820449_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual
2 19

Type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 40 Routine O Complaint O Follow-ap O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival! Time: i Departure Time: p County: Region:
Farts Name: A Owner Email:
Owner Name:Vh'1.� Phone:
Mailing Address:
Physical Address;
Facility Contact; G Title: Phone:
Onsite Representative: tit Integrator: Pis
4gAL
Certified Operator: Oa,rw5 tj Certification Number: 100 3,3.;710
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
"�'
Design Current
'� , Design Current
Swine C•a ci Po
h' p•
Wet Poult`�"
r3'
'Ca aci Po
P h" ` p•
Cattic Ca ci Po
Pa h' R
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non-l.a er
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
D . Poul
Ca aci P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Turke s
Turke Poults
Other
Other
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 NA ❑ NE
b_ Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes [] No NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No P NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [] Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [] Yes No ❑ NA ❑ NF
of the State other than from a discharge?
Page 1 of 3 2/4/2015 Continued

Facility—,Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ YesNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ElYes t No [ UNA ❑ NE
Struc e 1 Structure 2 Structure 3 Structure 4
Identifier: X_ G�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): t� 3 14
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
Structure 5 Structure 6
[] Yes �5 No ❑ NA ❑ NE
❑Yes P No []NA 0 N
If any orquestions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [� No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9_ Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes � No ❑ NA [—]NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. © Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, 7n, 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): Ctrs -0
13. Soil Type(s): %'_Uj;
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
P9 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[] Yes
r7hNo
❑ NA
[] NE
R uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
2l. Does record keeping need improvement? If yes, check the appropriate box below. ❑ YesNo ❑ NA [:]NE
❑ Waste Application [:1Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis ❑ Waste Tr sfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 214/2015 Continued

Vacil!D6Number:Date of Ins 60n:
24. Did the facility fail to calibrate waste application equipment as required by the permit
❑ YesNo ❑ NA [3NE
kNo
25. Is the facility out ofcompliance with permit conditions related to sludge? If yes, check
EJYes [] 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 © No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes (Q No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ YeNo E]NA ❑ NE
and report mortality rates that were higher than normal?
?_
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
rj
32. Were any additional problems noted which cause non-compliartce of the permit or CAWMP?
E] Yes No NA NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes PNo ❑ NA ❑ NE
rawin s of fac'Irty t better,�e Aare s to trans (use acid tro al pages astuecessa ommetr a ans'or
me _an ' ti z an her-eonnnWWI
ffiseltdig
Reviewer/Inspector Name:
Reviewer/Inspector Signature -
Page 3 of 3
ignature:
Page3of3
Phone:
Date: zi
2412015

I ype of visit: Gr compliance inspection V uperanon lcevlew V structure Evaluation V iccnrucal Assistance
Reason for Visit: ® Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: J ] Departure Time: D ounty-Q � Ij Region:
Farm Name: P-1 4 .1/ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
IV eed
4
Q
Certified Operator:
Back-up Operator:
Title:
Phone:
Integrator: frrest6��
Certification Number: 2V 3
Certification Number:
Location of Farm: Latitude: Longitude:
Current
Design
Current _
Designine
MIIesign
pacity Pop.
Wet Poultiry"
Capacity
Pop =1
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
-
"
Dairy Heifer
Farrow to Wean
Design
Currenit
Dry Cow
Farrow to Feeder
D , P�oultry . _
Ca acr
' Po .; : - _
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
113eef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
I . is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
[]Yes [�a No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes ❑ No P NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

]Facility . Vumber: - 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 IP NA ❑ NE
5tructirre 1 Structure 2 Structure 3 Structure Structure 5 Structure 6
Identifier: �/7�R^
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ YesNo [:]NA E]NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [P 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 Cr Window ❑Evidence Wi Dri ❑ Application Outside of Approved Area
12. Crop Type(s): S�
13. Soil Type(s): _ _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes OpNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
- No
❑ NA
❑ NE
1$. Is there a lack of properly operating waste application equipment?
❑ Yes
f
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
� No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes (P No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E�+ No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes V] No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facifi umber: -1 Date of Inspection:
I If
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes � No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes 99 No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ YesNo [—]NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes 8 No ❑ NA ❑ NE
IComments trefer,to question iT): Expiatn any YES answers andlor any addrhonal recommennauons or any Diner comments.
Use drawings of facility to better explam-situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: L ��
21412011

