310318_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Quai

'ooservatiion
on Q Technical Assistance
cy Q Other Q Denied Access
Date of Visit: r4Aij t -7 1 Arrival Time: ' 0; Departure Time:1-�=--- t County: t(L1 Region: U)l71
,
Farm Name: 4'7
Owner Name: 11Ki✓1 +[r
visit: %o t-ompuance inspection v tiperanon Keview V arrucrun
for Visit: ioutine Q Complaint Q Follow-up Q Referral Q
Owner Email:
Phone:
Mailing Address: AUG 17 2017
Physical Address:
Water Ouality Regional
Facility Contact: Title
1�
Onsite Representative: .�
Certified Operator: KCr,14 al ft✓ c�
Back-up Operator:
Location of Farm:
Latitude:
Regional Office
Phone:
Integrator:
57
Certification Number: /'8'7,S
Certification Number:
Longitude:
Design current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
�.i( D p�
Dairy Heifer
D Cow
Non-Dai
Farrow to Wean
Farrow to Feeder
Design Current
D . P,oult . ca aci 10
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts -,�
1. Is any discharge observed from any part of the operation? El Yes M�o-, ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [:]Yes [] No �A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No []_'j�_A ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [:]Yes [—]No i--T<A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes E3Mo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes G] o ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facilitf Number: / -31 - 31$" Date of Inspection: L(
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Z3_Ne-- ] NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[]-,?iA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z—_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion; seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
EEINo
❑ 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
Lallo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[TNo
❑ 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
ER -No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑- Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Ctu6 j3Byx-_�I, SCE a
13. Soil Type(s): L' IV U
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[ —No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
allo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
C No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[!!fNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[lNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[2-No
❑ NA
D 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
ENo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[�3 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0 No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facili limber: - Date of inspection:
24, Did the facility fail to calibrate waste application equipment as required by the permit?
❑Yes
r�'NCo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
Q'5o
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
E3'`'o
0 NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑�<
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
❑ Yes E)Alo" ❑ NA ❑ NE
❑ Yes E2- fro ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑Yes ❑Ko ❑NA ONE
❑ Yes [] N ❑ NA ❑ NE
❑ Yes [. blo [DNA ❑ NE
Phone:'(j.-4.3-333 T
Date: I
21412015

• Di'vis"ion of Water Resources
Facility Number I71
� - 3 f Q• Division of Soil and Water Conservation
Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
a If
Date of Visit: Iz//6 114 Arrival Time: eOO eparture Time: County: Region:
Farm Name: G Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: tQ
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current
Design •urrent
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle C►opacity Pop.
Finish
La er
Dai Cow
Feeder
Non -La er
Dai Calf
o Finish
r
Dai Heifer
o Wean
Design
C►►urrent
D Cow
o Feeder
D , P,oul
C_a sei
P,o
iry
Non-Da'o
Finish
ILayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turke Poults
Other I I
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?
❑ Yes 0 No ❑ NA ❑ NE
[:]Yes -E�No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes .E]—No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ,E�J`No
❑ Yes
ElYes No
[DNA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412015 Continued

Vacilit,v Number: - :3 Date of Inspection:
Waste Collection & Treatment
4. Is strage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [21No ❑ 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: I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ILI S
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes j2r No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed andlor 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 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 PNo
❑ 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 �lo
❑ NA
[] NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes �3 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below, ❑ Yes O No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure
to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
allo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E!rNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
ZNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�fo
T�!rNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes J�!rNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes 0No ❑ NA ❑ NE
the appropriate box.
❑WUP El Checklists ❑ Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZNo ❑ 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 Zf No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes -ffNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection: 6
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
25. Is tic facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
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 ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? []Yes ❑ No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ No ❑ NA ❑ NE
Comments (refer.to question #): 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).
71 a c) //6 .far -�rpes ocf r & (e c aro#s
�o�,,ao/S' Q •Q�
7/ t� A 4 dO
Reviewer/Inspector Name: Keuikz
Reviewer/Inspector Signature: A
Page 3 of 3
Phone: A0 Z&
Date: L&
21412015

(Type of Visit: OeCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: 6Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: C Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: :Zln p _ L.C. in (pic
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator: ze�s
Certification Number:
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design C«urrent
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
D ja Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D , P■oul Ga acit P,o
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non-Laye
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
JF—Fffi-er
Turke s
Turkey 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 oNo ❑ NA ❑ NE
[—]Yes eNo ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes 16No
❑ Yes 21�40
❑ Yes &No
❑ NA ❑ NE
❑ NA ❑ NE
[] NA ❑ NE
Page I of 3 21412014 Continued

Facility Number: - Date of Inspection:
J
Waste Coll- Lion & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
ZNo
❑ 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
Ej 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
EfNo
❑ 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 E2(No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes VNo
❑ 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 6 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes [7"No
❑ NA
❑ NE
maintenance or improvement?
1 L is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes dNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12, Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
EfNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
6 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[%f 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
4No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[?rNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
V�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 ,ZNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ t20 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E/No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ONE
❑NA ❑NE
Page 2 of 3 21412015 Continued

[Fa6idiy Number: Date of Inspection: %o
1 .
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes P3"No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes [2rNo
❑ 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 ;j'�No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[—]Yes P�-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 VfNo
DNA ❑ 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 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 No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ NA
❑ NE
�� rrrri .rin•rrrr�i
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comet. enls.':'
... "
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
6 rr-\ 4- records [ca� Sc�P
Phone: ! W7
Date: is f5-
21412014

­I'M. ..
on 615W, Quality
Facility Number u - O Division of Soil and Water Conservation
0 Other Agency
Type of Visit: gMompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
[season for Visit: 'Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: j Arrival Time: Departure Time: County:
Farm Name: d�V Fi4,,(yYt� `1 ' Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
OAsite Representative:
Certified Operator:.
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Region:
Integrator:
Certification Number:
aDl
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish I
Design Current
Wet Poultry C►apacity Pop.
ILayer I
jNon-Layer I
Design Current
Cattle C►apacity Pop.
Dairy Cow
Dairy Calf
Wean to Feeder
I
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Farrow to Finish
D . P,oultr. C•_a aci_
ILavers
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Imoacts
L Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes To ❑ NA ❑ NE
❑ 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 0 No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes No
❑ NA
❑ NE
of the State other than from a discharge?
Page l of 3 21412011 Continued

r
' Facifi7� Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
4 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: L f
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes
WNo
❑ 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
7No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes VNo [a 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 [XNo ❑ NA ❑ NE
maintenance or improvement? T
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 Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 8No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
PTNo
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
KNo
❑ 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
PTNo
❑ 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
VrNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ZNo
❑ NA ❑ NE
Page 2 of 3
21412014 Continued

Facility Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes' No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
r:
❑ 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 o ❑ 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 KNo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes VNo ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
❑ Yes ; No ❑ NA ❑ NE
❑ Yes ZNo
❑ Yes 0 No
❑NA ❑NE
❑ NA ❑ NE
Reviewer/Inspector Name: ..3WS Phone:
Reviewer/Inspector Signature: �ti,�,� Date: 4W_
Page 3 of 3 21412014

� � Divis""ion of Water Quality
Facility Number - 111=Divis
ion of Soil and Water Conservation
© Other Agency
Type of Visit: Mompliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral Q Emergency O Other 0 Denied Access ,
Date of Visit: Arrival TimedLL Departure Time: County: M06M
Farm Name: [,,W Y JV_j_&jk Owner Email:
Owner Name:
Mailing Address:--
Physkal Address:
Facility Contact: Title:
Phone:
Phone:
Region:
Onsite Representative:
Integrator:
Certified Operator:
�Q/�\��
rlp�t�("'y�p�/1�
Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
IF to Feeder
Farrow to Finish
Design Current
D , P,oultr, Ca_ aci_ P,a .
Layers
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
TurkeyPoults
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?
❑ Yes 71 No ❑ NA ❑ NE
❑ 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
J!jNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
JZ No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facie Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �10 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structur 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ;n 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 [DNA ❑ 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 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 KNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ETNNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes 4No
❑ NA
❑ NE
❑ Eye essive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 2TNo
0 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. FrNo
❑ NA
❑ NE
acres determination?,
17. Does the facility lack adequate acreage for land application?
❑ Yes Mo
❑ 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 Coverage & Permit
Yes
NA
NE
of readily available?
❑ iffNo
❑
❑
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes 5-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 J�N o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ' ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22, Did the facility fail to install and maintain a rain gauge? [:]Yes ;3 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: - Date of Inspection:
24 Did the facility fail to calibrate waste application equipment as required by the permit? Yes RNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes j6No
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?
NA NE
�NA NE
Yes ?f-No ❑ NA ❑ NE
Yes XjNo ❑ NA ❑ NE
[] Yes ff No NA NE
Yes P7No [] NA ❑ NE
❑ Yes ZrNo ❑ NA ❑ NE
[-] Yes �2'No ❑ NA ❑ NE
Yes ETNo
❑ Yes ;TNo
❑ Yes allo
NA NE
NA NE
NA NE
Comments'(refer to question ##): 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).
per, w'V, �
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: OL�._Ul
Date: 5b3hm
21412011

