310347_Inspection_20170101

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C: Division of Water Resources
Facility Number L �J� - 3 % 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Complia -Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: � Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: ,/ c�lL► C'g
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Owner Email:
Phone:
Title:
Latitude:
Phone:
Integrator:
Certification Number: /7<ZZ76
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer I I --d
Non -Layer
Wean to Finish
W n to Feeder
eeder to Finish
Z
j
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current
Dry Poultry Capacity POD.
Layers
Non -Layers
Pullets
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 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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ o
❑ YesrNo
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

FacilitX-Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E To ❑ 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):
d
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
1
�oD
❑ 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
El"No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[! No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑/ �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
Quo
❑ 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 M 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 eNo ❑ 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 Z1 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
eNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
dNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E No
❑ 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
�No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ENo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Fa�cilit}�-Pv umber: 2-2(4 Date of Inspection:
�
24. Did the facility fail to calibrate waste application, equipment as required by the permit?
❑ Yes
D-140
❑ 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
U 1Ve
❑ NA. ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[—]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
[r 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
No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E�No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Q'�10
❑ 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).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
'CVI S `JP -(
Phone: lj� �J
Date: j
21412015

Division of Water Quality /
Facility Number - O Division of Soil and Water Conservation
O Other Agency
Type of Visit: ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: ODRoutine ,O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: �r eparture Time: County-4221_v�
Farm Name: L Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: Q e
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone:
Title:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
4NLayer
Non -Layer
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current
Dry Poultry Capacity Pon.
Layers
Non -Layers
Pullets
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)?
Longitude:
Region:,% f- ,
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes No ❑ NA ❑ NE
[:]Yes EfNo
❑ Yes ff No
❑NA ❑NE
❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [:]Yes No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ZNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes PfNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

,.:'jFacility Number: :�/ - 6 i% Date of Inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
p'No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ,ETNo
❑ 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 eNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes Jallo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
0 Yes E2-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
0 Yes [�Wo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ NA
❑ NE
maintenance or improvement?
'L2�No
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes ,E'No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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 '12 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 L2'No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
0 Yes J2-No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes .ETNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes J2"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 J2 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes _J�fNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ZNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

,_
Facility Number: - Date of Inspection: G�
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes j2pNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Jallo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑NA ❑NE
❑ Yes ETNo ❑ NA ❑ NE
❑ Yes 'Jallo ❑ NA ❑ NE
❑ Yes
)zNo
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes J2 No ❑ NA ❑ NE
❑ Yes ,�No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes J21No ❑ NA ❑ NE
❑ Yes [:2 No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature: /
Page 3 of 3
Phone:
Date: K ,3 %
21412011

Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
�___ 0 Other Agency
Type of Visit f�Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 9outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: % Arrival Time: Departure Time: County: Q4 4 ab 0 Region: �f 2 Ce2
E
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: C � Title:
Onsite Representative: SHIP o%4Sn r/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
Farrow to Finish
Gilts
Boars
Other
❑ Other
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number: ,
Back-up Certification Number:
Latitude: = e = 6 = Longitude: = o = 1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
l❑ayer
1I ❑ Non -Layer
Dry Poultry
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
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 2 No ❑ NA ❑ NE
❑ Yes
)21 No
❑ NA
❑ NE
❑ Yes
ETNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
plio
❑ Yes
©No
❑ NA
❑ NE
❑ Yes
2TNo
❑ NA
❑ NE
Page 1 of 3
12128104 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P" No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes F�rNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes Wr No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes rxl�lo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes '7VNo" ❑ 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 ZNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
IEZ
❑ 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?
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.
❑ Yes ff No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
0 Yes Z No ❑ NA ❑ NE
❑Yes No ❑NA ❑NE
❑ Yes FNo ❑ NA ❑ NE
❑ Yes A
No ❑ NA ❑ NE
ElYes No ❑ NA ❑ NE
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes PNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Z_N0
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [-]Yes VNO
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the perm' ? ❑ Yes No
23. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E(No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
A No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[]Yes
�No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
O'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
?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
4No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
rNo
❑ 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).
uS� 3 r �i -From 316 //2-
-0
Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 of 3
LL'ow LG Phone: 7/� /�- 7y�
Date:
211412111