40
I ype oa visit: W �_ompuance rnspecuon V vperanon Keview i.J arrucnare nvaluanon V aecamem Asstsuance
Reason for Visit: • Routine Q Complaint 0 Follow-up O Referral a Emergency Q Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: e4Q Region: {1
Farm Name: P-1 2— /q _D Owner Email:
Owner Name: Vra--fie Fh~ Phone:
Mailing Address:
Physical Address:
Facility Contact: J'zm.V ' � Title: Phone:
Onsite Representative: Ir Integrator: re
Certified Operator. �a , € Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design C►anent
[] No
Design Curren#
Design Current
Swine Capacity Pop.
Wet Pqultry
Capacity - .Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
-
Dai Heifer
Farrow to Wean
Design Current
Cow
Farrow to Feeder
D . Point ,
@a aci " - Pop.
Non -Da'
Farrow to Finish
Lavers
Beef Stocker
Gilts
[Non -Lavers
Beef Feeder
Boars
Pullets
Beef 13 nd Cow
Turkeys
Other -
TurkeyPoults
Other
Other
---
Discharees and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at. ❑ Structure ❑ Application Field ❑ Other_
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes Da No ❑ NA ❑ NE
❑ Yes
[] No
fg NA
❑ NE
[—]Yes
❑ No
� NA
0 NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [—]Yes ❑No ® NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/412014 Continued

flFadfity 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 I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: C _P�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):34----•���
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes V1 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
X] No
❑ NA
❑ WE
waste management or closure plan?
❑ Yes
No
❑ NA
❑ WE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes]
No
❑ NA
❑ WE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
the appropriate box.
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
[] NA
❑ WE
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 P No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground p Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable/Crop Window ❑ E�videnc WindDrift � Application Outside of Approved Area
12. Crop Type(s): 'ngzs4t &le—" G*_C5_ 004�)',M
❑ WE
13. Soil Type(s): /1
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes (n] No 0 NA ❑ NE
15. Does the receiving crop and/or Iand application site need improvement? ❑ Yes Ra No E] NA ❑ WE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ WE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ WE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ WE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ WE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes vr%M-, No ❑ NA ❑ WE
❑ Waste Application p Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis 0 Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking ❑Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes K No [:INA ❑ WE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes � No ❑ NA [:]NE
Page 2 of 3 214/2014 Continued

� lFacillty 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 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other.
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes R] No ❑ NA ❑ NE
❑ Yes W No ❑ NA ❑ NE
❑ Yes � No [:]NA [:]NE
❑ Yes D3 No ❑ NA ❑ NE
❑ Yes 55 No
[:]Yes � No
❑NA ❑NE
❑ NA ❑ NE
Reviewer/Inspector Name: — M"koo Phone:
Reviewer/Inspector Signature: F Date: 11 1715--11
Page 3 of 3 2/4/1014

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Z f Arrival Time: O2: o, Departure Time: DL:30 County: —': TA l' -QW
Farm Name: � "i � R Owner Email:
Owner Name: ?nes 66 , Q Fttrm T) c, Phone:
Mailing Address:
Physical Address:
Region: FPD
Facility Contact: fUnciti Title: Phone:
Onsite Representative: � �e5 t-0-rY'►�,i Integrator: Prec�gae—
Certified Operator:Certification Number:
Sack -up Operator: PQ-(, L, - _G, Aka,( Certification Number: �-7 9�J
Location of Farm:
Latitude: Longitude:
Current � M. Dcs�g�orrent Design Current
Swine _Caact ``Po VPe Poiiltn CapgcityPap. Cattle Capacity Pop.
Wean to Finish La er Dai Cow
-
Dairy Calf
Feeder to Finish
Dairy Heifer
DesiU en Dry Cow
Dr Poul Ca ael Po Nan -Dai
Farrow to Wean b
Farrow to Feeder
Farrow to Finish
Layers Beef Stocker
Won -Lavers Beef Feeder
Gilts
Soars
Pullets
Beef Brood Cow
Turke s
Other -
Turkey Poults
Other
Other
DischarEes and Stream Impacts
I- Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ® No ❑ NA ❑ NE
[:]Yes ❑No
❑ Yes [:]No
NA ❑ NE
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 Dl ❑ Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ® No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/7011 Continued

