310489_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Type of Visit: (3) Co piiance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up Q Referral Q Emergency O Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: 2 9 County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: C�1"Q nak__ �'�I it Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Certification Number: 2 V%_3 7
Certification Number:
Latitude: Longitude:
Wean to Finish
I
I
I Layer
I
I Dairy Cow
EI
W ari to Feeder
I
I
INon-Layer
I
Dairy Calf
eederto Finish
[i.`�
1 9po
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
D • E Aoult iCa
aci Po
Non-Dair
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Poults
Other
Discharyes and Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
ZNo
❑ NA
❑ N E
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
4
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
i
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
o
❑ 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 I of 3 21412015 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
eNo ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):'jZ
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
ONo ❑ 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 eat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes �00
NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? Yes NA NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
a ro riate
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0< ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
2 rNoo 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
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
N ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No ❑ NA
Ell
[] NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o ❑ NA
❑ NE "
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Re aired Records & Documents
7X
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
NA
[] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No ❑ NA
❑ NE
the box
Pp P
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers / ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspection' 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 ❑ No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Ins ection:
f
24. Did the facility fail to calibrate waste application equipment as required by the permit?
If
❑ Yes
No ` 0 NA
❑ NE
25. Is'the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
Vo ❑ 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
❑ o ❑ NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No lA
Q NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[] Yes
�No❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 L 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
[] NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
i-,la " ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
o ❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Ml�
Phone: + to � 1� 7 /
Date:
21412015

Type of Visit: tD Co liance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 'Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: J d County: DkJPLIM0 Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: iJ lq e- Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 11412a
Certification Number:
Longitude:
Design
Design
Current
Design '
Current
Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
C►►attic
Capac'r�ty . P p
Wean to Finish
Layer
Non -Layer
Dai Cow
Dai Caif
Dai Ffeifer
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Dr, P,oult_r,
Design
Ca aci
Current
D Cow
Non-Dairy
Farrow to Finish
Layers
Non -Layers
Pullets
Turkeys
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Boars Eil
Other
Turkey Poults
Other
Other
Discharges and 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 DWR) [:]Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
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 WN,
o ❑ NA ❑ NE
❑ Yes
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
411 Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes C]/No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E37No
❑ 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 �o
D NA
❑ NE
waste management or closure plan?
if any or 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 2(f o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes WNo
❑ 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 In No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ZNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload 0 Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes V�No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Vo
❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes �o
❑ NA
❑ NE
20.'Does the facility fail to have all components of the CAWMP readily available? Ifyes, check
❑ Yes VNo
❑ 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 ❑ 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 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? D Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Ins eetion: (�
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �FNo
° ❑ NA ❑ NE
A Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ 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 ZNo ❑ 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 fait to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[] Yes
2No
❑ NA
❑ NE
❑ Yes
2 No
❑ NA
❑ NE
❑ Yes
ENo
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
❑ Yes
❑ Yes
Zo ❑ NA ❑ NE
r ❑ NA ❑ NE
�No ❑ NA ❑ NE
Comments (refer, to question:#) Explain any YES inswers and/or any additional recommendations or any other comments.
Use arawin>s of;fgcility;to.beEter explain situataonsleise_additiaual pages as ne.eessary).,
Reviewer/I nspector Name: `.JOIN N 'ice AM, l LI Phonek-U0 / / 16
Reviewer/Inspector Signature:Date:
Page 3 of 3 2/4 01

Type of Visit: Q Cpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 7Ro�utine 0 Com laint O Follow-upO Referral Q Emergency O Other 0 Denied Access
Date of Visit: y'/7,J /� Arrival Time: ® Departure Time: County: Ne Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: JQPAI 1 01 CL-L-CA Integrator:
Certified Operator: Certification Number: _ [
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
Sam
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -Layer
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dr. P.oultr.
Ca aci
P,o .
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
[tithe
urkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes /No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes gi
NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ YesNo
❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facility Number: -q Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1, Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: j.WJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E6No ❑ 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
C 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
N o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
/No
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2(No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[;J/No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[]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
dNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
0 Yes
[2-No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
20
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�o
❑ 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
la
❑ 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
i❑
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
NA ❑ NE
Page 2 of 3
21412014 Continued

Facili Number: - Date of Inspection:
24 Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ 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 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
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 the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAW MP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 2fNo ❑ NA ❑ NE
❑ Yes 4o ❑ NA ❑ NE
[:]Yes Vo ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes No NA NE
❑ Yes ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
Comments .(referto question #): Explain any YES answers and/or any additional recommendations or any,other comments.
Use drawings offacility to better explain situations (use additional pagesas necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q10 /M073 k
Date: /� j I S
2141 015

Type of Visit: U Cp�inpliance Inspection (> Operation Review O Structure Evaluation O Technical Assistance !
Reason for Visit: Routine 0 Complaint O Follow-up O Referral O Emergency 0 Other O Denied Access II
Date of Visit: Arrival Time: Departure Time: [ZTT= County: DURII Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: uvo�ll9n� [ 1;LL�(L -_ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: U 113
Certification Number:
Longitude:
Design Current
Design Current
Design
Current
Swine
Capacity Pop.
Wet Poultry Capacity Pop.
C*attle
Capacity
Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Layer
Dairy Calf
Feeder to Finish
"L Qlow
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D 4 P,oult . Ca aci
P,o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
113eef Brood Cow
Turkeys
Other
Turkey Pouits
Other
Other
Discharges and Stream Impacts
/No
1. Is any discharge observed from any part of the operation?
❑ Yes
C2
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No❑
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
gNo
NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facilit Number: jDate of Ins ection: i
V�aste_Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes V'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2
Identifier:
Spillway?:
Designed Freeboard (in).
Observed Freeboard (in):�
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes ❑ NA ❑ NE
[3Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA FINE
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 WNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below, ❑ Yes [�J/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 Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP []Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑ Yes YNo
o ❑ NA ❑ NE
❑ Yes [] NA ❑ NE
❑ Yes 54o ❑ NA ❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
[:]Yes �
❑ NA
❑ NE
[:]Yes No
❑ NA
❑ NE
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo ❑ 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 YJ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes j(No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: I IDate of Inspection: l
24.1 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 ❑ 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 dp,❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No 0 NA ❑ NE
❑ Yes To ❑ NA ❑ NE
❑ Yes MeNo ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
L1J No
VNo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments' (refer to question #): Explain any -YES answers. and/or any additionalrecommendations'or any other comments
Use drawings of facility tok better explain, situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
tL.'
Phon -
I
Date: J)q
2/q/2Q14

