820612_INSPECTIONS_20171231

NUH I H LAHULINA
Department of Environmental Qual

S i MS 6 TUNS
ioTof Water Resources
=CNTM-2=1_ K al _(9 Ea Division of Soil and Water Conservation
Q Other Agency
Type of Visit:�ommpliance Inspection Operation Review Q Structure Evaluation Q Technical Assistance
N
Reason for Visit: I Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: I S07ut,�- ISI Arrival Time: $ Departure Time: ; 6p County: S M NCOv Region:Fl
Farm Name: S'T i� U t:� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: C UV41i t3 r -,r -w �`y Title:
Phone:
Phone:
Onsite Representative: l ` Integrator: 1k 6 _s
Certified Operator: Certification Number: L% j b
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Finish
Design Current
Capacity Pop.
Wet Paoliry
Layer
Desigp
Capacity
Current
Pap.
Design Current
Cattle Capacify Pap.
Dai Cow
Feeder
-Layer
Dai Calf
o Finish
o Wean
o Feeder
to Finish
EBoars
a
D , P�ou!
La ers
Design
Ca aci
Current
P,o
Dai Heifer
Cow
Non -Dairy
Beef Stocker
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
1
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 Epio'❑ NA ❑ NE
F] Yes [:]No [ A ❑NE
❑ Yes ❑ No E3-KX- ❑ NE
❑ Yes
❑ No
❑ Yes
[a -No
❑ YesNo
lJlA— E] NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

'IFacility Number: f Z Ds ection: 4G
WaAe Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
U:L_Na—`nNA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
L.:J NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ 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-Ko__
❑ 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
R'llo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Q-No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[,_2�
❑ NA
❑ NE
maintenance or improvement?
1 I . Is there evidence of incorrect land application? If yes, check the appropriate box below_
❑ Yes
No
❑ NA
❑ NE
[] Excessive Ponding p Hydraulic Overload p Frozen Ground p Heavy Metals (Cu. Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus 0 Failure to Incorporate
Manure/Sludge
into
Bare Soil
0 Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C W 75
13. Soil Type(s): Aw Co C <
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q'1Qo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
0-Ko-
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
fNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
FD"-"
❑ 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
[]'�lo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? Ifyes, check
❑ Yes
( o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes
[IWaste Application ❑ Weekly Freeboard [:1Waste Analysis E]Soil Analysis ❑ Waste Transfers
r_1Rainfall C:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ElMonthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? E -]Yes [3N0
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes 0--N-0
[2-
1Qo ❑ NA ❑ NE
0 Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - I I I Date of lns ection: .TZ�
1;;
Lam"° ❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
![ —< ❑ NA
❑ N£
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
t o r❑ NA
❑ NE
the appropriate box(es) below.
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
❑ Yes
[3No
❑ NA
List structure(s) and date of first survey indicating non-compliance:
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[3No
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
0.14`o ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [J.> 6 [] NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [A-K5G _❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately. .
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
Lam"° ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[ENo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[3No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[3No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ED,,1Qo
❑ NA
❑ NE
Reviewer/Inspector Signature: Date: •S`y U
Page 3 of 3 21412015

(Type of Visit: O Compliance Inspection Q Operation Review Q Structure Evaluation 0 Technical Assistance I
Reason for Visit: 044'utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit. Arrival Time: Departure Time: 0 County: S/ J r"t Region:
Farm Name: �,��� ��"?, 7 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: �`�t S 94,161t4-114 Title:
Onsite Representative: It
Certified Operator: / r -&O
Phone:
Integrator: Ywl J "s
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: 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)?
❑ Yes E2,N'o�❑ NA ❑ NE
❑ Yes [] No
❑ Yes ❑ No
E3 -FA ❑ N E
[NA ❑ NE
d. Does the discharge bypass the waste management system? (if ves. notify DWR) 0 Yes Q 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 1] No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued
Swine_
Wean to Finish
Design
„�
C pact
C►urrentDes`ign
Pop. Viet Point -0
Current
Pap.
_ Design Current
Cattle Capacity Pop.
airy Cow
Wcan to Feeder
Non -La er
airy Calf
Feeder toFinish
n
-sI p
airy Heifer
Farrow to Wean_
- Design
Current
D Cow
Farrow to Feeder
Dry 1Moultr . _ ' Cte ia4 i
P,o P.
Non -Dairy
Farrow to Finish
Lavers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Turke Poultr
Other
" Other
_
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes E2,N'o�❑ NA ❑ NE
❑ Yes [] No
❑ Yes ❑ No
E3 -FA ❑ N E
[NA ❑ NE
d. Does the discharge bypass the waste management system? (if ves. notify DWR) 0 Yes Q 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 1] No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

FacWty 4inber: -6 t Date of Inspection:
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage pias heavy rainfall) less than adequate"? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Vj '"5 ❑ NA ❑ NE
❑ No � [] NE
Structure 6
❑ Yes �o ❑ NA [] NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
2 -No-
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
2 --No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
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
�o
❑ NA
[] NC
(not applicable to roofed pits, dry stacks, and/or wet stacks)
No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[r]-1,Io
❑ NA
❑ NE
maintenance or improvement?
❑ NA
❑ NE
Required Records & Documents
Waste Application
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
QNo
❑ NA
❑ NE
maintenance or improvement?
11, Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes EjNo ❑ NA ❑ NE
[❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
PAN ❑ PAN > 101/6 or 10 lbs. ❑ Total Phosphorus Q 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): CJ9
13. Soil Type(s):
^
[nNo
❑ NA [] NE
the appropriate box.
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2 --No
❑ NA
❑ NE
IS. Does the receiving crop and/or Iand application site need improvement?
❑ Yes
[1'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?
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
VfNo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
ETN�o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E:fNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? ]fyes, check
❑ Yes
[nNo
❑ 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
YNo
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ RainfalI []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

l
Facility timber: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes BNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes []-1'Sfo ❑ 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-complianec:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes E�No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes eNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes &No ❑ NA ❑ NE
and report mortality rates that were higher than nornial?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes 2/ No E] NA 0 NE
if yes, contact a regional Air Quality representative immediately.
30, Did the facility fail to notify the Regional Office of emergency situations as required by the [-]Yes eNo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes E] -No [] NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E3 -No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes B-ITo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ©'No ❑ NA ❑ NE
Comments (refer to. question #): Explain ny.y ,, answers and/or any additional recommendations or any,other cotwnenti,
Use drawings of facility to better explain situations; ase=:additional pages as necessa �a '' `�` w
( P g ry) yb t..
a t%
4?4
Reviewer/Inspector Name: 1 U u4tfPhone lV�✓ S
Reviewer/Inspector Signature: Dater 7
Page 3 of 3 2/4/2015

Type of Visit: Q<ampliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Olioutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: EA -w- RegionF
Farm Name: 5 ( G Ui~ *�_ Owner Email:
Owner Name: Y Phone:
Mailing Address:
Physical Address:
Facility Contact: 16 gV~tGk Title: Phone:
Onsite Representative: t' Integrator: V —J
Certified Operator! Certification Number: `
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Imoacts
I. Is any discharge observed from any part of the operation?
❑ Yes
�Io
❑ NA
❑ NE
Design�Current
D�e.:^sign Current.Design
Current
Swine
Capacity 'Pop:
Wet Poultry
Capacity Pop:
Cattle Capacity Pop,
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
[�iA
Wean to Finish
c. What is the estimated volume that reached waters of the State (gallons)?
Laver
airy Cow
Wean to Feeder
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
on -Layer
❑ No
airy Calf
Feeder to FinishDairy
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Heifer
Farrow to Wean
❑ NE
s1)esign Currer►t
Dry Cow
Farrow to Feeder
D , P.ouIt
Y4r.#'
Ca acih�Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Nor► -La ers
Beef Feeder
Boars
Pullets.
Beef Brood Cow
Turkeys
Turke 1'oults
r=M0_her
11erI
10thff
Discharges and Stream Imoacts
I. Is any discharge observed from any part of the operation?
❑ Yes
�Io
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
ETNA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
[�iA
❑ 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 [!I'*No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/412011 Continued

j Facifi Number: - Date of Inspection: .�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [B-<o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No [ -lqA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes I��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 No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
LJ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NE
9. Does any part of the waste management system other than the waste structures require
❑ Yes
G N
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
�No
❑ NA
❑ NE
Waste Application
❑ Waste Transfers
❑ Weather Code
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
No
❑ NA
❑ NE
maintenance or improvement?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
6No
❑ NA
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2< ❑ 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 pp ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12, Crop Type(s): C4 -) 14
13. Soil Type(s): rTV
14. Do the receiving crops diffet�from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
I& Is there a lack of properly operating waste application equipment?
❑ Yes
[4No
❑ NA
❑ NE
❑ Yes
[ o
❑ NA
❑ NE
❑ Yes
ZN' o
[] NA
❑ NE
❑ Yes
[�No
[DNA
❑ NE
❑ Yes
[2fNe
[] NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
[ZrNo
❑ NA
❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
[!fNo
[] NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design [] Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
�No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
[!rNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
6No
❑ NA
❑ NE
Page 2 of 3 2/4/2014 Candnued