Facility Number; - Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
JPNA
ONE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: �r 8 C
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): All %ft
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
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?
D Yes
[�j No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
E] NA
❑ NE
maintenance or improvement?
,U1
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes JM 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 CropWindow ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s): Clas4vtt
Pe
Gqs5&5"), sal, L!-lY::�•.1�UQ{QQ
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes rM No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [g No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes EA No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑ Yes No
❑ Yes [] No
❑ Yes 0 No
❑ Yes 50 No
❑©titer:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [E] No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
D' NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ Yes ® No ❑ NA ❑ NE
❑ Yes Q9 No ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facili Number: - Date of Ins ection: Z
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 [4 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface rile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[] Yes ® No ❑ NA ❑ NE
❑ Yes W No ❑ NA ❑ NE
❑ Yes T,No F]NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [j] No ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative? ❑ Yes 1:71 No [DNA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2011

lype of visit: i Uompliance inspection U operation Review V structure Evaluation V Technical Assistance
Reason for Visit: • Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 2Arrival Time: D 1 Departure Time: County,
ML
Farm Namee? - Owner Email:
Owner Name: L m�j Phone:
Mailing Address:
Physical Address:
Facility Contact: Lf(�j\1� Title:
Onsite Representative: 14
Certified Operator:za_&C�8/
Back-up Operator:
Phone:
Integrator:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Desigo 4Curren#
❑ Yes
Design
Current
Design Carrent
Srrzne Gapacitj2: Pop.Wet
Poultry
Capacity
Pop.
Cattle Capaciig Pop.
Wean to Finish
I Laye
❑No
NA
Dai Cow
Wean to Feeder
Non -La er
❑ No
NA
Dai Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
❑ Yes
❑ No
® NA
Dr
y Cow
Farrow to Feeder
Dr Poul
Ca aci
P;o' .
Non -Dairy
Farrow to Finish
La err
E] No
❑ NA
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
rl Beef Brood Cow
Turkeys
.he .
Turkey Poults
Other
Other
Discharges and Stream bnDacts
1. Is any discharge observed from any pari of the operation?
❑ Yes
W No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes
❑No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[:]Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
® NA
❑ NE
2, Is there evidence of a past discharge from any part of the operation?
[:]Yes
Eg No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
E] No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2014 Continued

Facili Number: - Date of Inspection: 1
[:]Yes
[§No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
E) No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[a Yes
Ire No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
EqNA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:_
18_ is there a lack of properly operating waste application equipment`?
❑ Yes
® No
❑ NA
❑ NE
Spillway?:
Designed Freeboard (in):
❑ Yes
V] No
❑ NA
❑ NE
_
Observed Freeboard (in): J I 3� _ `3b37
❑ Yes
O No
❑ NA
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
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
P No
❑ NA
❑ NE
8_ Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Ej 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
Wo
❑ NA
❑ NE
maintenance or improvement?
T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
E]Yes
P No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
0 Yes
$2 No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes
[§No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E) No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[gi No
❑ 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
V] No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
O No
❑ NA
❑ NE
the appropriate box_
[DWUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21 _ Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes t8 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2014 Condnued

Facility Number: - Date of Inspection: [.
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes FpNo ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes C@ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [-]Yes 23 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Comments (refer to question #): Explain any$YES','answers and
to
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
nal paRes`as necessary).
C7 Yes [p No ❑ NA ❑ NE
❑ Yes EpNo ❑ NA ❑ NE
❑ Yes K? No ❑ NA ❑ NE
❑ Yes Cg No ❑ NA ❑ NE
❑ Yes ® No
[:]Yes ® No
❑ Yes M No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Phone: _1 !0—�3 7 , 33 W
Date: id4l Y
21412014

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit- F Arrival Time: }A04._, I Departure Time: B SOD County: s Psi Region: FR,cr7
Farm Name: _1 A Owner Email:
Owner Name: s �- s �-' Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: �$ Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Desig. rt; Desigrt Current '. Design C►urrent
Swine Capacttyp4 '' Wet Poulkry "Capaty� Cattle Capacity Pop.
Wean to Finish Layer Dai Cow
Wean to Feeder Non -La er Dai Calf
Feeder to Finish x. Dai Heifer
arrow to Wean " -esign Curreu : ; D Cow
Farrow to Feeder D , �Po.ul - _ _ Ca aciPo Non -Dai
Farrow to Finish 'Layers Beef Stocker
Gilts Non -Layers Beef Feeder
Boars Pullets Beef Brood Cow
ajTurkeys
Other ��
Turkey Poults
Other 121 10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes `Pt! No ❑ NA ❑NE
a. Was the conveyance man-made? [:] Yes ❑ No ® NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) E]Yes ❑ No NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [] Yes [:]No [)q NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? []Yes N No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes E§ No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

