820540_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

PlDii-ision of Water Resource`s
Facility Number ©Division of Soil+and Water Conservation
O OEher Ageruey
r
e of Visit: Compliance Inspection Operation Review Structure Evaluation O Technical Assistance
son for Visit: QV; utine O Complaint a Follow-up 0 Referral O Emergency Q Other a Denied Access
Date of Visit: ArrivalTimc:j Departure Time: / ,' County: Region: //QD
Farm Name: //V Owner Email:
Owner Name: J00flaz) Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: ""9G-u.f ion Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude:
Longitude:
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes Jo ❑ NA ❑ NF
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 DW R)
[—]Yes
Ii Agn Current
❑ NA
Design Curren#
Design E5 rent
Swine
r .. y
C1a��pacity Pop t.
VYet Poul#ry
3�J� �, �.
-Cap�a.¢city Pop
;
.Capacity Pop.
❑ NA
[j NE
2. Is there evidence of a past discharge from any part of the operation?
[] Yes
IF.Cattle
❑ NA
❑ NE
Wean to Finish
Wean to Feeder
ceder to Finish
❑ Yes
Non La er
❑ NA
I Dairy Cow
Dairy Calf
[Dairy Heifer
of the State other than from a discharge?
Farrow to Wean
Des n' Current
D Cow
Farrow to Feeder
D.. P,ouEtry,
Ca a�cciid Po '.
Non -Dai
Farrow to Finish
Gilts
La ers
Non -La ers
Beef Stocker
Beef Feeder
Boars
Pullets
Beef Brood Cnw
Turkeys
Other
O
Turkey Poults
Other
IyeM-s�E-9aether
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes Jo ❑ NA ❑ NF
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 DW R)
[—]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)
0 Yes
❑ No
❑ NA
[j NE
2. Is there evidence of a past discharge from any part of the operation?
[] Yes
[r] No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
B N' o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2141201S Continued

F'acili Number: - Date of Inspection:
[311eo
❑ NA
❑ NE
❑ Yes
Waste Collection & Treatment
❑ NA
❑ NE
the appropriate box.
r4. 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
❑ Weather Code
Identifier:
[] Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ;
❑ Yes
No
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Ej- 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
D 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
E�Ko
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[a -<o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[-No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
[Ej`&o
❑ NA
❑ NE
maintenance or improvement?
I I . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [] N ❑ 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 E] Application Outside of Approved Area
�'I'�ra-
12. Crop Type(s): '}ru�Aqu ey_.-'Y
13. Soil Type(s): &C�_ / 41
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Ej"No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes BN ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes L_I No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[311eo
❑ NA
❑ NE
❑ Yes
[�lo
❑ NA
❑ NE
REguired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[:]<o
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[]'1Q_o_
[] NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
E:] Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[] Yes
[a -<o
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Sail Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
[] Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ;
❑ Yes
No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?❑ Yes ❑,7 l�o ❑ NA ❑ NE
Page 2 of 3 2/412015 Continued

FacilityNumber: - D 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 ❑4o ❑ 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 ofan actively certified operator in charge? ❑ Yes [aNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E5No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [J No
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 [�j N
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 No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32- Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 0-- o
Reviewer/Inspector Name: 5 / Y�`-i1�
ReviewerMnspector Signature:
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: �'70 D-25-6 f
Date: &sip%irf
Page 3 of 3 2141201 S

Type of Visit: (D Compt�iance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: aRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1 Arrival Time: Departure Time: =County: v— Region:
Farm Name: �� ir�5 f��.y�yN % Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: X'
rt --7 Title: jk� Phone:
Onsite Representative: ��..�.
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number: o
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 [E�No [] NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑Yes U No
❑ Yes a No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/2015 Continued
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Roultry
Capacity
Pop.
Cattle Capacity Pop.
Finish
Layer
Dai Cow
Feeder
]Non -Layer
Dai Calf
o Finish
-
Dai Heifer
o Wean
Desiga
Current
D Cow
to Feeder
D P,oult ,
Ca aci
P,o
Non -Dai
o Finish
EGilts
Layers
Beef Stocker
Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
Turkeys
Turke Poults
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 [E�No [] NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑Yes U No
❑ Yes a No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/2015 Continued

,.,Facili Number: - p I jDate of Inspection:—
Waste Collection & Treatment
�. 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
allo
[:INA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /9'
Observed Freeboard (in):
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
allo
❑ 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
0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
EA 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 Anolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Q No
[] NA
❑ NE
maintenance or improvement?
I I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus [] Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 0
t3. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ENo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ELNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [S�No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [SkNo ❑ NA ❑ NE
❑ Yes .R No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes _R No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [—]Yes [aNo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21 _ Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and t" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes (j'No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 2/412015 Continued

FaciliNumber: - 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 [B No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
[R No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes [a No ❑ NA ❑ NE
❑ Yes E4 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
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
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
No
❑ NA
❑ NE
Comments (refer to gaeshon #) Explain any YES answers'a d/or-any, additional recommendationsibr any
,.
other comments
Use drawings;of facility to bet#er explain sttuahons=_(us J!k i' onsl �ages`,as necessary,} ,
Reviewer/inspector Name:
Reviewer/inspector Signatui
Page 3 of 3
Phone: �%[!`3T—���5 t
Date:
21412015 i5

. ��-% _
- Divis'ion of Water Resources
Facility Number ®- �`< � O Divisioa of Soil and Water Conservation
® ether Agency
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Eteason for Visit: GrIfo-utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: f—/b Arrival Time: Departure Time: ,`3 County: `���� Region: r70
Farm Name: hOwner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Xi6&•;4' T0/7c Title: A2GV1Ztpr Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:'
Certification Number: 50W�l
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 � No [:]NA [—]NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes Qf-No
[:]Yes M No
❑NA C] NE
E] NA ❑NE
❑ NA ❑ NE
❑NA []NE
❑ NA ❑ NE
Page 1 of 3 2/4/2015 Continued