Facili Number: -to Date of inspection: G--,4
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [;]•N'o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes 2Vo ❑ 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 tion -compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes YNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the tune of the inspection did the facility pose an odor or air quality concern? [:]Yes [�No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes Flo ❑ NA ❑ NE
❑ Yes EZNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes dNo ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative? ❑ Yes ZINO ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [�No ❑ NA ❑ NE
Comments (refer: to question #): Explain any YES answers and/or anyadditional recommendations or=any±:other comments -.
Use drawings of facility to better explain situations (use additional pages as necessary).
i
Reviewer/inspector Name: k- 1 ` lr--�f� JB� Phone:
Reviewer/inspector Signature: Date:
Page 3 of 3
2/412011

Type of Visit: (<omC�pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: (2 outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:l /Q,00Departure Time: : Oa County: Region: 1---A
Farm Name:.S / try `rC ��a f rte` Owner Email:
Owner Name: S``r��w Phone:
Mailing Address:
Physical Address:
Facility Contact: 7m,(-) Title: AVAI ewrl-_ Phone:
Onsite Representative: j i,o integrator: 21--jgE.
Certified Operator: 77i--cJ Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: p Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b_ Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes B No ❑ NA ❑ NE
Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [R No
❑ Yes [a No
❑ NA ❑ NE
❑ NA ❑ NE
0 NA ❑ NE
Page 1 of 3 214/2011 Continued
Design Current
Design
Current
Design Current
Swine Capacity Pap.
Wet Pouftry
Capacity
Pop:.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
_
Dai Heifer
Farrow to Wean
Design.
Curren_ t
Dry Cow
Farrow to Feeder
hy
Pio ,
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Furkey Poults
Other
- ' Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: p Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b_ Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes B No ❑ NA ❑ NE
Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [R No
❑ Yes [a No
❑ NA ❑ NE
❑ NA ❑ NE
0 NA ❑ NE
Page 1 of 3 214/2011 Continued

i
[Facility Number: -to 1 Date of Ins p ection: — 7—
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Cg_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): c
Observed Freeboard (in): KI
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes (3 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes 0 No ❑ NA 0 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 [3 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ®No ❑ NA ❑ NE
maintenance or improvement?
Waste Aunlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes aL No
❑ NA
❑ NE
maintenance or improvement?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes CF�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
❑ NA
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
[] Yes
12. Crop Type(s): en ell Z6rJ/1 J yjS � —Ar
❑ NA
❑ NE.
the appropriate box.
-
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CA WMP?
❑ Yes ® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No
[DNA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
(2 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
® No
❑ NA
❑ NE.
the appropriate box.
❑WUP ❑Checklists ❑ Design p Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ® Yes o [:INA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [.Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield to 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 Z No ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

t
Facili Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ®, No ❑ NA ❑ NE
s
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [21 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 Iagoon
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 �Z No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes allo ❑ 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.
D Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ®No [DNA ❑ NE
[:]Yes Eg No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes 11 No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes ® No
❑ Yes JE No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #I):.Explain any YES answers and/or any additional recommendations or any other comineats
Use drawings of facility to better explain situations (use additional pages as necessary). � �
a �.. y
'09'
Reviewer/Inspector Name: �—
Reviewer/Inspector Signature: -
Page 3 of 3
Phone: D 33-33 a
Date:
214/2011

-7-31-15-
Type
7-31 /5 -
Type of Visit: i-Complia a Inspection Q Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: outme O Complaint Q Follow-up O Referral Q Emers!encv O Other O Denied Access
Date of Visit:rArrival Time: _ :� Departure Time: County: Region: (�
Farm Name: . 5� Vr r T�:W
Owner Name:_ 5 �Y U __
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: , T --r 4-) Title: Phone:
Onsite Representative: Integrator: t?TY
Certified Operator: Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
Design Carrent
Swine Capacity Pop.
We# Poultry
Capacity
Pop.
Cattle Capaci Pop.
Wean to Finish
Layer
Da' Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish 1
DaILI' Heifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
1?oult
Ca aci
P.o
Non -Dairy
Farrow to Finish
Fri
Layers
Beef Stocker
Gilts
Non -La era
Beef Feeder
Boars
1H
Pullets
Beef Brood Cow
Turke s
Qther
TurkeyPoults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
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 DNo
❑ Yes &jNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 214/2014 Continued

Number: 6- Date of Inspection:
rite Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 5, 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): (d
5. Are there any immediate threats to`the
�integrity of any of the structures observed? ❑ Yes [3.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
Ej 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
T Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
( No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
C3 -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): Z !(J
13_ Soil Type(s): 1/
14. Do the receiving cropsiffer from those designated in the CAWMP?
[]Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
K No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ELNo
❑ NA
❑ NE
18. Is there a lack of property operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q No
LPMIL
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
allo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E[ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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 [21 -No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Pity Number: - Date of Inspection: /
.4. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [50o ❑ 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. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[a No
❑ NA
❑ NE
❑ Yes
Eg No
❑ NA
❑ NE
❑ Yes
JZ No
❑ NA
❑ NE
❑ Yes [&No ❑ NA ❑ NE
❑ Yes ®, No ❑ NA ❑ NE
[:]Yes ® No ❑ NA 0 NE
❑ Yes E3 No
❑ Yes ®,No
❑ Yes allo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (eefei• to question.#): Explain any YES answers and/or any additional recommendations or any�other conimenis .
Use drawin6 of Facility to better explain situations (6se additional vap-es as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

V__
i ype or v isu: Lry t.ompnance inspection LJ qjperanon tceview C.l bxrucrure r:vatuation V i ecnnicat Assistance
Reason for Visit: 1$ Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: $ :3 Departure Time: ; 4 County: ��(� Region: 69
Farm Name: S eVip- T-ew Owner Email: T
Owner Name: ,, y✓ Phone:
Mailing Address:
Physical Address: 410 ga47 lo/it-le keb&o
Facility Contact: S-�evTiPiy Title: ��y� Phone:
Onsite Representative: S4Pve TP yl/ Integrator: _f`lJT B
Certified Operator: Tew_ Certification Number: 11?3IL�____
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharees and Stream Imnacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No [3 NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes [—]No [] NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
t
Page I of 3
[—]Yes ❑No
❑ Yes 0 No
❑ Yes ? [ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
2/412011 Continued
Design Current- :
DesignY
Current
DeSlgn current
Swine Capaci
op.
Cattle. Capacity Pop,
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
urren
Dry Cow
Farrow to Feeder
D . I;oult .
Ca aci
P,o P.
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
I
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
INS 1 11
Other
Turkey Poults
Other
Other
Discharees and Stream Imnacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No [3 NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes [—]No [] NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
t
Page I of 3
[—]Yes ❑No
❑ Yes 0 No
❑ Yes ? [ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
2/412011 Continued

[facility Number: 06 a - Date of inspection: $
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [R 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:
❑ Yes
P No
Spillway?:
❑ NE
18. Is there a lack of properly operating waste application equipment?
Designed Freeboard (in):
No
❑ NA
Observed Freeboard (in):!
Required Records & Documents
5. Axe 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.)
❑ Yes
No
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?
[ No
C] NA
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? [:]Yes [,g'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [,Ig 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
Q NE
maintenance or improvement?
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
Waste Application
❑ Weather Code
t; Rainfall [:]Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes [--]No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
Page 2 of 3
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
Window Evidence of Wind Drift ❑ Application Outside of Approved Area
® Outside of Acceptable Crop Window❑
L,,
12. Crop Type(s): (26, �%he& , soy �l
6°
13. Soil Type(s):
le -
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes W No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes 2 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 5d No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
P 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
[ No
C] 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.
to Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
t; 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
r] No
6§ NA
❑ NE
Page 2 of 3
2/4/2011 Continued

1~`acili Number: -
Date of Inspection - 1119
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [5] No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes tg No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
[] Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26, Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA [] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [] No ®-NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes N No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ER No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
152 No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? if yes, check the appropriate box below.
[:]Yes
fR No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Ca No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[Z No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 5Z No ❑ NA ❑ NE
Wire- S pajj� �t qt week 01 h Ell ttf ,-f �� tfclDr1v1hd-01v
Auj,s -, qty wcrt VW4 v ey Isle. - Ia, ►Ae� C� v I n +� e 'er
�eez)e ge+ en a�rorb+ 4'0 '� L _177e C�o� O C/ow) 1 n
Pease M A 11 raMwil ew,.4j o%L 11.Vttt s sign 00o each I r nd7 ajwb--
Owl �e v� na�� afi wfe k (
y
1 }FIs se/ a r ol` lu l'c� of 0@06�c far `vo i X70 � ',
� fields
�,Slrz leuels A'e a q9 of +ieVhm&i+ Va1U,"e• yov wil / have a �r j qb rpno-eslzly,
a� l e s read 0, 5`p,
lay 10,
Reviewer/Inspector Name: Phone: ���33-3fjC'� J
Reviewer/Inspector Signature: Date: 3
de
Page 3 of 3 2/4/2011