`t
(Type of Visit: Q 7Routine
pliance Inspection V Operation Review O Structure Evaluation O Technical Assistance
sit:
Reason for Vi0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: g aL Arrival Time: ® Departure Time: County: ,P! � Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: (S"O N 4 m.) 0-s LLkr_ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: ��13rJ
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current Design Current
Pop. Wet Poultry Capacity Pop.
Layer
esign Current
C►attle =C.—acity Pap.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
I7.s
t
Dai Heifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
ltrF Ca aci Pia P.
Layers
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Beef Feeder
Boars
iNon-Layers
Beef Brood Cow
Other
Other
oults
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 10 ❑ NA ❑ NE
❑ Yes [—]No
❑ Yes 0 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes E No [3NA ❑ NE
[:]Yes No [DNA ❑ NE
Page I of 3 21412011 Continued

Faoility Number: jDate of Inspection: 41
Waste Collection & Treatment
4. IV'storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ?J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3�
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 ZNo ❑ 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 environmentajl 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 YNo ❑ 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 9No ❑ 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 2f/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload [] Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes E No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes �N0 ❑ NA ❑ NE
❑ Yes FZ/No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ENo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ENo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
No
0 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
E No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facilit Number: 31 - Date of inspection: 13
24,' Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �ZNo
o El NA ❑ NE
25.'ls the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes D 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 do ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes [�4) ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes E�J/No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No. ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes [Z 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 2<(0 ❑ NA ❑ NE
33, Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes o ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any pother comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 of 3
0M o-JJ E, Phone( i I'} _ap
Date: 9 r A&h
2/4 2Oil

(Type of Visit: ()fCor�ipliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
�IW�W YIIYWI �I II��Y �
Date of Visit: Arrival Time: (r/� Departure Time: County; Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Owner Email:
Phone:
Onsite Representative: '!(y)'M Integrator:
Certified Operator:
Phone:
Certification Number: m0
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Swine Capacity
Wean to Finish
Wean to Feeder
Feeder to Finish
Current
Pop.
(7
Wet Poultry
La er
Non -La er
Dr. mu-It
Layers
Non -Layers
Design
Capacity
Design
Fpaei
Current
Pop.
Current
l;o P.
Cattle
Dairy Cow
Dairy Calf
Daia Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Design Current
C►apacity Pap.
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Pullets
Beef Brood Cow
U.ther
Other
Turke s
Turke Points
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 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[—]Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number; - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�5/No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: Lid Qo
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.)
WNo
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑ 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 environment l threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
o
❑ 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 [dNo
❑ 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 0o
❑ 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 o
❑ 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 5/N o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes F2/N.
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �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 2rNo ❑ 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 ;7No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility umber: - Date of Inspection: ij 'i..b
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
r
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑ NA ❑ NE
No ❑ NA ❑ NE
26. Did the facility fail 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
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
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
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
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32, Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
2%1 o ❑ NA ❑ NE
No ❑ NA ❑ NE
7❑ NA ❑ NE
No ❑ NA ❑ NE
Fo ❑NA ❑NE
o ❑ NA ❑ NE
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),
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
�� N �. ✓ ,, .,_ Phone:-134
Date:
2 120 1

(Type of Visit: UCo lance 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 O Denied Access
Date of Visit: I 9 Arrival Time: l D Departure Time: County: 000ttjj Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: J'60i llpo Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry @specify Pop.
Wean to Finish La er
Design Current
Cattle Capacity NOW
Dairy Cow
Wean to Feeder
I INon-Layer
I
Dairy Calf
Feeder to Finish 1 3 11
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dr, P,oult . Ca aci P,o ,
Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars Pullets
Turkeys
Other Turke Poults
Other Other
Beef Brood Cow
Discharges and 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 the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
WN
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: 3 1 - 141VI Date of Inspection: °t q
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 1 kmak
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 139,
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
21"No ❑NA ❑NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes dNo ❑ 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 [dfNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 6No ❑ 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 ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �o ❑ 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
Q No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[?to
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[�KNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ YesNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[a No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ YesVNo
❑ NA
❑ NE
the appropriate box.
❑WUP [:]Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes VNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Dumber: - Date of Inspection: 4 t
24. Did the facility fail to calibrate waste application equipment as required by the permit? �
]YesgNo
o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ 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
Last 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 Ef No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E�No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes
ZNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
ENo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
&�o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ YesZNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ 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 necessa
Reviewer/Inspector Name: +J uHH/>rAsiN%1.t�
Reviewer/Inspector Signature:
Page 3 of 3
Phone: C �yj
Date: L'9
21412011

Facti�ty=`Number �`°'
a
Type of Visit O Co piiance 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: p j Arrival Time: I— Departure Time: County:W4ad Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: `--J Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: e = ' 0 " Longitude: = ° "
� 3: 1}- i '?
urrerit°'. ,: -_ ,,f 'Deli n',` i Curr`erit '`; '_ � ` . �g :z�Dc ern,'; ,1Curre '
CSIg.C, `;23`.. »a'° ' g. M ? �`"�6.g:�'hR$@si,
Y fit#e.s F �. 4 a�
Swine'�G ` Ca acit Po ulation ,Wet Pouft
lt Ca act 1'o ulatton : Ca4tle Ca acit ` Po ulation
0 9.
t �►.��,� 3.� P.. Y.��P kk,�����_r�,EPw���,Pe��r4i�us,zp�.:uy.�....��.
❑Wean to Finish ❑ Layer :? El Dai Cow �+
❑ Wean to Feeder ❑ Non -Layer J El Dairy Calf
Feeder to Finlsh y ��,@tI�V'V'x a,5iynsy �I airyilelfer
❑ Farrow to Wean. ,* ❑ Dry Cow
r
Dry
❑ Farrow to Feeder `` �k ° ` `' `` ❑ Non -Dairy
�% ❑ Farrow to Finish ❑ Beef Stocker
#` ❑ Gilts
:�1� El Beef Feeder
❑ Boars ❑ Beef Brood Cow
®theC
6kit n�� 2.t"$? j'k T
, ❑ Other aR ,Number of Structures{
Lt.i�.�zs;+;.. ' .« s':>` 1aa..�'-;x=.:. _k. .is ,�-..€ c';a:;,,�>�,.k � ��.'i
❑ 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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge`?
Page I of 3
❑ Yes /No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ No ❑ NA
❑ NE
❑ Yes
❑ Yes
� ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
12/28/04 Continued