Type of Visit: UC
mpliance Inspection U Operation Review Q Structure Evaluation O Technical Assistance
Reason for VisitRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: Region:
Farm Name: 4Z,4Y— �4"AW l"14$1-!K S `7' Owner Email:
Owner Name: &NI tr )Aafxr4'4/ Phone:
Mailing Address: Y` &X 9� &Vk LAU) LLC / Y C.
Physical Address:
Facility Contact: \\ Title:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pap.
Wean to Finish
I
Design Current Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pop.
ILayer Dairy Cow
Wean to Feeder
[Non —Layer
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D , P,oult . Ca aci_ P,o
Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non-Laye
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharees and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes O.No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
❑ 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) 0 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 o ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: 3j - Date of Inspection: Q
Waste Collection & Treatment
'to
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: Q9�'
Spillway?:
Designed Freeboard (in): C S
Observed Freeboard (in): ~
S. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
14 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?
0 Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ 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
n Outside of Acceptable Crop Window n Evidence of Wind Drift F1 Application Outside of Approved Area
12. Crop Type(s):
13, Soil Type(s):
1)
L L
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
Q WUP 0 Checklists ❑ Design Q Maps ❑ Lease Agreements
❑ Yes I Zo
o ❑ NA ❑ NE
❑ Yes [DNA ❑ NE
❑ Yes
1� No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ YesAs
No
R Waste Application 0 Weekly Freeboard ❑ Waste Analysis Q Soil Analysis ❑rl:
ters
Q Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections 0 Monthly and 1" Rainfapections
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
0 Weather Code
Q Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Facility Number: - Date of Inspection: O
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
Yes
777❑���
❑ No
27. Did the facility fail to secure a phosphorus Ioss assessments (PLAT) certification?
Yes
❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
and report mortality rates that were higher than normal?
TT``
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
14
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
permit? (i.e., discharge, freeboard problems, over -application)
]�1
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA ❑ NE
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): 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).
5aAD6C'5LA9-u CA:S D k C DC-) IQ
. (:.� L� OG-�' "1 O 1 C_ w c Ds - li.�l t� C_r- M T
M141�� S "(LG ,4c7 ► Ur �GN rc-W VZG �-
MAJ
3lklra I.`�>
io13//�i 1.3
«n -Tcl Cco
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
�_Ivce� 5 6� ,
U)
Phone:
Date:
21412011

Type of Visit: Compliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up Q Referral p Emergency O Other O Denied Access
Date of Visit: uw�rl Arrival Time: © Departure Time:® County Nx /)y Region:
Farm Name: j�oY K emAN Fa nn ' Q--1 Owner Email:
Owner Name: qZONA116 _�AQ(k AN Phone: q )b — ac11R__M LH
Mailing Address: P. &piC 19 S A/C D R-S) Pr
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: K /-}UE Sm l 7 / _ Integratoor:
Certified Operator: S�� Certification Number: 1
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish La er
Design Current
Cattle Capacity Pop.
Da' Cow
Wean to Feeder
Feeder to Finish b
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Non -Layer
Da Calf
Design Current
I)r. $oultr. Ca aci P,o
La ers
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Gilts I
Non -Layer
Beef Feeder
Boars
Pullets
Beef Brood Cow
01—Tother
rke s
�TurkeyPoults
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)?
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 K
No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes&No
❑ NA
❑ NE
Page I of 3 21412011 Continued

FaciliNumber: - Date of Inspection: (p -711
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
o
tNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[:]Yes
Dd'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
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?
�Tl
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
gNo
❑ 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 l0 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): 1L]rC��'t ]
13. Soil Type(s):
i- NoFdL1'(_
14. Do the receiving crops differ from 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 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
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[]Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes] No
❑ NA
❑ NE
the appropriate box.
7�
OWUP 0Checklists QDesign 0 Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
0 Waste Application 0 Weekly Freeboard [] Waste Analysis Q Soil Analysis
❑ NV6te Transfers
[] Weather Code
Q Rainfall ❑ Stocking ❑ Croup Yid R 120 Minute Inspections [] Monthly and 1" Rainfall Inspections
Q Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes tNo
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: L- 1 Date of Ins ection: (0 f 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ YesONo
No ❑ NA ❑ NE
the aDUrovriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes OkNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No ❑ NA ❑ NE
0
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes Wo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): 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).
ls(_uC)CE SuRuEc\ &7,eMP7- W471L f
-- �- Now fn Rry 4ICC- -S 0A1 F-Ak "`^ pNS ! T&" C3uT ON E M I G fl 7 (3 E
07H69- F�K
A -
-511, J,ca
AleO� aA[E
5a
P
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �/0 __:H p � 4
Date: /O
z /I
21412011

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit &outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 0 0 `Arrival Time: Departure Time: County: C-I A± Region:
Farm Name: �'� Azrnw! `3 `l Owner Email:
Owner Name: RuymE ! Phone: K r1)gW 17jy"T
Mailing Address: i'•� • 1�]�i� ! �7-�� �Zi{�L1i L (li O� 0 C�
Physical Address:
Facility Contact: Title:
Onsite Representative: �E S�2I"'U/ LA'/viEpz
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 n [= A = Longitude: = o = i = it
Design C*urrent Design
•urrent Design Current
Swine Capacity Population Wet Poultry Capacity
Populatiou Cattle Capacity Population
❑ Wean to Finish
❑ La er I
I
❑ Dairy Cow.
❑ Wean to Feeder
1 10 Non -Layer I
I
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
Farrow to Wean
Dry Poultry
❑ DEY Cow
❑ Farrow to Feeder
❑ Layers
ElNon-Dairy
El Stocker
El Farrow to Finish
ElGiltsGilts
❑ Non-Layers
❑Pull
❑ Turke s
ElBeef Feeder
El
El Beef Brood Coyd
❑ Boars
Other
❑Turke Poults
❑ Other
1 1[01 Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
KNO
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
)eNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
)6_No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: J — J g Date of Inspection�a
rite gollection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: A-CWIV
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �-
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 16-No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
❑ Yes 7A No ❑ NA ❑ NE
❑ Yes 4No ❑ 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 ' No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 'R No ❑ NA ❑ NE
maintenance/improvement?
IL Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
El Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs [:]Total Phosphorus El 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) S Gi '6 eq,4 1 CV—N CAS 4,g AY S
13. Soil type(s) k? G.yu 4c",rl-
Q(UkF yt, IC _.
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
IP No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�4 No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
Dd No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
El
[I NE
18. Is there a lack of properly operating waste application equipment?
El YesgZ
❑ NA
❑ NE
Comments refer to " uestion'# "Ex lain.in YES answers andl a
Use di=avin(s offaci[i to better ex latn.situations. use,additio or anyrecommendations or any other comments w
nal g neeessa - . d-'
a es as �
g tY p { P rY)
Reviewer/Inspector Name I hmavolq 6,91A/Els
Phone:���,3�
Reviewer/Inspector Signature:
Date:
Page 2 of 3 12128104 Continued

Facility Number: — f Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes-P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ANo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists
0 Design 0 Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes X No ElNA ElNE
ElWaste Application ElWeekly Freeboard ❑ Waste Analysis ElSoil Analysis ElY/aste Transfers
❑ *ual Certification
0 Rainfall ❑ Stocking ❑ Crop Yield [:1 120 Minute Inspections Q Monthly and V Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes `ANo ❑ 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 '%Vo ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes 'N No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes KNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No *"ANA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes 1� 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 4No [:1 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 k
No I --]NA [INE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [gNo ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes %LN ❑ NA ❑ NE
Additional Comments and/or Drawings:
SC_ck0 �xEw�Q i wclT/{— o►oC
e7 co p�
19L1 9VA Tl O/V Dtl iz C>j_0.[
w.
Page 3 of 3 12128104