Facility No.Farm/Name
Permit _ Z COC
FB Dro s
cj�l j Qq0-5-%s
At,e Tze Date , ) $ Y3
OIC NPDES (Rainbreaker PLAT Annual Cert Daily Pipe)
Lagoon Name, S forspillway 1 byZ_2 3 4 5 6 7
Design Freeboard I Last Recorded in
Observed freeboard
Sludge Survey Date J
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Slud a to Treatment Volume if> 0.45
Date out of compliance/ POA?
WM
• . r"i��---�---
Fesignm. r�`i'——'---
Soil Test DateHavjai( Crop Yield Transfer Sheets
pH Fields >vka� Weftable Acres RAI GAUGE
Lime Needed D WUP ead x or incinerator
Lime Applied Weekly Freeboard o ity Records
Cu -I Zn -I c/ 1 in Inspections Check Lists
Needs S (S-125) 120 min Insp. Storrs Water
Needs P A i;i{Ip &L -So Weather Codes
Pull/Field
Soil Crop Acres
Do Ilk
'SA
12 C—W-SS is
Eno
1 1 /
Pull/Field
Soil Crop Acres
PAN Window Max Rate Max Amt
'SA
12 C—W-SS is
f Ma,-� !t0
Lv
-
_ 13a
Verify PHONE NUMBERS and affiliations Rfu VA 5
18,�- �—q
Date last WUP FRO' li 10q -t FRO or Farm Records
Date last WUP at farm !()131)q-) Lagoon # 330QX
App. Hardware Top Dike 9 p_r j ,
Stop Pump 4v,5 y,7
Start Pump yQ8
Ft 7 "=l
Conversion- Cu -1 3000= 108 Ib/ac-, Zn -t 3000= 213 lb/ac

Type of Visit: -V Compliance Inspection V Operation Review V Structure Evaluation V Fechnical Assistance
Reason for Visit: 'Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:.
Farm Name: Owner Email:
Owner Name: S Phone:
Mailing Address:
Region: L&
Physical Address: gd/�g &I Ck Pdjoke boyo
Facility Contact: sieve_ T_Pk'- Title: Phone:
Onsite Representative; S` vc-- 1 >°VL/ Integrator: "-p
Certified Operator: s f e✓e_Jr, Certification Number: Ig.3 Sy -
Back -up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
[] No
-Qesign
Current
Design Current
Swine x Capacity Pop.
Wet Poultry
Capacity`
Pap.
'Cattle Capacity Pop.
❑ NA
❑ NE
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
I I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
�'skf i
Design
Current
Dry Cow
Farrow to Feeder
D . P,oult .
G.PA
Non -Dairy
Farrow to Finish
JLavers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes tR No ❑ NA ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
[] Yes
[ No
❑ NA
❑ NE
Page 1 of 2/4/2011 Continued

Facility Rumber: Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2 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:
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
Spillway?:
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
Designed Freeboard (in):
acres determination?
Observed Freeboard (in):
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
a No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
Required Records & Documents
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
W No
❑ NA
❑ NE
waste management or closure plan?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
EdNo
❑ NA
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
Q No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
FO 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
5a -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 ❑ 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): /) W� ,S0X beM _r _
13. Soil Type(s): AVCD4
14. Do the receiving cops differ from those designated in the CAWMP?
[:]Yes
2 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
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
[aNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
EdNo
❑ 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 10 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes " No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA
❑ NE
❑ Weather Code
❑ Sludge
Survey
❑ NA
❑ NE
EBNA
❑ NE
Page 2 of 3 2/412011 Continued

1Pacili- lumber: 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 M 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 file drains exist at the facility? if yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA
❑ NE
[:]Yes
❑ No
U NA
❑ NE
[:]Yes
Callo
❑ NA
❑ NE
0 Yes [D No [] NA ❑ NE
❑ Yes [N No 0 NA ❑ NE
[] Yes �g No ❑ NA ❑ NE
❑ Yes U No
❑ Yes Eg No
❑ Yes D;F'No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #1): Explain any YES answers and/or any additional recommendations or any other, comments:-"_ {
Use drawings of facility;to: better explain. situations {use additional pages as necessary)
CW
V#d e ve4s vv," AV- 6) b" &--r Yof
!r
S
�, GQod� Yrork s eeA % barer rdealori t a��l � � � dirtltm'e q sepzc
?"f radot
w4fe a Mrek am m_oa
,Qt, Ybv do na� havt'to keer 1 RR is( Bf 64 s i9n C IVMPn `�� yyeartt
a }�� s ins`f]a�1 Q1 Carl hinP� 1 dS
r `` goy `s h o1 back �c
L'rt 1 ba`h o I rvos b o > f
Form,. -�Qldj q-rerordf a -e l� o04 shave eaepl a J noid a ba, -r,
f04 4k abo-l-e, i nudes lef+ off f lAdkft- Of/),
Reviewer/Inspector Name: aba, srljl7'� I
Reviewer/Inspector Signature: �A, ra'17t �Q.
Page 3 of 3
Phone: IAr-v)
Date: Se a Q 11
2/412011

kwrk 64,
Facility No. d- Farm D
Namee��7` Date 8�4'�r$�r
�Y SP i'D
Permit COC ✓ OICT NPDES (Rainbreaker PLAT Annual Cert Daily Pipe)
Lagoon Name, S forspillway 1 2 3 4 5 6 7
Design Freeboard 1 Last Recorded in
Observed freeboard
Sludge Survey Date
Sludge Depth ft b
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume ifs 0.45 p 1 $
Date out of compliance/ POA?
--Calibration-bke RM �,U-gvy "S
Desi �nFlow(gpm)
..-----
Soil Test Date am 1r
Crop Yield •�
Transfer Sheets
pH Fields
Wettable Acres ✓
RAIN GAUGE
Lime Needed
WUP ✓
Dead box or incinerator
Lime Applied
Weekly Freeboard
Mortality Records
Cu -1 Zn -I
1 in Inspections
Check lists
Needs S (S-1<25)
120 min Insp.
Storm Water
Needs P
Weather Code
► ���l.�Ft������
1• • •
1 •
Memo, a MEf
Verify PHONE NUMBERS and affiliations PA 0 of) yv8 11 y � y i) I -K�����
Date last WUP FRO �l`Ib-G� FRO or Farm Records
Date last WUP at farm\0-.) Lagoon ##
App. Hardware Top Dike
Stop Pump
Start Pump
Conversion- Cu -I 3000= 108 Ib/ac; Zn -I 3000= 213 Ib/ac

i 07
�'�3► -�l �Iwl
lyeek
CudZn 4r1 -
Sl�d�roi o
G oa! f a rc(oo,
- f7-1
SOnPI'^ 3 ROD
fa--oaa � rob
Pio- n
V-4
X10 If b nofibec4
��SJ'n�1-hay
v

�_31tt S Qvr Rl :j I I j
- - Davi ott of Water Quality
1' acility V umber ® 0 Division of Sail and Water Cortsery -00"
- 0 Other Ag rncy
Type of Visit: 0 Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: (2Routine O Complaint 0 Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time: "'�J Departure Time: County: _5,adqDJ2j Region: LP
Farm Name:yp Tf W Owner Email:
Owner Name: S-Wp levy Phone:
Mailing Address:
Physical Address: � 1f) bue, Pwck_Ph(, , R0)P_bffQ y
Facility Contact: S-�P,,�_T,�, _ Title: OWiii'- Phone:
Onsite Representative: S_kve 7ew Integrator: M 1B
Certified Operator: S 4f ve-Tehr Certification Number: MiE
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
❑ Yes
llesign
Current
Design C+urrent
Swine C«opacity Pop.
Vet Poultry
Capacity
Pop.
Cattle Capacity Pog.
Wean to Finish
❑ Yes
Layer
❑ NA
❑ NE
Dairy Cow
Wean to Feeder
❑ No
Non -Layer
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
Dairy Calf
Feeder to Finish .3 SaQ
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
Dairy Heifer
Farrow to Wean
❑ NA
Resign
Current
Dry Cow
Farrow to Feeder
Dr..Po.ultry
Ca gcity
P,o P.
Non -Dairy
Farrow to Finish
Layers
❑ NE
of the State other than from a discharge?
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Uthe
urkey Poults
Other
Other
Discharges and Stream Itrmuacts
I. Is any discharge observed from any part of the operation?
❑ Yes
CR 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 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
C!TNo
❑ 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 ! of 3 2/4/2011 Continued

