310672_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qud

1
Gty Num7
Type of Visit: CCom a Inspection O Operation Review p Structure Evaluation p Technical Assistance
Reason for Visit: Routine Q Complaint O Follow-up O Referral O Emergency O Other O Denied Access
r
Date of Visit: z( Arrival Time: Departure Time: Fj Oqp County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: .)00G4 / r/ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Design C►urrent
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pap.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
an to Feeder
I
INon-Layer
Dairy Calf
Feeder to Finish
9!
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D . P,oult Ca ac" P■o P.
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Otllter
Other
Turlce s
Turlcey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ffNo ❑ NA [_]NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
❑NA
❑NE
❑Yes ❑N ❑NA ❑NE
❑ Yes F��o
❑ NA ❑ NE
[—]Yes []No ❑ NA ❑ NE
Page I of 3 21412015 Continued

z r
FVility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy -rainfall) less than adequate? ❑ Yes 01 off❑ 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): 27 -3r'i
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E?Xo� ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? es ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Ap lication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �❑ 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 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes rNo� NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes No NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ff No NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
it
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 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 9F ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes EJ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes Qom[:] NA ❑ NE
❑ Yes .e"No ❑ NA ❑ NE
❑ Yes ffNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [J NNA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes �❑ No M NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ No ❑ NA ❑ NE
Comments (refer to,questiou!. Explain any YES spswers and/or any additiunal�recommendations or#'any other comments.`
g':. :
Use drawings o`f�faciliWi10 lietter exola n-situations '(use_additionanaQes'as ecessa vk ._�.. K E 3 {,. ?„ ,-
Reviewer/Inspector Name: L' C 9 �C + S v Phone: I0 7
Reviewer/Inspector Signature: ���� Date: 4 l 2 I / 7 I
Page 3 of 3 21412015

(Type of Visit: E )T liance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance I
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral Q Emergency 0 Other O Denied Access
Date of Visit: tit Arrival Time:Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: �'J A144-Ad KhL Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Swine C►apacityWet Poultry Capacity P.
Wean to Finish Layer
Cattle
DairyCow
Design Current
Capacity Pop.
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
6
Design Current
Dry Pfoult , Ca ale P,o ,
DairyHeifer
D Cow
Non -Dairy
Farrow to Wean
Farrow to Feeder
Farrow to Finish
La ers
eef Stocker
Gilts
on -Layers
4Beef
Feeder
Boars
Pullets
eef Brood Cow
Qther
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ o
❑ Yes o
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: - Date of lns ection: I
Waste Collection & Treatment
i. 4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure
Structure 2 � Structure 3 Structure 4 Structure 5 Structure 6
�Identifier: L.F�n
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3a-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes R7 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 E�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 en ironmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? [] Yes ❑ o ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? [:]Yes Yo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes No ❑ NA ❑ NE
maintenance or improvement.
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes y(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
©f o
❑ 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
WNo
❑ 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? 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 2fNo ❑ 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 InspectioZxl"'o
❑ 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? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permi ? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yesr ❑ 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:
ZZ
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
VNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
o ❑ 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
[7/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
[rNo ❑ 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 El ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ YesVNo
❑ 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 necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
L V
Phone y1i
Date:
21412015

Type of Visit: U 7outine
ance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance V
Reason for Visit: O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time:® County: CXA006 Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone:
e.-I Onsite Representative: EA! n Integrator: y
Certified Operator: Certification Number: 0 j
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design C►urrent
Swine Capacity Pap.
Wean to Finish
Wet Poultry
I I Layer
Design
C•apaclty
I
C►urrept
Pop.
Cattle
I Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
I lNon-Layer
I
Dairy Calf
Feeder to Finish
D Poult ,
Layers
Design
Ca aci
Current
P,o ,
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
jBeef Brood Cow
Other
the
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes n No ❑ NA ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
❑ No
[] NA
❑ NE
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 eNp
❑ Yes
❑ Yes WNo
❑ NA [] NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Facili Number: - Date of Inspection: p
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes k 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: LA W ay f LA &W6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): PSok b
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 El Yes
No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes gNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [Z('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):
M. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes Q o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes Co
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes WNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes �
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes VNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[(No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
M 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?
❑ YesVNo
o
❑ 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

Facility Number: - Date of Inspection: 16116
TE;� 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 2 C ❑ 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. T
❑ 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 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 2ZNA ❑ 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?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
❑ Yes Oo ❑ NA ❑ NE
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
E2/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
EJ'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
[a/No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: w FA A p t—, Phone( 10
Reviewer/Inspector Signature: Date: o — '
Page 3 of 3 21412015

Type of Visit: Qf Co pliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: p o Arrival Time: ® Departure Time: ® County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative: _f5l ATQAr� 02�— Integrator:
Certified Operator: Certification Number: �� S%
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design Current Desigu Current
Swine Capacity Pap. Wet Poultry Capacity Pvp.
Wean to Finish Layer
Design Current
C*attle Capacity Pop.
Dairy Cow
Wean to Feeder I
JNon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean Design Current
Farrow to Feeder D . $oul Ca a_ci_ Pao
Farrow to Finish Layers
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]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 [:]No
❑ Yes [�No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412014 Continued

Facih Number: - Z Date of Inspection: p
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑Yes No ❑ NA ❑ NE
• a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LJA cll I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): L/ 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 0 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 environmenta threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes N ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes To ❑ 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 hio ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window 0 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
E] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E21<o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E]r�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
C N90
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�j`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
[]A'o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[a"No
No
❑ 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

F kcillity Number: - Date of Inspection: d V
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No, ❑ NA ❑ NE
2.5. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ 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 E3 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 C 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 ❑AN`o ❑ 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 G] 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 Ej No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes dYNo
-1 ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ NA ❑ NE
Comments (refer to question ft 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).
70
Reviewer/Inspector Name: ll9044a.0Phone:C 1/d
Reviewer/Inspector Signature: Date: 36
Page 3 of 121412014

Type of Visit: (25 Coipip
,(,(liance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
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:--1--.7"J County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: fh_'�
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: 4
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current Design Current
attle Capacity Fop.
Wet Poultry Capacity Pop.Am r[fffDairy
La er ai Cow
Wean to Feeder
Non -La er
Calf
Feeder to Finish
ai Heifer
Design Current Dry Cow
1. , Ca gci. P,o , Non -Dairy
Beef Stocker
77a
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
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 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 ❑
❑ 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
❑ YesVNo
❑ NA
❑ NE
of the State other than from a discharge?
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 Ej 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: �V
Spillway?:
Designed Freeboard (in): pp
Observed Freeboard (in): E7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 6 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 dNo ❑ 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 environments threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �VNo
❑ 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 [3 Yes L] "' o ❑ 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 Vo ❑ 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 ErNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ;j4o' ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes &No
❑ NA
❑ NE
Required Records & Documents
ZNjVo
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
❑ 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 o ❑ 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 Z9
Judge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 9��o
❑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 Number: - Date of Inspection:
24: Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ 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 VN
❑ NA ❑ NE
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA ❑ NE
Other Issues
29. 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)
[:]Yes No ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
[:]Yes }o ❑ NA ❑ NE
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
to ❑ NA
❑ NE
No ❑ NA
❑ NE
a l� c ❑ NA
❑ NE
No ❑ NA
❑ NE
Iommments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better explain situations (use additional naees as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phane:�
�D
Date A41
2i¢ 011