Division of Water Quality
Facility Number L �!� - E�A 0 Division of Soil and Water Conservation f
0 Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: "x Arrival Time: 91; Departure Time: County:.
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: A,90 YkdJ7
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone:
Title:
Latitude:
Phone:
Region:
Integrator: f
Certification Number: / �2 Z Ca
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -Layer
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current
nry Pnnitry Canaeity Pnn_
Layers
Non -Layers
Pullets
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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ZNo ❑ NA 0 NE
❑ Yes
E f No
❑ NA
❑ NE
❑ Yes
RfNo
❑ NA
❑ NE
❑ Yes ZNo
❑ Yes jfNo
❑ Yes V"'No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number:31 _3 ate ofInspetion:
j
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 ZNo
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
.,,Z
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes ONo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes '12 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes PNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes F_IrNo
❑ 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 �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?
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.
❑ Yes JZNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes _2 No ❑ NA ❑ NE
❑ Yes Jallo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes J"No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes FNO
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection:
24. Did toe facility fail to calibrate waste application equipment as required by the permi ? ❑Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �' o
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
JE2'No
❑ NA
❑ NE
❑ Yes
L2-No
❑ NA
❑ NE
❑ Yes ;2-No ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes [.Pdo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes J;�'No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes �No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑,F6 ❑ NA ❑ NE
IComments (refer to question #): Explain any YES answers and/or any additional recommendations or an3Tother comments. I
Use drawings of facility to better explain situations (use additional pages as necessary).
31
r5alln V f C,,,-,X
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �J _' ZK
Date:
2141 011

��'1)ivision of Water Quality
Facility NumbeE:�:�® Division of Soil and Water Conservation
O Other Agency
I Type of Visit e 7Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
X,� I
Reason for VisitomRoutine 0 Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Feparture Time: County:
<
Farm Name: �/7 f'��� Owner Email:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: c
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = e = i Longitude: = ° = i
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑
Wean to Finish
❑
Wean to Feeder
❑
Feeder to Finish
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
❑
Layers
❑
Non -Layers
❑
Pullets
❑
Turkeys
❑
urkey Poults
❑
Other
Discharces & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ,["No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes oNo
❑ NA
❑ NE
❑ Yes ,No
ElNA
ElNE
ElYes No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): — -
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes Z No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes 21No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA El NE, N
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes J 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 ❑ YesNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ NA ElNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ,,PoN0 ❑ 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? El Yes �No ElNA ElNE
15. Does the receiving crop and/or land application site need improvement? ElYes E 'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes No El NA El NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ,E No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑-do ❑ 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):
IReviewerAnspector Name / (,� Phone: 7V2
Reviewer/Inspector Signature: Date: r
Page 2 of 3 IM8104 " Continued `

Facility dumber: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XN' o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ZNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes oNo ❑ 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 2'No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes M'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?
'P1110
❑ Yes0"NNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes O No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ZNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes [ o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes E)Ao
❑ 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 ZNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes -;2,<o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes 2 N
❑ NA
❑ NE
Additional Comments and/or Drawings:
Xs-
As —
Page 3 of 3 12128104

r
Facility Numbert/ 7
,0,]Jivision of Water Quality
0 Division of Soil and Water Conservation
® Other Agency
Type of Visit _C G<ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit XRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:Lti!G
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: �92 i Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: = o = 1 Longitude: = ° = i
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑
Wean to Finish
❑
Wean to Feeder
❑
Feeder to Finish
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes V(No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
/ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: Date of Inspection /I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
ElYes o ❑ NA ❑ NE
V
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
StrU7re 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �j y
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes J2 o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes ❑ 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 [1,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 El Yes ram]' 11� o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes _9'K0 ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes l` "'o ❑ 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 2<o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes [2'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes []- to
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ YesTo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name - �� / s e j Phone: �% f —
Reviewer/Inspector Signature: Date:
Page 2 of 3 [a1-161v4 uUncanueu