` Facility Number: - Date of Ins ectiop: (r' rD
❑ Yes
C.No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
fo No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E21 -No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
the appropriate box.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[?jNo
❑ 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
allo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
[:]Yes
❑--No
❑ NA
0 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 �No El 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): _4�2=44/'
13. Soil Type(s): VQ
14. Do the receiving crops differ from those designated in the CAWMP? [] Yes [n No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 3 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes allo EINA . ❑ NE
acres detennination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
C.No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
fo No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
D5 No
0 NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[a No
❑ NA
❑ NE
the appropriate box.
O WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes RNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfal I ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 53 No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes G§ -No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
[] NA ❑ NE
[] NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Faciti Number: - Ip I Date of Inspection: 47` b
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 B No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond 0 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 [DNA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [S No ❑ NA ❑ NE
❑ Yes [2 No ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes JZ No
❑ Yes allo
❑ Yes Cff-No
❑ NA ❑ NE
❑ NA ❑ NE
0 N E] NE
Comments (refer to question #):.Explain any YES answers .and/or _any additional recommendations or any other en -is ?Q
Use:drawings;of.facility to.better explain situations (use additional Pam as necessary):
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: X33-�
Date:
2/4/2014

Type of Visit:C_omlance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (� eutine Q Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other C) Denied Access
Date of Visit: Io Arrival Time:V ►7 Departure Time: 5 0 County: ��,�Jj v� Region:
Farm Name: .o rry,_ (IL Owner Email: - �"--
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: J,K. &P7 ?
Title: Phone:
Onsite Representative:—
Certified Operator:s�-+ c�
Back-up Operator: V r
Location of Farm: Latitude:
Integrator: 7
Certification Number:!
Certification Number: Co `
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other -
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DW R)
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?
E]Yes Z No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
O Yes ❑ No ❑ NA ❑ NE
E] Yes
Diirgn Current
❑NA
Des' n
Current
Design Current
Swine
Ca ace rov.
❑ Yes
a aci Y
Po
Cattle Capacity Pop.
Wean to Finish
La er
D Cow
Wean to Feeder
Nan -La er
DaiCalf
Feeder to Finish
-
Da' Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D . P,oul
Ca "aci�
P,o .
Non -Da'
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Soars
Pullets
NJ
Beef Brood Cow
Turkeys
w
Turkey Poulin
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 DW R)
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?
E]Yes Z No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
O Yes ❑ No ❑ NA ❑ NE
E] Yes
[—]No
❑NA
❑NE.
❑ Yes
6 N
❑ NA
❑ NE
❑ Yes
�Z No
0 NA
❑ NE
Page 1 of 3 21412014 Continued

Facility Number: - Date of Inspection: b
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes n 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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 7 _
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes t�j 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?
❑ Yes
0 No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
Q No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[ t�No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis []Soil Analysis
❑ Waste Transfers
❑ Weather Code
9. Does any part of the waste management system other than the waste structures require
❑ Yes
fD No
❑ NA
❑ NE
maintenance or improvement?
❑ NE
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
JZ No
❑ NA
D 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 Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12, Crop Type(s):
13. Soil Type(s): 9:
14. Do the receiving crops direr from those designated in the CAWMP? ❑ Yes F1 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes M No ❑ NA E] NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [ffNo ❑ 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
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
S�J-No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
0 No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement'? If yes, check the appropriate box below.
❑ Yes
64 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
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
0 No
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ff No ❑ NA ❑ NE
Page 2 of 3 2/412011 Continued

Facili Number: - Ds ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes allo ❑ 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 Zpo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes 5],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:
❑ Yes �o ❑ NA ❑ NE
❑ Yes Wo ❑ NA ❑ NE
[:]Yes �o ❑ NA D NE
❑ Yes T7�No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes � No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes C![,No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [5 -No
E] NA ONE
❑ NA ❑ NE
❑NA ❑N
Commcnts.(refer to question ft Explain any YES answers and/or any additional recommendations or anyuother comments
Use -drawings of facilityto better explain situations (use additional pages as necessary). k�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 901 f:q33JOrto
Date: ES` ZG -15-
21412011

IType of Visit: GrComph ce Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint O Follow-up O Referral O Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: ! p c'7 County: Region:
Farm Name: Owner Email:
,212
Owner Name:ae-alud Phone:
Mailing Address:
Physical Address:
Facility Contact: Xj iCoc./ fftT.9+ _ Title: AV-C�, ,i Phone:
Onsite Representative:
Certified Operator:
Back-up Operator: �-t
Location of Farm:
Latitude:
Integrator: c
Certification Number:
Certification Number: 17�D
Longitude:
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes D�]_No ❑ NA ❑ NE
[:]Yes ❑No
(:]Yes ❑ No
❑ NA ❑ NE
❑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 allo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes ® No ❑ NA E] NE
of the State other than from a discharge? T
Page I of 3 2/4/2011 Continued
Design Current
+Design Current . -
Design C•nrrent
Swine
Capac ty Pop
'Vet Poultry
Capacity .i P
Cattle Capacity Pop.
-.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
eeder to Finish
-:.. __
Dai Heifer
Farrow to Wean
Desi Currenf
Cow
Farrow to Feeder
D : P,aul
Ca aci- P
Non -D
Farrow to Finish
Layers
Beef Stocker
Gilts
Boars
"
Non -Layers
Pullets
Turkeys
Beef Feeder
I Beef Brood Cow
Other
Turkey Poults
Other
JIM
Other
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes D�]_No ❑ NA ❑ NE
[:]Yes ❑No
(:]Yes ❑ No
❑ NA ❑ NE
❑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 allo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes ® No ❑ NA E] NE
of the State other than from a discharge? T
Page I of 3 2/4/2011 Continued