Facili hlurnber: - &I Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �R 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): 1!3
Observed Freeboard (in): - —-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
CRNo
❑ 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
P 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
[�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
& No
❑ NA
❑ NE
maintenance or improvement?
Waste Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
N No
❑ NA
❑ NE
maintenance or improvement?
I I. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
1p No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 tbs. ❑ 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): CDfnlyheoiJ SC�/l�S
13. Soi I Type(s): j -
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
(.zR No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE.
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[3 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
tRNo
❑ 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
❑ No
❑ NA
❑ NE
91 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
W No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
5a -NA
❑ NE
Page 2 of 3
2/4/2011 Continued

t
Facilit y Number: 46P.,- Dale of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes rEr No ❑ NA ❑ NE
25_ Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 10 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
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:
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
❑ No
C'NA
❑ NE
❑ Yes
[Z No
❑ NA
❑ NE
❑ Yes ILA No ❑ NA ❑ NE
❑ Yes tg No ❑ NA ❑ NE
❑ Yes Eg No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the pen -nit or CAWMP? ❑ Yes
33. Did the Reviewer/ Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
®' No ❑ NA ❑ NE
Q9 No ❑ NA ❑ NE
No ❑ NA ❑ NE
Comments (refer to question',#€) Ex0EMn any. YES. answers and/or any addrtional!recommeridations or any;other-''commetltsw_k
'Ilse drawings of 1aeiliiv to .betteraexplatn,`siEaations (use•additionaLuases,as necessary). �'",� _.r
�r 7���v�o�I scu f1B� lw-ea�gao•�, Xf nft&- `p9il j j,ne� ice? 10 s �
S r, rnv1c Ofd ro flu `1' azo pt&prel pjaliZnd7 �o o�
Prod uta S Pct. a64&- rv&4A ea -1r oi t old, be- (,n � who- la/&,
� v o+} is � eci3 r' `ri 1 i A+ o-0 C �t AM i h u -Th � So/ beav wele
s pp -► c� y p� rrr pane . t'
oal y -(v -Ne end of 'he Porp,)n ryl�jd®w.
(Jv5
c
asp 1V) I 1 ee W 0 e- GO 'zo-f I, S 'A ? �5 [v
Q� will n clla�loS _j.��i�► a ears
C� -dim aid- reca_df;
Ladd N001 ne�lctbwe1 nc� cr� f4dvtf- cofy
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
crorc y haw�l s��d
-}wo er-f ha ve- 5 9
91� h,� 01 5-0,
Phone: ((Q -H3-3333
Date: v
/4/2011

S
A �
Facility No. $ a�0IL Farm Name Tew Date qt
Permit COC --� 01C� NPDES (Rainbreaker PLAT Annual Cert }
FB
Drops
Lagoon 1 2 3 4 5 6 7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date 3 11n[
Sludge Depth f# 4r
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume ,
Soil Test Date Wettable Acres . RAIN GAUGE
pH Fields WUP ,- ea o or incinerator
Lime Needed Weekly Freeboard Mortalityrecords
Lime Applied 1 in Inspections1l�dPCOv�
Cu -I ./ Zn -I ►..�"120 min Insp.
Needs P Q!'S�y�t Weather Codes
Cron Yield Transfer Sheets.
NAmt(lb/100OGal)�►� „
Pull/Field Soil Crop A"G& -P" Window Max Rate
Max Amt
IYA
Verify PHONE NUMBERS and affiliations
Date last WUP FRO j Date last WUP at farm
FRO or Farm Records���3#i 4�
Lagoon #
Top Dike 51
Stop Pump
Start Pump ` q, X1,7
Conversion- Cu -1 3000= 108 Iblac; Zn -I 3000= 213 Ib/ac
App. Hardware Ree /

?) I �G 3v3
Type of Visit &Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 19Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Dale of Visit:C[J I f N l arrival Time: Departure Time. ; County: S Region:
J
Farm Name: t-PuQ Tey Owner Email:
Owner Name: 5+e Ve ., V TIE V Phone:
Mailing :address:
Physical Address:
Facility Contact: — ye— T`0t/ Title: ©H`I'P Phone No:
Onsite Representative: VP_Integrator: -f—A
Ccrtitied Operator: 1J —rtW Operator Certification Number, ��
Buck -up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑O Longitude: =Q E—�
Swine
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
Farrow to Wean
❑ Farrow to Feede
❑ Farrow to Finist
❑ Gilts
❑ Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Pouttry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
Other
Poults
Discharges Stream Ini acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dair3i Cow
❑ Dairy Calf
❑ Dairy Heifer
EjDry Cow
❑ Non -Dairy
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: ❑
d. Does discharge bypass the waste management system? Of yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes &-No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
tE 1Vo
❑ NA
❑ NE
❑ Yes t�No ❑ NA ❑ NE
12/28/04 Continued

H n
❑ Yes
C'No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
Facility Number: 26— , Date of Inspection �Q
4. Does any part of the waste management system other than the waste structures require
❑ Yes
Waste Collection & Treatment
❑ NA ❑ NE
maintenance or improvement?
Date; Qvio
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
RNo
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
structure l Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
5FNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
Spillway?:
❑ 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
Designed Freeboard (in): Ig
12_ Crop typc(s) 0611 hehattt Spy bl%aj
Observed Freeboard (in):
13. Soil types) VCOC� V`NS I
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
1>_�No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
2 No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
6. Are there structures on-site which are not property addressed and/or managed
❑ Yes
R No
❑ NA
❑ NE
through a waste management or closure plan?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
-j;jNo
❑ 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
I"No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
C'No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
�Qla� 3a— 851
4. Does any part of the waste management system other than the waste structures require
❑ Yes
[�iNo
❑ NA ❑ NE
maintenance or improvement?
Date; Qvio
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
§�No
❑ NA ❑ NE
maintenancelimprovement?
11. is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
5FNo
❑ 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 typc(s) 0611 hehattt Spy bl%aj
13. Soil types) VCOC� V`NS I
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
B No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
2 No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
10 No
❑ NA ❑ NE
IT Does the facility lack adequate acreage for land application?
❑ Yes
R No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
-j;jNo
❑ NA ❑ NE
Comments (refer to question #}: Explain any Y+ES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
A.
�Qla� 3a— 851
Reviewer/InspectorName 'rn,.M; A14- r ,
Phone:4qw- X.-tj 3,33
Reviewerllnspeetor Signature:
Date; Qvio
Page 2 of 3 ii 12128/04 ' Continued

I
lu Pc . Am#ided Pipe 3
Facility Number: %a -- (pia Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes [�tNo ❑ NA ❑ NE
❑ Yes 52 No ❑ NA ❑ NE
21. Does record keeping treed improvement? If yes, c eck the appropriate box below. CR Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard §Rasote5nalysis ® 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32, Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
&No
❑ NA
❑ NE
❑ Yes
❑ No
2NA
❑ NE
SYes
® No
❑ NA
❑ NE
❑ Yes
CRNo_
❑ NA
❑ NE
❑ Yes
12 No
❑ NA
❑ NE
❑ Yes
❑ No
RNA
❑ NE
[]Yes
CRNo
❑ NA
❑ NE
❑ Yes
CR No
❑ NA
EINE
❑ Yes
CR No
❑ NA
❑ NE
❑ Yes
19 No
❑ NA
❑ NE
❑ Yes
R No
❑ NA
❑ NE
❑ Yes
C No
❑ NA
❑ NE
Addilrional Comments and/or Drawings:
34, D'4A Tt If
7, Lo bcr4TLl W.0 e- J,,6+ e loth w Pth rye old keaf �i4or nod` y e+S-eVot iq
CQbila, �j ��-dche `Cvr ao�,p-r�ccrdr nod -back ye`[-� rf1Q" h�►r^
r
1 n �� r ae W_ �ll
t, Pleibe e+ coPr od,2,,nc Analyses I -P ts)'Yt rLACDl'-Iiad �-
au
� u
st�ye�vP '
`Jv � o�
W oil ft; i� si t►� �'�o`�+al -��Pa-�rr��- va�u�, � 1 s y�
iv ig0 dals. s1 y `� �� � � �I�
p �-%'o i b 1','C� iRa �Wal�y
�f�v
Or�t�rxfio wQ r Q.
I� I be red ared- wl�h l� ado 6i
Page 3 of 3 12/28/04