.'
Facility Number: } Date of Inspection
i
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ Yes
J& ❑ NA ❑ NE
�No ❑ NA ❑ NE
❑ Yes 0No ❑ 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 9No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes �No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes _J�Yko
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ,0 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes XNo
❑ 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 ,Q'No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes PAo
❑ 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 PNo
❑ 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 J2�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 91flTo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes [2(No
❑ NA
❑ NE
Additional Comments and/or Drawings:
ze 'fall? 117/11c 9
a
.315* 9
011 0 0 zor
9,e -5-ze,�e ­5
Page 3 of 3 12128104

I'Division of Water Quality
Facility Number j ® Division of Soil and Water Conservation
® OtherAgency,
Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit',(D'Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: eparture Time: County: Region:
Farm Name: Owner Email:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: J6-S,eoO61
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = , = Longitude: = ° = ,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
i❑ Layer
�� ❑ Non -Layer
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
DischarlZes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes OTo
❑ Yes EI'No
12128104
❑ NA ❑ NE
❑ NA ❑ NE
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes 17No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
RfNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
ONo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
'7No
VNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
oNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
VNo
❑ NA ❑ NE
maintenance/improvement?
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 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 0'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes �No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes W No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes ZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �*o
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.,
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone:
- - -- -
Reviewer/Inspector Signature: Date: %2 O
12128104 Continued

F .611ty Number: ra Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Po ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ;TNo ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes U-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
J?-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
�2rNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ZNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
PNo
❑ 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
gNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
gNo
❑ 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
YrNo
❑ 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?
El Yes
/
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings: I
12128104

0 Division of Water Quality
Facility Number O Division of Soil and Water Conservation
® Other Agency
Type of Visit 0 Corylpliance 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: / a -L &f 1 Arrival Time: !tl 0 U Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative:y6N19LZ,1 Mz_L'e_6 rL Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = = Longitude: = ° = 1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑
Wean to Finish
❑
Wean to Feeder
❑
Feeder to Finish
`li 1 L
1100
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
❑
La ers
❑
Non -Layers
❑
Pullets
❑
Turkeys
❑
Turkey Poults
❑
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle ' Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
El No
El NA
El NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes 9'<o ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
Page 1 of 3
12128104 Continued

Facility' Number: Date of Inspection Ga
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: C.l46roviO l (A LL
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3(4 q L
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes O No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes E�'No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or enviro ental 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?
(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
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes dNo ❑ NA ❑ NE
❑ Yes [J No ❑ NA ❑ NE
❑ Yes �N
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No
❑ 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 Soi:
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
El NA ❑NE
El NA El NE
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
El NA
NNo
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
,L,rJ,
_
�No NA
El
NE
17. Does the facility lack adequate acreage for land application?
ElYes
❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
�"N
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):
%) LA &tm-o / Z AJ& C--o S 44 A XJJ7WA� ,> CC
AL
Reviewer/Inspector Name J o H� /pf�-X1 /J�(,L, Phone: 916 7A 7t
Reviewer/Inspector SignatureDate: o A.
Page 2 of 3 16ALS/v4 - uontinuea

B
Facility Number: — 7 Date of Inspection
Reauired Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ElYes 2J 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 a ropirate box
pp ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ 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
�o
El NA
El NE
23.
If selected did the facilityfail to install and maintain rainbreakers on irrigation equipment?
El Yes
Z
ElNA
ElNE
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
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
pl o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
El NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
D o
❑ 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
2 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
ZN
❑ 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
: Nj
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Division of Water Quality , f
Facility Number 0 Division of Soil and Water Conservation L/
- - - -- --- - - 0 Other Agency
Eof Visit/Q-Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
n for Visit_,& Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Owner Email:
Phone:
No:
Integrator• ®1���
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = f = Longitude: = o = i
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
1� IQ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
i
Number of Structures:
i
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes J/ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
[:]Yes
,21'No
❑ NA
❑ NE
❑ Yes
-dNo
❑ 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?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 7 U
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ;E3 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes �TNo ❑ NA ❑ NE
[:]Yes ,ETNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 2 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 1;2No ❑ 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 EfNo ❑ 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 El"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 Wirtclo El /j video4cp of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) I('c!/0
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes [2'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
?-'No
ElNA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
11
ElNA
ElNE
17. Does the facility lack adequate acreage for land application?
ElYes
/0
J] No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name v �� Phone:
Reviewer/Inspector Signature: Date:
Page 2 of'3 12MIU4 Gonttnuea

