040009_INSPECTIONS_20171231

s
(Type of Visit: ®Compliance Inspection U Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 1 Arrival Time: a Departure Time: ' L -County: Region:
Farm Name: �,,(� U"'�(MZ Owner Email:
Owner Name: f4,11,3 l.oek_A4, Phone:
Mailing Address:
Physical Address:
Facility Contact: �yE1c,/j `S L47k ib JV Title:
tr
Onsite Representative:
u
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Integrator: j jy '44 y/w
Certification Number: Z 25&-7
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
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?
❑ Yes �No [[] NA [:]NE
❑ Yes
r
'® NA
❑ NE
❑ Yes
❑ No
NA
DesignCurrent
Design
Current
Design torrent
Swine
Capacity Popp
Wet Poultry
Capacity
Pop:
Cattle Capacity Pop.,:
Wean to Finish
Layer
Dairy Cow
Dairy Calf
Wean to Feeder I INan-Layer
Feeder to Finish
Design
Current""
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D . P,oul
Ca ac'
I;a
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other A
Turkey Poults
Other
I 10ther
�u
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?
❑ Yes �No [[] NA [:]NE
❑ Yes
❑ No
'® NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
[:]Yes No
❑ Yes No
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/2015 Continued

JlTaOrhy Number: - Date of Inspection: 1 7
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ YesNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 9No NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes�No ❑ NA ❑ NE
(Le., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes [�) No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7_ Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any pan 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 qNo ❑ NA ❑ NE
maintenance or improvement? T
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes[� No ❑ NA ❑ NE
F-1ExcessivePonding [:]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
F1Outside of Acceptable Crop Window Evidence of Wi Drift A licat/io'n Outside of Approved Area
12_ Crop Type(s): Coo !;k( 4SS
13. Soil Type(s): A/,, &W,,4
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes MNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:)Yes �No [:]NA ❑ NE
acres determination? TT
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
17�
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
60No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
P No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? Yves, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes T No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P No ❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facile Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 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 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
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?
Comments (refer to question #): Explain any YES.answers and/or anyadditional recommeni
Use:drawines of facility to better exDlain situations (use aaditidnal'uakes as necessarv).' ,,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes [R No
❑ NA ❑ NE
❑ NA ❑ NE'
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes T No ❑ NA ❑ NE
❑ Yes [�j No ❑ NA ❑ NE
❑ -Yes IP
No ❑ NA ❑ N E
❑ Yes L?P No
❑ Yes No
❑ Yes TT No
tions or any other
Phone: Sar'
Date: tf
2/4/2015

2
z - � � �Di�i'stonYof Water Resources
ty 'tuber WSO UUv9' O DO}� soon a1' Soil and Water Conservation
�'F8c111 �Nu
�z
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral A Emergency 0 Other 0 Denied Access
Date of Visit: f , rjLT b Arrival Time: Departure Time:
Farm Name: CfeC k F/ 2LV Al,",?— Owner Email:
County: ,O . ,&?Al n Region: rA0
Owner Name: �/z / f 140&_4-811_L Phone:
Mailing Address:
Physical Address:
Facility Contact: ;qL vl.r `UOKf}{j / LL_ Title: C?� /,4/ 6W, ev:
tcsf�? 1TH�i
Onsite Representative: Integrator: L/7
Certified Operator- / l Certification Number: Z Z.57ly -;L-
Back-up Operator:
Certification Number:
Location of Farm: Latitude: 1Y 34. Q,33 Longitude: LA, j& . 0249
k
Design C•nrrent
`d
Wet
Design, Current Design. Current
"Cattle C� pacify
Swore
Capacity Pop.
Poultry
Capacity Pop. Pop.
a. Was the conveyance man-made?
❑ Yes
Wean to Finish
Pq NA
Layer
Dairy Cow
❑ Yes
❑ No
F1 NA
❑ NE
Wean to FeederZ
Non -La er
Dai Calf
Feeder to Finish
d. Does the discharge bypass the waste management system? (I f yes, notify DWR)
❑ Yes
DairyHeifer
Farrow to Wean
❑ NE
2. Is there evidence of a past discharge from any pan of the operation'?
F
esign Current Dry Cow
Farrow to Feeder
❑ NA
Dr Poult
Cai Po . _ - Non -Dai
Farrow to Finish
[)� No
Layers
Beef Stocker
= its
Non -Layers
Beef Feeder
Boars
Page 1 of 3
jPullets
Beef Brood Cow
2/4/2015 Continued
Turke s
_
y -
O�the�r�{ ; ..
Turkey Poults_
Other
Other
_,
.a
-
Discharges and Stream Imnaet5
1. Is any discharge observed from any part of the operation?
❑ Yes
1>1 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
Pq NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
F1 NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (I f yes, notify DWR)
❑ Yes
❑ No
rNA
❑ NE
2. Is there evidence of a past discharge from any pan of the operation'?
❑ Yes
Q! No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[)� No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3
2/4/2015 Continued