(Type of Visit: d Conp Hance Inspection U Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: G(Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: OUP r Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: VC, N tL• Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop. Wet Pouttry
Wean to Finish Layer
Design Current
Capacity Pap.
Cattle
Da' Cow
Design Current
Capacity Pop.
Wean to Feeder
I INon-Layer
IDa'
Calf
Feeder to Finish
73Liq
fer
Farrow to Wean
Farrow to Feeder
lt .
"ILayer;s
Design Current
Ca aci P,o ,
Dry Cow
Non-DaIEZ
Farrow to Finish
Beef Stocker
Gilts
Non -Lavers
Beef Feeder
Boars
jPullets
Beef Brood Cow
Turkeys
Other Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
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 JU °`o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes l=J o ❑ NA ❑ NE
❑ Yes �j�No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

FacA, i Nwober: 31 - '— Date of Inspection:
Waite Collection & Treatment
4. Is`storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[�/No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: C R Ultlty�iL
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ILI
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment reat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ YesVNo ❑ 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 o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes Q No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [•�No [] NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMR?
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 F] ❑ NA ❑ NE
/10
❑ Yes lf_J o ❑ NA [] NE
❑ Yes 4 ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
[:]Yes Fj No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes [2'No ❑ NA ❑ NE
❑ 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 ❑ Weather Code
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Fac' ' Number: i - Date of inspection: 1% jkct
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes / No ❑ NA FINE
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 DIN ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes Y - o ❑ 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 UK10 ❑ 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 MNo ❑ NA ❑ NE
❑ 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
❑ Yes
❑ Yes
MJ1V ❑NA ❑NE
Na ❑ NA ❑ NE
o ❑ 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):
W a ' VV<< 1.9 a N JZi<X WA U— AiJ
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 010 71 L- I S
Date: �Z
21412011

Date of Visit: Arrival Time: 16 Departure Time: LLLJ � �_J County: lDdeo Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: , JQ14 f j}lp j Kza_) _L. Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Cattle
Dairy Cow
Design C►urrent
Capacity Pop.
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D. P,oult ,
La ers
Design
C_a aci
Current
P,a ,
Dairy Heifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
113eef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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[4 [] NA ❑ NE
❑ Yes [:]No
[:]Yes [:]No
❑ NA ❑ NE
❑NA ❑NE
[:]Yes ❑ No ❑ NA ❑ NE
❑ Yes EYNO0
❑ NA ❑ NE
Yes ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: 31 - CA Date of Inspection: I ► i q h
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
Identifier: 1A 6'awZ/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 g
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Structure 5
E�/No ❑ NA
❑No ❑NA
Structure 6
❑ Yesj�'No ❑ NA
❑ NE
❑ NE
❑ NE
❑ Yes O/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? dYes [:]No [DNA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes CdNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes No ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2No ❑ 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? es EyNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? Yes ❑ No [DNA ❑ 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 [I/No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? [—]Yes [�KNo ❑ 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 El 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 rNo
N ❑ 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

FacilityNumber: - Date of Inspection: t p
24.'Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [�No ❑ NA ❑ NE
the appropriate hox(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 [3NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes 0/No ❑ NA ❑ NE
[—]Yes �No ❑ NA ❑ NE
[:]Yes ONo ❑ NA ❑ NE
❑ Yes
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
CJ'No
❑ NA
❑ NE
❑ No
❑ NA
❑ NE
7Flo
❑ NA
❑ NE
�J 0
❑NA
❑NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any.other comments: s :. <::; "::
Use drawings of facility to better explain situations (use additional pages as necessary).
V-.n.6tf1w,_ NCe DS WOE 4<-r t30_A • WVC V wAC.ftf_- SQIL WASW6- A6MJ
�5,� LIYYI� 1 EEh fA . k f- 4P caP y 4" [ Z U<J� T.
Cory
s
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
C. L.
Phone:
Date: 1 1
4/2 06 1

-Division of Water Quality�
FaC�lity`Number
'Division of So
il and Water Conservation
C
Oro
ther
Type of Visit ,Copliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit I Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: !! y b Arrival Time: /Z3 v Departure Time: County: 09Qt'•' _ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: JUIV AtIPA k) /I/I LA C (L- Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o [= ` =" Longitude: a o "
Design Current Design Current ; r ; ,Design
Current
rSwiue�Capacity Population NN:WetPoultry ;,Capacity Population: Cattle
„
Population
;:._r
,Capacity
J _?"yn'-..:.. "t y➢P.. .,iM,.d.-. >_.&`J.. x...
_ - .gym®
❑
Wean Finish
1 ❑ La
❑ Dairy Cow
to
er
❑
Wean to Feeder
] ❑ Non -Layer
I
❑ Dairy Calf
Feeder to Finish �f
JL ElDai Heifer
❑�
Farrow to Wean
.
= El D Cow
�
El Farrow to Feeder
�'Dry Poultry, r x � �; � ..=a
❑ Non -Dairy
La
Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure El Application Field El 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 1 of 3
❑Yes 0 No ❑ NA ❑ NE
❑ Yes
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure El Application Field El 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 1 of 3
❑Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
1
� o
[I NA
El NE
❑ Yes
�o
❑ NA
❑ NE
2/28104 Continued

Facility Number: 31— Date of Inspection r I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ 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): 3 P 3 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ENo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes u1 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentaZo
eat, notify DWQ
El7. Do any of the structures need maintenance or improvement? Yes ❑ NA ❑ N
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ZNo ❑ NA ❑ N
(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 CNo ❑ NA ❑ N
maintenance or improvement?
Waste Apiplication
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes WNo ❑ NA ❑ N
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ N
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
[]Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
E
E
E
E
E
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E?f No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ONo
❑ NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
dNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
� o
El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El 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):
21,� 5,X t- TFS r b��1S REM k-E 5 : 3 fl, N3 N(40� b XS A-V 4Z&*
T
Reviewer/Inspector Name a��. , L Phone: [(/ ..
Reviewer/Inspector Signature: Date: b
Page 2 of 3 1 12128104 Continued

y Faciilty Number: 31 — Date of Inspection rb
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes R(No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ENo ❑ 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.
U3 Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis - ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
El NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[I Yes
WNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[Q o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
a
❑ 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 VIo ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EdNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ENo
❑ 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
dNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
W�
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
o
ElNA
[INE
General Permit? (ie/ discharge, freeboard problems, over application)
Ybeio
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
ElYes
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
fld0iponal Comments and/or Drawings - r `
Page 3 of 3 12128104