Facility Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 0-t-
5.
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Z,No ❑ NA ❑ NE
❑No []NA ❑NE
Structure 6
❑ Yes �allo ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes R 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 2LNo ❑ 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, andlor 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 AppNeation
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes DK(No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? [f yes, check the appropriate box below. ❑ Yes CRNo ❑ 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): X� It_/ D✓ �✓ sir'J+
13. Soil Type(s): 177et L LU.
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 E6 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes M No [3 NA [—]NE
❑ Yes Cig-No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 54 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 0 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 ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 62 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 214/?011 Continued

Facili Number: - Q Date of Ins ection: J
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes N No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes J�j 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 EQ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ELNo ❑ NA ❑ NE
Other Issues
2$. 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 CAW M P?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
[]Yes KNo ❑ NA ❑ NE
❑ Yes E25,No ❑ NA ❑ NE
❑ Yes Ea No ❑ NA ❑ NE
❑ Yes 54No ❑ NA ❑ NE
❑ Yes R No
❑ Yes UkNo
❑ Yes [&No
❑NA F] NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: 770-4J_T3310
Date:
1/4/1011

Type of Visit: CErCompliance Inspection--(D-Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (� xoudue 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: /y3 Arrival Time: ► Departure Time: D a County:--�11fl �--�
-� ..,
Farm Name: D4. f6t"-rrt' Owner Email:
1
Owner Name: --l� r(�pp+l �fl /7 � Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: , .J Title: OlGzln t- P-- Phone:
Onsite Representative: Integrator:
Certified Operator: .�a -- Certification Number: /CA96 I
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
E] Yes [a No ❑ NA ❑ NE
❑ Yes
Design Current
# - �'
Design
Current
- Design Current
Swine
Capacity Pop.
Wet P ultryCap
qty
Pop.. 31111114
Cattle Capacity Pop.
inish
La er
Dai Cow
eeder
Non -La er
Dai Calf
ish
r
£`
Dai Heifer
rFeedertoFinish
Weannrret
DCow
Feeder
D pPoult '
ii aei
P,a .
Non -Dairy
Finish
La ers
Beef Stocker
Layers
lBeef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
E] Yes [a 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 [DNA ❑ 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 allo [DNA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

Facility Number: Date 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
Structure l Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 49(OV
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
E No D NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes 53 -No ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
[:]Yes
59 -No
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
� No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
bg-No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit'?
❑ Yes
5g.No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NA
❑ NE
the appropriate box.
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
,
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[3 -No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes C8 -No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable
_Crop
. jWiindow��, ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): - k5111. dc�►���'Y� _. — - —
13. Soil Type(s):Gr
14. Do the receiving crops differ from those designated in the CAWMP? 0 Yes [pj No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes EK No [INA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes S No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[K 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
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
a 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 PLNo
❑ 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 [S�No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [54No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection: ,
24. Did the facility fail to Calibrate waste application equipment as required by the permit? ❑ Yes [�kNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo ❑ 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:
25. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes J4 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No [:INA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes f 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? 0 Yes allo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes fR[ 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
CRNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond M Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
JZ No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
5kNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
5LNo
❑ NA
❑ NE
Comments (refer to question f: Explain any YES answers and/or any additional recommendations or any outer comments.' f"
Uge,drawings,bf.facility . to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �` 3
Date: r-13
2/412011

Type of Visit: @Compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: L-1 Arrival Time: Departure Time: vn County: y Region: t2 V
Farm Name: 1?nA en y 'i �j s� �QrN---� Owner Email:
Owner Name: ` Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: z5gr�yr Y ✓
Integrator: fl- 1
Certification Number:
Phone:
Onsite Representative: �5"O- �
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharges and Stream Impacts
I - Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance than -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 [No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes 0 No
❑ Yes No
[:]Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 214/2011 Continued
DeS�gni� rCurrentic
Design Current
Design LC.urrent
Swine
Capacity Pop `'' }Wet Positry
Capacity
Pop
Cattle Capacity Pap.
Wean to Finish
La er
ti
Dairy Cow
Wean to Feeder
Non -Layer
I
Dairy Calf
Feeder to Finish
-
- -
-
Dairy Heifer
Farrow to Wean
Design
'Current
Dry Cow
Farrow to Feeder
Dr Poul
Ca aei
Pio -
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
TUwffr ey 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:
a. Was the conveyance than -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 [No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes 0 No
❑ Yes No
[:]Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 214/2011 Continued

Facili Number: - O Date of inspection:
❑ Yes
® No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
allo
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
F[ No
❑ NA
0 NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
the appropriate box.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): }
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes
M No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
CB -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
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
❑ 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 j!jNo ❑ 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):rvy�
13. Soil Type(s): Met G r -T
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [allo ❑ 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 allo ❑ 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
allo
❑ NA
❑ NE
Required Records & Documents
l9. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
allo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
EKNo
❑ 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 I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [gNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes VS -No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: - Ds ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No 0 NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3.No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Doippplication
face tile drains exist at the facility? If yes, check the appropriate box below_
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
5�_No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
[—]Yes
53 No
❑ NA
❑ NE
❑ Yes [KNo ❑ NA ❑ NE
❑ Yes [21 -No ❑ NA ❑ NE
�ft-1
Yes �-No ❑ NA ❑ NE
❑ Yes JEJ No
❑ Yes M No
0 Yes [B -No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers andto-any additional recommendations or_any-other comments' ��j
Use drawings of facility to better explain situations (use additional pages as.necessary). K=
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/412011