Facility Number: jDate of Ins ection: d& /(
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes n No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No P NA ❑ NE
VruQ
rue Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): aJ
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [V No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) r`
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes [:a 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] No ❑ NA ❑ NE
maintenance or improvement?
Waste ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �0 No ❑ NA [:]NE
maintenance or improvement? 77��
11. Is there evidence of incorrect land application? if yes, check the appropriate, box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): �! L all
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes K] No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes M No ❑ NA ❑ NE
16. Did the facility tail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination? TT
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes � No
❑ Yes 1� No
❑ NA ❑ NE
❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes] No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [)o No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ONE
PQM,=e 2 of 3 2/4/2015 Continued

Faeilitv Nulmber: 4F - /7/) Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
�No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
M No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
CK No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34, Does the facility require a follow-up visit by the same agency?
❑ Yes [2] No ❑ NA ❑ NE
❑Yes [�No 0 N E] NE
❑ Yes [A No ❑ NA ❑ NE
❑ Yes 7W No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
[:]Yes �] No
❑ NA ❑ NE
❑ NA ❑ NE
❑ 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 egnlain situations [use additional nap -es as necessarv).
Reviewer/Inspector Name: i✓i✓, 7 f • ` �VFf / %�
Reviewer/Inspector Signature:�-
Page 3 of 3
Phone: Jiy. 7-33.,'10-9-
Date:
10-9-Date: �/_ l) GT 20( p
2/4/2015

Ii ype oz v isn. a i.ompuance inspection v vperanon xevtew tJ arrucwre r vaivauon v i ecnmicat ,%ssisrance
Reason for Visit: • Routine 0 Complaint Q Follow-up O Referral 0 Emergency 0 Other Q Denied Access
Date of Visit: Arrival Time: ;vD Departure Time: p County: Region:
Farm Name: (�'C y _ Owner Email:
Owner Name: 5' 4avj�G�16� Phone:
Mailing Address:
Physical Address: f
Facility Contact: _/rgyl7j [mow , Title: Phone:
Onsite Representative: Integrator: Ak"160741'_
Certified Operator: N Certification Number: 2 -
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design Current
_ Swime Capacity Pop.
Wet Pauitry
Capacity
Pap.
Fettle Capacity Pvp.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
I Non -La er
DairyCalf
Feeder to Finish
Dairy Heifer
Farrow to Wean
MIAMIgn
Current
Cow
Farrow to Feeder
D EN Poul
Ca aci
P,o ..
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
1.1
Turkeys
Other
Turke Poults
HOther
Other
Discharees and Stream ImDaCts
1. Is any discharge observed from any part of the operation? [:]Yes 5a No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No [S) NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) [:]Yes [] No ( NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [:]Yes ❑No ® NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [—]Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/42014 Continued