Type of Visit Compliance Inspection 0 Operation Review O Structure Evaluation Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: _
Bach -up Operator: _
Location of Farm:
Title:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: [= o [= I = Longitude: = o =
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry
Capacity Population
Cattle Capacity Population
❑ Wean to Finish
ID Layer
❑ Dairy Cow
❑ Wean to Feeder
I0 Non -Layer
I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑Non-Dai
❑ Farrow to Feeder
❑ Layers
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑Turke Poults
MM
❑ Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (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 1 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes o ElNA ElNE
❑ Yes No ❑ NA ❑ NE
Page I of 3 12128104 Continued

Facility Number: 31 —
Date of Inspection o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a 3 D
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E!(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 0 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 2N0 ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 6/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 Ld No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 'VrN ❑ 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 Ibs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
D'NNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
LI No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
El No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
E�X
❑ NA
El NE
18.
Is there a lack of properly operating waste application equipment?
El Yes
T Zo
❑ NA
❑ NE
/.''fir .f
Comments (refer to:question #) , Explain:any YES;answers and/or any"reco.mmYendationrvY s or an other comb ents`-
=Use drawings-6f°faci6ts,to: be'tterexplamaituations: (useadd�tronal pages as,necessar}J: ..;
Reviewer/inspector Name - r
Phone: 9 U
Reviewer/lnspector Signature:
Date:
12128104 Continued

Facility*Number: 31 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA EfNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ONE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA L 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?
-23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes ❑ No ❑ NA ldN
[I Yes El No [I NA
❑ Yes ❑ No ❑ NA ❑ N
[IYes ElNo ElNA NE
❑ Yes ❑ No ❑ NA L1 NE
❑ Yes ❑ No ❑ NA L7 NE
❑ Yes ❑ No ❑ NA E?I�E
❑ Yes ❑ No ❑ NA [34
❑ Yes ❑ No ❑ NA M<N
❑ Yes ❑ No ❑ NA [3 E
❑ Yes ❑ No ❑ NA 7NE
El Yes ❑ No ❑ NA
12128104

IType of Visit Qf Coptpl+ance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: U
► S Arrival Tune: Departure Time: County:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
L / Title: Phone No:
Onsite Representative: �Ja�✓H'Tit!]91✓ %'CI �lL Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o =' = Longitude: = 0 ='
=
DesigAn@orrent,
Design Current Design Current
Capaculatio
Wet Poultry Capacity Population Cattle Capacity Population
inish
rFeeder
❑ La er
❑Dai Cow
eeder
❑Non -La er
❑Dai Calf
Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry ❑ Dry Cow
❑ Farrow to Feeder
I
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
Gilts
Non -La ersPullets ❑Beef Feeder
PE113oars
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other Number of Structures:
Discharees & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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 C No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
❑NE
❑Yes
❑ o
❑ Yes
No
❑ NA
❑ NE
❑ Yes
WNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — 'f� Date of Inspection a
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
Structures 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (�'LC�11/ I (X Cy/Zi
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 9-q �. 5
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 01No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes LI o ❑ NA El NE
8. Do any of the stuctures 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 El Yes No [I 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 WNo ❑ 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
15. Does the receiving crop and/or land application site need improvement? Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
o ❑NA El NE
❑ No ❑ NA ❑ NE
V No ❑ NA ❑ NE
Q'No ❑ NA ❑ NE
[PrNo ❑ NA ❑ NE
.' ,;,, . .. _ x � ,, . °.°ck��.:" a � ''' an— y4 r b•:'i' ..
'Comments>(refer to::queshon #)-Expla�n;any YESanswers and/or anyrecommendahons or<anyaother�comments h , -;
Use drawings of factlity,to better explainsituations,?{use _addtttonalmages
1 N�� LAI,�
Reviewer/Inspector Name Lim- , : A Phone: q10
Reviewer/Inspector Signature: Date: lU /S p
1 4 1 Continued

Facility Number: — Date of Inspection �5
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑p ❑ Checklists ❑ Design ❑Maps ❑ Other
❑ Yes 4o ❑ NA ❑ NE
❑ Waste Transfers ❑ Annual Certification
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ NA ❑ NE
❑ Yes l!J N
❑ Yes No
El NA ❑NE
❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes ❑ NA ❑ NE
❑ Yes 7 ❑ NA ❑ NE
❑ Yes 9N El NA ElNE
❑ YesVN9'
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
o
❑ NA
❑ NE
❑ Yes
�No
❑ NA
[I NE
❑ Yes
�
CVNo
❑ NA
❑ NE
❑ Yes
To
❑ NA
❑ NE
❑ Yes
kd'No
El NA
❑ NE
ElI:J'No Yes
❑ NA
❑ NE
Additional' Comments an_dlQr_ Drawings;_
I2128104

Type of Visitpliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit gRoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: t O 1 V Arrival Time: a� Departure Time: County:Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: _j6WAT1;ArJ 'MSt--` remintegrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e = I = Longitude: = ° 0 , =1 fL
Design Current Design
Current
Design C►urrent
Swine Capacity Population Wet Poultry Capacity
Population
Cattle Capacity Population
❑ Wean to Finish ❑ Layer
❑ DairyCow
❑ Wean to Feeder ❑ Non -Layer
❑ DairyCalf
Feeder to Finish 34`{
❑ DairyHeifer
❑ Farrow to Wean
Enpoultry
❑ Layers
❑ D Cow
❑ Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Beef Stocker
❑ Nan -La ers
❑ Pullets
❑ Turke s
❑ Gilts
❑ Beef Feeder
❑ Boars
❑ Beef Brood Ca
Other
❑ Other
❑ Turke Puults
❑ Other
I
Number of Structures:
Discharges & Stream Impacts
1, is any discharge observed from any part of the operation?
❑ Yes
E 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
❑ NA
❑NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Z
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[ No
❑ NA
❑ NE
other than from a discharge?
Page ] of 3
12128104
Continued