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes A No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists l
❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking [Z 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
0 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[A 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
[71 NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
E5 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
Q NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P'No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
F_j No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ff 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
ZNo
❑ 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
Page 3 of 3 12128104

A,
b6l - --- -- I
g.
Water ConservaWn­-,z­..
0f0
-v
th
Type of Visit d Co pliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit' 7Routine 0 Complaint 0 Follow up 0 Emergency Notification' 0 Other [3 Denied Access
Date of Visit: Z49Aji Time:
Facility Number EZID-ME-C] rO Not Operational 0 Below Threshold
0 Permitted [3 Certified 13 Conditionally Certified El Registered Date Last Operated or Above Threshold: .........................
Farm Name: ............I~.. 4 k fAejTV-%.5 County: ...... D.UPL:.r4j .................................. .......................
...........................................................................................................
OwnerName: ................................................... ........................................................................ Phone No: ......................................................................................
MailingAddress: ..................................................................................................................... ..................................................................................... ..........................
FacilityContact: .............................................................................. Tide: ................................................................ Phone No::...................................................
Onsite Representative:........ j- E WUDSO........................................................ A Integrato*r: ....... . Y ..................................................
.. ... .............. ............
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
El Swine [3 Poultry [] Cattle [] Horse Latitude 0 49 Longitude 0 4 94
"ur-11 eAgn., jjjjj` __ ;3� , I—, , 11 1 ­­1 ent
bDesign
Design "Current ""q
�wi aa
pldi
ity �p6puli&fi pflatbi n:­
ty-1 11a "C'Cattier',
['WeatoFeeder
Layer Dairy
Feeder to Finish
❑Non-Layer Non -Dairy
Farrow to Wean
❑ Other
Farrow to Feeder
K'�
Farrow to Finish
El Gilts
❑ Boars
_o
Number of La""
1E
X,
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: [] Lagoon [] Spray Field E] Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? [I Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ..................................................... ................................... .................................... ................................... ................................... .......
Freeboard (inches): 39
12112103
[] Yes MjO
0 Yes El No
El Yes D No
❑ Yes
03 NUO
❑ Yes
INN
wl�
❑ Yes
VNq
; /No
0 Yes
Structure 6
Continued

Facilify Number:, Date of Inspection 2 6
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 ❑ 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
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes L�Zo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [�] IN0
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type C5U) 021'r1rc(L ANOUA S
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes p
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 7NUX6
b) Does the facility need a wettable acre determination? ElYes c) This facility is pended for a wettable acre determination?ElYes FNo
15. Does the receiving crop need improvement? ❑ Yes
16. Is there a lack of adequate waste application equipment? El Yes
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes No
liquid level of lagoon or storage pond with no agitation? /
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes d
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ElYes No
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.
' mments'; irefer..to. uestiain E lairi YES ttsw"rsan'd/o ,an 'wr"ecommendat onsfo'c:an oEl►erico'`
{...,; _ ,q. > . > . .,� _ p . any, a e y..
Usedrawmgs,of faciLlyta betterex lain>sifuiations="(use additiaiial: a es as tiecessaiy};=F `
;P.;. P.,-9 '`❑ Field Copy ❑Final Notes
77
i
�►�R �- C Can �S S.►J Ga e> Slafl PE
T
�•u' e�`•r _� <�m eµ�^S
i .`€, ^ .yN= `�'";tkd ., tiF�-..z+2, `6y.�',-�. _':%� .}=r ..`.5%.x:�t
Reviewer/Inspector Name t A, R.NC,:tl .' ' 3 * .,'
u�z�: �-. �.��. �...�. ��,.��.
Reviewer/Inspector Signature: Date: (o O
12112103 Continued