_ 'REV IsE-0
Facility Number- — CotXj Date of Inspection lata
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes N'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes CR'No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑ Checklists El Design [:3 Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. RYes ❑ 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
N�'No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
[XNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
IN No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
(3No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
CgNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
CRNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAW MP?
❑ Yes
IR No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E9 No
❑ NA
❑ NF.
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
MNo
❑ 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
12�Tlo
❑ 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
RNo
❑ NA
❑ NE
Addiitional.Gommegts,andlor"Drawings : `
.�.�.. ,. -... d�
A UoMTIof Ne-
_
-7,�-o oa, tae-sfo`�S w �J&j wf- aid wh�r7L. ©a h,&4 ,
u s n ofi S /o cW ,
Q1, PYoje Coep cid �r�� and ty�P1 i � usl� Ccn ctr 1a
aq, ?leakAhd. Q06R ca
'?Y4aolo SI �dye�sL�y�e +d cie_ Nk "ecard.r a"e @009
{` � tzPGifm t9>�- V D��m P 1'..t rP�� a� G, �� �•-i
h w�,� Qoadaas.,s-ftdyQ
WWreaeAligqSLI✓ -e
ae4 ri x.,50, y00a
`p yl�ur 0� t4 91 E0 beajj ���'% hark ,
Welt m aih�`a l�4 �� .
Revt`sr0� o e3 �y e lft - �'1"nd� a no`s foy?
Ia �1��
b'd�lb�� Was do1,e !�'7 �oa8✓t 43 /ylaf �.9row$' a
Page 3 of 3 12/28104

Facility No.CS"(� , Farm Name
Permit ✓/ COC
Pop, Design Current
Type
f4Lvv Jew _ Date
OIC NPDES (Rainbreaker PLAT Annual Cert j
FB
Drops
La oon 1 2 3 4 5 6 7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft _
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
AIS aofrU-CvrliSs�rc
Calibration Date
bqji6n Flow
Actual Flow
Design Width
Width
�,l1 ------
C v Ssaw �*
Soil est Date D
pH Fields
Lime Needed
Lime Applied
Cu -1
Needs P
Zn -I v QZn
NO
Crop Yield
Wettable Acres
WUP
Weekly Freeboard t
1 in Inspections , . -
120 min Insp.
Weather Codes
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
Mortality Records
Waste54eve T,
Analysis
• iii
Pull/Field Soil Crop Acres PAN Window Max Rate Max Amt
1(e 5-0 <
Verify PHONE NUMBERS and affiliations
Date last WUP FRO3� Date last WUP at farm
!0-
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu -I 3000= 108 Ib/ac; Zn -I 3000= 213 Iblac
4,9 4"! tr
App. Hardware

Type of Visit & Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine Q Complaint Q Follow up 0 Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: � �, f Departure Time: b tom, County: .ill Region: Ff.
ii ,,�� t
Farm Name: 51-e 2,p T-evy Owner Email:
Owner Name• `e✓'P_ D Te w___ Phone:
Mailing Address:
Physical Address:
Facility Contact: V ', Title:
Onsite Representative: V i�✓
Certified Operator: 1 s" -e
Back-up Operator:
Phone No:
Integrator:U-_ dol✓►'f
Operator Certification Number: AWA i 35S
Back-up Certification Number:
Location of Farm: Latitude: = o = I 0 u Longitude: = o = I = N
Design Current
Swine Capacity Population
Design
Wet Poultry Capacity
Curren# Design Cnrrent
opula#ion Cattle Capacity Population
❑ Wean to Finish
❑ La er
Discharge originated at: ❑ Structure ❑ Application Field El Other
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
® Feeder to Finish
❑ Yes
Dairy Heifer
❑ Farrow to Wean
Dry PoultryDry
Cow
El Farrow to Feeder
[I No
El NA
El Farrow to Finish
❑ Layers
❑ Gilts
❑ Non -Layers
❑ Boars
❑ Puliets
El No
[INA
ElTurke s
2. Is there evidence of a past discharge from any part of the operation?
Other
ElTurke Poults
El NA
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
❑
❑ Nan -Dai
El Beef Stocker
Beef Feeder
El Beef Brood Co
1. is any discharge observed from any part of the operation?
El Yes
[�No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field El Other
a. Was the conveyance man-made?
❑ Yes
❑ No
El NA
[INE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
[I No
El NA
[INE
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)
E] yes
El No
[INA
[3 NE
2. Is there evidence of a past discharge from any part of the operation?
E] Yes
'91 No
El NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
f N
❑ NA
[INE
other than from a discharge?
12/28/04
Continued

` Facility Number: ga — Date of Inspection 1 L
❑ Yes
No
Waste Collection & Treatment
❑ NE
15. Does the receiving crop and/or land application site need improvement?
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
51 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:
❑ Yes
No
Spillway?:
❑ NE
18. Is there a lack of properly operating waste application equipment?
Designed Freeboard (in):
® No
❑ NA
Observed Freeboard (in): J
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[RNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
tRNo ❑ 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?
E'Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
tRNo ❑ 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 E-1 NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ER No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
tRNo [INA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 ibs []Total Phosphorus [:]Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Cir
.)/n lyre 5'
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 ardor operate per the irrigation design or wettable acre determination ?
❑ Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question. #) Explain any YES answers and/or, any reeommendat�onstor� any other commMR
"_ 4 - r `�-
Use dra►vpngs iiTfacilit�° to better e�plarn stttateons' {use additional pagesAas necessary.}- y,
Reviewer/Inspector Name ,air, ? £ Phone: `'I (AL3 j1v
Reviewer/Inspector Signature: ,-rT " Date: '} -7 N i
LJ 12/28/04 Continued

Facility Number: — (p Date of Inspection 7
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 Ej No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design ❑Maps El other _34
21. Does record keeping need improvement? Ifyes, 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by swne agency?
❑ Yes
IR No
❑ NA
❑ NE
❑ Yes
❑ No
Q NA
❑ NE
❑ Yes
®'No
❑ NA
❑ NE
❑ Yes
fj�No
❑ NA
❑ NE
❑ Yes
[;No
❑ NA
❑ NE
❑ Yes
❑ No
[INA
❑ NE
❑ Yes &No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes J@ No ❑ NA ❑ NE
❑ Yes & No ❑ NA ❑ NE
❑ Yes
ER No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
A�dditsonal C n nen#s'`ansllor Drawings:
i, ►Cft}o 1°vvin�% Ch 1xr�s f3 J.,n�''``' `�%vr► 1�, -
rV i L4 sI(,dct-/tit? �e r^ �G y -'�;�, S��a' �M�.� � �t� C 1 ��+
' n P e aim hdi ,1 ew v t-, Iiee; I &v -t t 'fP.- it el M - qv fo Glo
Mork` CCS^ c.�o �'!�- l r ^ . L &Y
f
�J
(�c?i". 1�� rj i C �r a Y3i 1 i btuI1� S!�r7� .AA
re(alf.6El
128/44

Faci3ty No. �J Farm Name s4e, :T Date l !
Permit COC OIC_ NPDES {Rainbreaker PLAT Annual Cert )
Pop.Type Design Current FB Drops
.4
-hh 700i
F
Lagoon 1 2 3 4 5 6 7
Spillway.
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft & % 1.
Liquid Trt. Zone ft
Calibration Date
=114are ��---�---
Soil Test Date
pH Fields
Lime Needed
Lime Applied
Cu Zn
Needs P
Crop Yield i
Wettable Acres
WUP
Weekly Freeboard
Rainfall >1n
T1 in Inspections
120 min Inspections
Weather Codes
Transfer Sheets
RAI GAUGE
ead box)or incinerator
Ma a i y Records
Waste Date
Amt (1. 000
�-
Pull/Field Soil Crop RYE PAN Window Max Rate Max Arnt
n MISM,13—
YVh� !
dab
S A -Iabld,�61L
Verify PHONE NUMBERS and affiliations
Date last WUP FRO r Date last WUP at farm App. Hardware
FRO or Farm Records 10311q, SIIR�G C1&� m ,*vFm P
Lagoon#
Top Dike
Stop PumpG`(. %� -'� �'rJLL��jIcY�'��:
Start Pump `iq�� ���'�Cit i'� �c y,
Conversion- Cu -I 3000= 108 Ib/ac; Zn -I 3000= 213 Ib/ac ��1 fr} 1 '.41 G-