Facility Dumber:] - 6'ja Date of Inspection a 1 to
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: L-Al-7— PJO N_'L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 21 2>1
5. Are there any immediate threats to the integrity of any of the structures observed?
El Yes
,�
LI 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
dNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[—� No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
Ld INo ❑ 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
0No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
dNo ❑ NA ❑ NE
maintenance/improvement?
1. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
TJ 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)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
,B
d No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[-] Yes
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
� ,I
L o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2(No
❑ NA
❑ NE
am cx'CL6 t,+ Ate 5 ce N l� C -A'TM tilt/ E -To
Reviewer/Inspector Name I_ 6 1. o rA 2,Oki Et Phone: Ics TtL, - 7 �$
Reviewer/Inspector Signature: Date: to

I
Facilityumber: 31--jo'12 Date of Inspection 110 a
keouired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes N ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes LI No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Mans El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
O No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Fr/No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
LQ /No
[INA
ElNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
L< N
❑ NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes7Np
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
CJ No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
D o
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
L/l 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
O/N c
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
WNo
3 I. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
N
El NA
❑ NE
33. Does facility require a follow-up visit by same agency?
El
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

()rDivision of Water Quality
V acility Number]---® 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit t2,C.,ommpliance Inspection Q Operation Review O Structure Evaluation 0 Technical Assistance W r Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time:
1'
I. U
Departure Time: County:
AeL1M& Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: J a 10 REHAIJ t r ,n/1 mtom t~ L
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Gilts
Boars
Other
❑ Other
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 c =' 0 " Longitude: = o 0' = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turke Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population,..:
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: ED
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?
1
❑ Yes ETNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
El NE
❑Yes
❑N
El Yes
LI No
❑ NA
❑ NE
❑ Yes
L4 No
❑ NA
❑ NE
12128104 Continued

.[Facility Number: — 10 Date of Inspection
Waste Collection & Treatment
`4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�,/
Lei 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: LOWO I LA&M,.J'2-
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
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
ZNo ❑ 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
ental threat, notify DWQ
envir7yes
7. Do any of the structures need maintenance or improvement?
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑Yes
�No El NA [I 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
El Yes
,�/
L7 No El NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
,,__,., //
0� o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
ONo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
,ZNo
(,� No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
JWN90
❑ NA
El NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ 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):
40 LACOdd A/N U T Su IY E4,KJ xi, gy CNO &0-) SC"D L(-,Trf t 1� n wQ
Reviewer/Inspector Name if go p,2WRIG op q Phone: U/U /76 -- /j Y1
ReviewerlInspector Signature: JA A Date: Vu p
121Z6/U4 Continued

I Facility Number: 31 j — 6371 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes L`J N El NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes [ No ❑ NA ❑ NE
the appropirate box. ❑ ❑ ❑ ❑ M ❑
P WUChecki�sts Design aps 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 1"
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
D No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ElNA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
7NO
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ff No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
pe<
❑ 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
L✓J 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
bNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
p 1
❑ NA
❑ NE
Additional Comments and/or Drawings:
I2128104

Type of Visit compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival TimeDeparture Time: County: Region: z1 e
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
0
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 a = d = Longitude: 1=1 ° =1 ` "
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Populafion Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
1 ❑ Non -Layer I
❑ Dairy Calf
❑ Dairy Heifer
El Dry Cow
Feeder to Finish
Farrow to Wean
El
Dry Poultry
Farrow to Feeder
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 1 of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Struicture 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
❑ 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 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift El Application Outside of
Area
12. Crop type(s) zel_Aw� 61&fli�
13. Soil type(s) Z^
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 6ther.comm K� ' eats F
Use drawings of facility to better explain situations. (use additional pages as necessary): �>
Reviewer/Inspector Name ] Phone:
Reviewer/Inspector Signature: Date:
Pane 2 af.3 12/21VOQ Continued

• Facili'iy Number: ­3 — 7 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. ❑ V Up ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 10"Ifes ❑ 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
❑ 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:
c d co .
0 a. 6
cog .2.1 .}s V()
&000, 1KarG�L d�cords
r//I��G
r4lee
15err/l (e
!&aXZ- 3�-
��YGYI
Page 3 of 3 12128104

Type of Visit .O'Compliance Inspection 0 operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint 0 Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: UA
Farm Name:
Owner Name:
;Mailing Address:
Physical Address:
Arrival Time: ' Q 01 Departure Time: County:
ZN/'/ll� L�. Owner Email:
Facility Contact: D
% Title:
Onsite Representative: P[�1 a�TT7JTI.,
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feede:
Farrow to Finish
Gilts
Boars
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region: 11// 0
Latitude: 0 0 = ' = Longitude: 0 ° =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
--- 11 10 Non -Layer
Other
❑ Other -
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
l
❑ Beef Feeder
❑ Beef Brood Co
I
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 'P�No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
;2 o
❑ NA
❑ NE
❑ Yes
)�?No
❑ NA
❑ NE
12128104 Continued f

Facility Number: S Date of Inspection O.
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes B`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: I
Spillway?: `
Designed Freeboard (in):
Observed Freeboard (in):_6 7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ['No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes 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?
❑ Yes 2 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes ZNo
❑ 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 ONo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
[--]Yes JZNo
❑ 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 Evidenccee of Wind Drift ❑ Application Outside of Area
12. Crop type(s) ..9 6 j J 6 �G:i � �� 0
13. Soil type(s) ZcyJ
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ffNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes .ETNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes ENo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
[--]Yes -ETNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes j2 No
❑ NA -❑ NE
Comrpents (refer to question � Explain any YESanswers a i�d/ore a,-n-y,�r�e] ommeudations ©r aqy{vther�cagmments -�4 � � � S
ailse draw�ngs_ofMfgcility:to laetter,expla�n situations n(gse addthongl=pages�aa `necessary}���t �:,,t � $ �,��� , � �;�a; �*�;�� .
r _I Phone:
Reviewer/Inspector Name 5,
Reviewer/Inspector Signature: Date: j Q,
12128104 Continued

Facility Number: 3 1 —K7 Date of Inspection G
Rettuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes -ErNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes )2No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. VYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [�420 Minute Inspections ❑ Monthly and 1" Rain Inspections Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
,ETNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
ONo
❑ 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
J[allo
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
ONo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
P'No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
; '&o
❑ 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
RNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[')<To
❑ NA
❑ NE
Additional Comments and/or Drawings:
17'o E-1 f k2' r ceS-e A
. W12
off' /y1 _ZRe2-
c a 1'16-P's '- 51�e
F-x,, - C/Us - !2v / CU/- - rPGD :s
7Z
12/2,VO4