Type of Visit �Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
JS§.RI
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �j C�% Arrival Time: ® Departure Time: County: Lt� Region:
Farm Name: AQrn AN �_AQP S H_ Owner Email: Owner Name• 'V t F_ _� wuy)gJV Phone: 9 10-99R _'119r '
L>,O . froA
Mailing Address: -an 5 ,1Qxx,- n/ iZd N a C—L1_LA V 1 LL E,/VG D P S
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: KEU 1 A/ 1AR- M ON
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:) 9745C�
Back-up Certification Number:
Latitude: ❑ o = 4 ❑ « Longitude: = ° = 1
Design Current Design C►urrent III
Capacity Population Wet Poultry Capacity Population C•atticCpulation
0WC-
rrene
❑ Wean to Finish
❑ Layer I
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer I
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
Farrow to Wean
❑ Farrow to Feeder
Dry PoultryDryEl Cow
❑ Non -Dairy
❑ Layers ❑ Beef Stocker
❑ Nan -La ers ❑ Beef Feeder
❑ Pullets
❑ Beef Brood Co
El Farrow to Finish
❑ Gilts
❑ Boars
❑ Turkeys
❑ Turkey Poults
❑Other
Number of Structures:
Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gaIlons)?
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
KNo
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
V-11,o
❑ NA
❑ NE
❑Yes
No
❑ NA
❑ NE
Page I of 3 12128104 Continued

e
1
FacilityNumber: 3
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: lA ia00'V
❑ Yes 0 No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in): J 9.
11-5
Observed Freeboard (in): aq Is
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes XNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes KNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes JJ No El NA [I NE
maintenance/improvement? - \
IL Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) 9 _q_M 17 A
13.
Soil type(s) dAtZ>
Do the receiving crops differ from those designated in the CAWMP?
El,�
Yes
,/
I� No
ElEl14.
NA
NE
15.
Does the receiving crop and/or land application site need improvement?
❑
kiNo\Yes
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
gNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
,KNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
JdNo
❑ NA
❑ NE
ComYm'ents+(reter�tokluesnou�#) ytxplainmap YES answers:and/or any„recommersdaiions or any other'eomments.
zYu° 'vz-z.iYVnT`l'V+'�. .. ,°n`#?d{ k!4 s+ ae#'.ww?;°' k*s14. .. i \,
tiJse drawrngs'of facilrty�to�better explayn ituahons. (use ladditttonalapagesrasinecessary,,):.
GAUC'�RAi-iC�rV �F- S c_t.�t�6 E S�R�E� �l�C T L11 g U EA.�
`
CaE>' ccqLj of SLLAUG - EAE Ski jevV �r i jCRa� K�EJp w S�Ecc►c�fl�
it 191102 �• S
Reviewer/InspectorName F MANrS(a Q_wrS Phone: "l!O=19(0- 30+
Reviewer/Inspector Signature: Date: 5192J09
Page 2 of 3 12128104 Continued

Facility Number: —31K Date of Inspection 5 �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 No ❑ NA ❑ NE
the appropirate box. Q WUP ❑ Checklists g p ❑ Other
` ❑ Design 0 Maps
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ANo ❑ NA ❑ NE
[] Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑ �aste Transfers ❑ Anual Certification
❑ Rainfall 0 Stocking 0 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 9No ❑ 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 [A 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 A
NA ❑NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes §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 JNo ❑ 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 A No ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss reviewhnspection with an on -site representative? ❑ Yes kNo ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes 4No ❑ NA ❑ NE
Additional Comments: and/or Drawings:
.,.0 C� A� S �t �fl-T � GZ�S �d�v oar i�rs� DO
wA �-
�T�j0L'W hl INS
Page 3 of 3 12128104

Faciiily Number'- 3
jMDivision��of Water Quality
0 Division of Soil and Water Conservation
Q.Otber`"Agency
Type of Visit tq Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: [Lai j M Arrival Time: 0O Departure Time: County:
Farm Name:
Owner Email:
Owner Name: _ ►iLC�/1�/1� ] i 1�- %/ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: n
Onsite Representative: ON 6` [2
Certified Operator: r A4 AI
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Region
Operator Certification Number: 1 �4D
Back-up Certification Number:
Latitude: =1 o= I1=1 {f Longitude: 0 0= g 0
Design Current' Design Current ' Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Populat�ortr
❑ Wean to Finish ❑ La er
❑ Wean to Feeder I : ❑ Non -Layer
Feeder to Finish
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
n Rnarc
Other
❑ Other — -
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:' �f
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes gNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
El NE
❑Yes
El No
❑ Yes
JD�No
❑ NA
❑ NE
❑ Yes
Wo
❑ NA
❑ NE
12128104 Continued

Facility Number: -31-3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ANo ❑ 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): G), S
Observed Freeboard (in): ,� R{
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes KNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed ❑ Yes XNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4fi 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 )4 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes U(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 KNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ro ElNA ElNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ 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
kNo
❑ 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
1� No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
EqNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
J54—'No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary): ,
<:� pT cjop !� a -F- C QjC j> b I 1�,Q�, ek PEA:r Q-9j.,fdLI) S
f-Aa. MKS 6tam#1
Reviewer/inspector Name Phone: -7 5�>'f
Reviewer/Inspector Signature: Date: COi Q
Page 2 of 3 12/2&04 Continued

Yacility.Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
KNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking f4Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rain Inspections ❑
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
V No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
gNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,VNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
X�No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
9No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
4 NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
_KNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours,and/or document
❑ Yes
jro
❑ 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
J�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
J�_No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
(rNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

I ODivision of Water Quality
C Facility Number '� 0 Division of Soil and Water Conservation
0 Other Agency
IType of Visit A Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance i
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access Ij
z_
Date of Visit: _ Arrival Time: Q � Departure Time: .� County:
Farm Name: 4114AL Owner Email:
Owner Name: Phone: _
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: !/
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
r22
Region: ZLZ
Phone No:
Integrator: A42?1&iL
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = = ie Longitude: = ° = d 0 6f
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑Ia er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkcx Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current .
Cattle Capacity °Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Da 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
No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes 5No ❑ NA ❑ NE
❑ Yes �/ No ❑ NA ❑ NE
12 8/04 Continued
Y

'Facilio Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �No El NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes yNo ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )Z(No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes O'No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ,.❑.,%No )zNA ❑ 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 Y No ElNA ElNE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes l,Q No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes to
❑ NE
Other Issues �'
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �No El NA [I NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ElYes �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 [I NA El 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 El NA El NE
General Permit? (ie/ discharge, freeboard problems, over application) /
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes X,No [I NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes No ❑ NA ❑ NE
Additional Comments and/or Drawings:
4/77
41AI
12128104

V im _
Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ElYe ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: k1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Zle
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ YesNo ❑ 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 ElNA ElNE
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? Xyes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 4No ❑ 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 A lication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) AZWM!�/14-/ ems/ 1. V5'a r Dd/aSe�_
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ANo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
XNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
XNo
❑ NA
El 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 recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewerflnspector Name / Phone: V f .�
Reviewer/Inspector Signature: Date:
12128104 Continued

i
" Division of Water Quality_
Facility Number", 3 O.Division ofSoil and Water Conservation : �f
-- O',Other Agency
Type of Visit Ycompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit XRoutine Q Complaint 0 Foilow up O Referral () Emergency 0 Ot er ❑ Denied Access
Date of Visit: Q Arrival Time: Departure Tiime: ,ru/ unty: c�pGz Region:
Farm Name: �!J Owner Email:
Owner Name: A o.
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Phone:
No:
Integrator:
Operator Certification Number -
Back -up Certification Number:
Latitude: = o = = Longitude: = o E__1 0
a. f 4}
Destgn Curren#'. Design Current DesJigni Current
Swine: Capacity Population ` Wet Poultry Capacity Population Cattle f-Capacity Population'".
❑ Wean to Finish ❑ Layer
El Wean to Feeder E 1 ❑ Non -Layer
Feeder to Finish
Farrow to Wean Dry'Poultry `
❑ Farrow to Feeder E
❑ Farrow to Finish
❑ Gilts
❑ Boars
:Other
❑ Other �.
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
-Dairy
eef Stocker
orNon
eef Feeder
eef Brood Co
Number of Structures C
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
El No
El NA
❑NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes�oNo
❑ NA
❑ NE
12128104
Continued

Facility Dumber: —
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?'
il tru e Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes XNo
El Yes ❑ No
Structure 5
❑ NA ❑ NE
El NA El NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Rp No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes )dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,�(
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes yJ No ❑ NA [I NE
maintenance/improvement? 19f
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes /No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or i 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window Evide ce of.Wind
/Drift ❑ Application O e of Area
12. Crop type(s) CAMIn
13. Soil type(s) AA AU-8
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes XNo ❑ 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 )Z No ❑ 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 [3'No ❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name �� r0 Phone: 1�
Reviewer/inspector Signature: Date:
Page 2 of 3 12 8104 Continued

Facility Number: —� Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes IL! 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 El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 9Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard El Waste Analysis ❑ Soil Analysis ❑ Waste Transfers El 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 oNo ❑ 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?
❑ YesANo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ko
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
oNo
ElNA
ElNE
27_
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[:]No
XNA
El NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
R'No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
;d 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
r
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
qNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ZNo
❑ NA
❑ NE
Additional Comments and/or Drawings: '
r ez!
Z9
Page 3 of 3 12128104

Type of Visit Orcompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit / Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: l'S O Arrival Time: %ZD Departure Time: i ount}':
Farm Name: / �� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:_ Title:
Onsite Representative:�1�2 _
Certified Operator:
Back-up Operator:
Location of Farm:
Region: 61)";
Phone No.
Integrator: �l!►�. %�. 1 �IQ/�'��
Operator Certification Number:
Back-up Certification Number:
Latitude: [= c = 4 [=44 Longitude: = ° [� d
Design
Swine Capacity
Current. Destgn Current Design Current
Population Wit Ponitry Capacity,, P>op�lation Cattle Capacity Population
p
❑ Wean to Finish
❑ Layer
❑Dai Cow
❑ Wean to Feeder
10 Non -La ei I
I
Dairy Calf
Feeder to Finish
2 t7
Dry Poultry
❑ Dairy Heifei
El Farrow to Wean
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ La ers
❑Non -La ers
❑ Pullets
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑ Beef Feeder
❑ Boars
10 Beef Brood Co
❑ Turkeys
❑ Turkey Poults
Other
-
Number of Structures: .
❑ Other
❑ Other
DischarLyes & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
/No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
A
El NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
;dNo
❑ NA
ElNE
other than from a discharge?
12128104
Continued