1� (H) UV_j 11 IU IDWE
Type of Visit lb Compliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason fpr Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:tAlrGl o Arrival Time: 111 .TSq Departure Time: I F 00 PH I County: Scat esal Region: FRO
Farm Name: S*ve- TeW _ Owner Email:
Owner Name: S+f vt D Tt W Phone:
98 ' tt � �-ebaro
Mailing Address: Q �QrQ., 4�vt C M1
Physical Address:
Facility Contact: _ RW Title: Phone No: a qQ_a rDs
Onsite Representative: Rvon h _ integrator: "
Certified Operator: 54"e_ Operator Certification Number.AM
I (?3.5S -
Back -up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0
=6
=66 Longitude: =0=1
°=1 = Ii
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Design
C*urrent ,� Design Curren t
Design C►urrent
Swine
l►apacity
Population Wet Poultry�CapacityPopulation
Cattle ,: Ga RE Population
a. Was the conveyance man-made?
❑ Yes
❑ Wean to Finish
❑ NA
❑ La er
❑Dai Cow
❑ Wean to Feeder
❑ No
jaW 014
iry Calf
�Feeder to Finish
yy�3.:
❑Dai Heifer
❑ Farrow to Wean
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
4-
'ID�ry Poultry
`
❑ Cow
❑ Farrow to Feeder
❑ NE
' ' "''
❑ Non -Dairy
❑ Farrow to Finish
❑ NA
❑ Layers
❑ Beef Stocker
❑ Gilts
®cNo
Non-Layerers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
12128104
Other.
is
❑ Turkey Poults
❑Other
❑Other
Numfie� of'St ictures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
[j Yes
CgNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
EINE
K 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
® No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
®cNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

.Farility Namber$a p Date of inspection
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
CkNo
❑ NA EINE
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): 19
T
Observed Freeboard (in): 4-3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[RNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
b. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
IRNo
❑ 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?
[SYes
❑ No
❑ NA ❑ NE
S, Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
WNo
[INA ❑ 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
JRNo
[INA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
M1
❑ NA ❑ NE
mai ntenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
N7No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn. etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) lin'
13. Soil type(s) A S 1
14. Do the receiving crops differ from those designated in the CAWMV?
❑ Yes
['No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
r'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
[RNo
❑ NA ❑ NE
18. Is there a lack ofproperly operating waste application equipment?
❑ Yes
&—No
❑ NA ❑ NE
Reviewer/Inspector Name ! Phone: 01Q) 433- 3QQj( 3
Reviewer/Inspector Signature: Date:
Page 2 of 3 12/28/04 Continued

Facility Number: a Date of Inspection F55
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes t5iNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes W No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps [:1 Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Mwc, ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stacking ❑ 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 El NA El NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No fqNA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[]Yes
�jNo
[:INA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
fallo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
UNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
UNA
❑ NE
Other Issues
Gh 4 +� 1,�e 01141y1P 6 ,1- np S 1� was chit IA
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
I'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 concem?
❑ 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
2No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Tnspector 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
U -No
❑ NA
❑ NE
Adatr�flaal comrtaents and/or Drawings: r � .
.J� 1
-%t K?Aj c- Wk ch WT_ S� a'1 �G�' -1'lfle #P1� - N�' `#or -O 1) Sedd Iy1 lc6/
..
as. �V I nPej_S1cdye.r,#ve7 b7 fd o f y �P_or
Q 1. La -k -j+ so ilI sve (@0M) Old _ rvaa�e aVJ yS �_ ore a-- labs.
Gh 4 +� 1,�e 01141y1P 6 ,1- np S 1� was chit IA
1�1 CIE" Irl
Page 3 of 3 12/28/04

Facility No. U— (Oil Farm Name
Permit "---� COC -,
Pop -Type Design Current
S412--le.Tei-I Date i611N
OIC
FB Drops
NPDES (Rainbreaker PLAT Annual Cert)
Lagoon 1 2 3 4 5
6 7
Spillway
Design freeboard
Observed freeboard in 3
��---
Slud a Survey Date Perm Liquid ft
_
Ick 3 1 Sludge Depth ft
Calibration Date
- •
Actual
Width
��---
Soil Test Date .. QQn 1 in Inspections .�
pH Fields Crop Yield ✓ Wettable Acres 120 min Inspections .�
�
Lime Needed f Weather Codes
Lime Applie WUP Transfer Sheets
Cu ZnWeekly Freeboard ✓ RAIN GAUGE
Rainfa k >1" ✓ ,
Pull/Field Soil crop RYE PAN Window
cao Qx4im= 1r0 "Wt
600q T
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm
Id )a& -)
Top Dikes' I
Stop Pump' -7 = ���' ?'ee 3 43
Start Pump . = a0-4
App. Hardware Max Rate in/hr Max Amt in.
0.33- 1'0

c
r� Division of Water Quality VIA
Facility NumberZ O Division of Soil and Water Conservation '
Other Agency r
Type of Visit V Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint IKFoilow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ZI O Arrival Time: Departure Time:
Farm Name: �� —r�—s�
Owner Name: J we--
Mailing Address:
County:
Owner Email:
Phone:
Physical Address: (��,,�
Facility Contact: 1L �Yi 5 Title: LZ '�- 4 r t' Phone No:
Onsite Representative: �Y integrator:
Certified Operator_ Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Region:
Latitude: = ❑ i Longitude: =0=4 °=4
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I ❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
E]Dry Cow
❑
Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes tZNo ❑ NA ❑ NE
❑ Yes
❑ No
%NA
❑ NE
❑ Yes
❑ No
JX�NA
❑ NE
O NA
❑ NE
❑ Yes
[:]No
❑ Yes
�bo
❑ NA
❑ NE
❑ Yes
_UbNo
❑ NA
❑ NE
12128/04 Continued

r Facility Number: Z 1f
Date of Inspection a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes )4 No [INA [__1NE
a. if yes, is waste level into the structural freeboard? ❑ Yes / o ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure Structure 6
Identifier:
Spillway?: 14 17
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yeso ElNA E]NE
(ie/ large trees, severe erosion, seepage, etc.) ���```���"`------'''"'
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes No [INA ❑ 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
ltthreat, notify DWQ j�
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 Wo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes h No ❑ NA ❑ NE
maintenance or improvement?
Waste Anolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 1>_2)+Io ❑ NA 04�4E
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �PNo ❑ NA �4 NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ 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 'WE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NANE
Reviewer/Inspector Signature: e Date:
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑ No
❑ NA
R NE
17. Does the facility lack adequate acreage for land application`?
❑ Yes
❑ No
❑ NA
�LNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
(PINE
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):
A14' nT� hCe S�-�'t2�G � 4S ►iG��
6n Dec ,V07 t• h � b►_
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: e Date:
12/28/04 Continued

r
Facility Number: Z Date of Inspection Z Q
Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes "'A No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA I?NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design (__1 Maps [3 Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA WE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
�a No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
N NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
P,NA
❑ NE
Qther Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
IdNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document❑Yes
� No
[:1 NA
[:1 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
V,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
ANo
❑ NA
❑ NE
12/28/04

Division of Water Quality X-1
Faculty Number $ Z Z Q Division of Soil and Water Conservation
O Other Agency
Type of Visit INCompiiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint O Follow up 0 Referral
0 Emergency 0 Other ❑ Denied Access p �
Date of Visit: O Arrival Time: D3 o Departure Time: 11 L1V (J 1 County: rn. Region: ti V
Farm Name: - Owner Email:
Owner Name: %Ag � `' Phone:
Mailing Address: _
Physical Address:
Facility Contact: Title: ` 0 Phone No:
Onsite Representative: Integrator: M"'
6
Certified Operator: �> �Q.�•� Operator Certification Number: `
Back-up Operator: S.U-� Back-up Certification Number:
Location of Farm: Latitude: e [--] ' [_—] Longitude: =o=,
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ E a er
❑ Wean to Feeder ❑ Nan -La er
E4Zeederto Finishj 0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non-Laycrs
❑ Pullets
❑ Turkeys
I❑ urkqy Poults
D Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field 0 Other
a. Was the conveyance man-made?
b_ Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Fieifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes P No ❑ NA ❑ NE
❑ Yes
❑ No
gNA
❑ NE
❑ Yes
❑ No
�NA
❑ NE
❑ No ANA
❑ NE
❑ Yes
❑ Yes
I] No
❑ NA
❑ NE
❑ Yes
❑ No
NXNA
❑ NE
12128/04 Continued

Facility Number"
Date of Inspection ( S
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?
❑ Yes ANo
❑ Yes U No
0 N 0 N
❑ NA ❑ NE
Structure 1 Structurc 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? ❑ YesVo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes ;KNo ❑ 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? 7Yes ❑ 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 ❑ YesNo [--]NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ YesNo ❑ NA ❑ NE
maintenance/improvement? '' �t
11. Is there evidence of incorrect application? If yes, check the appropriate box below. [:]Yes A No ❑ NA [j NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop
'�W`` Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop types? ` Qi+rt " t�.!'C,��L - tnS , STil�GQC
t )
13. Soil
type(s)
14. Do the receiving crops d1ler from those designated in the CAWMP?
❑ Yes 1� No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes %No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[_—]
Yes JgNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes XNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �&No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: `� 1 O `f W,5
Reviewer/Inspector Signature: Date:2zn7
12/28104 Continued