#Perruitted= 13 Conditionally Cer#fied 13 Registered
Farm Naive:
Tune:
Date -Last Operated�bove Thr hold:
County:
Owner Name: ., , , .w Phone No:
Mailing address:
Facilitv Contact: ....... Title:Phone No:
Onsite Representative:�6,/ve . _ Integrator:
7.
Certified Operator•. Operator Certification N r: ._ .. .
Location of Farm:
❑ Swine 0 Poultry 0 Cattle ❑ Norse Latitude • 4 44 Longitude • d «
Discharees & 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/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 ❑'1�Io
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ;PI'No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Na
Structure 1 &2�r 2 Structure 3 Structure 4 Structure S Structure
Identifier:
Freeboard (inches):
12112103 Continued

Facility Number j — Date of inspection r
5. Are there any immediate threats to the integrity of any of the structures ob ed? (ie/ trees, severe erosion, 0 Yes �No
v seepage, etc.)
6- Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑yes No
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? ❑ Yes No
S. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? If yes, check the appropriate box below. [] Yes �No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type 1
13_ Do the receiving crops differ with those sigM nated in the Certified Animal Waste anagement 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 N No
16. Is there a lack of adequate waste application equipment? ❑ Yes No
r
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes fi!(No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ffNo
roads, building structure, and/or public property) /
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes "No
Air Quality representative immediately. j
Reviewer/Inspector Name
Field Cove ❑ Final Notes
l�XsClefl� �
Reviewer/Iaspector Signature:
Date:

Facility Number: -
Required Records & Documents
21.RFail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23_ Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(it/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss reviewCmspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NI MES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Foam ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes�No
❑ Yes Z No
© Yes ❑�io
❑ Yes "[ago
❑ Yes ';�o
❑ Yes _P No
❑ Yes Pl�o
❑ Yes jafio
❑ Yes PIKo
'afes ❑ No
❑ Yes �No
❑ Yes 1�o
[:)Yes �o
❑ Yes •ENo
❑ Yes �o
12112103

1
Type of Visit compliance Inspection O Operation Review )6 Lagoon Evaluation
Reason for Visit O Routine O Complaint 0 Follow up 0 Emergency Notification Q Other ❑ Denied Access
Facility Number
Date of Visit: Time:
Not O erationai 0 Below Threshold
0 Permitted [3 Certified 13 Conditio ally Certified D Registered Date Last Operate r Above Threshold-.
Farm Name: yS��� �%iL2/C? #� �'� County:��L-�/y
Owner Name: FL!%f 1 / _ _ �7%f1.v/1�t!'i'S Phone No:
Mailing Address: _
Facility Contact: %] Title: /Phone Now:
Onsite Representative: +!/�LtfirG� %/rT ! 2/�!�r—� Integrator:
Certified Operator:
Location of Farm:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑Horse Latitude ' � �u Longitude 0 '
Design Current
awtne Ua achy ra ulanon
Wean to Feeder
13 Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Farrow
Gilts
Boars
Design Current Design Current
Poultry Ca acid Population Cattle Capacity Population '
❑ Layer I I ❑ Dairy
❑ Non -Layer I I I J[__1 Non -Dairy
❑ Other f
Total Design Capacity
Total SSLW
"Number of Lagoons l - I L Subsurface Drains Present ILLJ Loon Area
IioldingPonds [Solid Traps E : ❑No Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste CUlIrction & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
St ture I Structure Structure 3 Structure 4 Structure 5
Identifier: __ _
Freeboard (inches):
05103101
fray Field Area I
❑ Yes &No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes P(No
❑ Yes ❑ No
IVY es ❑ No
Structure 6
Continued

Facility plumber: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
El Yes
❑ No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste AApllcation
10. Are there any buffers that need maintenance/improvement? -
❑ Yes
❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
Cl 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
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20_
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
El Ye
CIO
24.
Does facility require a follow-up visit by same agency?
ElYes
o
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
0
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Field Copy ❑ Final Notes
- I-)�rzl�i�
%1%EF_ D �iJ Su�3f,-1 �' Jr
- IJfF.p .3 D ,DAL/ �° � Foy # 1 t
—16'rep '113
Reviewerfinspector Name ]
Reviewer/Inspector Signature:
Date:
05103101
Continued

Type of Visit `Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Emergency Notification Other ❑ Denied Access
Facility Number / Date of Visit•.
Permitted 0 certified [3 Condit!;wlly Certified [3 Registered
Farm Name: LI,.yS xjQj % �Z__
Owner Name:
Mailing Address:
Time: 09-igd
Date Last Operate Above Threshold: _
County: �1aL Z�)
Phone No:
Facility Contact: Title: Phone No:
Onsite Representative: 1AA t e, - Integrator: 4&]�W!4
Certified Operator: Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude
Design Current Design Current Design CurentY
Swine Capacity Population Poultry Ca .scity Population Cattle Capacity : Population
❑ Wean to Feeder 1 10 Layer ❑ airy
Feeder to Finish IEJ Non -Layer I 1 . ❑ Non-Dai
Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lago©ns © , ❑ Subsurface Drains Present ❑ Lagoon Area ❑ S ra Field Area
Holding Ponds [Solid Traps sr 0 ❑ No Liquid Waste Mana ement System
Discharges & 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)
c. If discharge is observed, what is the estimated flow in gallmin?
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
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: #/� C 2
Freeboard (inches): 4 J
05103101
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
XNo
❑ Yes
❑ No
❑ Yes
No
Structure 6
Continued

4.
- J
t
• 1I
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 [--]No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El 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 ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application ?j/{ Excessive Ponding ❑ PAX D❑ Hydra iic Overload El Yes El No
12. Crop type �j�(�1`C1 UDPc lCtizG I . S�1 kLL V`i�r�ZIJ �9U,ERSfA�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility, is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Reouired Records & Documents
17. Fail to have Certificate of Coverae & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps. etc.)
19_ Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soiI 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 D«`Q 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 AVW?
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ No
❑ No
❑ No
❑ No
❑ No
❑ No
❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑Yes El No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
10 No violations or deficiencies were noted during this Asit. You will receive no further correspondence about this visit.
.=. . - w— - - � s �. Y,:;..«..'� �;: - •— '7�-: - x-....awl �- ;--.: '� � a �- �,
`>'3---.:.- to questidif#)
C:!`Ezplam any. YES ry
omments;(refer ..answers sAdlorany �etommeniiattans ar stty mmeuts. s w
lain sttuatrons: (use addsbonal pages As necessw
L=se drawings of facility to better ezp ryj Field Copy ❑Final Notes
a_
I+IOl,E �SZT �iJAc� C'°r/yq i v �nI.SPE[' T/n �CC�fj►tfs� DF anro
SFr 7 )0035z,0/-,6 WMWoiia FAP07., 14e-0
�- L�✓z� ��Jc r DF /`f� r� 'Q0SCtIn 2 G ,E v I., T,�i� 4F�jFA2EGDk)
EGO *4 �E5
Reveewer/InspectorName �' _ = �..� t_-• ��-.�,.��_ .��;�~�.�,c.�.�a-.�.�. �. _�-�:8:=.•��
Reviewer/Inspector Siggnature. /X/17 Date:
05103101 v Condnued
M