Facility Number: - 14 0 jDate 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 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2 .3u _r 2-9 ?i`1
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [P 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 ® No ❑ NA ❑ NE
waste management or closure plan? T
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 LP No ❑ NA ❑ NE
8_ Do any of the structures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA C—] NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) TT
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA C] NE
maintenance or improvement? TT
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 15g No ❑ NA ❑ NE
maintenance ar improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes M No [DNA ❑ 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 ofWind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C9"1 c�C4 ) r JMr aL_
13. Soil Type(s):
as -
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [g 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
M No
❑ NA
E] NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
f5Q No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
EA No
[:]NA
E]NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
[] Yes
P No
E] NA
[3 NE
the appropriate box.
T
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes 0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/412011 Continued

Fgcili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ YesNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check E]Yes No ❑ NA ❑ NE
the appropriate box(es) below.
Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge ievets in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ 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 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?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, cheek the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑Yes WNo ❑NA ❑NE
❑ Yes ® No ❑ NA ❑ NE
Yes C�j No ❑ NA ❑ NE
[:]Yes P No
[:]Yes 5a No
❑ Yes M No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
"- rnments {refer to question ff): Explain any YES answers and/or.any additional recommendationsfor4'any otlxer comments.
Usedrawings of, to better explain situations{use additional pages.as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2011

JF
Type of Visit • Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral 0 Emergency O Other �❑ Denied Access
Date of Visit: 4110 Arrival Time: 2J Departure Time: Q ' County: -SAM Region:
Farm Name: P` 14— Owner Email:
Owner Name;
Mailing Address:
Physical Address:
Facility Contact: r' -u LJ
Onsite Representative: �S
Certified Operator:
S J�• Ic., Phone:
Title:
Phone No:
Integrator: Rei-1RQL
Operator Certification Number -
Back -up Operator: Back-up Certification Number:
Location of Farm: Latitude: F --I o Longitude: =o u
Design Current
❑ No
Design Current
Design Curren
Swine Capacity Population
Wet Poultry:
Capacity Populatt
C*attle Capacity Population
❑ Yes
❑ Wean to Finish
❑ La er
❑ NE
❑Dai Cow
MNo
❑ Wean to Feeder
❑ Non -La er I
I
❑ Dairy Calf
❑ NA
❑ Feeder to Finish
A
El DaiHeifer
Farrow to Wean+e�
Dry
Poultry
I
❑ D Cow
❑ Farrow to Feeder"'
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ N ers
El Beef Feeder
❑ Boars
❑PMets
Pullets
❑ Beef Brood Ca
❑ Turkeys
O#her
❑ Turkey Poults
❑ Other
10 Other
Numlaer of Structures:
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 t?�No ❑ NA EINE
❑ Yes
❑ No
IFNA
EINE
❑ Yes
❑ No
EPNA
❑ NE
❑ Yes
❑ No
[PNA
❑ NE
❑ Yes
MNo
❑ NA
❑ NE
❑ Yes
'0 No
❑ NA
❑ NE .
Page 1 of 3 12128104 Continued

Facility Number: — Date of InspectionRVI�D 0
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No tPNA ❑ NE
Struee 1 Structu2 Structure 3 Structure 4 Structure 5 Structure 6
Identi f er:
Spillway?:
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
0 No ❑ NA
Designed Freeboard (in):
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
qq
Observed Freeboard (in): <r �d1-� J51
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA , EINE
(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?
Soil type(s) �1
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)
❑ NE
16.
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No ❑ NA ❑ NE
maintenance or improvement?
Does the facility lack adequate acreage for land application? ❑ Yes
1P No ❑ NA
Waste Aatflication
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
$1 No ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
0 No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑/Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) .� a E9'rct �j_ t 7�' . t �. (Qww�-
Feat
13.
Soil type(s) �1
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
OM 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
N No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
1P No ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
[A No ❑ NA
❑ NE
Reviewer/Inspector Name Phone: ID -s0 �r :3r_lsco
Reviewer/Inspector Signature: Date: 10 Q
Page 2 of 3 12/28/:74 Continued