Type of Visit: Q<o=outine
nee Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ®f Arrival Time:
; OD Departure Time: ► County:'�...c:gaE sr� Region:
Farm Name: EE40rl-eys f7ivp 2=�a►�n � 1 Owner Email: �—
Owner Name: "-e y Phone:
Mailing Address:
Physical Address:
Facility Contact: Ile g 0'7 r,V Title: Phone:
Onsite Representative: s
Certified Operator:-�-pp� gp ray
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number: /ZeYlj
Certification Number:
Longitude:
Discharges and Stream Imaacts
1. Is any discharge observed from any pari of the operation?
Design
Current. �° "
Design
Current
Design Current
Swine
Capacity
Pop. WetMull ry
Capacity
Pop.
C*attle Capacity Pop.
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
-
❑ No
Wean to Finish
❑ NE
Layer
Dairy Cow
Wean to Feeder
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
Non -La er
❑ No
❑ NA
Dairy Calf
eeder to Finish
❑ Yes
�-o i"
❑ NA
❑ NE
Dai Heifer
Farrow to Wean
allo
- `.
Design
Cu rrent-
Dry Cow
Farrow to Feeder
D gPoul
Ca aci
1?op.
Non -Dairy
Farrow to Finish
Layers
k Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
-` Turkeys
Other"
Turkey Poults
Other
Other
Discharges and Stream Imaacts
1. Is any discharge observed from any pari of the operation?
❑ Yes
[RNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
allo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

Facili Number: - n Date of Inspection:
Waste Collection & Treatment
#*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):
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
[S 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
[S 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
Rg.No
❑ NA
❑ NE
maintenance or improvement?
Waste Aonlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[g No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes n 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):-Be'/—MJ'2 _
13. Soil Type(s): _ Al a e, AU,, �
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑. NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA ❑ NE
❑ 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 ail components of the CAWMP readily available? If yes, check ❑ Yes [allo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes allo
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes C�-No
DNA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facili Number: -Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? D Yes allo. ❑ NA ❑ NE
2 5. 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 provide documentation of an actively certified operator in charge? ❑ Yes [ANo ❑ NA ❑ 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
and report mortality rates that were higher than normal?
23. 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 CA WMP?
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 2 No ❑ NA ❑ NE
❑ Yes Callo ❑ NA ❑ NE
❑ Yes [allo D NA ❑ NE
❑ Yes
C,No
❑ NA
❑ NE
❑ Yes
(0 No
❑ NA
❑ NE
❑ Yes
C,No
❑ NA
❑ NE
❑ Yes
CB -No
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments a vs
Uie drawines of facility to better explain situations fuse additional oaaes as necessarv). -t
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: M300
Date: 6 1z
2/4/2011

tI
it,
A
Type of Visit O'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit I911fo—utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: S L? Departure Time: County: ��`~ Region:
Farm Name: .&ezr_a/ azd!LL Owner Email:
Owner Name:_ l imA _ 3 b `I+ff _ Phone:
T --
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: XJd
Certified Operator:
Back-up Operator:
Phone
No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =' ❑ ' ❑ « Longitude: ❑ ° =' = 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 E No [:INA ❑ NE
❑ Yes
Design Current
Design Current
Design C►urrent
Swine Capacity Population
Wet Poultry Capacity Population
Cattle C*apacity Population
❑ Wean to Finish
10 Layer
❑ Dai Cow
❑ Wean to Feeder I
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish
❑ Yes
❑ No
❑ Dairy Heifer
❑ Farrow to Wean
❑ NA
Dty Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ NA
❑ NE
❑ Non --Dai
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Poults
Numbeuce%jilill
❑ Other I
I[j I I
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)
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 E No [:INA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[K No
❑ NA
❑ NE
❑ Yes
®-No
❑ NA
❑ NE
Page 1 of 3 12/28/04 Continued

0
Facility Number: — Date of Inspection��
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard? -
Structure I Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes VNo
❑ Yes ❑ No
Structure 5
0 N [:1 NE
❑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 E3 No ❑ NA ❑ NE
(ic/ 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?
Ryes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
X,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
NNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
f2�No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below_ ❑ Yes ONo ❑ 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) e at �
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?
❑ Yes M No
❑ Yes DINo
❑ NA ❑ NE
0 N El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes )KL No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes nNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes fallo ❑ NA ❑ NE
Reviewer/Inspector Name Phone• p
Reviewer/Inspector Signature: Date:O/D
Page 2 of 3 12/28/04 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E!�No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes jQ 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
BNo
❑ NA
[:1NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
9No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
C.No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
IiNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
f,No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
9 N
❑ 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
j,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
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
PkNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P.No
❑ NA
❑ NE
Additional Comments aadlor Drawings: `'
Page 3 of 3 12/28/04

a
Type of Visit (D.Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �� �' A rival Time: rD Departure Time: ��.� County: Region:
Farm Name: CQ�•�-�-� Owner Email:
Owner Name: Qj&f- WID Q r ZPof Ll Phone:
Mailing Address:
Physical Address: If
Facility Contact: _ Title: Phone No:
Onsite Representative: ��a.fr Integrator:
/�--
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [� o =6
=is Longitude: =° 01 ="
Design Current
Design Current
Design Current
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
tPoultry Capacity Population
Cattle Capacity Population
jmyw-v�a❑ La er
a. Was the conveyance man-made`?
❑ Dai Cow
❑ No
❑ Non -La er
❑ NE
❑ Dai Calf
❑ Yes
❑ No
❑ NA
❑ Da Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Layers
❑ Non -Dairy
❑ Farrow to Finish
Non -La ersPullets
❑ Beef Stocker
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
ElBeeCFeeder
POGilts
Boars
❑ NA
❑ Beef Brood Co
:: t, - -
❑ Turkeys
[&No
Other
❑ TurkeyPoults
other than from a discharge?
❑ Other
❑ Other I
Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
®Ao
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made`?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
D .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