1
r Li
Facility lumber: 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 bclovv
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 anv evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure. and/or public property)
24. 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 permanentitemporary cover?
Additional
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑)'cs ❑No
❑ Yes ❑ No
El Yes [I No
Ski 6OMP R��0�F �y C�-t� C �rFFO— C�
�RF_ Ani 0f J r•(zL 7' E�°�R-r r�E�►-� AM 5 �"�0 P F occ�
6E- CAREFUL�i Wz--rtA WN'�47F- nn p pLzck TzoA) s ��
t AF-,5,:r p V, EL -'Os'
/I
MAN®R
N.
P" �)' E 4� 0 ro> 39 5-;31? ao 0� 22,6
�\qe;z7l-c- fii> (vlq-8g23
05103101

}g. _ - 4
Division of Water Quality
r' Q Division of Soil and' Water. C6nservatio4-�
Q Other Agent' y f
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
L rO Facility Number
Date of Visit: i' O Z O� Time: i Printed on: 7/21/2000
31 (�r]Z
Not Operational 0 Below Threshold
0 Permitted E3 Certified [] Conditionally Certified © Registered
Farm Name: .......... • U. [.1.`"`. r`1.f !� !.�.. t`..........:4" 2.......
Owner Name: 5-hk II J-".."," ..........................................................
FacilityContact: .............................................................................. Title:.........................
Mailing Address: ...................................
Date Last Operated or Above Threshold: .......................
County: PV� 1;n
Phone No:
Phone No:
Onsite RepresentativeT .SL4b,"Jr .................... Integrator: 0 tt�"I
Certified Operator:.."........""......".................................................................................".......... Operator Certification Number:.........................................
Location'of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �� �� �« Longitude �• �� ����
= Design
Current Design Current Design Current
Capacitytion
Po elation Poultry Cattle P
Wean to Feeder
❑ Layer [I Dairy
Feeder to Finish
❑ Non -Layer ❑ Non -Dairy
Farrow to Wean
Farrow to Feeder
❑tither
Farrow to Finish
Total Design Capacity
a3: Gilts
Boars
Total S%W
� Number of Lagoons
Z Subsurface Drains Present ❑ Legnon Area ❑ Spray Field Area
_ x
Hollthag Ponds / SohdyTraps ❑ No Liquid Waste Management System
Discharges & Stream I• maacts
1. Is any discharge observed from any part of the operation? ❑ Yes j2Vo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes o
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes
x5r<o
c. If discharge is observed" what is the estimated flow in gal/min'? ), t (I
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes fNo
2" Is there evidence of past discharge from any part of the operation? ❑ Yes JC;rNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3
Identifier: _ ........ .JJ .................... ............Z.....".............................."."........
Freeboard (inches): ,3;q 50
5100
❑ Spillway ❑ Yes�No
Structure 4 Structure 5 Structure 6
Continued on back

Fad tq Number.-3/ — Date of Inspection OF �f
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes J?fNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes jzfNo
(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 XNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes J1ko
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes "40
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ff No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes f no
12. Crop type '9e,-r, Udy° & e-a ZZ 4 1510 _N -1 t Gr4 h"
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 ANo
b) Does the facility need a wettable acre determination? ❑ Yes E]INo
c) This facility is pended for a wettable acre determination? ❑ Yes gfNo
15. Does the receiving crop need improvement? ❑ Yes gNo
16. Is there a lack of adequate waste application equipment? ❑ Yes 131NO
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/ WLTP, 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?
:o yiQlaiQtis:odgfciencips-ware pQteO dttri>g this:visit; Yoit will;eciye Riou>Tther.. .
correspoudenke abbuf this visit.
tgettts'(irefer to question
e drrawMW of [acility tarbi
•The i(�,(t'r,• )
in any -YES answers andlor
C. r6f�rl el r14 r"er- irretf eKe We// kcF4,
❑ Yes ,fNo
❑ Yes EfNo
❑ Yes R No
❑ Yes ZNo
❑ Yes ;dNo
❑ Yes Oi No
❑ Yes -zNo
❑ Yes 21'No
❑ Yes ZNo
Reviewer/Inspector Name , x
w -�a �-te t,.r
Reviewer/Inspector Signature: Date: 1 P P S/pp

-Fartlity Namber: Date of Inspection !6
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 1 No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes,)2YNo
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 .dNo
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 X/ 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? ❑ Yes ❑ No
Additional omments an orraves
5/00

-
�. - O Division of Soil and Water Conservation F"
O Other Agency
Type of Visit )gCompiiance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number rl Z 11)2teofVisit. !Z 12 DO Time: q= 0 Printed on: 10/26/2000
O Not Operational O Below Threshold
$j Permitted [3Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ...............
Farm Name: s�..V-s! i n �� 1} �R TT County:..../ t....................................... ......................
OwnerName:.........eW'j...:�ati 1.)'hsi.S................................................ Phone No:.......................................................................................
Facility Contact: ...............................................................................Title:
MailingAddress:.................................................................................
Onsite Representative:.... w,e•j-5-4411; I
......................
Certified Operator:..........
Location of Farm:
PhoneNo:...................................................
Integrator: ,,v� _,. rAtjr
f.............�tw.......................................
Operator Certification Number:. .........................................
ak
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �� ��� Longitude • ��
Design Current
Swine Canacity Ponulation
❑ Wean to Feeder
ff Feeder to Finish
r]
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Nan -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ID Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharttes & Stream Impacts
1. Is any discharge observed from any part of the operation'? ❑ Yes XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes k No
h. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ) ❑ Yes VNo
c. If discharge is observed, what is the estimated flow in gal/tnin? h�r
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes jo No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ;V No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ja No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes )ffNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ................ .......... 2— ........................................................................................................... _.._..................................................... ....................................
Freeboard (inches): 33
5100
Continued on back