Facility Number: j —
Date of Inspection d /�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: tky5
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 ��No
El Yes
Structure 5
❑'NA ❑ NE
❑ NA ❑ NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes 2(No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t eat, 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 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 2(No ❑ NA ❑ NE
maintenance or improvement?
Waste Agnlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of 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?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ ❑NA El NE
No ❑ NA ❑ NE
No [INA El NE
Y❑ NA ❑ NE
L"J No ❑ NA ❑ NE
y�.�s`r�
Ca"mments (i efer to`quest�oq #) .Explain any.YES.-answers and/6-r�a�y recommendations or!any,other;comments
Use drawings or racility to better°explain situations. (uWe additianal�pages as necessary}., a i
Reviewer/Inspector Name,
Phone:
Reviewer/Inspector Signature:
Date: b r
Page 2 of 3 / 12128104' 'Continued

f Facility Number: 31 — Date of Inspection
ReQuired Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
N/No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
El Yes
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
0 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
io
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
<o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit'?
❑ Yes
PNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
'f""
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
9114/0
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Z�46El NA
El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
r 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
ENo ❑ 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
�o ❑ 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
dNo ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No ❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

,1�
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ( Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: o Arrival Time: Departure Time: County: f let -I N — Region:
Farm Name: I Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
1-110
Onsite Representative: Jd�VAT&ad n A Y0,
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [_—] e =' = Longitude: = ° =' =
ff Design Current Design Current llesign
Swine Capacity Popation Wet Poultry Capacity Population. Cattle Capacity
Current
Population
❑ Wean to Finish
10 Layer I
1
❑ Dairy Cow
❑ Wean to Feeder
JEJ Non -Layer I
I
❑ Dairy Calf
Feeder to Finish
/7?_O
Dry Poultry
❑ Dairy Heifer
❑ Dry Cow
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Non -Dairy
❑ Beef Stocker
El Beef Feeder
❑Beef Brood Cow
Number of Structures:
❑ Layers
❑ Farrow to Finish
❑ Gilts
❑ Boars
El Non -La Layers
❑Pullets
El Turkeys
❑ Turkey Poults
10 Other
Other
❑ Other
Discharges & 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?
❑ Yes
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
7No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: —n7 Date of Inspection 1 d
I)
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: i 96tf6e
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �.{5
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 dNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes dNo ❑ NA ❑ NE
❑ Yes E' No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
E No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
dNo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
2No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Lj No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
E No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 101bs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop 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
EffNo ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
d,
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
,i_/No
I� No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
is .§" i1*%-'i ttt t'
Comments (refer to goeshom#) Explain any YES answers@>gand(or; anyt.recommendat�ons ar any other comments. `
] f}
Use drawings of facility to better explain sifuattons:; (use addrtional pages as necessary:)
' .3 �...R' l.d@' � Fa:�,5.4 ii'�: '.� g 11: A G y '�. g� < ^•4@-'
j ICC. P U PY d 4.�� NI Rf Gb�bl,
ReviewerAnspector Name - f " i _'- r r z' 7A Phone:
Reviewer/inspector Signature: Date: " d
f 12128104 Continued

Facility Number: Date of Inspection 8
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ETN' o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ER No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other ,�,/
21. Does record keeping need improvement? If yes, check the appropriate box below. L/ Yes 24o ❑ NA ❑ NE
❑ Waste Application ❑ kly Freeboard ElWaste Analysis [ISoil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ZCropYield ❑ 120 Minute Inspections [:]Monthly and 1" Rain Inspection�No
Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �'WN
o El NA El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? El Yes o ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? dyes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes D'No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes QK° ❑ NA ❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2No
❑ 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?
El Yes
,��
1!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
El Yes
2 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
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
12128104

11
iReasonforVisit
Type of Visit _0 Compliance Inspectlon O Qperation Review Structure Evaluation Technicak Assistance Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Arrival Time: Departure Time: County: d�11°1,�;,j� Region:
Owner Email:
Physical Address:
Facility Contact: I. 'r Title:
ARI OnsiteRepresentative: vdNtfI-{L__ W1���
17
Certified Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 00 =]' = Longitude: =° =' =
Design @drrent
Design Current Design
Current
Swine Capacity Population Wet Poultry
Capacity Population C++attic Cap +city
Population
❑
Wean to Finish
❑ Layer
❑ DairyCow
El
❑
Wean to Feeder
❑ Non -Layer
❑ DairyCalf
Feeder to Finish
'b
)
❑ DairyHeifer
Farrow to Wean Dry Poultry
❑ D Cow
❑
Farrow to Feeder
❑ Non -Dairy
❑
Farrow to Finish ❑ Layers
Gilts ❑ Non -Layers
Boars ❑ Pullets
❑❑Beef
Turke s
❑ Beef Stocker
❑ Beef Feeder
Brood Cow
❑
❑
Other
❑ Turkey Pouits
❑
Other ❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
EjNo
❑ 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
EdNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[;10
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

F
Facility Number:
Date of Inspection
r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Nc ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[Z/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
ENo ❑ 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?
Cl Yes
C�No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
P�No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
ENo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
VNo ❑ NA ❑ NE
maintenance/improvement?
H. Is there evidence of incorrect application? If yes, check the appropriate box below.
El0 Yes
f
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
(a No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
NNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
,IQ
o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
2No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
v
❑ NA
❑ NE
'3767fINNU ''��§„i �u'� 1Y .°„�`t,"k i""•`.�., r ' ". + 4� � x19� 4 R.
Comme .s�(refer o question$#). ExpIa n anygY'V a s andl r ny r ommendgtions,pr any other comments
s ln� }:.
Use drawin ogac11M't�Qe�eV eRp�in�� � g(lux � d� all-77
Reviewer/Inspector Name f-- T T—.-T� y
Phone: !/
739(
Reviewer/Inspector Signature:
Date: a
Page 2 of 3 f 12128104 1 Continued