Facility Number: Date of Inspection L Lal�iLLJ
Required Records & Documents �� t
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desi r
gn El ❑Other
21- Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ 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
R3 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
;9 NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
9@ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
1P No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31-
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
Page 3 of 3 12128104

r
Is
Type of Visit • 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: o.3,, o County: JA*" - 00 L Region: lZk'D
Farm Name: / T +� Owner Email:
Owner Name; Phone:
Mailing Address:
Physical Address:
Facility Contact: �� Title: Phone No:
Onsite Representative: _:J-a"s lamb Integrator:ae
Certified Operator: Operator Certification Number: W4
Back-up Operator:
Location of Farm:
c.;; P,opu_fation
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Discharges & Stream impacts
Back-up Certification Number:
Latitude: [_—] 0 =' a N Longitude: [::]0=' ="
Design Current
Swine
MignG,urrent
Wet Poultry Capacit Population
❑ Layer
❑ Non -La er
Dty Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turka Poults
❑ Other
Design C•nrrent
Cattle Capacity Population
❑ Dairy Cow
❑ Daiia Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Da'
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
1. Is any discharge observed from any part of the operation?
❑ Yes
Wo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Cl Yes
❑ No
NA
❑ NE
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued
J

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 1PNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No DONA ❑ NE
Structure I Stnicture 2 Structure ? Structure 4 Structure Structure 6
Identifier: C
Spillway?.
Designed Freeboard (in):
y
Observed Freeboard (in); p� t
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes�No
❑ Yes
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ NE
15. Does the receiving crop and/or land application site need improvement?
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?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
❑ Yes
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
(PNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
18. Is there a lack of properly operating waste application equipment?
❑ Yes
4. Does any part of the waste management system other than the waste structures require ❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [l Yes
tpNo
❑ NA ❑ NE
maintenancelimprovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
�LNo
❑ 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 ofAcceptableCrop Window Evidencein__d��Drift [:]Application Outside of Area
o��f11Wind
/❑
,. '
12. Crop type(s) W fwrnuda 6,gss [_7Y�
W >` fJ
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
r,)Vo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
KNo
❑ 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
K�No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: t�-q 33oD
Reviewer/inspector Signature: Date:
12128104 Continued

4
Facility Number: A— Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP El Checklists ❑ Design El Maps El Other
❑ Yes VNo ❑ NA ❑ NE
❑ Yes PNo ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Y No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
2& Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
PNo
❑ NA
❑ NE
❑ Yes
❑ No
JdNA
❑ NE
❑ Yes
W No
❑ NA
❑ NE
❑ Yes
§Q No
❑ NA
❑ NE
❑ Yes
&No
❑ NA
❑ NE
❑ Yes
1XjNo
❑ NA
❑ NE
❑ Yes
14 No
❑ NA
❑ NE
❑ Yes
§3 No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
C9 No
❑ NA
❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes EXNo ❑ NA ❑ NE
Additional Commeiits�andlor Dsaw�gs:
T
I M8104

1( %
Type of Visit 0 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
420
Date of Visit: Arrival Time: %/ "1 �A "" `r -s Region:
Farm Name: _ Owner Email:
Owner Name: Tr@stk8o__, Fla -ems t `C ' Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: S
Certified Operator -
Back -up Operator:
Location of Farm:
Phone No -
Integrator:
Operator Certification Number:
Sack -up Certification Number:
Latitude: n u Longitude: [� o[� t 0
Design Current
Design Current
Design Current
Swine Capty Population
Wet Poultry Capacity Population
Cattle Capacity Population
Finish
❑ Layer
❑ Dai Cow
❑ Yes
o Feeder
❑ Non -Layer
❑ NE
❑ Dai Calf
to Finish
❑ No
❑ Dai Heifer
KEe
91 to Wean
D , Poult ,
ry r} '.
❑ D Cow
to Feeder
F
❑Non -Dai cz
tc Finish
La ers
❑ Beef Stocker
❑ NE
Non -La ersPullets❑
Beef Feeder
2!�No
❑ NA
❑ Beef Brood Co
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Turkeys
V No
Other
❑ Other
El Turkey Poults
El other
Number of Structures:
Discharges & Stream Impacts
1. is any discharge observed from any pan of the operation?
❑ Yes
PNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
PNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
NA
79
❑ 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
❑ NoPTNA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
2!�No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
V No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: Date of Inspection
Cl Yes
Waste Collection & Treatment
❑ NA
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 IRNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: o)_ e� � � A C �
® No
Spillway?:
❑ NE
Designed Freeboard (in): o` , r 10)0 4V
Observed Freeboard (in): 12q�
❑ Yes
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes )3 No []NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
18. Is there a lack of properly operating waste application equipment?
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes ❑ NA ❑ NE
through a waste management or closure plan?
'RNo
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 /JKNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes UNo ❑ NA EINE
(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 bio ❑ NA ❑ NE
maintenance or improvement?
Waste Application
14. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes M)No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes PNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift El Application Outside
of Area
O &-SS (!f�J}"� ]
�ljl9{
[
12. Crop type(s)Q I G" ►'�
4t
13. Soil type(s) l z"Y% kg,_, --
14. Do the receiving crops differ from those designated in the CAWMP?
Cl Yes
XjNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
(PNo
❑ 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
bNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
&No
❑ NA
❑ NE
Cainments (r rft uestion•#) Explatn auyiYESoatiswers an�4r any recommendit[o Is or any other Comm
Use drawttt sof fac� to better a :*lain 5[tuati0ns nse�add tion�l a a necessa ; ,
Zip
Reviewer/inspector Name F Phone: 43
Reviewer/inspector Signature: Date:
Page 2 of 3 12/28/04 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ VVTJP ❑ Checklists
❑ Design EJ Maps El Other
❑ Yes %No ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes R No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27_ Did the facility fail to secure a phosphorus loss assessment (PLAT) Certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
❑ Yes
15 No
❑ NA
❑ NE
❑ Yes
P9No
❑ NA
❑ NE
❑ Yes
�3 No
❑ NA
❑ NE
❑ Yes
5 No
❑ NA
❑ NE
❑ Yes
a No
❑ NA
❑ NE
❑ Yes
29 No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes j5No ❑ NA ❑ NE
❑ Yes ff) No ❑ NA ❑ NE
❑ Yes
'D No
❑ NA
❑ NE
❑Yes
1PNo
El NA
C-1 NE
12/x8/04