Facility Number: Date of Inspection?
NVaste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. Ifyes. is waste level into the structural freeboard?
Struclure 1 Stmeture 2
Identifier:
Spillway?:
Designed Freeboard (in)_
Observed Freeboard (in):
StruCturl' 3 Structurc -1
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 ;9 -No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Struk;ture Slwcture 6
❑ Yes ['No ❑ NA ❑ NE
❑ Yes %No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
VNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
V 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
�9 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that. needYes
❑
(No
El NA NE
maintenanc hmp'rovement?
11. is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
I%-,' 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) / t-
13. Soil types)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
F -A No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[5—d No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
El Yes
XNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�4No
❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
yNo
❑ 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:
Reviewer/Impector Signature: 0Z Date:
o 1&Z8194 [_on hued

Facility Number: — Date of Inspection
r
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 [3No ❑ NA ❑ NE
the appropriate box. ❑ WIJP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [KNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ 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
[9 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
Q.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
EgNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[SNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2 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
J5� 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
C,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
4No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
R No
❑ NA
[__1 NE
Additional Comments anill, rj , raw�ngs,
]W&10a
]W&10a

i ype of visit (e -Compliance Inspection 0 Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �e,-2yffrArrival Time: i Departure Time: . County-- Region:��
Farm Name:f�,��� I- rgo_ /At ! 1 Owner Email:
Owner Name: `` u ((/~ V ^ er V Phone:
Mailing Address:
Physical Address:
Facility Contact: t Title: Picone No:
Onsite Representative:f �;--Q— Integrator: 41rz� �+s� QZJ 1
Certified Operator: —� Operator Certification Number: 1 / om, t 1
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = I ❑ d Longitude: =0=,
o❑, ❑ 4I
Design Current
Design. Current"
.. Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capa��ty Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer I
❑ Dairy Calf
❑ No
[� Feeder to Finish
Dry Poultry
❑ Dairy Heifer
❑ D Cow
❑ Yes
❑ Farrow to Wean
❑ Farrow to Feeder
❑ NE
- -
❑ La ers
❑ Non -Dairy
❑ Beef Stocker
❑ Farrow to Finish
❑ Gilts
❑ Non -Layers
u
❑ Pllets
❑ Turkeys
El Beef Feeder
❑ Beef Brood Co
❑ Boars
❑ No
Other
❑ Turkey Poults
❑ Other
Number of Structures: 1I
❑Other11
J,No
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
A�[No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
J,No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
JZ[No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28104
Continued

W ,
Facility Number: 5 Date of Inspection ®�S/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes CKNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: cy
Designed Freeboard (in):
Observed Freeboard (in): 3-3
5_ Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes JZ No ❑ NA ❑ NE
(icl 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 J,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 CSNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes J -No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes A 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)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�@ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ yes
®- No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
54 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
,-NO
❑ NA
❑ NE
Comments (refer to'gaestion #): Explain any YES answers and/or any.. recommendations or any other comments:
Use drawings of facility to better explain sitaations..(use additional pages as necessary).
Reviewerllnspector Name r(/' r�� Phone:
Reviewer/Inspector Signature: Date:
rage 2 of 1 12/28/04 Continued

Facility Number: Date of Inspectiond
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [2�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes JgNo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes V.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
;,No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
O&No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
U,No
❑ NA
❑ NE
25_
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
V -No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge!
❑ Yes
01 -No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
9 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
MNo
❑ 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
W 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
5d 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
N No
❑ NA
❑ NE
33.
Does facility require a follow --up visit by same agency?
❑ Yes
J4 No
❑ NA
❑ NE
Additional: Comments and/or Drawings:
Page 3 of 3 12/28/04

U1,41
Meh inion of Water Quality S 4 ---
Facility NumberELKI—�]0 Division of Soil and Water Conservation -30-7
0 Other Agency
Type of Visit Z<mpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit &Iio'utine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 7- t -D Arrival Time: 7'"D O Departure Time: County: Region:
Farm Name:
�A�`L' ✓4 Owner Email: C�
Owuer Name• , e lft'no" � �Z� _ Phone:
Mailing Address:
Physical Address:
Facility Contact: a Oma? Title:
Onsite Representative:
Certified Operator:
Operator:
Rack -up Operator:
Location of Farm:
Swine
Phone No:
Integrator: y(/t2�
Operator Certification Number:
Back-up Certification Number:
Latitude: =0
❑ 1 ❑ u Longitude: ❑ o ❑ � ="
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish j IQ Layer
❑ Wean to Feeder 10 Non -Laves
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Lavers
❑ Pullets
❑
Turkeys
❑ Turkey Poults
❑ Other
Discharges & 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? (I f yes, notify DWQ)
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Col
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: Tj
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ l'cs `0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NF,
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes jo No ❑ NA ❑ NE
❑ Yes M No El NA ❑ NE,
12128/04 Continued

IFacility Number: 9S—
Date of Inspection t1" 7
Waste Collection & Treatment
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
DD No
❑ NA ❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) Iess than adequate`?
❑ Yes
,...�
EK
❑ 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:
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
Spillway?:
❑ NA ❑ NE
15.
Does the receiving crop andlor land application site need improvement? ❑ Yes
0 No
Designed Freeboard (in): %
16.
Did the facility fait to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
RNo
❑ NA ❑ NE
Observed Freeboard (in): -3y
Does the facility lack adequate acreage for land application? ❑ Yes
N No
❑ NA ❑ NE
18_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
VN No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
M No
❑ NA
❑ NE
through a waste management or closure plan?
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 Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
14 No
❑ NA
❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
DD No
❑ NA ❑ NE
❑ Excessive Ponding [:]Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
Reviewer/Inspector Signature: Date: L'~
❑ PAN ❑ PAN > 10% or l 0 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 (S) 'e
,,wae6
13.
Soil type(s) ^s G
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
[I No
❑ NA ❑ NE
15.
Does the receiving crop andlor land application site need improvement? ❑ Yes
0 No
❑ NA ❑ NE
16.
Did the facility fait to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
RNo
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
N No
❑ NA ❑ NE
18_
is there a lack of properly operating waste application equipment? ❑ Yes
RNo
❑ 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):
Reviewer/InspectorName "wr/-e 1A ,,4, Phone:
Reviewer/Inspector Signature: Date: L'~
I2/Z8/94 Continued