Facility Number: 3 1 — r1 2- Date of Inspection Printed on:
9" 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 of
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?
10/26/2000
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 ❑ Hydraulic Overload
12. Crop type Cerv-,vdti 6mze,_-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Revi ewer/] nspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Rio yiolafianjs;or defi.nries -were nutec during phis;visit: Yop will reeeiye Rio further ; ;
correspondence. abotilk this visit.
❑ Yes No
❑ Yes No
❑ Yes 70 No
❑ Yes F' No
❑ Yes No
❑ Yes No
❑ Yes §4No
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Yes ❑ No
❑ Yes ❑ No
❑ Yes Ig No
Yes ❑ No
' Yes ❑ No
❑ Yes 29 No
❑ Yes ONo
❑ Yes 29 No
❑ Yes Q'� No
❑ Yes No
❑ Yes No
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments:: r
Use:drawings of facility to better explain situations. (use additional pages as necessary) —L -
T. Rase ^^.owed �iiA61-, a6ow} 3�r�Gl,es I,�ji,cn Gv ivsOt jvL7eoKQrV1 �YtiC�14s
So as "'04 4o c U4 +oo 61ose. J
/s. Gr-ot.,.er- kal ;h I', el d SS 6e-+ween 10/9/O0
ho ..Sr'wll )r0in c Yp� '�' S ye� F rah-izd j P1An4 ,rr AA11 9ralh ; n Ai_r {►el o[
by 1 ZJlS1pp. Need +o tArrove IoL4 we4 q,reots faj F_jejo(S 2,31-44,
Ner-cl -fin i-.,,fv-ove be,rv"vAA S4arid +'-, ro,-,e areas. On V elcl S) grower
needs +6 use, ro O � •-1 iv h•%oW ;" Gnd 1-* *)a 4o -10 9-c4z b-1j j1, U euoyrt)
1
Reviewer/Inspector Name J {ia1-teLy or j 1 %� Lip f _
Reviewer/Inspector Signature: , �e Date: 5100

Facility Number: 3 —� I)ate of [inspection 1 1 btj Printed on: 7/21/2000
odor lksues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge At/or below OYes ❑ 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 ® 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 JgNo
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 PS No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �ffNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Jg Yes ❑ No
js. toni) zoo j 4a �.�oMaf Goe-, s-Ail es4e-bl;s4 v te-o4 At I C,•,.,,1c
4e all r,ed vls R4 ome lei pew- n6re in jebrvicey i ool eX60rfioh
! � • !V ee� -� 1�aYe iaen e r a t der' ►� ;-} � }� r e �/�a
`�, Need )GIGc vY� e4 es i g h 7 ►l �op r *`.�A !" i 0" -rev- � a_g aa� �-
1 • use �eg; nI VN floii
�s� w�.s-i� �1�,a�yS�S O�a-jed t,,.�-��,�h bd days of Ct ff
2I's, Growerfr
Y2ed tD 6e ke oK c
�J,.S
Ajo4C : G e-e+.Je✓ S0L%IS 1%Q p Lin 4C A A eAS -1 — L� i-* r C. AYpl 14
is rlZ acres ' w046 f AVN shor../s Fp-e U5 j- Tl at Vac re, Y -
N Ve - Q evtst)r4e �ino► �cr¢or e1 tin i•CrGi �hd IAA
� 5 �
p1ree
J
5/00

3 = Division of Soil and-Water`Conservatxon ''operation Review
© Division of Soil and Water Conservatiion Compliance
S
rvts�on of Water QuaLty `Compliance Inspection j
x 7, wOfher Agency. OperatioRe nviews y j
S n
Routine 0 Complaint 0 Follow-u of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection G 24 hr. (hh:mm)
Permitted © Certified 0 Conditionally Certified J3 Registered
FM Not O erational Date L E Operated: •,,,-.••,,.-„•.••••••.•.•
Farm Name:` l�'1 ` ��.............................................. County:..............-...... - 11'� ..........
OwnerName: ........................... ....................... Phone No........................................................................................
FacilityContact:.............................................................................. Title:................................................................ Phone No: ........
MailingAddress:..........................................................[..............................................................................................................-......-............-.-........ ..........................
Onsite Representative:... P.....,........ \� F......................................... Integrator:......... .
Certified Operator:................................................................................................................ Operator Certification Number:.................. I.......................
Location ofF'arm-
i
......................................................................................................................................................................................................................................................................... 1
Latitude �° Longitude • �' �"
Design Current Design ;Current ' = _ Design
Current
Swine Capacity Po ulatton Poultry -Capacity-°Poputatiori . •.. CaE�e :Capacity
"❑
Po tilahon , ,;:
❑ Wean to Feeder Layer ❑ Dairy
Feeder to Finish --' ❑ Non -Layer ❑Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish _ Tofai Design'Capacity
_ ❑ Gilts
_ ❑Boars = Total SSLW
❑Lagoon Area ❑ Spray Meld Area
Number'of.Lagoons- ❑ Subsurface Drains Present ir
Iioldiri .Ponds'/ Solid Tra s
g p ❑ No Liquid Waste Management System
W:
Discharges & Stream Impacts
I. 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/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
WNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
beNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
kd No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ........ ............... ......................... ..........
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes C�No
Continued on back
3/23199

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?
(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 main ten ancelimprovement?
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
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: No-yiol'ati6 is;ot- &fldenctes •v.Tere noted di,wi tg tbis;visiC.- You wiil•t6p*i ii6 (Utth& ;
• . • correspondence: ahoutk this :visit . .
❑ Yes KNo
❑ Yes No
❑ Yes kfNo
❑ Yes NfNo
❑ Yes t2(No
❑ Yes beNo
❑ Yes. >rNo
❑ Yes t3'No
❑ Yes ❑ No
XYes ❑ No
Yes ❑ No
XYes ❑ No
❑ Yes j (No
❑ Yes 9No
❑ Yes 0 No
❑ Yes Wo
❑ Yes 0 No
❑ Yes 0 No
❑ Yes �SrNo
❑ Yes No
❑ Yes Z No
Gotnmerits (refer to .Question 9). Explain-ab -YES-answers andlor'at recommendations or any other'comiments:
y y
Use_drawings.of facility to better explain situations (use additional pages as necessary)
rep-
k, .
Reviewer/Inspector Name CIF 3-3
Reviewer/Inspector Signature Date:
3/23/99

Facility, Number: Date of inspection mt�lm
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
es
❑ 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
)�No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
;�INo
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
ANo
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
J1J'No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
[ -N/ 0
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
ko
Additional�,Commentsor_._ r_awings_ t W , _
_. anq
( J
3/23/99