'O's I Za -
i Division of Water Quality
Facility Number ®-� 0 Division of Soil and Water Conservation 4--.-
- _ 0 Other Agency ►Z,
(Type of Visit r Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time* �� Departure Time: Z� � County:
Farm Name: -iz- ice"- f,) { Owner Email:
Owner Na e: ` `
Ums ", Phone:
Mailing Address:
Physical Address:
Facility Contact: 64 Title: Phone No:
Onsite Representative: Integrator: �Q S
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Region:
Latitude: [=O 0' Longitude: 0 ° =I
= "
Design Current Design Current
Swine Capacity .;Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder ❑ Non -La er
❑ Feeder to Finish
arrow to Wean 71
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ 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)
Cattle
Design Current
Capacity Population_,
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Coyd
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
'K'No
❑ NA
❑ NE
❑ Yes
❑ No
$1 NA
❑ NE
❑ Yes
❑ No
® NA
❑ NE
[9VA
❑ NE
❑ Yes
❑ No
❑ Yes �jjNo ❑ NA ❑ NE
❑ Yes gNo ❑ NA ❑ NE
12128104 Continued

facility Number:-qq9 I Date of Inspection o1
❑ Yes
P No
Waste Collection & Treatment
❑ NE
15. Does the receiving crop and/or land application site need improvement?
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
7 N ❑ NA ❑ NE
a_ if yes, is waste level into the structural freeboard?
❑ Yes
® No ❑ NA ❑ NE
Strut I Strut 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: !t
❑ NA
Spillway?:
18. Is there a lack of properly operating waste application equipment?
ElYes
Designed Freeboard (in):
Observed Freeboard (in):
❑ NA
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
WNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
Tri
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
R No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
Wo ❑ 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
P No [INA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
)p No ❑ NA El NE
El Excessive Ponding El Hydraulic Overload El Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
1111
❑ PAN ❑ PAN > 10% or ]0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift [3 Application Outside of Area
12. Crop type(s) 6 — Cr _ S� C"i r 0/..5
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAW -MP?
❑ Yes
P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
O No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
P No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ YesNo
❑ NA
ElNE
18. Is there a lack of properly operating waste application equipment?
ElYes
lNo
❑ 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):
L,u1�1 'A%c �a LOOL .4,, base QAt d Sc i✓fG..:.,.� a.,o
Reviewer/Inspector Namej5T 1 J��Uv MALW7 Phone: )D 00
Reviewer/Inspector Signature: Date:
12128104' Continued

22.
Did the facility fail to install and maintain a rain gauge?
C] Yes
P No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Facility Number. A I I Date of Inspection
❑l No
MA
Required
Records & Documents
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
M No ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
g4No ❑ NA ❑ NE
❑ NE
the appropirate box.
❑ WtJP El Checklists ❑Design [I Maps ❑Other
Did the facility fail to have an actively certified operator in charge?
❑ Yes
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste
Transfers
❑ Annual Certification
❑ NE
❑ 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?
C] Yes
P No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑l No
MA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
Ivo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
)Rt+Io
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
)R�No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
�NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
IgNo
❑ 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?
❑ YesNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
1.2/2$/04