Facility Number: 31 — Date of Inspection f C?
W. t C 11 s t" & T t t
e o ec ion _ rea men
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? v ❑ Yes Z
No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
St}uctur, }I N Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: O
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ONo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes )No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen�reat,
notify DWQ
7. Do any of the structures need maintenance or improvement? Yes jSkl4o
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes V(No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No
fin
❑ NA ❑ NE
maintenance or improvement?
Waste Application
l0. Are there any required buffers; setbacks, or compliance alternatives that need ❑ Yes No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence ooffWind Drifl ❑ 'one Outside of Area
,7pplica
12. Crop type(s) : _i/1�F��C
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`
❑ Yes
P No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�No
❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
CdNo
❑ NA
❑ NE
nU*s4et:-'1
awd.'� x a > , s rr e -tea; _
nts(refer to questton,#) Explain any Y11S@answers andlor_any recommendations or any other comments.
ssof facdity to betteraexplatnsttuanons tuse�addihonal pages a5"�neces as
Reviewertinspector Name I I Phone: Wo- 9ko'
Reviewer/inspector Signature: Date:
12128104 Continued

Facility Number: 131— Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 40No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ;2(No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
XNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
;dNo
❑ 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
XNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
;dNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ NoXONA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CA WMP? ❑ Yes PNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes No ❑ NA ❑ NE
General Permit? (iel discharge, freeboard problems, over application) 10
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes P No ❑ NA ❑ NE
12128104

M
(Type of Visit XGompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit .Routine O Complaint O Follow up Q Emergency Notification O Other C] Denied Access
Date of Visit: Time:
Facility Number
Q Not Operational Q Below Threshold
)2fermitted�Certified 13 Conditionally
Certified 0 Registered Date Last Ope or Above Threshold:
Farm Name: ....rs._ +�......�.�.�.1-a•},-..r,�'}1.�....f...-�. County: ......_ . �.�.....................................
Owner Name: .... Phone No:
%tailing Address: .... ............. . .............. . ............. .._ �. .....� ..... ......................
--- W. .. �_ ----............ ... ._. .......
Facility Contact: Title:.._ .. __.............._...._ .. Phone No: _... _. .... ....�__..............
Onsite Representative: Integra
tor:��;
Certified Operator:------- ............. .. _ Operator Certification Number:
Location of Farm:
wine []Poultry ❑ Cattle ❑ Horse Latitude �0 �` �" Longitude �• 4 "
Dischaiees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes_,2So
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ZWo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Z31go
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Strjjcture 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .........Iff—tuT..-3_ .....................................................................................
Freeboard (inches):
.12/I2103 Continued

Facility Number: — 3 Date of Inspection
'.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 maintenancefimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding QPAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certi
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Animal Waste Management Plan (CAWMP)?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes OVo
❑ Yes J;M
❑ Yes ONo
❑ Yes ErNo
❑ Yes Z"No
❑ Yes eNo
❑ Yes M40
❑ Yes ,-No
❑ Yes Er o
❑ Yes ❑ No
❑l Yes ❑ No
A z es ❑ No
❑ Yes ❑ No
❑ Yes ,b No
[]yes
❑ Yes No
❑ Yes 00
"Comments {refer tognestwos� #} �Ezpla�n any YES�aiswers arrd/or anp recomaiendahons oraup ot>rer co ,�,` �. w=
_muient5.
-Use dravc�ngs of fac ty to better eicplain situations. {use addit,onai pages as necessary}: ❑Field Co ❑Final Notes
V eu Co rr� Y) oa, e 4 e �� m ti rya
US
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
Il/12/03 Continued

Facility Number: — Date of Inspection
',R'iequired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ,0<0
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ WUP, checklists, design, maps, etc.) ❑ Yes .ENO
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes J;3'No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 13'go
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes .fNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ENO
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes �l o
28. Does facility require a follow-up visit by same agency? ❑ Yes a-Ro
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 0 No
\TPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes PIKo
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit 0 Compliance Inspection 0 Operation Review Ckl!agoon Evaluation
Reason for Visit O Routine O Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Date of Visit: Time:
Facility Number
Not O erational 0 Below Threshold
Lj Permitted 0 Cerhfi d Li Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: ai Y}+a County: 0F/_ Jq/L/
Owner Name: Phone No:
Mailing Address:
Facility Contact:
Onsite Representative:
Certified Operator: _
Location of Farm:
Title:
Phone No:
Integrator:
Operator Certification Number:
gpi wine ❑ Poultry ❑ Cattle ❑ Horse Latitude o 1 Longitude • 4 u
Design r Current Design Current Design Current
Swme` Ca icity' I',e ulation Poultry Ca acity P•.o ulation C_attic Ca achy P,o ulation
❑ We n to Feeder ❑ La er ❑Dai
s eeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean - a"`
ElFarrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars RISS VV '
Number of Lagoons ❑ Subsurface Drains Present ❑ La oon Area JE3 Spray Field Area
Holding Ponds /Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
St ctur ' Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Continued

n
," Facility Number: 3 t 3�� Date of Inspection o
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion. El Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes El No
(If anyof 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? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes ❑ No
9. Do anv stuctures lack adequate. gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
NL'aste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment_?
❑ Yes
❑ No
Reouired Records S Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design. maps. etc.) ❑ Yes ❑ No
19. Does record keeping need improvement? (ie/ irrigation. freeboard, waste analysis & soil sample reports) ❑ Yes ❑ No
20. Is facility not in comptiance with any applicable setback criteria in effect at the time of design? ❑ Yes ❑ No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ❑ No
22_ Fail to notify recional DWO of emergency situations as required by General Permit?
(ie/ discharge. freeboard problems. over application) ❑ Yes []No
23. Did Reviewer,'Inspector fail to discuss review,'inspection with on -site representative? ❑ Yes ❑ No
24, Does facility require a follow-up visit by same agency? ❑ Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP7 ❑ Yes ❑ No
[] N-o violations or deficiencies were noted during this visit.. You will receive no further correspondence about this visit.
_ � � arm• --. _-_. _ _ -.: � :�a•-^ _t�,,,� .� ._,_ -----'-�..x�xe���_xr__ - :�.:�� �+.. �.",F. :� � .�
Use drawings of facility, to better explain situations
i n') ; ry= = ❑ Field Copy - ❑ Final Notes W:
&*-
r'� jam r' j",!�a� 7 `ta Q �l nr bih� �p���i►-. i •, 1.07 h oal lf eire'e
O'k- D Az h C ;P Ltij1�. �/�i(i���7ht'�G wa S hD !`Avia1.
Reviewer/Inspector Name
Reviewer/Inspector Signature:
05103101
Date:
Continued

Type of Visit /' Compliance Inspection O Operation Review 0 Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up 0 Emerge n Notification O Oth ❑ Denied Access
lln4..
Facility Number "�'�"�
Not Operational 0 Below Threshold
[ Permitted ©Certi ed rditiona y Certified [] Registered fZaate Last Opermwtv�')
r Above Threshold:
/Farm Name: �AAM 8,0 G k s� 5' 1 County:
Owner Name: _. 1ti Mj1-)r-F gmft1 Phone No:
Mailing Address:
Facility Contact: Title.•r 44 Phone NoC
Onsite Representative: n `� D Integrator: �3f
Certified Operator- Operator Certification Number:
Location of Farm:
VSwine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �• u Longitude 0' 0• �4
'Design' Current - Design Currenf Design Current
Sane
Ca actty .. Po _ulati►n -._ Poultry Ca spry aPa ulatioia ,mm :Cattle _ Ca actty . Po Mahan .
❑ Wean to Feeder , ❑ Layer ❑ Dairy
Feeder to Finish I 7-If OP❑Non-Layer L ❑ Non-DairyI :::di
Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish
T©tal Design CapacttF
❑ Gilts
❑ Boars aW.
T©tal"SSLW j
Number of Lagoons =, ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holdmg:Ponds 1 Sand Traps ❑ No Liquid Waste Management Svstem
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes X
No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes; notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes N0
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes X140
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste ARDlication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? , 0 Excessive Ponding JLJ PAN
12. Crop type ot&M MAzz-
13. Do the receiving crops differ with those deesign� the Certified Animal Waste
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
Plan (CIAWMP)?
16. is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes YZ No
❑ Yes [11No
❑ Yes No
❑ Yes [�No
❑ Yes No
❑ Yes I
No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes o
❑ Yes �?No
❑ Yes No
❑ Yes No
❑ Yes
�No
❑ Yes
❑ Yes
10"No
LA No
❑ Yes
No
❑ Yes
No
/
❑ Yes
No
El Yes
o
❑ Yes
No
❑ Yes
0 No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Coniatents_(refer to uesttoii 9): - Exptatit any Y tla©swers-And/or, act eetwmmend_aitons ar snv o r comments
q Y
_ _
Use drawings of facility to better explain situations.^{use addtpoasl pages as necessary) _ Field Conv ❑Final Notes 1
�� /�7occJ L/fGvo�/ ofAtIA -000AI 75k Qr
ro
1#ewr Aec QKFs-rzoi►�5 f}!VY Srgr '0�'Vz) 9; vw �MP
ReviewerAnspectorNgme
ReviewerAnspector Signature: Date: 2% Oy
05103101 Continued