Facility Number: Date of Inspection
Renuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Pen -nit readily available? ❑ Yes a No ❑ NA ❑ NE
20" Does the facility fail to have all components of the CA WM P readily available? If yes, check ❑ Yes 5a No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Docs record keeping need improvement? If yes, check the appropriate box below. ZYes ❑ 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 ❑ Weathcr Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
PO 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
[W No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
i4 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
14 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
UNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWW?
❑ Yes
NJ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Rj 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
0 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3l.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
0,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
KN*
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
&No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12/28104

vision of Water Quality
Faciiity.,Number J Go*q eon of Soil and Water Conservation t
z
.. Q40ther Agency.
L*
Type of Visit PfCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ® Arrival Time: Departure Time: ,� '� County: Region: 0"--R�
Farm Name: Zongz 44Owner Email:
Owner Name: 1)/I rLuo"a Phone:
Mailing Address: G ,5 V77,1 ,I �1 eL Zjj-V.--- IV G --
Physical Address:
Facility Contact: _9-v i�lld 13 Oh ��„ Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
"Swine
�J❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Other
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =' [—]' ❑ Longitude: =) ❑ = N
Design Current Design Current
Capacity Population Wet'Poultry `sCapacity Population
❑ Layer
❑ Non -Layer
i
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
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?
�hds
Cattle Capacity Popul
likation
_
❑ Dairy Cow
❑ Dairy Calf
❑ Daia Heifer
EIDTy Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures_'
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 I of 3
❑ Yes �@ No ❑ NA EINE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
Q No
❑ NA
❑ NE
❑ NA
[:IN E
❑ Yes
No
❑ Yes
"O' No
❑ NA
❑ NE
❑ Yes
CKNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
C* 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑Yes
CKNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
JRNo
❑ NA ❑ NE
.Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):D
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
54 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
[RNo
❑ 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
JO No
❑ NA ❑ NE
8. Do any of the stuetures 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
.4 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑Yes
Ej No
❑ NA ❑ NE
maintenance/improvement?
IL . Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
®No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside
of Area
12. Crop type(s) ac r^ -
13. Soil type(s) Ma lfJo
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[] Yes ® No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
6wol&,--
❑ Yes 1A No ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
Reviewer/Inspector Name ���p�*� Phone: L
Reviewer/Inspector Signature: Date: li="tl
12128104 Continued

Facility Num !_,: — Date of Inspection
1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [KNo ❑ NA ❑ NE
20. Does the facility fai I to have all components of the CA WMP readily available? if yes, check ❑ Yes RLNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q�-No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [9No ❑ NA ❑ NE
23. If selected. did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes IR No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
25- Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
tgNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
14 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
CANo
[INA ❑ NE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
NJ No
❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
(] Yes
g 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
C,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?
E-1 Yes
No
El NA El NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[&No
❑ NA ❑ NE
Adiiiti 41 is rmrtents andloir Drarvlr
11!28104
11!28104

® Division of Water Quality
Facility Number ,�� 0 0 Division of Soil and Water Conservation
D Other:
FF
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: LOQ, i Departure Time: County: 5a� A-) Region:
Farm Name: Owner Email:
Owner Name:. Phone:
Mailing Address: �G 3S �r�rine uJfIG._ C/�'4-."' _"V r 3z9
11
Physical AddressJ'KJ ?D .9
Facility Contact: , Title:
Onsite Representative:_
Certified Operator: — e5 icAi _
Back-up Operator:
Location of Farm:
Phone No:
Integrator: Ar-MA*ax C_
Operator Certification Number: -A 194 C,/_
Back-up Certification Number:
Latitude: ❑ o =.
Longitude: 0 0 =' =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish tjkv jVq el
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non-Layet
Dry Poultry
Non -L.
Pullets
TurkeN
Poults
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)
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Design Current
Capacity Population
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 [A No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
. EINE
❑ Yes
❑ No
[:INA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128/04 Continued

Facility Number: g.Z — rya Date of Inspection
�1. f"'--_. Qvrvcr 3laF�4 44t.) is
Waste Collection & Treatment
�a.x�.. %hcr� ceesi�r..
� kv e jor, Gk
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:
NJ No
❑ NA
Spillway?:
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Designed Freeboard (in): 19 Ji
❑ NA
❑ NE
Observed Freeboard (in): vlVD ii
-❑ Yes,[1a
No
❑ NA
❑ NE
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.)
❑ NE
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
5d 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
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
R No ❑ 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
[)9 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No ❑ NA [:1 NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
19 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ]0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s) r- &-p. uag?'A ,da--�-w e-
�1. f"'--_. Qvrvcr 3laF�4 44t.) is
w viv�;rrf
�a.x�.. %hcr� ceesi�r..
� kv e jor, Gk
� h�.e-e-4- e-,
i cg6Pki �y a<
rcYLrt c:wd� d�Fr�..�.
13.
13. Soil type(s)
Reviewer/Inspector Name F—Z
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
NJ 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,[1a
No
❑ NA
❑ NE
17. Does the facility tack adequate acreage for land application?
❑ Yes
M No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[*No
❑ NA
❑ NE
�1. f"'--_. Qvrvcr 3laF�4 44t.) is
w viv�;rrf
�a.x�.. %hcr� ceesi�r..
� kv e jor, Gk
� h�.e-e-4- e-,
i cg6Pki �y a<
rcYLrt c:wd� d�Fr�..�.
Reviewer/Inspector Name F—Z
f Z
Y Phone:
Reviewer/Inspector Signature:
Date:
12128104 Conlinued