❑ WUP ❑Checklists p Design [] Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes P No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [X] No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [] Yes f�o No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued
Facility Number: jDate of Inspection: Z413a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[:]Yes
V] No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
�1 NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier: i
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
F] 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
F%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
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11 _ Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
� No
E] 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 Cro Window Evidence of Wind Drift ❑ Application Outsideof Approved Area
12. Crop Type(s):�f qs
//b� CJr� �1/�r✓S
13. Soil Type(s):
14. Do the receiving crops di er from those designated in the CAWMP?
[:]Yes
No
❑ NA
C] NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
© No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[5g No
❑ NA
❑ NE
Re uired_Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
V] No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
`F' No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists p Design [] Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes P No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [X] No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [] Yes f�o No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes ® No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes M No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [5@ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes M--- No E] NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes U No ❑ NA ❑ NE
❑ Yes [� No ❑ NA ❑ NE
0 Yes M No ❑ NA ❑ NE
❑ Yes [,UNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ®'No ❑ NA ❑ NE
33_ Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes M No ❑ NA ❑ WE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes jjg 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: Phone:
Reviewer/Inspector Signature: Date: �8
Page 3 of 3 21412011

IType of Visit: ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Vjs_� Q Routine Q Complaint O Follow-up O Referral O Emergency O Other Q Denied Access II
Region:
Date of Visile Arrival Time: O:A�Q Departure Time: �l' County: ,o� -p
Farm Name: 6:.d V CGI pt,,-, 4"Z Owner Email:
Owner Name: �jt�✓ir LO'ok-a-L i-11 Phone:
Mailing Address:
Physical Address:
Facility Contact: `;rla J I,S �b1�7'Title: Phone:
W 1,
Onsite Representative: Integrator: Ma
�J!
Certified Operator: 81 Certification Number: Z� {
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current_
Swine Capacity Pop.
Wean to Finish
Design
Wet Poultry 'Capacity
La er
Current
Pap.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Layer
Dairy Calf
M Feeder to Finish;,,:
5 �=; � �
- -
Dairy Heifer
Farrow to WeanDesign-
Current
Dry Cow
Farrow to Feeder
D , AP,ouI Ca aei
PoP
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
�....
Turkeys
�..:
Other
Turkey Poults
Other
Other
Discharges and Stream Imuacts
1. is any discharge observed from any part of the operation? ❑ Yes T No [:]NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field F-1 Other:
T
a. Was the conveyance man-made? ❑ Yes ❑ No V2 NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No 01 NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No BNA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes �] No ❑ NA 0 NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 0 No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

Facili Number: jDate of Inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: f
n No ❑ NA ❑ NE
❑ No NA ❑ NE
Structure 6
Spillway?:
❑ Yes
[� No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
Designed Freeboard (in):
❑ Yes
0 No
❑ NA
❑ NE
Observed Freeboard (in): ZQ
❑ Yes
® No
❑ NA
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[X No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
T
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit'?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
T
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 Wiind_ow, ❑ Evidence o ind Drift Application Outside of
Approved Area
12. Crop Type(s): S l � "'� , La SiS oa�r� <+l r [3vA.�� V V ✓
13. Soil Type(s): A"tal J�
❑ Yes
[� No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
14. Do the receiving crops dider 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
❑ Yes
No
❑ NA
❑ NE
acres determination?
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[� No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
E] Other:
2 L Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
T
❑ NA ❑ NE
Page 2 of 3
2/4/2011 Continued

i
[Facility Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes P No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes fp No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No [] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
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?
❑ YesNo
[—]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
[D 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_
❑ YesLPJ
No
[:]NA
[:]NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWW?
❑ Yes
KNo
❑ NA
0 NE,
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No
0 NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
EP 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: f?,/
Phone: -Y.73 -Azo
Reviewer/Inspector Signature: O }, / / k .6 le.,
Date:
_9110
24 �(
Page 3 of 3
2/4/2011