,acuity Number: 3 — Date of Inspection 7-f
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUp 1] Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
❑ Yes Q4 ❑ NA ❑ NE
❑ Yes D o ❑ NA ❑ NE
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ['No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
I"No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ErNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
El"No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
E:-No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ErNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [Ko ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
C
El 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
FerNo
❑ 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
t 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
- LI No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
�2N/o
❑ NA
❑ NE
Additional Comments and/or. Drawings f ' ^ k,
Page 3 of 3 12128104
Page 3 of 3 12128104

e ivision of Water Quality
Facility Number, 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit Com fiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: OUPL-rJJ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title: Phone No:
Onsite Representative: L,>,,jArWAd AAIL41L Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Sack -up Certification Number:
Latitude: 0 0= 6 Longitude: 00
0 4= 44
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
7.,cl 6
% v O
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Puilets
❑ 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?
Design Current
Cattle _ Capacity Population
❑
Dairy Cow
EI_Dairy
Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes Id No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ErNo
❑ NA
❑ NE
❑ Yes C No ❑ NA ❑ NE
12128104 Continued

Date of inspection
Facility Number: 3 —
,Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structur 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
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
ONo ❑ 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 notify DWQ
threat,
'No
7. Do any of the structures need maintenance or improvement?
El Yes
ET❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'?
❑ Yes
1J 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
0- o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
L! No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
CJ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Driii ❑ 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
L/JNo
ElNA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ElYes
El NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?] Yes
,3/No
ld No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
dNo
ElNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
ElYes
DIN' o
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
af�i�
Reviewer/inspector Name Q i1 A (-L- Phone: �Q D y6 - �a
Reviewer/Inspector Signature: CIL Date:
1 12128104 - Continued

I.Ficility Number: 31 —V971 Date of Inspection '1 7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes M No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
0/yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ We ty Freeboard El Waste Analysis ❑ Soil Analysis El Waste Transfers
❑ Annual Certification
El Rainfall El Stocking Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections El
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
I(j No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Q'�o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EKo
❑ NA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
O No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
'No
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
ElC1N No
,❑:1, !NNA
A
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
I' 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
t_I 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
Lt 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
2 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
B No
❑ NA
❑ NE
Additional Comments and/or
12128104
f

rCrDivision of Water Quality,
y Facility Number. S O Division of Soil and Water Conservation
_ 0:Other Agency
Type of Visit compliance Inspection O Operation Review O structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: ce Region `'`f loe
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: PIl
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity. .Population
❑ Wean to Finish
10 Wean to Feeder I
ceder to Finish I / ;- YO I
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 4 Longitude: 0 ° = ' =
Design Current
Wet Poultry Capacity Population
❑ Laver
❑ Non -Layer
U Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish j ❑ Layers
❑ Gilts ❑ Non -Layers
❑ Boars 4 ❑ Pullets
-- — I ❑Turke s
Other ❑Turke Poults
❑ 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?
Design Current
Cattle Capacity Population =._
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures: �I I
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility Number: l — 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 El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
V X (7 (000
301c� G
AL
Page 3 of 3 12128104

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Struc ure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(iel 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 ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ 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 []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 l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) C' �f
13. Soil type(s) 11011.1 a /%
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ yes ❑ No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ 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):
AL
Reviewer/inspector Name Phone:
Reviewer/inspector Signature: Date: Q.6
5
Page 2 of 3 12128104 Continued

y81
Type of Visit 0 7Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I Arrival Time: Departure Time: 00 County: _009L ,W Region:
Farm Name: pF FARE Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: GEog V1 ^G` 0DY
Certified Operator: -%,Q -T%4.1
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator.,. mQa pl �
Operator Certification Number:
Back-up Certification Number:
Latitude: [= c = S = Longitude: = ° 01 = "
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish Zy 0 1
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La et
Dry Poultry
❑
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'?
Design Current
Cattle Capacity Population
❑ Daia Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes JNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes V'z
El NA El NE
El Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

Fa ility Number: 3 ( — a
Date of Inspection
Waste Collection & 'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: LA 4,zP?J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3�
5. Are there any immediate threats to the integrity of any of the structures observed?
(ic/ 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 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes WNo ❑ 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
JNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
YNo
❑ 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
ENo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
`o
❑ Yes
❑ NA ❑ NE
maintenance/improvement?
7No
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
El Yes
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
Y
12. Crop type(s) t�SU
13. Soil type(s) N D
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E(No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[�
El NA [I NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,❑
Yes
1� N70
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA ❑ NE
18, Is there a lack of properly operating waste application equipment?
❑ Yes
LJ No
❑ NA ❑ NE
tom,) yf C P Copy 6� UP-T.Cr+TE JF C,,1 E2.A G�, w:n',_ 4 S?_� 1zD
tRW
ReviewerlInspector Name(; , 3•. Phone:
ReviewerlInspector Signature: Date: - as
1L/66/114 i-anrtnuea

Fa4lity Number: 31 — .8 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropiiate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ElNE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ElYes No ❑ NA ❑ NE
Yes ❑ No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No Q N
El NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
El No VIA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
0 No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No ❑ A ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Vo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes ❑dVo ❑ 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 W91 ElNA [INE
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 ❑ Yes7No.
El NA [I NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ElEl NA ❑ NE
33. Does facility require a follow-up visit by same agency'? ❑ Yes❑ NA ❑ NE
Additional;Comments .and/or Drawings:' s ;, kt y ; -�V' a „�'�tii �...
12128104

r
Type of Visit J9 Compliance Inspection Q Operation Review 0 Lagoon Evaluation
Reason for Visit QRoutine 0 Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time: Z �
Not O erational 0 Below Threshold
Permitted [XCertifled 0 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: 4/ .0 �r.�! County: II&I , ''
Owner Name:
Mailing Address:
Phone No:
Facility Contact: Title: Phone No:
Onsite Representative. �[/�O , A ft J?d (/ Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry [:]Cattle [:]Horse Latitude De 04 [[ Longitude 0 6 �
Design Current
Swine . Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current 'Design Current
Poultry Ca pacity Population Cattle Caoacitv. Po ulation
❑ Layer ❑ Dai
❑ Non -Layer ❑ Non-Dairyli
❑ Other
Total Design Capacity
Total SSLW
Number.of Ligoons 10 Subsurface Drains Present ❑ Lagoon Area ILI Spray Field Area
HoldingPonds L Solid Traps
p ❑ No Liquid Waste Management System
Dhcharees 8 Stream Impacts
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? ❑ 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/mid?
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 ❑ No
a t ollection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier: In
Freeboard (inches): !/
05103101 Continued