Facifity Number: 3 —3 q,71 Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes /No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes
25. Did the facilityfail to have a actively certified operator in charge? ❑ Yes 7Nq
Y P
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes YN
o27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yeso
28. Does facility require a follow-up visit by same agency? ❑ Yes o
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes /No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form [:]Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

A Division of Water Quality
Facility Numbeir, 3 j �f
�J � 7 ', 0 Division of Soil and Water Conservation
O, Other Agency
Type of Visit C,00m�pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit XJ Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: �% d Arrival Time: 0�3 D1 Departure Time: County: Region
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 1e. dudso
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
pr
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Owner Email:
Phone:
Phone No:
Integrator:
q
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = l = Longitude: = o = S = «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑Non -La et— - - - - - - - --
Other
❑ Other - - - ----- - - - - --- - -
Dry Poultry
❑
Layers
❑
Non -Layers
❑
Pullets
❑
Turkeys
❑
Turkey Poults
❑
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifej
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures: 7:1
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 ZNO ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes EfrNo
❑ NA
❑ NE
❑ Yes _0No
❑ NA
❑ NE
12128104 Continued
i

Facility Number: 1,7 ) — Date of Inspection G ! v
Waste Collection & Treatment
4. A storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes o To ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
01,4o
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
2<o
❑ 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
2No
❑ 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
;2'No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
127No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect 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 l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
;?] No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
FZr%Io
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination %
❑ Yes_,2No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
O No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
PJ'No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any.other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: % Date: -7
\ 12/28/0 Continued i

Facility Number: — Date of Inspection O
Required loecords & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ,ONo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check 01yes ❑ No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ,ONo ❑ 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?
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
.ErNo
❑ NA
❑ NE
❑ Yes
❑ No
,0NA
❑ NE
❑ Yes
❑ No
ZNA
❑ NE
❑ Yes
❑ No
E2'NA
❑ NE
❑ Yes
2rNo
❑ NA
❑ NE
❑ Yes
ErNo
❑ NA
❑ NE
❑ Yes VNo ❑ NA ❑ NE
❑ Yes Eallo ❑ NA ❑ NE
❑ Yes ( Ko ❑ NA ❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
E54o
❑ NA
❑ NE
Additional Comments and/or Drawings:
49, CGof�) O(\e5lc��
OVA
12128104

DSWC Animal..Feedlot Operation Ievievv
❑ ... ,.
®DWQ An><mal Feedlot Operation Site Inspection
IG Routine 0 Complaint 0 Follow-uR of DWQ inspection 0 Fo[low-up of DSWC review 0 Other
Date of Inspection °b
Facility Number I
Time of Inspection : y 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:.1.25 for I hr .15 min)) Spent on Review
[Certified ❑ Permitted or Inspection includes travel andprocessing)
❑`` Not Operational Date Last Operated: ............................................................................................................................................rp....,.�..
FarmName: .... 14A...14...... Y :..................................................................... County:.D.,ji.�:1.4-,..................................... . I... ►... .
Land Owner Name:...a..o.§..V....... ... ..ta.. .........................
......... Phone No: 4xia �. �� /�
FacilityConctact:.................................................................................. Title:.....:.......................................... Phone No:..........................................................
Mailing Address:.....`i.1......�9.`................e.R......................... M.s�:�l.!!.....i..�.b.�l.�....0 ........6er.
Onsite Representative:.. c� .�. h...... Y.A-w.'!..✓........................................ Integrator:.....
Certified Operator:. �,��. ....... t-4.,......... � � �...................................... Operator Certification Number: ...
Location of Farm:
�a...!^ti r !e.4':.0 . .......5.5. ..�.....'D .......s,......C�.. .., Y A.i�.�..![Vb..Q1.... ........... .s.. .....all!\.9..b.�<R.....
... z... '...r......
W."
....S.P .I.&Q1......... I:uf.......
� .....Tnx..s. a.V.x%...
..r r. .....R..�
..��.� rR......................................�y
Latitude Longitude2.9
?7 • ®
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes Iff No
2. 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 Surface Water? (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)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97
maintenance/improvement?
❑ Yes a No
❑ Yes Q No
❑ Yes
E No
` 1
❑ Yes E[No
❑ Yes 5'No
[:]Yes EKNo
21 Yes ❑ No
Continued on back