at.,9191122
Type of Visit: 0 Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 0 Routine O Complaint O Fallow -up O Referral O Emergency O Other O Denied Access
Date of Visit: 1 v Arrival Time: O �4l Departure Time: County: A-�5W' j
Farm Name: (�-•lGC 0tyyy"- Az' Owner Email:
Owner Name: ai3 /,jqj�4 7 Phone:
Mailing Address:
Physical Address:
Facility Contact: / ����r����" r' ` Title:
Onsite Representative: y
Certified Operator: I
Back-up Operator:
Region: .fiQ=&-�D
Phone:
Integrator: r�
Certification Number: 2
Certification Number:
Location of Farm: Latitude: Longitude:
..t
Design Current
M
Design
Current
Design Carrent
NA
Swine 3
Capacity Pop.
Wet�Poultry
Capacity
Pop.
Cattle ItRop.
Wean to Finish
Layer
airy Cow
Wean to Feeder
Z o
Non -Layer
aia Calf
Feeder to Finish
aia Heifer
Farrow to Wean:
Design
Curreat
Cow
Farrow to FeederDrv?Pouh
Ca aci
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
I
on -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
,.�Turke
Will
s
_.
O#her
Turkey Poults
Other
Other
Discharges and Stream Impacts
1 _ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes �] No ❑ NA ❑ NE
❑Yes
❑ No
It"
[-]NE
❑ Yes
❑ No
NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes SP No
❑ Yes No
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 214/2011 Continued

Fa6i it Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. if yes, is waste level into the structural freeboard? ❑ Yes
Structure t Structure 2 Structure 3 Structure 4 Structure 5
Identifier: I
® No ❑ NA ❑ NE
❑ No 1P NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
�l
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 g No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes � No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Q9 No ❑ NA ❑ NE
maintenance or improvement?
Waste ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes® No [:]NA [—]NE
maintenance or improvement? T
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes `t' No E]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): C�f&c
13. Soil Type(s):
14. Do the receiving crops differ om those designated in the CAWMP?
❑ Yes
W No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
42 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
© No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes]
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. [:)Yes M No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [j] No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 1�No ❑ NA ❑ NE
Page 2 of 3 2/412011 Continued

Facility Number: Lr I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(es) below_ TT
❑ 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
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? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawinzs of facilit.v to better explain situations (use additional vap-es as necessarv).
C] NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
[] Yes ® No ❑ NA ❑ NE
❑ Yes [V No ❑ NA ❑ NE
❑ Yes q No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
new Cac
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2071

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: ``Arrival Time: Q Departure Time: i : Y County: SeVj Region:
Farm Name:.rQk�Z Owner Email:
Owner Name: '��� Phone:
Mailing Address:
Physical Address:
Facility Contact:- 4 Title: Phone No:
Onsite Representative: Integrator:i0t
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0
=4
0 Longitude: =0=6
°=6 = «
Design Current
Swine Capacity Poptil� &0
❑ Wean to Finish
Wean to Feeder
El Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
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 C►apacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
d i
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes P No ❑ NA ❑ NE
❑ Yes
❑ No
1p NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
�j NA
❑ NE
❑ Yes
❑ No
❑ Yes
(9 No
❑ NA
❑ NE
❑ Yes
52 No
❑ NA
❑ NE
Page I of 3 12128104 Continued

FaCtL%j, Number: — Date of Inspection / h
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 55 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No L?NA ❑ NE
Strure 1 Structure 2 Structure 3 Structure 4 Structure 5+ Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes WNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[V No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
PNo
❑ 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. (nse additional pages as necessary):
WW
A,
N0 Swb4(A/ CQ CtVa,�_4 vh
Reviewer/]nspector Name '� Phone: �D�� 3
Reviewer/Inspector Signature: Date:
Page 2 of 3 12/28/04 Continued

Facility Number: L�—� Date of Inspection �I
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes KINo El NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes F No ❑ 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 . 1P 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
"INo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[P 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
`(p No
❑ NA
❑ NE
26_
Did the facility fail to have an actively certified operator in charge?
❑ Yes
0 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
gg No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAW MP?
❑ Yes
P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ 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
P 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
❑ Yes1�No
[INA
[_1NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
T No
❑ NA
❑ NE
Page 3 of 3 12/28/04