Facility Number: — I Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ 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 Annlication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
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
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
i 18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ to UP, 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 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 notiA- regional D�VQ 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 wbich cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
© No violations or, deficiencies were noted during this visit. You will receive no further correspondence about tliis visit.
: i r,:{ -..0 wi.:4"•"iG'4k •tt .w.rhq. - ]2
Comments (refer to gbestaoa E:tp]a3n any YES'snswers andlar atry,recommendations t►r any other comatenta. ' o",$
i fs
.' ; {
t3€ y L.3ie...t7
L � -. '-i
Use drawings oof to better expIaiii sttuations (use additional pages tree ary} 3 , ❑ Field Copv ❑ Final Notes
�facillty gas qt 9
—
Reviewer/Inspector Name � �{FA�•a�.���.�,:
.. ?V� .aMe4 :[,. �!9 ,a. ..i Sw1 4 d.:�f,e�.!:��... inu � iJf $��.r,=3ii .^€ na7ti4iwsl.�s�",..
Reviewer/Inspector Signature: Date: I LI 16 1-4
O5103101 j Continued

Facility Number: 3 — W late of Inspection Z/
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?
27. 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?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
�_. t ona ommettts an , or, i•aw ii s: # v„ wr��i,�,, , �.. �. F �� � `� {`�� �. •,.:. -�•�E a �. .
rr� j
05103101
05103101

Type of Visit t) Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Y8 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of visit: DZ Time:
Q Not Operational Q Below Threshold
13 Permitted © Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: _ _... _.......
FarmName: ......Wr..k!....... !.!...1............................................... County: ... I!: -- -- -- -- -- -- .,.....................
OwnerName:.------------------------- ------------.._----------------- Phone No; ------------------------------------ ------
MailingAddress: ...................................................................................................................... ......................................................................................
Facility Contact: ...........................................................Title:................................................ Phone No:
Onsite Representative:. !� ✓ A P� Integrator:__ C /� �
Certified Operator: ................................................... .......................................................... Operator Certification Number:
Location of Farm:
❑ Swine - ❑ Poultry ❑ Cattle ❑ Horse Latitude • L Longitude �' �4
:Des
Swine :. 'Ca
❑ Wean to Feeder
19 Feeder to Finish /Z
❑ Farrow to Wean
❑ Farrow to Feeder
`I ❑ Farrow to Finish
❑ Gilts
❑ Boars
"Current
Po`ulation ,'Poultry
❑ Layer
,111E] Non -La
❑Other
Desigre Current
-Ca ac . �Po ulation Cattle
�:❑Dairy
Design Current
-------------
tlI1111Y IYYYYY IIIY NIIIIMIIIIII�
3 Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
3 No Liquid Waste Management System'����K
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes El No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes tg 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 50.No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 4No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Ja No
Stru7ure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ........................... .........-•--•--•--.................................. ........................... ........................... ...................•--•-...
Freeboard (inches):
ne in 7 In 7 i+...-.J.... _.r

UNW/UL
Facility Number: 3/ -- =o (
Date of inspection Q 2
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 Aonlication
4Un!lrruea
❑ Yes ®No
❑ Yes $3 No
❑ Yes V1 No
❑ Yes fffNo
❑ Yes 1�1 No
10. Are there any buffers that need maintenance/improvement? ❑ Yes Th No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes & No
12. Crop type �/yt � � I/ D,�4'(t d
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 E9 No
c) This facility is pended for a wettable acre determination? ❑ Yes �INo
15. Does the receiving crop need improvement? ❑ Yes 1P No
16. Is there a lack of adequate waste application equipment? ❑ Yes FINo
Required Records & Documents
17. Tail 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 j No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 1p No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes 09 No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 52 No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes El No
24. Does facility require a follow-up visit by same agency? ❑ Yes EgNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP7 ❑ Yes [&No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
�Camm,�en��fer to{quest�op��� n�a y
S answ rsan o anyarecommen
at ons or�any o er ommenis.
Used gs of facility�tol bette e 1 a� 'ilk
u io s...(use additRo cai pa ads necessa . y:�° ❑ field Capy ❑Final Notesall
F
Reviewer/Inspector Name` '' r '' , �'+y,'F
;"z'k�`'ri►`�?
Reviewer/Inspector Signature:
Date:

Facility Number: Date of Inspection
gdor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atfor below
liquid level of lagoon or storage pond with no agitation?
27. 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 fans) 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?
❑ Yes N No
❑ Yes No
❑ Yes No
❑ Yes No
r
❑ Yes No
❑ Yes No
❑ Yes 0 No
Additional Goffinth@nts andlor'Drawings:
AL
05103101

Facility Number Date of Visit: CJ-�J Time: 3d
Not Operational Q Below Threshold
U Permitted 13Certified 0 Conditionally Certified 13Registered Date Last Ope or Above Threshold.
FarmName: ....L.",. ... .......................... County:....0,.......�.......................................................
OwnerName:........................................................................,.................................................. Phone No: ................................................................................. -- . ..
Facility Contact:
Title:
MailingAddress..... ...................................... .....................
Onsite Representative: t ... --alit-.Ir:c�.. ....................
Certified Operator:
Location of Farm:
PhoneNo:.. .................................................
Integrator:.. 1.....................................................
Operator Certification Number:
1ts� SK Ir723 'al
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude
Designs . Current ;
Design -- Current, Design Current, ,
' 'Swine Ca` aci ' Po llatEon
Poultry - ,Cii, aci Po ulatian Cattle Ce act ;'Po'"elation
_._ ..
❑ Wean to Feeder
❑Layer - ❑ Dairy
MO
Feeder to Finish a
❑ Non -Layer ❑ Non -Dairy
o3t
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other ; s
❑ Farrow to Finish
Tot81 bim 'C$paCity
❑ Gilts
❑ Boars
'Tohd,SSLW—
i Num r of agoons
❑ Subsurface Drains Prese!LtjjE3
Lagoon Area
10 Spray Field Area
Haldilig Pnnds I Solid Tritp
❑ No Liquid Waste Management System
.,
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
kluo
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. Dees 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
P No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
�No
11
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ElSpillway
❑ Yes
vq No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: .......................................................................................................................................................................................................................
Freeboard (inches): �j 3
5/00
Continued on back