Facility Number: Date of Inspection
Required Records & Documents
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 [)D No ❑ NA ❑ NE
the appropirate box.
❑ WUP [:1 Checklists ❑Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [9 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [� 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
(f No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
04
*No [ NA
NNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
2T
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
X NA
® NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[P 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
0 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
33_
Does facility require a follow-up visit by same agency?
❑ Yes
[] No
❑ NA
❑ NE
Additional Comments and/or Draw n s
12/28/04
12/28/04

of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit • Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of visit: -/2 - U T-une:
� 5 D
Q Not Operational Q Below Threshold
Permitted Mtertified 13 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: ......... ..... •••••••
Farm Name: Qo e� u--f!..•II.. _.... ........... County:
Gj/d - Sga- LSI
Owner Name: .....W Q��¢Q ,�u-,� p / Phone No: 9/0S9� �SOId
.Mailing Address: _. �%8.... ....... °�!I. e S.Y.iI i{....!Lt� { 1 ?lt N - -- -n 3 2 .9 . _.. _......
Facility Contact: ..... Title: . Phone No: Sri G 87
Onsite Representative; ......
_:�vrwPsl Integrator:...Pim, 7� Gc�C.... ........._.__.W_.._...—_. --
j c ......
Certified Operator.._, , , p�.( h,.a�.f� -.. JOMA ..W`--- Operator Certification Number:, ...............___.__.-----.
Location of Farm:
EIZ'w4ne ❑ Poultry ❑ Cattle ❑ Horse Latitude �• ��
��� Longitude �• �� ���
Design current ;- ,Design-"
Current= -
_ -
C,n-rent z
nese _
:.
Swine..- -CapacityPb ulatioir.=_ ouitrY.._. W.- Ca ' ci
Pa �atioo
Wean to Feeder ❑ Layer
I
❑ Dairy
-'Ewer
to Finish t ❑ Non -Layer
1 ❑ Non -Dairy
Farrow to Wean
Faaow to Feeder Other
-
Farrow to Finish
Total -DeMLFn� CaPactty
E
Gilts
€_
;
Boars
o
of
:Tai:3SLW
I
Nmnber of Lagoons77,
_
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
❑Yes B -1q_6
Discharge originated at. ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes [31Zo
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 Q -No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 0-M
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes [�
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier
Freeboard (inches): 50
12112103 Continued

Facility Number: 8_� — y o
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
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 Application
10. Are there any buffers that need maintenancefimprovement?
❑ Yes �o
❑ Yes B'MO
❑ Yes 0"fgo—
❑ Yes EfN—o
❑ Yes [Tlgo
❑ Yes [5' o-
11.
II. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes UNo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
,em /3
12. Crop type4�.s Sa-i��1 G•u,'n 1 4�aYe) Qe..+,v�4 �9.a.ss
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes B -No
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
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
Air Quality representative immediately.
❑ Yes GNo
❑ Yes ado
❑ Yes EkNo
❑ Yes Eallo
❑ Yes BNo
❑ Yes ❑ No
❑ Yes 0 -No
❑ Yes g No
❑ Yes O -No
Comments ref "u
( er to.question #) Explain aay YES answers�aud/ar arecommeudat.on or any othe oom rents, . x r
:Use drarviags-of fsa)lity to better ezplata sitoatt9s. (use sddzttuxtal as necessary) field Copy E]Final Notes
p —
Reviewer/Iuspector Name
k..
Reviewer/Irtspector Signature: ^B Date: .a
12112103 Continued

Facility Number: 8:1- _sy p Date of Inspection
Required Records & Documents
21. Fait 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?
25. Fail to notify regional DWp 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?
INPDES 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 ❑ Crap Yield Form [:]Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes 0'go-
❑ Yes [3190
❑ Yes d1�o
❑ Yes [3Vo
❑ Yes EjV6
[:]Yes [�No
❑ Yes Erf�o_
❑ Yes ONO
❑ Yes L1No
❑ Yes B1<0—
Yes
1 ?oYes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes []No
❑ Yes ❑ No
Q No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ff
ddttional �m[LLLntS u+{M w{IlpUg
!/ �o4ry yaed yfass cover C.rvMrl
e 'Io�il�nr� �onC.
e corels use
� ••, 5 ,v e // keI04'
P
12112103

FacilityNeer. 2 -.!514
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Date: _ 3 (2
Time: /D;-') _5�_
General Information:
Farm Name: - F -G 11 County:Zxmd DSv-. �.
Owner Name:, cc�.F, a _ gof%Q M Phone No: _�1�=S'S
On Site Represz.ntative: Cke.r. fro Integrator. rP
Mailing Address: //Rt G &Z -23r�0
73
Physical AddressA=ation: r^ fie Qar+1 o-� R„,$s,r o toy r 4
Ste.13
_`+
Latitude: 1 I Lon 'rude: I 1
caution Description: (based on design characteristics)
Type of Swine No. of Animals. 7jpe of Poultry No. of Animals Type of Cattle No. of Animals
0 Sow 0 Layer Cl Dairy
O Nursery 0 Non -Layer 0 Beef
8Feeder 6p
OtherType of livestock: Number of Animals:
Number of Lagoons: (include in the Drawings and Observations the freeboard of each lagoon)
Facility Inspection:
Lagoon
Is lagoon(s) freeboard less than I foot + 25 year 24 hoar storm storage?:
Yes U
No Q
Is seepage observed from the lagoon?:
Yes ©
NoV
Is erosion observed?:
Yes 0
No OB
Is any discharge observed?
Yes ❑
No J8
Q Man-made ❑ Not Mon -made
Cover Crop
Does the facility need more acreage for spraying?:
Yes ❑
No (4
Does the cover crop need improvement?:
Yes ❑
No (�
( list the crops which, meed improvement)
Crop type: C,)=Zu Acreage:
Setback Criteria
Is a dwelling located within 200 feet of waste application?
Yes ElNo
&
Is a well Iocated within 100 feet of waste application?
Yes a -,No
-
Is animal waste stockpiled within 100 feet of USGS Blue Line Stream?
Yes 0
Non
Is animal waste land applied or spray irrigated within 25 feet of Blue Line Stream?
Yes a
No
AOI — January 17,1996