Facility Number: bate of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
2T Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
O5103101
❑ Yes ❑ No
❑ Yes No
El Yes /// [�V0
❑ Yes /zNo
❑ Yes No
❑ Yes No
❑ Yes ❑ No

of Visit or-ompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint. O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: 0/ Time: i S
Q Not O erational Q Below Threshold
Permitted © Certified 13 Conditionally Certifiedd] 13 Registered Date Last Operated orAboveThreshold: .........................
Farm Name: ?..................................................�"^•s`lCounty:.. >! L.l..'... ..... ............ I .... ........... ....... ...._...... .
............... ..................................
Owner Name: .......... \,O 2,n t r ✓h A' ...... Phone No: ................................................ _...... ...._ ..
FacilityContact:...................................................-----....................... Title :....................... ......................................... Phone No:
MailingAddress:..........................................................-
Onsite Representative:..,K Y /�►�'h..................................................... Integrator:..? r?"7.''�' ..C!:f:a 9f ...................
Certified Operator:
Location of Farm:
............................................................. Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' A 46 Longitude • 4 Ad
Design Current
Swine - :Capacity Population
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Gilts
LEE
❑ Boars
Number of Lagoons ` , ❑ Subsurface Drains Present ❑ Lagoon Area ❑Spray Field Area
- ,
Holding Ponds / Sollid Trap. ❑ No Liquid Waste Management System
DischargesAi Stream Imnacks
1. Is any discharge observed from any part of the operation?
❑ Yes R&o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ANo
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes ONo
c. If discharge is observed. what is the estimated flow in gavmin? �Ct
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes PING
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ff No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes,6No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes )ZINo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............... 7..............................................................................................................................................................I..............................
Freeboard (inches): 33
5/00 Continued on back

Fdciliiy Number: 3 —316 1 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (�ic/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes �No
(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? ❑ YeNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes 3 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes )D No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes"qNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑-No
12. Crop type 166 ✓v✓ , V'of � �6i4 ,L114 ��_ _ ✓'�i J �1 /
13, Do the receiving crops differ with tho4 designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 'TNa
14. a) Does the facility lack adequate acreage for land application? ❑ Yes /�No
b) Does the facility need a wettable acre determination? ❑ Yes Mo
c) This facility is pended for a wettable acre determination? ❑ Yes
/�No
15. Does the receiving crop need improvement? ❑ Yes // [Tgo
16. Is there a lack of adequate waste application equipment? ❑ Yes
',�No
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes "-No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes_,E3'j`io
19, Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? /❑ Yes''No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes .'No
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application) ❑ Yes
No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes�o
24. Does facility require a follow-up visit by same agency? ❑ Yes IQ -No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
�'�i� YiQl tigris:o dgfc�e ties v►erg P004006t g his;visat; Yoj w ltee'iye 00
wires o deike' about: thfs visit: • ....
CnmmenL�:(refer to question #) _Explain aay YES answers and/or any-reconun—i ations or. 'outer c0i6meii - _
I `! ' Veeaf - ,o ha vI? kxisl�_ ,sa�cp�¢ S ri on a ro u) rlt e b�S)rJ �SYG� �711� Ua t
lilctve I.v 7e a�n�1 SAS domed w�44it, (�4 Ays oral/ a�,o�.'c�;ar7
a" 1- ; s - kp u. O be- useb( c !C t/ /4/,' 40 �-T
T' e 1-qysa,7 d�s! 5t 4WJ regV/"eP( -erec,toC4"d 4, 2-QA �B�tsUJ� e..�;�Z,
ccAh � 41 s�la/ sJ -to vg,�,�' 1 -��, �. �e� � ,.,r� >�', Cry 'r�jOeV �-}e
6kCG4►^d�' �6 G�Qs15h� �����t,v;�e t C ✓iPCc��ar a►tite � S -Tp �e�i�Y
Reviewer/Inspector Name-..-
Reviewer/Impector Signature: Date: 5100

acility Number: Date of Inspection O/
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below Yes ElNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Ye�No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes J2 No
roads, building structure, and/or public property)
29. Is the Iand application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ZNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes
,ONo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ❑'No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional omments and/or swings:- i.
Gan4
n,A 0,00 Aq on
•
7-7ie aeea G d""-w 41,e 11,,&scs ctind e 1ay0dv1
-the- 4dr"4 t/dR C"r We
5/00

39 Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date or visit: Time: OQ Printed con: 7/21/2000
Facility Number
t 0 Not O erational 0 Below Threshold
jff Permitted ❑ Certified ❑ Conditionally Certified 13 Registered Date Last Operated or Above Threshold: .........................
Farm Name:.............................................. f ►"} County: _, U/� i i.�..................................................
.............� _G ...................... v
Owner Name: L i � go S tt " Phone No:
..................................._._.....................7...._.................__......................_...--.. ..... .. .............................
Facility- Contact:
Title: ............................................................ Phone No:
IN-lailing Address: ................................................................................................................ ..........................
Onsite Representative:. ►V L kQs' ; t� L,,.. {plt"' 1--._...... Integrator: �............._._................................._........
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �=• °
Longitude �• �° �«
Design Current Design Current Design Current
Swine Ca acitv Population Poultry Capacity Po ulation Cattle Capacity Population
❑ Wean to Feeder ❑Layer ❑ Dairy
Feeder to Finish 2({Q,4 ❑ Non -Laver ❑ Non -Dairy
Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons 1 ❑ Subsurface Drains Present rea ID Spray Field Area
Holding Ponds I Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge on-Maied at. ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance: man-made'
h. if discharge is observed. slid it reach Water of the State" (If yes, notify DWQ)
c. II-discharLc is ohscrvcd. what is the estimated flow in galhnin?
d. Does discharge bypass a lagoon system'' (if yes, notify DWQ)
2. Is there evidence of past discharge from any part df the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate' ❑ Spillway
Structurc 1 Structure; 2 Structure Structurc 4 Structure 5
Idcntificr......................................................... ............... ... I ............................... ....
Frechoard (inches): 1
5100
❑ Yes Q No
[--]Yes ;[ No
❑ Yes dNo
V1 /4
❑ Yes RNo
❑ Yes KNo
❑ Yes KNo
Yes ❑ No
Structurc 6
Continued on back

FacilityNumber- •3r —S]gj Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (le/ trees, severe erosion, El yeSo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 91 No
(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? ❑ Yes 9 No
B. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes . J0 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑Yes
ONo
]
12. Crop type }� e r L' r ecV t-�tv►Cr � en", ).-I.
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
ErNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
tSNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
P9 No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
'es
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
ONo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
Yes
❑ No
20. Is facility not incompliance with any applicable setback criteria in effect at the time of design?
❑ Yes
J] No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
j No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
Oe/ discharge. freeboard problems, over application)
El Yes
] No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
❑ Yes
'S No
24. Does facility require a follow-up visit by same agency?
ElYes
JE No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
; o ViOlalflplls;ot- &ficle-nd'es Wrere "riE}ted- duffng �hi5;visit' -;Y64 will-reeeiye Rio' futther
' COrris Oidefi ' ' ab' k tlii5 V 151t. ; ; ; ; ;
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
"7 Wo-k 10 1/q(✓ e 1^ /n>n&' level -4 � c �L PIF -4a rrepire r, 4, f c_�t�}C5 1
G $-ble ��^� �`� `^'la'3✓�/
�S �f6f� t�D l'e�''i0}•e {?Drit3BYf►^,✓d{(�C�o!SSGS TrO�"l L'Qrsy�'�lilra �r:?�f�,
' > L' : f Vie' r 1 L( G r O Lv e r� C, C-0 v,e- rBSI 47e
rfi t-.! R f e a rJI/L M c cd S -IJ'•d �G r^Gi ZEd
vse w'01.4e
IReviewer/Inspector Name _` .4 pl e .✓1 1 I "'14 h ,rj I I
Reviewer/Inspector Signature:
Date: 9/1 J /09 5/00