Facility Number: j Date of Inspection [] CZ
-- U.v><OoU -�'o o cam. C i", Ne,s. CUCF c-(V�� %coutij-,`
Co C t'n "4
Re uired Records & Documents
VqU �-�-� t 5 �-3 � Y,Q -�o 4 C.
Ja.�a.
� ��r�5 cxf� 0. �
v� �
p�J
gG 00W L b 11- —07
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
)kYes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�io
El NA
❑ NE
the appropirate box. WUp ❑ Checklists Desi
ElElgn El ❑Other
r
21. Does record keeping need improvement? if yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly FreeboardWaste Analysis El Soil Analysis ❑ Waste Transfers [:]Annual Certification
[]Rainfall ❑ Stocking ❑ Crop Yield El 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather Code
22. Did the facility fail to install and maintain a rain gauge'?
❑ Yes
PgNo
❑ 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
344No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
'5tuNo
El NA
El NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Q� No
❑ NA
❑ NE
Other Issues
/
28. Were any additional problems noted which Cause non-compliance of the permit or CA WMP?
❑ Yes
ANo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
"No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ YesNo
❑ 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?
/XYes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
-- U.v><OoU -�'o o cam. C i", Ne,s. CUCF c-(V�� %coutij-,`
Co C t'n "4
4-c. b��z "Do -ode aykaJQf f� � -e_
V
VqU �-�-� t 5 �-3 � Y,Q -�o 4 C.
Ja.�a.
� ��r�5 cxf� 0. �
v� �
p�J
gG 00W L b 11- —07
uS-T ,
e o�xe w11 n se�� onJc� .
11/28/04

Facility No, �-r� ' Time In Time Out Date - v
Farm Warne Integrator
Owner y^i- Site Rep
Operator No.
Back-up No.
COC Circle: General or NPDES —,77
Design Current Design _ Current
Wean - Feed
Farrow - Feed
Weaa_-_fjDjsh
Farrow - Finish
eed - Fin' h
Gilts 1 Boars
arrow - can
Others
FREEBOARD: Design
Sludge Survey } L OL,
Crop Yield
Rain Gauge
Soil Test Wettable Acres L_
Weekly Freeboard Daily Rainfall
Spray/Freeboard Drop Y C
Weather Codes 120 min Inspections
Waste Analysis:
Date Nitrogen (N)
S i 13 Z LA
Observed
Calibration/GPM I
Waste Transfers
Rain Breaker
PLAT I-
1 -in Inspections
Date Nitrogen (N)
IJ
PultfField Soil Crop Pan Window
,-
W7)
W�

Type of Visit 0 Compliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit ®Routine 0 Complaint O Follow up O Referral O Emergency Q Qther ❑ Denied Access
Date of Visit: I MXM Arrival Time: Departure Time: = County:� n Region:
Farm Name: 'QL ,r �� � Owner Email:
Owner Name: �- _ ���� ^, _ Phone:
Mailing Address:
Physical Address:
Facility Contact: Q�-n t ^ Title: T -4-r na Phone No:t
QS
Onsite Representative: 1 Integrator: _ 1t YOU, lax—_t'
Certified Operator:SAIZ �P Operator Certification Number:
S �' 4 2.3�` Back-up Certification Number:
Back-up Operator: p
Location of Farm: Latitude: E__1 e ET u Longitude: ❑ o =I I= "
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Popltry"Cptty Populaon
acti
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
*A
❑ NE
❑ Wean to Feeder
Layer
:- , : r: ,_x=-."- T
❑ Dairy Calf
❑ Dairy Heifer
Weeder to Finish 135ZO
❑ Farrow to WeanDa
Dry Poultry .-
'`'�^'' ' A r-
Cow
❑ Non -Dai
❑ Farrow to Feeder
❑ Farrow to Finish
La
❑ Layers
❑ Non -La ers
❑ pullets
El Turkeys
❑Beef Stocker
❑ Beef Feeder
❑Beef Brood Co
❑ Gilts
❑ Boars
Ji 1A
Other
❑ Turkey Poults
❑ Other
Nambei of Structures:
❑ Other
❑ NA
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
*A
❑ NE
b. Did the discharge reach waters of the Statc'? (if yes, notify DWQ)
❑ Yes
❑ No
ONA
❑ 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
Ji 1A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
15fNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
k�No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

Facility Number: %U-07_1
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 ZNo ❑NA EINE
[--]Yes ❑ NoA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): t t
i
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
U 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? ❑ YesNo ElNA [:1NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) IP
9. Does any part of the waste management system other than the waste structures require ❑ YesNo ❑ NA ❑ NE
maintenance or improvement? 0
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Vj No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Wo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ I-leavy Metals (Cu, Zn, etc.)
❑ PAN ❑ FAN > 10%or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window �❑ Evidence or Wind Drift ❑ Application Outside of Area
12. Crop type(s) (ICY n lei 1L CUY ► t M- ril USACC+
13. Soil type(s)
14. Do the receiving crops ditYr from those designated in the CAWMP? ❑ Yes C ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ONo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes No ❑ NA ❑ NE
IT Does the facility lack adequate acreage for land application'? ❑ Yes PNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes nNo ❑ 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. (ase additional pages as necessary): s;
p,,. ter can ;nlie. �. cn &A ha/n 6,neil �&re.
_Sr a-�s , R,e seed 4 rnLL ECA � ,A spr : S
Reviewer/Inspector Name �E" JV Phone, 3 3 f�
I Zn
Reviewer/Inspector Signature: Date:
Page 2 of 3 12/28/04 Continued

Facility Number: a Z Date of Inspection O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
❑ Yes
9 No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
[]Yes
[�No
[]NA
❑NE
w
❑ 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
'K No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
KNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
)ZNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Wo
❑ 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
Pio
❑ NA
ElNE
and report the mortality rates that were higher than normal?
w
/
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Wo
❑ 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
[ytWo
❑ NA
❑ NE
Additional Com -m. . Wand/or Drawings:
C 5 cx),s se N P GE 5 S+-aJz fx1 m i 5
c.e, 60- f m . E�x t lla A A Qc.cjv,� i
w
Page 3 of 3 12/2$/04

r
Facility No. Time In Time Out
Date (&�
Farm Name Integrator
Owner �Y Site Rep h
Operator u �t ems. -Y No. Q , )
Back-ups _ No.
COC _,� Circle: General or PDES
FREEBOARD: Design
Sludge Survey
Crop Yield l�
Observed
Calibration/GPM ✓ 1
Waste Transfers �~
Rain Gauge Ra' eaker
Soil Test PLAT V Wettable Acres
Weekly Freeboard Daily Rainfall �� 1 -in inspections
Spray/Freeboard Drop
Weather Codes
120 min Inspections
Waste Analysis:
Date Nitrogen (N)
Us z .z
Date Nitrogen (N)
z zv 3,1
Puffleld Soil Crop Pan Window
r S, I -Ut 3U

Type of Visit 49 Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit • Routine 0 Complaint U Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: y - 'O Arrival Time: II: 30 Departure'rime: County:
Vv6 s'loot
Farm Name: _51e,e xj.w Owner Email:
Owner Name: L -A-111 Tery Phone:
Mailing Address: 980 de "C le IPoad %?49&-4;,,-0 ,Ale X4382
Slee
Physical Address: 944 $SLS
yen er Coll
Facility Contact: ve *et/ Title: Phone No:
Onsite Representative: Integrator:N -X 6/J
CQ Mo(/.Sr nl✓i � � ircr...n J
Region: E?O
Certified Operator: Sfe✓e Te w Operator Certification Number: 1935 -
Back -up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: F_] o M' M Longitude: F::] o F71' = "
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 E94o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
"Design Current
Design Current
❑ NA
Design Current;:
Swine Capacity Population
Wet Poultry .. Capacity Population
Cattle
Capacity. Palpitation,'
❑ NA
❑ Wean to Finish
?Layer I
❑<o
Dairy Cow
II
-
❑ Wean to Feeder
10 Non -Layer
❑ Dairy Calf
1
eeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
".
❑ Farrow to Feeder
,-
❑ Non -Dairy
❑to Finish
❑
LaersFarrow
❑Beef Stocker
❑ Gilts
> ❑ Non -La ers?
❑Beef Feeder
❑ Boars
El Pullers
❑ Beef Brood Cor.,;
❑Turke s
Other
10 Other Other
❑ Turkey Poults
El Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes E94o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
E3<o
❑ NA
❑ NE
❑ Yes
❑<o
❑ NA
❑ NE
12/28/04 Continued