❑ Division of Soil and Water Conservation ❑ Other Agency
® Division of Water Quality
10 Routine O Complaint O Follow-up of DWO inspection O Follow-up (if DSWC review O Other
Facility Number 6�2
0 Registered Wertified © Applied for Permit jWPermitted
Farm Name:........... Nmit� C� rr:......' . �....f .. AL .............. ............
...... ......... .......
OwnerName: .........................bpua.y.............. 1hi4�1)s............................
Date of Inspection
Time of Inspection I (o t 40 124 hr. (hh:mm)
r] Not Opera Date Last Operated: ............
County:......... ...................................... .......................
........ Phone No:...L.-ng..(.M4L\........................
Facility Contact: ..................................... .. Title:....................... Phone No:
MailingAddress: .................. YY?. [- ............................... ....... ........................................... .ali'G.�........
OnsiteRepresentative: ..........�.11.....i e'S....�....tr ..... Ley........... Integrator: ...... lxvlfj�
Certified Operator................................................................................................................ Operator Certification Number:................................---......
Location of Farm:
......... on....m5k.... .5a.f......at....kf.W4...LL}..o.:.5...r. ILS ..... tlair.....:a......s�,...1.l.faZ.�.............�-fk.......�.t...b�...c.-3.�...........................
..I..... I...............................................................................
Latitude • 0' " Longitude 0' 0' 0"
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes Wo
2. is any discharge observed from any part of the operation? ❑ Yes 1P 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 gallmin? 1U
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 P No
5. Does any part of the waste management system (other than lagoons/holding ponds) require Yes IF No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes iP No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes DI No
7/25/97

Facility Number: 5 t — 7Z
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
0 No
Structures (LapoonsAolding Ponds Flush Pits etc.
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6.
Identifier:................................................................................................
...................................
Freeboard(ft): i .A .......................... Z....................................................................................... .......
10.
Is seepage observed from any of the structures?
❑ Yes
H No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
91 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
® No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
M No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
crop type b........................Yral1...`�:'t�................................... .........................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
® No
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
IM No
20.
Does facility require a follow-up visit by same agency?
® Yes
❑ No
21.
Did Reviewerlinspector fail to discuss review/inspection with on -site representative?
❑ Yes
01 No
22.
Does record keeping need improvement?
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
[N No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
P4 No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
P No
U No.vio'lationso' deficiencies.were-iloted-during this:visit.•.Y.ou:wiU receive -no further-
: - correspkidence vi out this:visit:- :: ; .
�. U C%^_hVl u3h S�rr.j�+� hAo-r a�ras5ed wc�kytj,'S,
Wco jl
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"'VI � W1U S�noui� 6a lylaiw �o A�1Qr 121 Co'rJi 'l D" �f. ; flj'i►Hi,cjbr.�I OL Zg'I25/97
Reviewer/Inspector Name ,vM
Reviewer/Inspector Signature:
Date:

Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
7 �
Facility Number Date of Inspection 7z
Time of Inspection Ela=24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
® Certified ❑ Permitted I or Inspection includes travel andprocessing)
. ❑ Not Operational Date Last Operated:. ..... _ _� ..... .._ .__ ........ _.... .. _.._. _.. _ .... ..... ...._.......
FarmName: 71h...II ...._ ... _ ......... _...__... _._.M County: ..ls.r1...._ .... _....._....... _.... . ..... .....
Land Owner Name:._ 5 ( [ _.......... ...._�..... ..Phone ...._ ..... ..... _W
Facility Conctact• .......5 l STitle: Phone No: � Z li
Mailing Address: y....._..Z i ..........
Onsite Representative:. G0 Integrator:
Certified Operator: .1.11 ... .............. ......_...._........ .. Operator Certification Number: _.�.._..... _.....�.....
Location of Farm:
�QA.. ..................... 4
.. �...S sn , ._ . .... __.... �...._ ..... _ .......-.._......__....__...._...... __..... -_..__....... ,_...._......... a
Latitude ®' ° ©u Longitude s ®4 [O 64
Type of Operation and Design Capacity
ire Design on Design Currrent Des n Current
Curren
Ca aci SO'ilatiPoultry Ca "aciPo islahon Cattie Ca atgci" •l'a "ulaho"n
❑ Wean toFeeder 11*1 � ❑ � er ❑ Dairy
Feeder to Finish 72. 4 ❑ Non -Layer ❑ Non-
Farrow to Wean �# .� ' .
Farrow to Feeder Total Design Capacity 7 2
Farrow to Finish
e
,ElTEAS
Other <�
Wr ;vim
Number of Lagoons f Holding %Qij Subsurface Drains Presentgg
`�� ��� ❑ Lagoon Area ❑Spray Field Area
yy,
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes [%No
2. Is any discharge observed from any part of the operation? ❑ Yes qNo
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? N A
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes E:54No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes 60 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 M Yes ❑ No
4/30/97 maintenance/improvement? Continued on back

Facility Number:.. ( .......
A Is fgcility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (l,anoons and/or Holding Pond)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4
L.7
❑ Yes q No
❑ Yes §M No
❑ Yes -0 No
❑ Yes P9 No
Structure 5 Structure 6
10.
Is seepage observed from any of the structures?
❑ Yes
No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
[R 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
No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
No
(If in excess of WMP, orf runoff entering waters of the State, notify D{WQ)
15.
Crop aSt4s� X1i�Ltis .. .....� _.... ......... St1aL�1� .1iY1d.ItQ. .._...... .... ....._ ...... �......
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
JA No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
14 No
18.
Does the receiving crop need improvement?
JM Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
P No
20.
Does facility require a follow-up visit by same agency?
® Yes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
P No
For
Certified Facilities Only
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
® No
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
24.
Does record keeping need improvement?
❑ Yes
0 No
Cominents (refer to gueshan'. Explain any YES answers and/or any recommen ahons'or any other comments. — ,
Use drawings,offacilit to better explain situations: (use additional pages as necessary)
5, 1ry skodJ be. ftTa 4jje Skac j �e ha+rvectri.
4
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SOS ON t Opts 56"Id IOU M-' tlev. (,-aGYge 61+ - Or, Il'utie.ir we -It 3�A loe '�`(W cw 6v[Sa &J.
3
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cc: [Avtsion of Water Vuaiiry, crater Vuaitry -3ecnon, Paciiity Assessment Unit 4/3U/9 /

Site Requires Immediate Attend
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT .
i AND AL FEEDLOT OPERA OI NS SITE VISITATION RECORD
DATE. 1995
Time:`ZZ
Faun Name/Own(
Mailing Address:
County:Jcr.O/�'1�''
Integrator. Phone:
On Site Representative: 1� %�iy� �- �%Z�S'�eJ— Phone:
Physical Address/Location:
Type of Operation:' Swine.-_4z Poultry Cattle
Design Capacity: Number of Animals on Site: .3K-7 l-,
DEM Certification Number: ACEycl- DEM Certification Number: ACNEW
Latitude:' tea" 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 I Foot + 7 inches) (Eels or No Actual Freeboard: Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or6 Was any erosion observed? Yes or No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized:C,;4LI�-oue-g'I
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? e or Nd
100 Feet from Wells? es r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or T
Is animal waste land applied or spray irrigated within-25 Feet of a USGS Map Blue Line? Yes or 1(�0
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied. -
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments: 5%1 ?_// 71 14fh S/ Q /u --
Inspector Name
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.