Faeility Number: 3� — 318 Date of liispcction
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ yes ANo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes. No
28. Is there any evidence of.wind drift during land application?- (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 15No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Yes ❑ No
AdditionalComments,-. or. rawings:=
`►. (een4) OY! 1, c`�A h eVe►1 S. i�i 0d ���" Z► s ucl�} G� 0 F.��
�
1to,-
sea So►1 . -4C e'A9rS "o►'� �-121Q�2' 1 s�ar� jd ►^'taTal. L12S-te �I�►� r1wO
Nn �= Jae sure aff i► - �Q•, w;�,�c�ws c� �f��Ps t�l�;c�,
NF
3/23/99

- : )a Division of Water Quality
QDvision of Soil and Water Canservatiow
4
Other Agency
g y
Type of Visit ,& Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
Permitted © Certified E3 Conditionally Certified [] Registered
Farm Name: L ; I ffa -S / 1 L rq '
.......................................................................-............-..................
Owner Name: f' .'r -pS L
t 4,
............ ...... ...........................................................................................
g �4 Tiine: 00 Printed on: 7/21/2000
Q Not Operational Q Below Threshold
Date Last Operated or Above Threshold: .........................
County: .,V�I ;`L
Phone No:
FacilityContact:.-............................................................................ Title:.................................-.............................. Phone No:..........-...............-........................
MailingAddress:....................................................................................................................................... ..........................
OnsiteRe Representative: -......�G 5�'C - --- 4-j -]................................ Integrator:.. J-
p ` .l-.......................................................-.......--..................
Certified Operator............. ............................................................. Operator Certification Number: ...............
Location of Farm:
Fw
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �� �" Longitude • �� «
Design Current
Swine Cnnacity Pannlatian
❑ Wean to Feeder
Feeder to Finish
_7q,8,0
q Q
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I FE31
Dairy
❑ Non -Layer Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons JE1 Subsurface Drains Present ❑ Lag -on Area 10 Spray Field Area
Holding Ponds / Solid Traps 10 No Liquid Waste Manaeement Svstem
Discharees & Stream IImpacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed; was the conveyance man-made'?
b- If discharge is observed, did it reach Water of the State`? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
I Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?- ❑ Spillway
Structure I Structure 2 Structure ; Structure 4 Structure S
Identifier: ... ........... —I...............-.-..... ................................ ................ ......-................................................ ....................................
Freeboard (inches):
5100
❑ Yes 10 No
❑ Yes
fi4 No
❑ Yes
&No
1 1A
❑ Yes
WNo
❑ Yes
$No
❑ Yes
%No
-P Yes ❑ No
Structure 6
Continued on hack

��ti �'
.� !
,� �.

FaWility Number: 3 j =1 I)ate of Inspection !! 6�
P Q Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 0 No
(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?
❑ Yes
'E"i No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
❑ PAN ❑ Hydraulic Overload
11. Is there evidence of over application? ❑ Excessive PII
❑ Yes
No
1ondii�ng
12. Crop type e r �^ l� O� �ec SLL� L! f I L7rci t ' X
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
El Yes
f No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
�5No
16_ Is there a lack of adequate waste application equipment?
❑ Yes
No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
Er No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
0Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Y? No
21. Did the facility fail to have a actively certified operator in charge'?
❑ Yes
Pff No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
Oe/ discharge, freeboard problems, over application)
❑ Yes
JO No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
❑ Yes
No
24. Does facility require a follow-up visit by same agency?
❑ Yes
No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
E. o yWhti6ris:or• deficiencies •were h6ed- ill hhi this:visit: - Y:ot1 Wi11- -eeeiye iio fui th&
corieso ondeiioe: about. this visit:.....:...: .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
q. W r k 40 %ot v f- 1,A90 rl )Glee" -�c S�eP f Ivmp �o �pf'Q�grL �r /7vret' G�th'4S� AL
(.>c � L✓Ga-{4-cr 2-t�. �O So ,+1 G l'cs�0��)bI/P� *',^%e)%j
1S C,16r1�- �D reltQre non6�v»�..da�rBtfSeS Irem �e►-�IvaIQ ��el�,
d ��vwer Go al �2��� {�er,�,;�
19. AWaste sq,.,rle ►iced s -�Ae AKq 1 Zed F'or GVrra�1� �v"',�, Lve��S,
I
Gros,q er v1ce- -t'o beg eof Ong Lvejk1v --I'r e e barir-A r'ecprA s. e -1 vre 40 1
use w,07s-le Aneil y S ; a� ZR�- Z'S I'V -X f i 6,0 d, s OF cWe 0, 1 s -�p r (Gcn4)
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: QO 5/00

1.
facility Number: 31 — 318 Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ANo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 19 No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
roads, building structure, and/or public property)
JRNo
29_
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
% No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
M No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
�4No
32,
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
)9 Yes
❑ No
Additional omments'an or, rawtngs
(6Bn4) 6l fp J 1 cg'� ion n eveS. Vi 11 0iJ4 TK12 - Zi s �a.- "cIt Gr`r "'9 �
sea soh./ rTCo-,1 r s�au�d a�A w'�i5-�e
13e Svr'e 4oIdlazJaff Oce4i'o), wf1140 S' -f6r Crews Wh;c�
are show►, ;n Wq -qe Ptah
3/23/99

W Q Division of Soil and Water Conservation -`Operation Review
f :Q Division of Soil a. Water Conservation -Compliance Lisgectton
ivision of Water Ai - fa'D Qu_ 'ty -.Compliance Inspection Y
Q OtherAgency'Operation-Review Y.
JJVRoutine O Complaint O Follow-up of DWQ inspection O Follow-tuE of DSWC review O Other
Facility Number ?r $ Date of Inspection 2 3
Time of Inspection 24 hr. (hh:mm)
[xPermitted,2rCertified ©,Conditionally Certified Q Registered 113 Not Operational I Date Last Operated:
e D
FarmName: ...............�-..1. ....... . s. ��................ County• :......... .L.!...^...........................................
Owner Name: .......... ........... Phone No:
FacilityContact: ....................................... .. ......... . Title: ................................................................ Phone No:
MailingAddress: .......................................................................................................................................................................................................... ..........................
Onsite Re resentative• .l..LM..�...... `.......�................. .. InteKrator•�.1.........................................
Certified Operator: ..., ......•., ................................................................. Operator Certification Number:,.1_.8 V " 8
Location of Farm:
Latitude it Lan T ,— •—'— ' �` �' �• g' ude
Design Current Design, Current Design Current
Swine "
Capacity Population. Poultry Capacity . Population Cattle Capacity Population"
❑ Wean to Feeder
Weeder to Finish
Zq eu
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Subsurface Drains Present ❑ oon rea La A ❑ Spray FieW Aare
Number of Lagoons ❑ g
Holdin Ponds / Solid''Tra s �_ ❑ No Liquid Waste Management System
g P
Discharges & Stream Imp
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? El Yes 0 No
h- If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes P'fIo
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑1f10
2. Is there evidence of past discharge from any part of the operation? ❑ Yes (P'No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 0No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes PNo
Structure t Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches):................................................................................................................................................ I.............
............................ ..................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ;allo
seepage, etc.)
3/23/99 Continued on back

Facility Number. 3 — SIP I Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑)Excessive Ponding ❑ PAN
12. Crop type i ! is S_ G "' ...%
� Z3
❑ Yes ,dNO
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23_ Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Rio yi . 406ris ;or 0 fide 0 ' were poted duritig �liis; visit; - You will •teeeiye rio further - ; ;
correspondence. a� 44f this :visit.. .. .. ..... ........ ..... . .
❑ Yes J�No
[:]Yes IVo
❑ Yes ,JNo
❑ Yes ZNo
[-]Yes ZNo
❑ Yes 0<0
❑ Yes "[�Ko
;a"&s ❑ No
❑ Yes Jhlo
❑ Yes No
❑ Yes
Yes ❑ No
❑ Yes R(No
❑ Yes P40
❑ Yes '�2No
❑ Yes P No
❑ Yes 1;40
❑ Yes XNo
❑ Yes �(No
❑ Yes jfNo
Co mints (refer 16 question 4):_ Ekpliijn ail yYES answers and/or any"reco nmendattons or`any other comments''
iJse :dravvitgs of facility to beer_in situatrons (usdtionapages as necessary)
, explaIT
17) GST Coo Py of 74W 1 r" • -- MEP W"% ` t- 0.) Fi1Q-M 7_g_C b XkXC, r-
t mac.' Li F-s A4 Li �r r2_Cq,&c) iL-0 LCr
Iy b� nif-r'D s AA I'kf -rn spiv ht ;,�i NkU-S irJ-V I Ca4-CMD
C.`" cf1a ) 39S -310o rj
Reviewer/Inspector Name j
o .J f2 a i
.01
Reviewer/Inspector Signature: � �� ] , w1Date: b h?_ & / 9
3/23/99

Facility Number: 3r — 3 Date of Inspection I
Oder Issues ��TT
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below /Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes JPNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ,140
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes -0 No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) 2'Yes ❑ No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes .0140
—32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? 'PKes ❑ No
difionalComments an or: rawings
Z6> JAAV P;Pe.) od 4EaCg ; �.�'n/'E,� { B�� �aUE. .5,%, 'Cr aft
Af— L.A.GaOF ,
SAs-ou0S lkZE- ?-k S`f'
3/23/99