- - - � Division of Water Quali
ty
�FaClilty Number Q Division of Soil and Water Cons[I--- ervation
Q Other Agency
Type of Visit 4D Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: ' ' Arrival Time: O$ rJV4 � Departure 'Time: .� � County: Aj - O
Farm Name: �l l]�� fdUV- 4 2 Owner Email:
Owner Name: ,^ —rC"; i L "1 L Phone:
Mailing Address:
Region:
Physical Address:
Facility Contact: Tricyt`5 Wu4'1 r Title: Phone No:
Onsite Representative: N Integrator: LLC—
q
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0
=6
❑ i! Longitude: =0=6
o=6 = S,
Design Current
Design Current :
K.NA
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle
Capacity Population
❑ an to Finish
10 Layer
❑ Dairy Cow
Wean to Feeder 3
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish
-
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
0 No
❑ Non -Dairy
El Farrow to Finish
❑ Layers
El Stocker
❑ Gilts
❑Non -La Non -Layers
El
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood CoVd
El Turkeys
OtEter
❑ Turkey Poults
Number of Structures:wl_77__���
❑ Other
❑ Other
­.-
1'0511
Discharges & Stream lis
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes R No ❑ NA ❑ NE
❑ Yes
❑ No
K.NA
❑ NE
❑ Yes
❑ No
® NA
❑ NE
[�JNA
EINE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: — Date of Inspection I JANU 4�qlla
❑ Yes
Waste Collection & Treatment
❑ NA
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less th equate? ❑ Yes
P9 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes
❑ NoNA ElNE
Structure 1 Structure 2 Structure 3 Structure 4 Structure
5 tructure 6
Identifier:
❑ Yes
Spillway?:
❑ NA
Designed Freeboard (in):
17. Does the facility lack adequate acreage for land application?
Observed Freeboard (in):
00 No
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes®
No El NA [INE
(ie/ large trees, severe erosion, seepage, etc.)
(,
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes]
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
] No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Arc there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
( No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
vi ence
❑ Outside of Acceptable Crop Window El Eof Wind Drift ❑ Application Outside of Area
�QS C
12. Crop type(s)
(4 ( $ ' 4(
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
00 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
K3 No
❑ NA
❑ NE
wal M444%vj 4,",M,
Phone:
Reviewer/Ins ector Name E- ,$�`
Reviewer/Inspector ,: _ 1. 03 i-3 dt3
Reviewer/Inspector Signature: J� Date: ifl
Page 2 of 3 12/28/04 Condnued

Facility Number: — Date of tnspection
Required Records & hocuments
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists
❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22_
Did the facility fail to install and maintain a rain gauge?
❑ Yes
["No
[j NA
[INE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[� No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
f P No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWM P?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes]
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12/28/04

Type of Visit 0 Compliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 41 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visii . Arrival Time: �] Departure Time: IQ: .� County: T A %A Region: I ko
-3 jr-L
Farm Name: Owner Email:
Owner Name: rCWtS ��t�1 _ Phone:
Mailing Address:
Physical Address:
Facility Contact: �j i S ��� Title: Phone No:
Onsite Representative: �I Integrator:14
Certified Operator: Operator Certification Number:
Back-up Operator:
Bach -up Certification Number:
Location of Farm: Latitude: =" =' ❑ Longitude: 0 0 =' ❑ u
Desi n
g
Current
PNo
Desi n Design Current
g .. -Current
SwineCapacity
PopulationOWN..ultry
Capacity Pop IaE�on, Cattle . pacity Population
❑ Wean to Finish
❑ Layer
❑ Yes
❑ No
❑ Dai Cow
EINE
Wean to Feeder
j0W
❑ Non -Layer
[P NA
❑ NE
❑Dai Calf
Feeder to Finish
❑ Dairy Heifer
❑ Yes
s, ❑ Farrow to Wean
q NA
Dr. Poul
y
❑ Dry Cow
❑ Yes
❑ Farrow to Feeder
❑ NA
❑ NE
J ❑ Non -Dairy
❑ Yes
❑ Farrow to Finish
❑ NA
❑ La ers
❑ Beef Stocker
❑ Gilts
❑Non -La ers
❑Beef Feeder
12/28/04
Boars
❑ Pullets❑
Beef Brood CoTurke
s
kthe,:_
❑ Turke PoultsOther
❑Other
s
Number of.:Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
PNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
P NA
EINE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[P NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
q NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page l of 3
12/28/04
Continued