Type of Visit 0 Compliance Inspection Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit & Routine 0 Complaint Q Follow up O Referral O Emergency 4 Other ❑ Denied Access
Date of Visit: Arrival Time: L=am Departure Time: County- Sed/\ Region:
Farm Name: r 1 •i. 1t
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
(�
Onsite Representative: '
Certified Operator:
Back-up Operator:
Phone No:
Integrator: P"S
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =0
=1
= Longitude: ❑ ° ❑ I = U
Design Current
Design_ Current
Design Current
Swine Capacity Population
Wet Poultry `' @�apael Papulation
Cattle C•aparity -A— -ti
❑ Yes
dNo
❑ NA
❑ Wean to Finish
❑ La er
❑Dai Caw
❑ Wean to Feeder
❑Non -La er
❑ Dai Calf
❑ Feeder to Finish
Nom°'"' `` `==:'
❑ Da Heifer
Farrow to Wean CD
t7ry Poul ,.
❑ D Cow
❑ Farrow to Feeder�i.,..
❑ No
El Non -Dairy
❑ Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑Beef Broad Co
-
❑ Turkeys
-
UtherAi
❑ TurkeyPoults
❑ NA
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
❑ Yes
dNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made?
1:1 Yes
El No
,�/
Qd NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
e 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
lLXA'
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Io
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

Facility Number: ;Z7_7y�Date of Inspection
'Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes `V- ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No @ A ❑ NE
Stru tyre I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in); Iq
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No OJ4 ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed [:1Yes ElNo eNA EINE
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? ❑ YesNo ❑ NA [INE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ YesNo [INA [3NE
(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 j!fNo ❑ NA ❑ NE
maintenance or improvement?
Waste AQalication
10. Are there any required buffers, setbacks, or compliance alternatives that need []Yes 51No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. [:]Yes CONo ❑ NA EINE
❑ 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) DG s SG &"J
13. soil type(s) �.
v
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 treed improvement?
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
Q No ❑ NA ❑ NE
1� No ❑ NA ❑ NE
®No El NA El NE
�]No El NA ❑NE
rnents {reuestion #): Explain any lYES answerawings of facility to better explain situations. (use additional pages as necessary):
PU-
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 1 12/28/04 Continued

Facility Number: Date of Inspection
[acquired 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 M No ❑ NA EINE
the appropriate box. ❑ V*TUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [�PNo ❑ 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 Rj No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'?
❑ Yes
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[P No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
O No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes[�
No
ElNA
El 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
[4 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
[9 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
WNo
❑ NA
❑ NE
Additional Comments andlor'Drh*ings.'` ;f
•
Page 3 of 3 12/28/04

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit ® Routine Q Complaint Q Follow up . O Referral a Emergency Q Other ❑ Denied Access
Date of Visit: / /�S Arrivat'I'ime: 5 ; 3b Departure Time: County:Sd�,a_� o.v Region: F��
Farm Name: i a — Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: e n I4 3 Q w s. V ap
Certified Operator: ! v�
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator* -k
C 3� -!--
Operator Certification Number: f F1'i If L
Back-up Certification Number:
Latitude: E=]0 0' =" Longitude: =00' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ La yer
❑ Wean to Feeder ILI Non -Layer
❑ Feeder to Finish -- - j
Farrow to Wean Ll <3 o f YS l
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other- - -- -- f
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑Turkc s
❑ Turkcy Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a- Was the conveyance man-made!
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Daia Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: ®I
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 ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
C] Yes
❑ No
❑ Yes
[E No
❑ NA
❑ NE
❑ Yes
E9 No
❑ NA
❑ NE
12/18/04 Continued

Facility Number: gj — yy
Date of Inspection FI -TV
o�
Wa e'Collestion & Treatment
4. Is storage capacity (structural plus storm storage plus beavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3, Structure 4 Structure 5 Structure 6
Identifier: ~ G '0 14 GZ S -y
Spillway?: 9 3 I s J S!
Designed Freeboard (in):
Observed Freeboard (in): s- 3 7 �;_3 3 " 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [M 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
[0 No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA ❑ NE
maintenance or improvement?
Waste Agplication
10. Are there any required buffers, setbacks, or compliance alternatives that need
0 Yes
® No
❑ NA ❑ NE
maintenance/improvement?
It. 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 ❑ FAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window (:]Evidence of Wind Drib ❑ 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
® 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 i
❑ Yes
❑ No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA ❑ NE
7- / e&7ovc- -VrOY. 6.-1- �,,m
1 a V 440A.-+ i3 +U t -t, e-- t-o'r ,
Reviewer/inspector Name 1:` l�/� : '' : u � yt , Ik° ; Phone:
Reviewer/Inspector Signature Qi _2a'1 Date:
12128104 Continued