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
,VNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
dNo
(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
PdNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
0 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
ONo
Waste_ Application
10, Are there any buffers that need maintenance/improvement?
❑ Yes
No
I I. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
No
12, Crop type C Lr�,Sc
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
BNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
UNo
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
ONo
16. Is there a lack of adequate waste application equipment?
❑ Yes
Ef No
Reouired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes A 'No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.) ❑ No Yes
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes 9No
20. Is facility not in compliance 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 VNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes allo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes Mo
24. Does facility require a follow-up visit by same agency? ❑ Yes Wo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ,E�No
;..iib.5:o. .gee�... * •�r. �#.. a.iEng sit; . Y:o. wadi .�eesriye
: cariespo denCe: abaut: this
,
. lai situations' use addibo a es �s n ` ` �,' t �'� 3 F� ` ° _ `
Use d3rat�ings of faculty tu' better ,exp n ( nal p -. g , ecessary); r `# t' p+'� r F
Se
e,?
Kr Riau y��C." ry'4,
�r 3I —L Y as L'O,
o ve,A
Reviewer/Inspector Name
Reviewer/Inspector Signature: q, Date: 5/00

' Facility Number: — 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 KYes ❑ 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 j (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 k!rNo
32, Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes JKNo
Additional omments'an ors ra ngs: 1 'r , sE e r �_ r { �..� {i' T ' r` i(ts° ( tr j'p'3
5/00

Division of Soil andrWater Conservation -Operation Reveew
rya 13.Division of Soil and Water Conservation ,Comphance Inspection
jyision of Water Quality Compliance Inspection „ i a
f r a r r r f �
��. Ot}ier Agency: bpkratlon..Rev1eW'r. fir'' r/J rE itr
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspections
Time of Inspection 24 hr. (hh:mm)
Permitted Certified 0 Conditionally Certified 0 Registered 10 Not Operational Date Last Operated:
Farm Nome: ........... .................... ...County a..........
Owner Name .................... Phone No:.......................................................................................
Facility Contact: .. ..'>!Cl!L ....... Title :... ...... ......... tea..... Phone No:...................................................
Mailing Address: ..........................................................
Onsite Representative: "' r"„" ............................. .. Integrator:.................... �5..........................................
Certified Operator: .................. ... . .... ....................................................... Operator Certification Number:,.................................
Location of Farm:
t....-.. ............................................................. ...... ..... .� �.�:,: ,�..,,�::,::,: �,:�::�. ,, �::�.::�.:.,.,.,-. ............................ ............. .....t T 1
Latitude �'°J�•� Longitude
Design Current,..':
: is Desi g gn Current Design Current E„
.,Swine,, Capacity Po ulationn:,. Poultry. Ca acit Po ulation Cattle Capacity. Population
❑ Wean to Feeder ❑Layer ❑ Dairy
Feeder to Finish ;." ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Other
❑Farrow to Feeder , .• ` ,
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons �,: ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding•Ponds I Solid Traps ; ❑ No Liquid Waste Management System r.
Discharge- & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: [3Lagoon [3Spray Field [3Other
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? (I1'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
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard(inches): ... ......}i.................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes *0
❑ Yes ❑ No
❑ Yes ❑ No
--AIA—
❑ Yes ❑ No
❑ Yes �No
❑ Yes -
❑ Yes PNo
Structure 6
...............................
❑ Yes Ilk
Continued on back

Facility Number: Date of Inspection
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?
❑ Yes
q(No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
A'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
XNo
11. Is there evidence over appli ation? ❑ Excessive Ponding ❑ PAN
❑ Yes
�do
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
`RNo
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
KNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
PCNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
KNo
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
KNo
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
lq:�o
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?
(ie/ discharge, freeboard problems, over application) ❑ Yes '[9Vo
23. Did Reviewertlnspector fail to discuss review/inspection with on -site representative? ❑ Yes JNYo
24. Does facility require a follow-up visit by same agency? ❑ Yes [kNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes XNo
N . Mhtttjris:ok- ftficjenc;ies mere poled. Oor'tiig �his:visit: • Y:oir Will-teceiye pti futthos • . .
• corres�oridence. about.thLNisIt. • • .
Commentsf r"efer;td"questign #) Explain any;YES#answers and/or any;recomtnendatyons or nny other comments',
,LJse'�drawings of facility to better ezplatn situat[ons',(use,addEtrooal pages as;necessary);: $n r� ,f �, . �.6)� 4- `7
Reviewer/Inspector NameI.`'!7l!'�t�l ��i V./
7, ';Oj .� � , 7-
Reviewer/Inspector Signatu
Date:
3/23/99

dq
Facilit Number: 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
s
Ale
❑ 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
P40
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
XNO
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
XNo
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
)KNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
VNo
32.
Do the flush tanks lack a submerged fill pipe or a pe rm anon t/te mporary cover?
XCN
❑ No
Additional ommen an orf rAWin ?. � �; � �7t� }"bxd'➢ �ta�= r ��: k sEh F 3 ,,d, n�� r.,?a�r�, a'
i
Y
3/23/99