Facility Number: .31........ —... H...
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ENo
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
0,No
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
R1No
Structures (Lagoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
KNo
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
;'
Structure 6
�..�............ ............................ ............................ ............................ ..........................f
............................
10. Is seepage observed from any of the structures?
❑ Yes
'gNo
11. Is erosion, or any other threats to the integrity of any of the structures observed?
[Yes
❑ No
12. Do any of the structures need maintenance/improvement?
® Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type r ........ . i1
�... .............. .4... .gin........ . �r.Y,......................... .C_ah±O.�.......................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
[9 No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
19No
18. Does the receiving crop need improvement?
❑ Yes
91No
19. Is there a lack of available waste application equipment?
❑ Yes
® No
20. Does facility require a follow-up visit by same agency?
19 Yes
❑ No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
IgNo
For Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
allo
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
O No
24. Does record keeping need improvement?
❑ Yes
E,No
Comments (refer. to `question#) Explain any. answers'and/or any recommendations, or any other comments:
Use drawings of. facility to better explain situations.. (use additional pages'as necessary)
5. C v r re ` d k i v. S t� L. a�v`Q, q ( e-
W dti' Q
0V Q_'l v
./ I Z• D e- cl Lrro S 1' 0 v, c u o d 'J
�., 0- 11 • T1n v,, e- e4- t-0 b e L l e o- cl v e,v4L
l LL e .Q—t u ".
f� l 'C'-1 Q l/1 i. I/l 'Q. L Ci i� to �, I :�1. S' �9 �i V I O, Y ✓WO W
.A o r e,V @ > a �-� A Y-q � e_ �
Reviewer/Inspector Name _ I,
Reviewer/Inspector Signature: Date: 41 If
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Divisioneof Water Quality _
Q Division of Soil and Water Conservation
'® Other Agency
Type of Visit-.6compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit -0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
E:
Facility Number
Date of Visit: Time: �i''sa Printed on: 10/26/2000
�) 3 y � t5� I'
® Not Operational ® Below Threshold
Permitted ® Certified ® Conditionally Certified ® Registered Date Last Operated or Above Threshold: .........................
FarmName: ........ .. ... ��` ''.s............................................................................ County: 1 v�J �ft:!`........................................................
Owner Name: �c �e�)'' fl
............................ �.?u:.:..6"................................................................... Phone No:.......................................................................................
Facility Contact: .................................................. Title:................................................................ Phone No:
...............................................................................
MailingAddress:.......................................................................................................................................................................................................... ..........................
L,
. Integrator: .....................................................r^w-LSOnsite Representative:0� .i...j.45A..........0 ttsI..
.........................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
[]Swine []Poultry ❑ Cattle ❑ Horse Latitude ' ` " Longitude • 6 G9
Design Current
Swine Canacity Population
❑ Wean to Feeder
ffPeeder to Finish
0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I ❑ Dairy I I --d
❑ Non -Layer I ::::j ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Fietd Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ElSpray 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 discharue is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3
Identifier: ...................................................................................................
Freeboard (inches): -Z
5100
❑ Yes Ef No
❑ Yes '] No
❑ Yes No
❑ Yes 0 No
❑ Yes 4-7 No
❑ Yes 0 No
❑ Spillway ❑ Yes © No
Structure 4 Structure 5 Structure 6
..............................................................................................................
Continued on back