Division of Soil and Water Conservation ❑ Other Agency
® Division of Water Quality
® Routine O Complaint O Follow-ue of DIVQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number ,3t
Time of Inspection 1: 24 hr. (hh:rnm)
© Registered io Certified 13 Applied for Permit (3 Permitted 113 Not Operational Date Last Operated: ,,,,,,-
Farm Name: )..... hq. h County �;
OwnerName: ................ . ......................... fi.................................................... Phone No:... 1.1.0. �. `l.$.-. Cal? ?..........................................
FacilityContact: ................................... :.......................................... Title: ................................................... ............ Phone No:
MailingAddress: ...... qL1........ ars......M:.i.f........:...................................................R4.11 u,WaUj..t.js:............................................ L4.V.q ...........
Onsite Representative:...., tj.ZGk... j§?*zr................. g �,.44.t YR.�t. .....................
................................................ Integrator: �7
Certified Operator-.,P..V.yA- �,... d� ................. .. Operator Certification Number, ..... 10008 . ..............
Location of Farm:
r, .... emu` +.. t ....0f... ...1.8�4;..A... S`i.......... I ....... I ..................
................................ .................... .............. ............. ......... ......
Latitude ®•,' �" Longitude
Capacity
❑ Wean to Feeder
Ea Feeder to Finish
Zy 0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current. Design
Poultry Capacity Population .Cattle _'Capacil
ant
tion
U Subsurface Drains Present jl❑ Lagoon Area I❑ Spray Field Area
No Liquid Waste Management System
x e
❑ q g Y
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes $9 No
2. Is any discharge observed from any part of the operation? ❑ Yes [$1 No
Discharge originated at: ❑ Lagoon' ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes M No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DR'Q) ❑Yes [24 No
c. If discharge is observed, what is the estimated flow in-aVmin? JV
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes Q3 No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ( No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes C9 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes EO No
rriaintenance/i mprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes EP No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes M No
7/25/97 Continued on back

Facility,Number: I,— ita
8. Are there lagoons or storage ponds on site which need to be properly closed'?
Structures fLaLoons.lfolding Ponds, Flush Pits, etc.)
9. is storage capacity (freeboard plus storm storage) less than adequate?
Stnicture l Structure ? Structure 3 Structure 4
Identifier:
Freeboard (tt): ...... ..... .............
10. Is seepage observed from any of the structures?
11, Is erosion, or any other threats to the integrity- of anv of the structures observed'?
❑ Yes [U No
❑ Yes I No
Structure 5 Structure fi
12.. Do any of the structures need maintenance/improvement?
(If anv of questions 9-12 was answered yes, and the situation poses
an immediate public f health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers'?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ............. 6KoPv w.................... ykk,w..... .. ............... .................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)"
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/]nspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit'?
❑ Yes
U=V;A No
❑ Yes
Vn No
® Yes
❑ No
3 No.violations or deficiencies were -noted -during this,v_ isit.- .You -will receive•no further
correspondence iihout-this,visit:.
❑ Yes .2 No
❑ Yes ® No
..........................................
❑ Yes
No
❑ Yes
No
Yes
❑ No
❑ Yes
I29 No
❑ Yes
IN No .
❑ Yes
[N No
t Yes
❑ No
Q9 Yes ® No
❑ Yes ® No
❑ Yes V) No
Com.6ents''(refer"to question #): <Explain any. ITS answers and/or any recommendations or any tither comments T
Use drawings of facility to he- ter explain `situations.`( use additional pages as necessary}:
t2, �wvur c1C� well o� AA, kayo, Skov)J 6e wzw(d-
i B r Cov. nJ 440,4s 6 i `w`1rvJ< Uv--
de, skL j 6c.. i+, � �dx- W�s{� s1a�. 1� S � 6e-
gjd,kJ, Correct a eLQ_5e. �p� ce,c , -5"S i vti L skald bf il9tt� wksi. ta�cviartn� ili{roec�ar� �]aj4kce.
Z3. rr-rv— ccr-k:�rc4trjj, SAC o,,+ 4iWu- Or "t [aech
vidtktt] 114,ce TOIL t i, Lore [ -Z 4r11.5 Si1W1j 1W ft%AZ 4 D isZ Leach,,
lz.� c�rdsr,o.i D,r. �X�•
�t�mtn,�on, 7/25/97
Reviewer/Inspector Name' g
Reviewer/inspector Signature: Date: 1 y

❑ DSWC Animal Feedlot Operation Review
E]DWQ Animal Feedlot Operation Site Inspection
I0I1outine Q Complaint O Follow-up of DWO inspection O Follow-up of D;S%VC review Q Other 1
Facility Number 1
© Registered Q Certified 0 Applied for Permit © Permitted
Farm Name: ........ 1:7` .. r
Owner Name: ............. L&...... B�kl .....
Date of Inspection
Time of Inspection L _3:3p J 24 hr. (hh:mm)
C] Not Operational I Date Last Operated:... .
County:
Phone \o:.. gto cr
.. g-. fix..I.............................................
Facility Contact: ......� �b.......%A G .................................... Title:...... O.QhAr ................... Phone No:
MailingAddress:....... Q......11. t fop.. .1AL........................................................... ........... wG![llL.t.m......................................... ..... ir......
Onsite Representative: ....... U.� ....... `G.................................................................... Integrator: ........ .crxyi[, .................
Certified Operator................................................................................................................ Operator Certification Number, .........................................
Location of Farm:
.... . r».................... �.&p.:........Aim.....t:.S......lP:.............
WL4.65...........! . R..AIZ-A.....ota._..sau4l.._wc_ ..................................................................................................................
Latitude 0` 1 " Longitude 0• '
Design Current
Swine Capacity Population
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
— Design Current . Design. Current.•
Poultry Capacity Population Cattle Capacity. Population
❑ Layer I I Dairy
❑ Non -Layer I on -Dairy
❑ Other
Total Design Capacity_ 2,4�
Total SSLW -2-;tc1-lrwn
Nufiiber of Lagoons ! Holding fonds ' ❑ SUbSurface Drains Present ❑ Lagoon Area I0 Spray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Dischari=e orit inated at: ❑ Lagoon [I Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed. did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the'estimated flow in gayniin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes kNo
❑ Yes bq No
❑ Yes
KNo
❑ Yes
N No
❑ Yes
EKNo
❑ Yes J& No
❑ Yes &No
❑ Yes CWNo
❑ Yes ® No
❑ Yes CgNo
Continued on back
a
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97

1
Fa'Eility Number: 31 —
�'
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons.flolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2
Identifier:
Freeboard (ft): ..........2Z 1.......
10. Is seepage observed from any of the structures?
Structure 3 Structure 4 Structure 5
11. Is erosion, or any -other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(if in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .............0004-W ......................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0 No.violations or. deficiencies were noted during this" visit. - You.will receive no further
correspondence about this:visit.;.
❑ Yes K No
❑ Yes Q No
Structure 6
❑ Yes 14No
❑ Yes R1 No
IYes ❑ No
0 Yes RNo
❑ Yes b6o
❑ Yes No
❑ Yes VWNo
WYes ❑ No
❑ Yes ® No
❑ Yes allo
❑ Yes X No
91 Yes ❑ No
Yes ❑ No
❑ Yes [f'No
ll Yes l(No
ComMents (refer t6question #) , Explain anyXES answers and/or any, recommendattons:nr any, other'commenik
Use"drawings of facility twbetter explain situations. (use additional pages as necessai v)
A
t,z. �o.rc. [a50or, kidl s6vid 6-- ms edea.
I6. Co -ski Crop Im firld #L s61d h,. t*1yoverl-
Zz. Ni CA joo owe, slodd 6, updJJ Mon` . AK vvJ& J wask_ satkp& a-nvdj si5 sivuld
be i°�`` s; 4
19. Na ce. i 'ccc ,'cn O�" WaN� t� �CzFlies "S aVai tA101.c &f ttnk Qf inyeGlt�l.
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: f Date:

�...... �:::r.,�s_j,►a� .�:r-eec�oz:;`.0 el�a�Ion :;;.Revs
a1 Fe:ed16
Facility Number
Date `of Inspection Time off Inspec#song
Z <:i>ZI:(o. v 24 hr time
Farm Status: ❑ Routine JaComplaint ❑ Follow-up
Farm dame:County:��t"�
Owner Name:Phone No:
Mailing Address: �v, 11V
Onsite representative: G '� `•��1�GrC /SC7 �' C Integrator: 6412'e011-s
Certified Operator Name: SICr7S�� G
Location of Farm:
I 7 ram, Z',¢ -- , 4
1
Latitude '�'" Longitude
❑ Not Operational Date Last Operated:
Type of Operation and Design Capacity
.gar; :;xsi�r` '".-"':..�, xr "�." --�i.: `�'".`,�' .. r -^e ",, -c;; -» -+ " 4-,_"'—r _cy`"+"s ..20Z_-JW.�--�' �r ';kx"q-t'�"'=t
-...."�IVutrri�ern.u.ltry �.Nirmf�erCatrle:.Nutr:berx
� Wean to Feeder: Laver Dairy
Feeder to Finish Z _ Non -Laver Beef
.113FRrrow to Fonder
Farrow to Finishnz
'' Other Type of Livestock �� `
Subsurtace I)r n P es nt � ago ❑ S
L on Area � pray d
:.">�R=.�"=5>,r�'; .�.ef+'���..��",c�^�::.���-.'ems...- : ..:�.�iz:,?�"`"-�t�_��.,.,,.. ..•.-- � -
General
i. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Surface Water? (It yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Was there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
❑ Yes 13 lib
® Yes E] Info
❑ Yes EI No
R Yes G No
❑ Yes R Nb
❑ Yes JR Klo
❑ Yes g.1 Kb
[l Yes JN Nlo
Continued on back

7. Did the facility fail to have a certified operator in responsible charge (if inspection after 1/1/97)?
• 8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes No
Structures Laaoons and/or Holding Ponds)
9. Is structural freeboard less than adequate? ❑ Yes [] No
Freeboard (ft): Lagoon 1
Lagoon 2 Lagoon 3 Lagoon 4
yak
10. Is seepage observed from any of the structures?
11. is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenancelimprovement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adquate markers to identify start and stop pumping levels?
Waste Aocilication
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWO)
15. Crop type C—D Cc S_ _ .. Z A A 21
16. Do the active crops differ with those designated in the Animal Waste Management Plan?.
17_ Does the facility have a lack of adequate acreage for land application?
18. Does the cover crop need improvement?
19. Is there a lack of available irrigation equipment?
For Certified Facilities Only
20, Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
21. Does the facility fail to comply with the Animal Waste Management Plan in any way?
22. Does record keeping need improvement?
23. Does facility require a follow-up visit by same agency?
24. Did Reviewer/Inspector fail to discuss review/inspection with owner or operator in charge?
❑ Yes IgNo
,K Yes Cl W
[} Yes S Na
Yes
[] Yes Na
❑ Yes No
0 Yes [2 No
24 Yes 0 No
❑ Yes 0 No
,® Yes ❑ W
❑ Yes ❑ W
Ccimmenis�tre#e o xquest�on ) Explarrt any ES: nswets�ndtb any-reco mrnendatfons aor an other�corrtments ;
Useawm s�f•fas�i�4t�.�better�e larn::srtuairons u§e3addttional� a es"as.'neees �`" ''�� ����....�`��„
?j✓- KM
w`77 dt<^`y"e^' 'fw,.%3 'i'.v- +i.. -e+_. ty '++A- �Fi"-..� - - fit '�S`YY
i=..w�.mr... -h. k'-, 2`s.' `i• Yk - t
"0^,,. a . t 2, �,; '*s.:- '.x{-�,},'g`J fi x.-'r-wk.;�^ ^�•" r S = +•��
•r r�
y r -�.+ -t✓i.'E'C'-,y
t
� f� 4✓ /!i•{/ - � 4 / � +'7 ' R/ /7�Z�' _ L f' '� f
='",
{�" J ti,�/ / I LV%
ti.
Za
'�aY�.,`-'�'"y.;.?y. �,A�:.�,..�:°rx,���"-. '"�w..M v ,� ��iab �'� �..+�.ti�ar...:�-��,> -,Y -. - � Z.+cai r2a•-.. er� ��� �3�t�'` :x:
i Reviewer/Inspector • Name "�`"��''" `� �'�' �`' " `� �'" �` �" `�` "'
'";��,. "''.�=• � �3� � �- , x � � � i. r�' -""ice '�'
Revrwerllns ector Si naturec:._..'�•.�. r .":'-.�..... ._,. :.�'M .... '�.� _.Dale_ - .,�_��.---�'"'�".
i
cc: Division of Water Ouality, Water Quality Section, Facility Assessment Unit 11/14/96

x,
�.�Faclilt ? Number
Farm Status:
Farm Name:
Date- of Errspecti:onTrme of Enspectjcart:
fZ.ay i„ Use"24hr time'
❑ Routine' Complaint ❑ Fallow-u
Owner Name:c?��C Phone No:
Mailing Address: w�� ���✓/11 �G.��� ,.� _
Onsite representative: _ G C Integrator: (fA2leoll'5
Certified Operator Name: .....
4-�Cc7s�� C
Location of Farm: -
Latitude �`'�" Longitude Q' Q` L.�44
❑ Not Operational Date Last Operated:
Type of Operation and Design Capacity
_ . YW Nirrrtlser
.;Number r ,Pou.ltr,
attle.. ,�..�lumber.:��y
Wean to Feeder
Laver
Dai
Feeder to Finish
Ej Non -Laver I
r1l Beef
Farrow to YVeaa
❑ Other Type of Livestock
k
13 Farrow to Finish
iV n e a �ag`'°�nns'�l��aiding P s a��`�� ❑Subsurface Drarns Present 4 s
'�` � �-; -' � �` �' � ��� ��� � � ❑ LagoonryArea � ❑Spray Freid Area
General
i. Are there any buffers that need maintenance/improvement? ❑Yes No
2. Is any discharge observed from any part of the operation? ® Yes ❑ No
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes No
4. Was there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes A No
maintenance/improvement?
Continued on back

b. Is facility not in compliance with any applicable setback criteria? ❑ Yes 19 No '
i 7. Did the facility fail to have a certified operator in responsible charge (if inspection after 1/1/97)?
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes 9Kb
Structures (Lagoons and/or Haldina Ponds?
9. is structural freeboard less than adequate? - ❑ Yes ❑ No
t
{ Freeboard (ft): Lagoon 1 Lagoon 2 Lagoon 3 Lagoon 4
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenanc Amprovement? F�r
(if any of questions 9-12 was answered yes, and the situation poses an
Immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adquate markers to identify start and stop pumping levels?
Waste Application
14. Is there physical evidence of over -application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type
16. Do the active crops differ with those designated in the Animal Waste Management Plan?_
17. Does the facility have a lack of adequate acreage for land application?
18. Does the cover crop need improvement?
19. Is there a lack of available irrigation equipment?
For Certified Facilities Only
20, Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
21. Does the facility fail to comply with the Animal Waste Management Plan in any way?
22_ Does record keeping need improvement?
23. Does facility require a follow-up visit by same agency?
24. Did Reviewer/Inspector fail to discuss reviewCnspection with owner or operator in charge?
❑ Yes RrNo
,K Yes ❑ No
❑ Yes 9 Na
❑ Yes ,9 No
13 Yes ❑ No
❑ Yes ® f to
❑ Yes & No
❑ Yes 14 No
❑ Yes 2[Na
❑ Yes ® No
Yes ❑ No
❑ Yes [:1 No
i® Yes ❑ No
El Yes El
tn
{�,+��-� �C,f✓T(ifj<.`u���-:s ������1 ��^^3Pz �y,���•%1';d ` .,� f- x
✓ as,
jyW
r -
�`°.,,.rtk�� � � `x �' x r c "��.� .W<�1 a.�a3rx�'d �',.»��-"";.=t"'o•. e �rz�cei i�.e '���' � ���'3n��:
����A� � :r .��a : � �^ � �^y s,�� �t--�,r�+ �-�, �z �t'".��' � � � <� ��ac e �•`.�'"' "tea � '�*�`:. j
e
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 11/14/96

l N ►
6
N. C. DIVISION OF ENVIRONMENTAL' MANAGEMENT
COMPLAINT/EMERGENCY REPORT FORM
WILMINGTON REGIONAL OFFICE
Received b.: IDa 0 i D _ �� ly.t Mte/Time:1D
fikaergency: Ccalplaint: County: 1 �12 --
Repotrt Received Frm: A X d K)
Agency: A) I A Phone No. _ )IA --
Ccplainant. A oo 0
Phane No. AJIA
Caaplaint or InciCleat :�jjc1..ZI Ad &. It' 3 if-_ {�.�LAc ft� ZTn iGVA4cu.atr .
7q-i:) t A-J~ -rO L 3 dos ►� A�� -v �g. ----
rime and Date oocurred:-Z42--f (-
Location of Area Affected: ZA) M i if 20,4.21 / /.-�Y , 4. _
Surface waters Involved.- Groundwaterinvolved: - Other:
Other Agencies/Sections Notified: G-
rnv�estigatian Details:-� U- ro55-
Investigator: / _ Date:�'�
EPA Region IV (404)34 4M2 Perticida 733-3556 Enngency Managersari 733-3867 Ws7 qe Racurces 733-7291
Solid and Hazankw Waste 733-2178 Marine Aorherier 726-7021 Water Supply Branch 733-2321 U.S. Coad Guard MSO 343-4881
127 Cardinal drive Extension, Wilmington, N.C. 28405-3845 • Telephone [phone] s Fax [phone]
An Equal Opportunity Affirmative Action Employer