t �
Maintenance
Does the facility maintenance need improvement? Yes Q NoA
Is there evidence of past discharge from any part of the operation? Yes ❑ No JR
Does record keeping need improvement? Yes ❑ No Ip
Did the facility fail to have a copy of the Animal Waste Management Plan on site? Yes ❑ No JR
Explain any Yes answers:
cc. Facility Assessment Unit
prawinzs . or Observations:
AOI — January 17,1s6
Date: -� 13
Use Attachments if Needed
., --.. � -. - � . �'rT r„+eq�r_ c.��_ -'n er:tt�tV:t��' r.YrrtT ri-wr•..,���..�;+�:,-,-,-.if�'R�:•- ...: -.

t
Site Requires Immediate Attention:
Facility No. $� ^�
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 7 - 4 1995
Time: 1 2c /:;,
Farm Name/Owner: Wz"11
Mailing Address: &6 C"• h"r,
;7O'31ZS,
County: 5f'49V$e41 _ _ _
Integrator: r< 1) 1 •'/r k Phone:
On Site Representative:. C/) Phone: I d -9-Z
Physical Address/Location:_ Wit- /Wwc/ �L, Tuxw_fief'40L 1"41
i '/1 p n/ /?-V kr4rt.1V 44
Type of Operation:
Design Capacity: _
DEM Certification
Latitude: °
Swine Poultry Cattle
Number of Animals on Site: '-f 60
Number.
ACE DEM Certification Number: ACNEW
Longitude: N 6 S /S ' /410
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches)
Was any seepage observed from the
Is adequate land available for spray?
Crop(s) being utilized:
Does the facility meet SCS
No Actual Freeboard: Ft. Inches
;s)? Yes or ]`_OAVas any erosion obse ed? Yes or t
r No s the cover Tp adequate?s or No
minimum setback criteria? 200 Feet from Dwellings? es or No
100 Feet from Wells? je.Jor No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes orsd
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or 60
Is animal waste discharged into water of oe state by man-made ditch, flushing system, or other
similar man-made devices? Yes or(No) 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:
Inspector Name
,o
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

r + A
P4je 37
UMTS C ROL330► DEPAATHMU OF , MALTS a NATMRAL RESOMRCES
DI`TISION OF ENVIRONMENTAL MANAGEMENT
Fayetteville Regional Office
Animal Operation Compliance Inspection Form
All questions answered negatively will be discussed in sufficient detail in
the -Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
SECTION I
Animal O eration -R n -i s�
Horses, cattle, swine poultry, or sheep
!. Does the number and type of animal meat or exceed
the (.0217) criteria? (Cattle (100 head),
horses (75), swine (250), sheep (1,000), and
poultry (30,000 birds with liquid waste
system)) -
2. Does this facility meet criteria for
Animal Operation REGIS'T'RATION?
3. Are animals confined fed or maintained
in this facility for a 12 -month period? -
4. Does this facility have a CERTT= ANI!lAI.
WASTE IgMGMCWT PLAIii?
5. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
6. Does this facility meet the SCS minimum
set -back c_iteria for neighboring houses,
wells, etc?
T I N I COMMENTS
V1,
d
W
�M7PEGi�IDH rDA3'
�..F1iRrS NLS
T,,.f.7�,+r..-..<.e��.��+np.,.
'""'wra., •,,,,:..V�d',,. a� "f�..- +-cfG ,'A iDRES 7: ��;y,`°c�i• nw'P> +�"�` ww , . TWA
Co e)o Z oam�w ;7oV j�
55.26o
All questions answered negatively will be discussed in sufficient detail in
the -Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
SECTION I
Animal O eration -R n -i s�
Horses, cattle, swine poultry, or sheep
!. Does the number and type of animal meat or exceed
the (.0217) criteria? (Cattle (100 head),
horses (75), swine (250), sheep (1,000), and
poultry (30,000 birds with liquid waste
system)) -
2. Does this facility meet criteria for
Animal Operation REGIS'T'RATION?
3. Are animals confined fed or maintained
in this facility for a 12 -month period? -
4. Does this facility have a CERTT= ANI!lAI.
WASTE IgMGMCWT PLAIii?
5. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
6. Does this facility meet the SCS minimum
set -back c_iteria for neighboring houses,
wells, etc?
T I N I COMMENTS
V1,
d

� � I
a
tield Site anaaeme�
I. To animal was.Lw sLucV11M or iagoon
construction within IOD ft. of a OSGS
Map Blue Line Stream?
2. Is animal waste land applied or spray
irrigatCA wi th4 n 25 #t. of a UOGO asap
Blue Line Stream?
3. Does this facility have adoquat• acreage
on which to apply the waste?
4. Does the land application'sits have a
cover crop in accordance with the
C3FtTIFIGTIs.X+i Px,&W
5_ Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar man-made dtvices?
6. noes the animal waste management at this
farm adhere to Best Management Practices
( BMP) of the approved W T M CATION7
7_ Does animal waste lagoon have sufficient
freeboard? How much? (Approximately )
B. is the general condition of this WO facility,
including management and operation,
satisfactory?
SECTION IY
Qmments

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