4o
❑ NA ❑ NE
maintenance/improvement?
H. Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
QjXo
❑ 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) CL-L e 1-01¢4a-r— a r
13. Soil type(s) JA Z )4 R
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Lgo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site creed improvement?
❑ Yes
❑'No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination!❑
Yes
Pf-4o
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑, 11 o
El NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
,
�To
❑ NA ❑ NE
/011104190 e4-%. 'r -164 -e 5
a -. _ a ✓du — ", 7%C fcGif tC/d/A"
Reviewer/Inspector Name d !C !S f
!tR, E .w Phone.
Reviewer/Inspector Signature: Date: �'/_ -9-a-
12/28/04 Continued

Type of Visit 0 Compliance Inspection O Operation Review Q Lagoon Evaluation
Beason for Visit • Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number L y q 9 or visit.- !D 77 /o Time: �0
Q Not Operational Q Below Threshold
® Permitted ® Certified 13 Conditionally Certified © Registered Date Last Operated or Above Threshold- W—•
Farm Name- S 6 a rmk DA-v. i ek5 F4t r vwt County: Sa w. Q S o V N
Owner Name: S V1 G ra Da+n + e A S Phone No: __,. `l 1 - S6 fa 2 3
Mailing Address: l 2 Z _1 Pa►�D ar► , e� S U Sal e • ,t b u rs � r✓ 2$ 38 S'
Facility Contact: ___S 6 e �a%_ Bart t eAS Tj*tle• Phone No:
Onsite Representative: `S t% a ra i _ _ �aA : e C, Integrator.
Certified Operator—_ R!°�� ._ ��n s �.�5-
_,Operator Certification Number. 1113 I •
Location of Farm:
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • �� �" Longitude • �u
t Carrot` CIIrreaat Cmrr�t
__
Swine , . onPaY.. -Po' 'on' Cattle
Wean to Feeder 2 s- I Zoo Layer Dairy
Feeder to Finish Non -Layer Non -Dairy
Farrow to Wean
Farrow to Feeder Other
Farrow to Finish
Total
Gilts
Boars T ta1 SMW
s, °
�r
Numiier 16f
Ns' cha gees & Stream hm
I. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a_ If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes gNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes JgNo
Waste Collection & Treatment
4_ Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Po
Structure I Structure 2/ Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ____ ._1 T Z
Freeboard (inchcs):
12112103 Continued

Facility Number: $ — yqg Date of Inspection 1b S a
5-Are there any immediate threats to the integrity of any of the structures observed? Cie/ trees, severe erosion, ❑ Yes qNo
seepage, etc.)
6- Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes BNo
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? INYes ❑ No
8. Does any part of the waste management system other than waste structures require mai.ntenancelimprovement? ❑ Yes gNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑Yes jg[No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancetimprovement? ❑ Yes Jallo
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes ANo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Capper and/or Zinc
12- Crop type r wL ctiS.40 L4 P S m . le
r-a'• h T-e— ra ss k vKi [
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes R) No
b) Does the facility need a wettable acre determination? ❑ Yes ® No
c) This facility is pended for a wettable acre determination? ❑ Yes 9 No
15. Does the receiving crop need improvement? Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes j,SNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attar below ❑ yes [j No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? [J Yes LK No
19. Is there any evidence of wind drift dining land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes JRNo
roads, building structure, and/or public property)
20- At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes J4 No
Air Quality representative immediately.
❑ Field Copy ❑ Final Notes
Has a r►ew des�sn capaco+j o- 2Y-4S -Ceeler. Mr.
un e.a per,. i4 A es vto+- ;+r+d t }mc +L—. S c1trto., e . S w � � t o c.� w ,+-k Y e-1 k
L-a r~ erL, i" t C.e,.,. V-VA 0�"P. c-e. � e Jw+a.
(DOL-� &',lay sqz- �-t4t)
1. Adt-a ctx 'tite 6 0-F _e1 n a 14D"I- 1,4 t.-�-
15. Qe45 v $tet 'co � e, Yvt t +t 5 pr" tC- e.l4k 4m Kl&"-+ 44,g f,5 �e sc ue.
Reviewer/inspector Name
Reviewer/Inspector Signature:
Date:
12112103
Continued

Facility Number: Q 2 — Date of Inspection a s o
Rewired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes WO
22. Does the facility fail to have all coonents of the Certified Animal Waste Management Plan readily available?
(ie/ WTJP,�checklist' ems, designmaps, etc.) ❑ Yes &No
23_ Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 13-No
❑ Waste ApplicatieMr"❑ Freeboa>rt""❑ Waste AnalysiVO Soil Sampiine
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 5No
25_ Did the facility fail to have a actively certified operator in charge? ❑ Yes CgNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(id discharge, freeboard problems, over application) ❑ Yes N No
27. Did Reviewer/Inspector fail to discuss reviewhnspection with on -site representative? ❑ Yes ZNo
28. Does facility require a follow-up visit by same agency? ❑ Yes No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
NPDF.,S Permitted Facilities
30. Is the facility covered under a NPDFS Permit? (if no, skip questions 31-35) ❑ Yes 0,No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35 _ Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below_ ❑ Yes ❑ No
❑ stocking Form ❑ Crap Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about thi's visit.
S.Ow" , bkf Mr. �,..: zls rec e...-ttf »•,-Je .4
e j .� aF7�ca� trk 4D ✓1tr�S�-may 1��. �a �Q�/ ��.t coq�a.r- +T-r
WA vle aA � 4 ge � -� ,�tsF e Pla.,.� ufh�+e--' as
Wasc.L��•s 8/Z010w
Il�la�a3
0.2�
Z ILa/o,(
llip/04
0.90
to jzr/o`i
o- $z
12112/03

Site Requires Immediate Attention:
Facility No. g'e - j�fP
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: In , 1995
Time: �<t7
Farm Name/Ow1
Mailing Address
County: .�
Integrator: Phone: 9laP�e �f
On Site Representative: Phone: 5-�P 7 - �3
Physical Address/Location:
,, i©ob
Type of Operation: Swine Poultry Cattle
Design Capacity: Q Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ° , Longitude:- ° "
Circle Yes or No
Does the Animal Waste
(approximately l Foot +
Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
7 inches) or No
Was any seepage observed from the goon(s)?
Is adequate land available for pray&yes or No
Crop(s) being utilized:
Does the facility meet S S minimum setback criteria? 200 Feet from Dwellings? ff °sl or No
100 Feet from Wells? &� or No
Is the animal waste stockpiled within 100 Feet of USGS BIue Line Stream? Yes orb
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes one
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or(!!�) If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments: r!)
A��fj 4
d +�
Inspector Name
cc: Facility Assessment Unit
Actual Freeboard: � 2 Ft, Inches
Yes or(S) Was any erosion o�l�? Yes or®
Is the cover crop adequate? e or No 3
Signature
Use Attachments if Needed.
<1