Facility Number:?/ Date of inspection T 6 V Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes fi�No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑Yes{"No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes] No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes r--A'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 91 No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ElYes XE No
12. Crop type .So j� & A Vol
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes —RNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes �'No
16. Is there a lack of adequate waste application equipment? ❑ Yes F6(No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑Yes 7 N
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 No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes V'No
24. Does facility require a follow-up visit by same agency? ❑ Yes -0 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 15f No
13: Nd-yiolati6iis;or• deficiencies -*ere ilgted- during this 'visit: - ;Y;oit will-eeeeive do further - : .
correspondence. about this visit . ................... . .....:...:...:...:...:... .
.Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary): ,
'OLV1tt t, ,G% 1 S Y(O °i ci--tse.q Orn�� i't�oMOuuU� -t `ra-� ie,Id
v Sgd G� S' �, r� ry �"�� �' ���o y1t � �'°'`r't�hl
�'a6 e� "1 vt vci 5� a tz rriC &e 0 w4i lt tie xr C' r'�' p 1',e -i �/; s ►°S
w �
r a ,� o
O(d via / �� O-� O.'fj/7d 9 J t"^iu t" iN 7 r'I Y�. '-1'
,!74 df, ad 0;1 Ike a C�o� - r,✓ e vl-{e✓ �d h 6'1 v� < / �e- ��y�''c.f
�tGC re °Lo"ved)�J�cr1
/ e
Reviewer/Inspector Name 157, t,+,c-�wGl, l �A t S
Reviewer/Inspector Signature: - Date: 31-30 0 1 5100

Facility Number: — SL[17 Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 'g ] 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 FrNo
28. Is there any evidence of wind drift during land application?. (i.e. residue on neighboring vegetation, asphalt, El Yes JR No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ® No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ®No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes fj No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
NdditionaLCommentss'` and/or rawmgs: k
7 F
J

Division of Water Quality
iviision,of Soil and Water Conservation,' a
0 Other Agency
Type of Visit .Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit E
outine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: ime: Printed on: 7/21/2000
—rf 0 Not O erational 0 Below Threshold
Permitted ® C rt' ied Conditionally Certified ® Registered Date Last Operat Above T reshold:
Farm Name: r,��41�4.tCounty ...F/L.?(�� ........... ....... ...................................................... 1.......
OwnerName: ................................................... ........................................................................ Phone No:.......................................................................................
FacilityContact: ................................................... :.......................... Title:................................................................ Phone No:...................................................
MailingAddress: ............................................................................................................................................................................................. ..........................
cr-
Onsite Representative:..,...,... ntegrator:...... „,,. ,
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location'of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� ��� Longitude �• �� ���
Design Current Design Current Design_ Current
Swine : C ap4citv Population Poultry Capacity Population Cattle Capacity Population,
❑ Wean to Feeder ❑Layer I JEI Dairy
Feeder to Finish �/ ❑ Non -Layer I j JE1 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
`"' ❑ Gilts
E ❑ Boars Total ssm
Nuutber."o£Lagoons ] ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Folding Ponds Solid Traps ❑ No Liquid Waste Management System
Discharnes & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes $,No
Discharge originated at: El Lagoon [I Spray Field El 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 dischar,,e is observed. what is the estimated flow in galhnin? —
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes NfNo
Waste Collection & Treatment \\
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 4No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...... .....�...r.................................................. ...............................................................................................................................................
Freeboard (inches):
5100 Continued on back

I — Wfij�
Facility Number: — Date of Inspection V47 'I Printed on: 7/21/2000
5. Are there any mm diate threats to the integrity of any of the structures obser ed ie/ trees, severe erosion, ❑ Yes [$�No
seepage, etc.) / \
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes KNo
(If any of questions 4-6 was answered yes, and the situation poses an \
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over ap ication? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type `/7
13. Do the receiving crops di fer 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?
13: -io •viol'atidris'or• clef ciencies •were inoted• during •thisMsIC • Y;oit'Will -t. eceive lid further'
corres�oncTence.a�oul this.visit. .•. .. .. . . . ........................'
❑ Yes ONO
❑ Yes XNo
❑ Yes MNo
❑ Yes R410
❑ Yes C(No
❑ Yes Wo
❑ Yes KNo
❑ Yes r0
El Yes No
❑ Yes ONO
[:]Yes kNo
❑ Yes RNo
❑ Yes P(No
❑ Yes WNo
❑ Yes o
❑ Yes OrNo
❑ Yes No
❑ Yes MNo
7—\
❑ Yes 0&
Comments (refer to question #): Explain any YES answers and/or any recommendations or Any 'other comments.
Use drawings of facility to better exp 'n situations. (use additional pages as n cessary
[� e2�� MA l b� 2 o S
beer\-. 4a-O� &,L-�
v/ I
Reviewer/Inspector Name
Reviewer/Inspector Signature:

Facility Number: - ZUT Date of Inspection Dt7t7 Printed on: 7/21 /2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge At/or below ❑ Yes KNb
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'No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes '94LNo
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 o
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 RNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 1Y0
5100

+�. if�vl~sion of Soli sad �?ntex Conservation � >"
' Q°Othe - r envy
Type of Visit Ig'Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit routine 0 Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: //+ Time:
L rO Facility Number 3j 3
Not Operational 0 Below Threshold
® Permitted ® Certified ® Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
Farm Name: d t:& � " on S County: 4 zi10/it/'7
Owner Name:
Mailing Address:
Facility Contact:
Onsite Representative: 61
414Zr�
Certified Operator:
Location of Farm:
Title:
Phone No:
Phone No: /
Integrator:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 1 a Longitude ' 4 u
;.Design : -Current_ Desigu� re°Current_°r ° '-°',.._ ' .:'Design Current
Swine " .Caacity 'Population °°'Pouttr ._ea0aciw, Population,'--"Cattle°a: �: 'Ca aci Pojiulation;
❑ Wean to Feeder 3 , ❑ Layer l ❑Dairy
®Feeder to Finish 9ri ti ❑Non -La er I!�, ❑ Non -Dairy
❑ Farrow to Wean
❑ ❑ Farrow to Feeder Other
❑ Farrow to Finish Total Design�Capacity
❑ Gilts
" ❑Boars"gtal" SSLW ;
Nujnber of,Laooris, ; , �'-; <�=,"` ❑Subsurface Drains Present ❑ Lagoon Area 10 S ray Field Area },;"
:'Holding Ponds !.Solid Traps y 0 . ° `„ ° _ ❑ No Liquid Waste Management S stem
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure l Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
❑ Yes ®IdV—
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes EINV—
❑ Yes G5 F —
ti
❑ Yes ®-Nv-
Structure 6
05103101 Continued

a
Facility Number: 3/ — ,3If 7
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was, answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes El-Ni o
❑ Yes [3 o
❑ Yes �o
❑ Yes E-No
❑ Yes [-No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
[9-No
11.
Is there evidence of over application? ❑l Excessive/�P'�onnding❑ PAN [I Hydraulic Overload
El Yes
[9-No
12.
Crop type �f/z� �s-� 54 .��'v,� ZWl '4/ / 'e -411r
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
E-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
0 o
16.
Is there a lack of adequate waste application equipment?
❑ Yes
[moo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
EiNo
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
ES -No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ 44e,
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
QLLo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
[}Plea.
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ®.Hoo.
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes [9 i
24. Does facility require a follow-up visit by same agency? ❑ Yes RL.No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes Rio_
EJ—No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Cbmnients'(refer to question #):" E�cpiaih',:any:YES`answervan&or' airy recomnienciatioais°or any,�Ciier.comment5
Use drawings of facility to better explain situations: (use addit#onat pages;as necessaryjr ` °, ':- :,❑Field Ganv 'ElFinal Notes T
T
._ ., ... _,.„, .... ,. ....._.. e.,,_.,,.._..„.._ .. .w,_.... _.mow.., __ .. _._. _. ...
Reviewer/Inspector Name /
Reviewer/Inspector Signature: J Date: G
05103101 D
Continued

Facility Number: Sf — j Date of Inspection
-
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Additional Comments and/or Dra-wings:,
O5103101
❑ Yes
❑ Yes [9 d6
❑ Yes ❑ ino
❑ Yes (3-no
❑ Yesn-r o
❑ Yes ES�
❑ Yes [!�' o