Facility Number: Date of Inspection
Requited ftords & 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 CA W MP readily available? If yes, check [[ Yes [0 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ CheckIists
❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
.7.o� ,?, t �.o, 1.
❑ Waste Application ❑ Weekly Freeboard Cl 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 © No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes R No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[� No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
© No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
P 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
(9 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
i0 No
❑ NA
❑ NE
A_dihot`al ColismeIItsaii/ioMDfa�ttgse..
12/28/04
12/28/04

Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation !
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: 3'/U Time: ' ; I S" rd
Q Not Operational O Below Threshold
GH"ermitted O'Certii"ied 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: --------
Farm Name: ............ .............................. l... =1 ---4-0 ........ ... County:...
Owner Name• Phone No: 0
.Maihng Address: O , Q .. y 3 J' T N.... ........ -M3_,2
3_,2 ........
Faciiity Contact: .......(,. '2n!X.......�? + iP[3. ....._...Title :....................... .. . Phone No: _..._ -_ ...__....
Onsite Representative: ---- I `_R n_r�� .... Integrator....,_.,Pe .C-SyG--1.s_,.,_.
Certified Operator:._.................SL i11G�' . W c ..� 4?. 1�7C ................... Operator Certification Number:.......
Location of Farm:
04W'ine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude • 6 69
;cCiil'[C1E
Swine x CaaPo niitEon
Wean to Feeder
Feeder to Finish
ow to Wean o y go d
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Discharges & Stream Ipacts
I- Is any discharge observed from any part of the operation? ❑ yes Bfio
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes [Tfio
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ)
[:1 Yes [To
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 RNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Mxo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes MXo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I' / 159- r ......................................................
Freeboard (inches):
12112103 j(rn d Continued
D49ign Cirrellt :-
try_t,C c" ;JPa p lation, _ Cattle
w> -
Layer
Dairy
Non -Layer
Non-Dair
Other
-
_ x Total Designs Capacity
Total SSLW ':
Discharges & Stream Ipacts
I- Is any discharge observed from any part of the operation? ❑ yes Bfio
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes [Tfio
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ)
[:1 Yes [To
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 RNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Mxo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes MXo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I' / 159- r ......................................................
Freeboard (inches):
12112103 j(rn d Continued

!"I
Facility Number
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(f any of questions 46 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancefimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste AvOication
❑ Yes M -Ko
❑ Yes 2.11-C,
❑ Yes [moo
❑ Yes [9 -Ko
❑ Yes B No
10. Are there any buffers that need maintenancelimprovement? ❑ Yes MNo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes [9446
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type L
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAwmyr ❑ Yes [}-Ko.
14, a) Does the facility lack adequate acreage for land application? ❑ Yes ❑-lqo
b) Does the facility need a wettable acre determination? [:]Yes (RNo
c) This facility is pended for a wettable acre determination? ❑ Yes OINO
15. Does the receiving crop need improvement? ❑ Yes E340
16. Is there a lack of adequate waste application equipment? ❑ Yes MNo
Odor lh."es
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below ❑ Yes [c-}'fto
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 0.90
19. Is there any evidence of wind drift daring land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes RNO
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
El Yes Q -Ko
Air Quality representative immediately.
°Cos(rap ayreosorff#t Snrother cammeats. ,
'.Use drawt�s of faetitiy to /better e>ipia�a sztnatta�. (ose;a�ddttsanai pages as teary) Ogeld Copy ❑Fina! Notes ��.
AL
77 7
Reviewer/lInspector Name !' /( //�� -- % � -1 :,,-�
Reviewer/Inspector Signature: Date: 4 3 -/47 -0 Y
12/12/03 K M 13 Continued

f
1 Facility Number: _ Date of Inspection
Required Records & Document.~
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34, Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form E] Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes E iso
❑ Yes �o
❑ Yes O -No
❑ Yes [-No
❑ Yes [two
❑ Yes 04 NO
❑ Yes [;moo
❑ Yes allo
❑ Yes [i�o
av"e's ❑ No
❑ Yes EdA0
❑ Yes [2xo
El -yes ❑ No
M,es ❑ No
❑ Yes Mq<o
M,No violations or deficiencies were noted during this visit. You wit! receive no further correspondence about this visit.
ddtuonal Comments:andlur Drawings
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