©Division of Soil and Water Coaserva�on' .OperuGon Review �`` ,�r :'
r r� Q'DiYtsion of .Soil and Water Conservation i ,ComphaRCeIlSpectlon
r ® Division of Water QUBlltj' „y�Cplilh�lailCe')nspectloll r r2i 1'rz VJf. ra
Fo�'.y.'- Upration.RevieWf, _ �ii f
Other Agence
{ r f`E`1'V Fr ,p ✓f �::'} ii, f.i e'.�`P! , !� iF.a.e'63<�l��e. '
10 Routine Q Complaint O Follow-up of DWQ inspection Q Follow -tip of DSWC review 0 Other
Facility Number 3 Date of Inspection
Time of Inspection t 24 hr. (hh:mm)
❑ Permitted (Certified ❑ Conditionally Certified © Registered Not Opera Dante Last Operated:
{til County:...... ht.�4.i.l.t:...................
Farm Name: .........................................
Owner Name: Phone No•
.t�...............1s�,_................................................................. `�)............................................
FacilityFacility Contact:............................................................................... Title:................................................................ Phone No: ...................
Mailing Address: ....i}Dy ....,.,. .Q4 ..,,.N(.... (-iia ...., '...................................... ......�t��G1/.1��t. jll�................................... Z 1..........
r l 1...... +
Onsite Representative:.......ir �.b......�]n 4?1''........... 6-�— ....1 0.1
....... Integrator:..... 1FYQ�.I.�t ............................... ......
Certified Operator:................................................................................................................ Operator Certification Number:.,................ ....................
Location of Farm:
{.l(.t?^....�r�......t�.1?....... `ai ......1?.........�,..... �..p.....�...t!�l...........Qf...... oF....... L.?...........................................................
............................ " .. ......................
Latitude Longitude
Design Current `jg Dastgn Current J_ Design . Ctkient "
Swine Capacity Population Poultry. Ca acity. Po'fiulation Cattle Capacity Population,
s
❑ Wean to Feeder ❑ Layer ❑Dairy
Weeder to Finish j2 [] Non -Layer I JE1 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
t3
Farrow to Finish Total Design Capacity f Z 4
❑ Gilts,ldo
❑ Boars i Total 9SLW
Discharges & Stream Imuacks
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated a: []Lagoon ❑ Spray Field []Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ® No
h. 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
Identifier:
❑ Yes [� No
WA
❑ Yes [ No
❑ Yes No
❑ Yes No
❑ Yes 10 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Freeboard(inches): ............H.0.................................................:...................................................................I..........................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, 0 Yes Q No
seepage, etc.)
3/23/99 Continued on back

Facility Number: 3 (— 495Date o Inspection
6. Are there structures on -site which are not property 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)
T 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
❑ Yes (j No
Kyes No
❑ Yes No
❑ Yes W No
❑ Yes KV No
❑ Yes PNo
13. Do the receiving crops differ with those designa(edtin the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [.-No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 19 No
b) Does the facility need a wettable acre determination? ❑ Yes R1No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
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?
yMaf idhs or &fieie'nd'ps •were )iOfgO• Ootirig 4:hls;visit' • Yoji will teboiye rio; furfth •
correspondence. ahotit. th' .visit.. • .
fF 1 " 1 F 3ei '47
Comments (refer(to question #} F ExplAm'any YES;
ansners a
Use,drawings of facility to better explain situations (use.addi
7, �hru?f f��Ka. Wail st,%Uj � L,Ovsk w.a�e11e�.
� �� �1'�e5 'tn� I�goa� S�ouIU lae ��
FIm �;it 5h6u)) be Z)xW i
Reviewer/Inspector Name i
Reviewer/Inspector Signature:
�►uu3Nagea as uC�eaaa�.ylz #R, 'aa'!1,I tL
or 18e 1411 f ayov� SVr'Ce .
3/4 " r-\'l 0 risk 6—L -
Vol
Date: 1�"ii I
❑ Yes n No
❑ Yes 0 No
❑ Yes t—k)No
❑ Yes raj No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes 0 No
❑ Yes �No
❑ Yes No
❑ Yes No
3/23/99

*:
Fac4ity Number:
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
MYes
❑ 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
5ONo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
PNo
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
7No
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
No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
PpYes
❑ No
3/23199

Division of Soil and Water Conservation ❑ Other Agency
® Division of Water Quality
Routine 0 Com laint 0 Follow-up of DWQ inspection 0 Follow -tie of DSWC review 0 Other
Date of inspection fad/
Facility Number
Time of Inspection � 24 hr. (hh:mm)
[] Registered i FCertified 0 Applied for Permit © Permitted 10 Not Operational I Date Last Operated:
w.b .
Farm Name: .............���`-fin',, .... County: ......... �it,..........................................................
Owner Name :.................. +..... .. Phone No:....�`1.1� �.�.Y ..r..! i.! ..
Facility Contact: ....................................................................... ... Title: . Phone No:
......................................................................................................................
MailingAddress:........ 6i.�i....... 4 ........................................ ........... .4u xi, .r..N. ................................. .z III ........
Onsite Representative:......
.......�..�........ t.?.Qi�r..-c. .................................................. Integrator :.......... jc&rvz!' .5........................
................. ..............
Certified Operator;................................................................................................ ..... Operator Certification Number ......................
Location of Farm:
... ....
...... ..... ....... .. ...... .
Latitude ="
Longitude
. =° =' 11
i estgit ;, : Current`,
Design Current
De"sign " Currertit
Swine E 'Capacity Population
Poultry.
Capacity Population Cattle
Capacity Population
❑ Wean to Feeder
I0 Layer
F Dairy
❑ 17eeder to Finish
p
❑ Non -Layer
Non -Dairy
❑ Farrow to Wean
❑Other
❑ Farrow to Feeder
❑ Farrow to Finish
Tntal Design Ca.paCitym
a .
❑ G1IrS
4
` Total SSLW
❑Boars
u s
'
(General
1. Are there any buffers that need maintenance/improvement? ❑ Yes No
2. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes [� No
b. If discharge is observed, did it reach 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 [P No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes 0 No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes hm No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes r" No
maintenance/improvement? Ta
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes T
No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes 1P No
7/25/97