r
Facility Number: a —(J Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural pits storm storage plus heavy rainfall) less than adequate? ❑ Yes �o ❑ NA ❑ NE
a. Ifyes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA EINE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: T :
v
Spillway?: no
Designed Freeboard (in): f. q �!. -
Observed Freeboard (in): -3 7 ��
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
El -No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
2'N-
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
9 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
0"No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
dNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ NA
9. Does any part of the waste management system other than the waste structures require D Yes
allo ❑ NA ❑ NE
maintenance or improvement?
❑ No
Waste Application
E�?,O E
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
ONo ❑ NA ❑ NE
mai ntenance/improvement?
El NA
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.)
[I Ko
❑ PAN ❑ PAN > 10% or i O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
I.-IlIq 4Jj%q G -dam 132 -fes' /4,4V
12. Crop type(s) Car rt .S ov s
i
13. Soil type(s) A y /3
14. Do the receiving crops iffer from those designated in the CAWMP?
❑ Yes
2'N-
❑ NA
❑ NE
No
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
B
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
El Yes
❑ No
❑ NA
E�?,O E
17. Does the facility lack adequate acreage for land application?
C1 Yes
❑ No
El NA
L�
18_ Is there a lack of properly operating waste application equipment?
❑ Yes
[I Ko
❑ NA
❑ NE
Reviewer/inspector Name d �( ,C3r `° � _ "' Phone: 9/0- q96 - !Sk
Reviewer/Inspector Signature: Date: -
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?
14
❑ Yes lyd'No ❑ NA ❑ NE
20-
Does the facility fail to have all com onents of the CA WMP readily available? If yes, check
❑ Yes
❑-<o
[INA
El NE
the apprppirate box. ❑ ❑ Che sts ❑ Dmf n ❑ A ❑ 0,*e
Y uy X5 -1-2e0: ; Please AI e-
21.
Does record keeping need improvement? If yes, check the appropriate box below.
les
❑ No
❑ NA
❑ NE
❑ West, ArphmTim ❑ wkly Prefboard- ❑ s ❑ wntti
^Transfers
0-1cmual Certification
O­Raia€ate ❑ Uwkittg— ❑ GmV'rMId ❑ 12"htate-inSp--ris ❑
3 I.
s ❑
Wefftlse�
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
EKo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
allo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
D''1Qo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑l o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
M-NTo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
Eh<F'-
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 2114o ❑ NA ❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
9'go
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
Y uy X5 -1-2e0: ; Please AI e-
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
L2 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
�
3 I.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
0No
❑ NA
❑ NE
P/`GofvGr�
General Permit? (ie/ discharge, freeboard problems, over application)
�/
DFS q�s�
S
32.
Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
El2 Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
EK.
❑ NA
❑ NE
Ad€dttianat�Comnient�aodJ,v.ir Drawings
P af. 4,3 e-
Ca�P %tT'e -se j A4
�Yililua � �e��: ><,'c cri�.o,] 7 dr •�v01J �`v
[,Ce .:q 4ale,'9
Y uy X5 -1-2e0: ; Please AI e-
4/,f
�
e ,�f '73o /1?aI'k
e 7 31,y„>, �uP
P/`GofvGr�
/1 Lr, ���cl T`o�so� f✓ ;<'d 6art'
DFS q�s�
S
unr.� So:vt /
� Gjrri�FS � t�4ar� S�a��f
/o ann Fl � r0 �vOr�C On , +iS,c�e 5%Pr5
12/28/04

Type of Visit 40 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facilim Number Date of Visit: ti' O Time: : t!
Not Operational 0 Below Threshold
ermitted �ertified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: sieve 7—e6v County: Grr F�V
Owner Name: Aleve TC w n Phone No: DO- 6-31- 3 g -21
Mailing address: 990 Ao%n 6r c A Kota o L 2 3A
�.
Facility Contact: rnw Title:
yap
Onsite Representative: re w _
Certified Operator: Sieve _ lekz
Location of Farm:
Phone No:
Integrator:Mur'OL ,3raw
Operator Certification Number: / 9 3 Ss"
[wine ❑ Poultry ❑ Cattle ❑ Norse Latitude 0 �' ��» Longitude 0 •
Design Current
Swine ranacih Pnnnlatian
❑ Wean to Feeder
QTeeder to Finish 3 .�t D
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boris
Design Current Design Current
Poultn Capacity Population Cattle Capacity Population
❑ Laver ❑ Dairy
❑ Non -Laver 10 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ La oon Area ❑ S rai• Field Ares
Holding Ponds I Solid Traps ❑ No Li uid v1'aste Nlanaoement Svstem
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ yes �o
Discharge originated at: ❑ Lagoon ❑ Sprav Field ❑ Other
a. If discharne is observed, was the conveyance man-made? ❑ Yes ©'Po
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ) ❑ yes 21N0
c. If discharse is observed. what is the estimated flow in sal/min? -�
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes �o
2. Is there evidence of past discharge from any pan of the operation? ❑yes [91�0
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes MTo
Waste Collection 8- Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes �o
Structure 1 Structtue ? Structure 3 Structure 4 Structure 5 Structure 6
Identifier: /
Freeboard (inches): 3!;
05/03/01 Condnued

Fa ' rty Number: S2 — 6/
Date of Inspection 9-0
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Apl2licatiorp
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type Cell/t7 . �tlfir� 5014eo.vs
❑ Yes [,.}moo
❑ Yes EJIN/o
❑ Yes B'go
❑ Yes ONO
❑ Yes ONO
❑ Yes 9 -go
❑ Yes -foo
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAW.MP)? ❑ Yes M No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes PN -0
b) Does the facility need a wettable acre determination? ❑ Yes [
c) This facility is pended for a wettable acre determination? ❑ Yes P-N'o
15. Does the receiving crop need improvement? El Yes El -No
16. Is there a lack of adequate waste application equipment? ❑ Yes UNO
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes B lqo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ONO
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes [INo
Air Quality representative immediately.
-c6iia hts (V etr to o:#). 1 ;may YFs w mocyor any , stjfto_ai yy ots _
drav�ta�gso� �£riLty to tretter exptatmsxtnabons. (u addrteon� pages as pessary? [wield Copy ❑ Final Notes 7
_ ::='sem 1:'t'•.� ate`' �' ,.a:-��...� ����.,'_x ���. _.� .r;.r��_ .,;-.a � �.,.��. _� _.a.=_� . :`.� .:..�_t, � _�:.� �--;�-��,.. .�
a
r►
Reviewer/inspector 1Vame fl" " °,1
Reviewer/inspector Signature: lYZa% f Date: G U
12112103 Continued

FacMity Number: SA !G/� Date of Inspection O
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility f4to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WV(chec�li�ts, design-a4ps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Ap lication ❑-*eelaeard ❑ his [I Sailing
q-/10 -) 3. 3-� 2?,q y - -)� 7 _-7,r
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AW'NV?
' PDES 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
❑ ❑ R--sir"I ❑ n
❑ f29-Ntmuw_LnspeG6ens ❑
❑ Yes Q#o
❑ Yes
9 -No
❑ Yes
©-No
❑ Yes
IUNO
❑ Yes
ETNo
❑ Yes
EkNo
❑ Yes
ONO
❑ Yes
[.lido
❑ Yes
[bio
0 -res ❑ No
❑ Yes a<
❑ Yes M -NO
❑ Yes E#o
❑ Yes 21 o
❑ Yes Q -KO
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this VWL
Add rttonal'.Co6iiii6 5 andlnr.'Dtiwtngs -_ x = s
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12/12/03

Site Requires Immediate Attention: Alo
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DA'Z`E:TUiT 1995
Time: 15= 49
Fane Name/Owner: 54--_oe_ Tc -_3
Address: .t� M
County: !60 as +. • 1
a r.+ _ • f s
On Site &.—n 1
Physical s i s r I Ira.oN ♦. :•.
Type of Operation: Swine X Poultry Cattle ,
Design Capacity: Number of Animals on Site: _ 3
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 34 Longitude: -7,? 033 ' low
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) Yes or No Actual Freeboard:�_Ft. Incites
Was any seepage observed from the lagoon(s)? Yes or No as any erosion observed? Yes or(O
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? mor No
100 Feet from Wells? �0 or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes ort&
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or No
Is animal waste discharged into water of OK state by man-made ditch, flushing system, or -other
similar man-made devices? Yes orIf 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 t-�s -L t��1.►at�d �v ti-:�.,� d1
Additional Comments: l
l k--•�_ .aa� ct Sort�� inSL�rT r�:ctrr_, �_'�QS._..�` 'a4 ;nS[kG�;UnM kne f�el t
Inspector Name z *"J o (txe Signature
5,44c -7M +�3c.6,&%,4L Rick.
C-'C,Yetfe-L.;f(e NC .2&goI
cc: Facility Assessment Unit Use Attachments if Needed.