Facilitj Number: 3(—ttft
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes rEj No
Structures (Laaoons.floldine Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 9 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
...................................................................................................................................................................................................................
Freeboard(ft):..........k.:................ ................................ ... .................................... .................................... .................................... ............ I .......................
10. Is seepage observed from any of the structures? ❑ Yes RNo
11. is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes No
12. Do any of the structures need maintenance/improvement? ❑ Yes No
(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?
❑ Yes
ANO
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
No
(If in excess of WMP, or runoff entering}. waters of the State, notify DWQ)
JU
15.
Crop type .............. jr-h(y...............1n1�A 1.•......... 3..h.Q .............
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
QPNo
17.
Does the facility have a lack of adequate acreage for land application?
•❑ Yes
No
18.
Does the receiving crop need improvement?
❑ Yes
No
19.
Is there a lack of available waste application equipment?
❑ Yes
No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
PNo
21,
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
P No
22.
Does record keeping need improvement?
XR Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
A No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
OIo
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
,u No
0• No.vitilatioiis•or deftciencies.were-noted-iluring this:visit. Yoiu:will ikei ive.1r6 tirt eir-.-
:. coerespi)Wejko about this'visit:• :.:. ; :.: .
ZZ. 54,E rtcaiJs s6vld bt iCt r�i.v, 6+0
cP�n .
1 .
Reviewer/Inspector Name
Reviewer/Inspector Signature:
caller ar w ode, tj1 j• c*k wLa n` ?A ni
,J
�v�`� a, Soya T 1", k9-7.
7/25/97
Date:

�„'�" q, `' `R `a '.,.'s. F :u „ „ :, <.. 'a.:t•Y •z , r, 2bi.'M 4'a53euu .'. :f .' r M: e":
,; ❑ Division of Soil and Water Conservation ❑ Other Agency����
Division of Water Quality �` ,
� � h M
,,,.� ,��,�'�;� rcr ^� �,, ..�s , e .�9„ w• _� �,x,„ •°�^*>:,�'^sza � �zs�'°�4�.�.^x� �. � .` a�„ i� "����4'� i
Routine OComplaint 0 Foilo,.ti'-u or i)Nv ins ection 0 Follow-up of DSWC review 0 Other
Date of Inspection D
Facility Number 31 Time of Inspection I =1 d 24 hr. (hh:mm)
© Registered M Certified © Applied for Permit E3 Permitted 113 Not (} cratinnal Date Last Operated:.........
FarmName: ..........1Ia1910. .................................... ....................................... County:...Dmki ,....................,
Owner Name: e i.......1.!'1.?*.,.............................................................................. Phone No:..�Ri�� .��:..����...
Facility Contact: ......,�1.,.... �rayill ..........................I..... Title: ......... owji,i!-lr........................................ Phone No:.. l.P.�..Z48.-... �........
MailingAddress:... klft.... ... .� .. 1�.............................................................. ...... ......,..................................... _9501 ..........
Onsite Representative:...... a. %k. ........................................................... Integrator :......C(��1(l^t?.f.�.S..........................................................
Certified Operator .,.....W ll. tr�...............�.;�pej................................................ Operator Certification Number ...... :M1.32.....................
Location of Farm:
Talt,t..... ......... t...... �..... ac , tCs..... ur�......�.G..�.....�n......SR...l.7,irk►......e.rrr,.....s.....A....r!�.i.iI.......on......faae.�t...si �.
................ ............. I
Latitude =0=` =« . Longitude =" =° "
'9 Destgt% ,,Current-
Design Xurrento ° t Designs Current` x`
SwineCapac�tyPopulattoq
Poultry Y Capacity, Population„ Cattle Capacity Populatr<on `<
❑ Wean to Feeder
s.
❑ Layer
..
❑ Dairy
:
{' S
Feeder to Finish
1,2.40❑
Non -Layer
I0 Non -Dairy
"
El Farrow to Wean
' V' `:. ,. .,..' a� x �: '' s • f'a;Y: . f.;-';
I' '�:'*sy, ? F� 3 w w x xx,"-,,;, r'
•
El Farrow to Feeder
❑ Other
:; ,
`-
ElFarrow to Finish
„..�
F Total Design Capacity
f
❑ Gilts
4 �
Boars
TotaUSSLW
„
-
Number:: of Lagoons l,Holdm Ponds';
x -'
❑Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
g:E
No Liquid Waste Management System s W
F
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes 9No
2. Is any discharge observed from any part of the operation? ❑ Yes q No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes $9 No
b. If discharge is observed, did it reach Surface Water'? (If yes, notify DWQ) ❑ Yes M No
c. If discharge is observed, what is the estimated flow in gal/min? A] /A
.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. Were 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 M No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes V No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes P No
7/25/97 Continued on back

r
Facility Number: 31 —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons.tiolding Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3
Identifier:
Freeboard (ft): 3.1
10. Is seepage observed from any of the structures?
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 .......... L<7t-c............... lr? "t................ SRY6............................................................................................
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?
® No.viailations:oe deli.ciencies.were- noted- , during' this; visit.;.Yodwill xecei' `ito:furtheF,:-
. . • cbrrespbtidence about this•.visit:- ' .... � � ; � ; ' .: • . � ' .. • . ' . , ` � . ' , . .
❑ Yes ® No
❑ Yes ® No
Structure 6
❑ Yes
® No
❑ Yes
No
�l Yes
❑ No
❑ Yes
( No
❑ Yes
JQ No
❑ Yes [&No
❑ Yes U No
❑ Yes 5@ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
Z Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes No
12- 80,,rc. was WfVVn 6 1PCCYt� ��tri� f �7E msce je`j• p I I
re c" � sl o Q � � �V tok oum�- a" 4e-1) n uv►s ft}cr. i(Y'�q Pm � sW d 43,
7/25/97
Reviewer/Inspector Name10T; / w �s �`'` y + v
Reviewer/Inspector Signature: Date: ���

Site Requires Immediate Attention: ND
Facility No. 3 t • 4 a4
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: `b , 1995
Time:
wl7i
Farm Name/Owner:Per-
Mailing
Address: OIq- Eas- lyc- a4 2a%"Lv+lie_ 7-gr)8
County: Du R i a
Integrator. Phone: C91o) ig o - 44 i `a
On Site Representative: Phone:
Physical Address/Location:
Type of Operation:
Design .Capacity:
Swine
1o40
Poultry . Cattle
Number of Animals on Site:, ' I C) 4 O .
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 34- ° SS ' 4 3 " Longitude: Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Q or No Actual Freeboard:Ft. Inches
• Was any seepage observed from the lagoon(s)? Yes or o as any erosion observed? Yes or
.Is adequate land available for spray? e No Is the cover crop adequate<ffor No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria?. 200 Feet from Dwellings es r No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or 1�o If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
kJr, 0 V
Inspector Name Signature
cc: Facility Assessment Unit
Use Attachments if Needed.