Facility Number: Date of Inspection t 3`-a-0
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 ❑ No ;E�NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes No ❑ NA EINE
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 t9 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes MNo ❑ NA EINE
(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 29 -No ❑ NA EINE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ':"'No El NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes RNo ❑ 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 ❑ Evidence9LWind Drift ❑ Application Outside of Area
12. Crop type(s) 1 UVQ9W MrmtAdA t9-Y*6Mm. fla5+14-P 1 , � ►L
13. Soil type(s) fig,,, , &4t4 j
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
PgNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
S No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
N No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
JSNo
[INA
❑ 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 additiottai pages as necessary):
Reviewer/inspector Name .P F , Phone: q
Reviewer/Inspector Signature: Date: 3 lel~Oy
Page 2 of 3 12/28/04 t) Continued

Facility Number: — Date of Inspection
Required Records & Documents \
19. Did the facility fail to have Certificate of Coverage & Permitadily available'? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 13 No ❑ NA EINE
❑ 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 P No ❑ NA ❑ NE
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes n No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
n No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
9 No
❑ 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
1)9 No
❑ NA
❑ 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
' No
rj
❑ 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
[?3 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�No
❑ NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
to No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
PNo
❑ NA
❑ NE
Additional-Comiriieots andL;>��
or Drawtngs y ,
a
H,
Page 3 of 3 12128/04

Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency 11
Type of Visit 19 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 ❑ Denied Access
Date of Visit: I 117WOO I Arrival Time: Q Q r+• Departure Time: County: 24_1�60ry Region:
Farm Name: '�` w- Ll-
� y Owner Email: l CJ f
Owner Name: `�"t^AX),o5 M . �.00I` aLl f � Phone: (iogI K ` +qq
Mailing Address: —_ 60go-oo-11t)
__
Physical Address:
R_ L
Facility Contact: (irGU� i S�Q�O� 1 Title: Phone No:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
4
N
Integrator". M".0
Operator Certification Number: 9PS7467
Back-up Certification Number:
Latitude: a o =d
066 Longitude: 0° ET
0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish I ❑ La er
Wean to Feeder 1 3 al 1 35-00 ❑ Non -La er
❑ 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?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system`? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes P No ❑ NA ❑ NE
❑ Yes
❑ No
EP NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
$No
❑ NA
❑ NE
❑ Yes
N9 No
❑ NA
❑ NE
12/28/04 Continued

V Facility Number: —
Date of Inspection 29 Gg
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [4 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No �] NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes � No [:1 NA [__1 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 Co No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No El NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system otber than the waste structures require ❑ Yes El No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) -wti�tO1L2 � Qla4l a& -TC 5"• l7YiLch OY60
13.
Soil type(s) Xr--ij-he-61
Reviewer/Inspector Name Phone: l0 _3 0a
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P)No
[:INA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
El Yes
p No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
01 No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
R No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
P 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):
WeA( Ma�KWnt4 recpdS
Reviewer/Inspector Name Phone: l0 _3 0a
Reviewer/Inspector Signature: Date: //01146
12128104 ' Continued

Facility Number: — Date of Inspection Zg
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes FM No El NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes IM No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 99 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Ep No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
N No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ON.
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
10 No
❑ NA
[3 NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
60 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
g] 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
VgNo
❑ 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
�w 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
[Z No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
Comments and/or Drawings:
12/28/04

Type of Visit i♦ Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine Q Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit:Arrival Time: '. QM Departure Time: County: SO r1 Region: ��
Farm Name: &DId d Ctwk- Fav-r+'S * -), Owner Email:
Owner Name: Loo Phone:
Mailing Address:
Physical Address:
Facility Contact: L+�a�J l s ; Title:
Onsite Representative:
tl
Certified Operator: H
Back-up Operator:
Phone No:
Integrator cam/
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ e =1 ❑ u Longitude: ❑ o ❑ I ❑ u
J
Design Current
Design Current
Design Current
Swine C*apacity Population
Wet PoulEry Capacity Population
Cattle Capacity Population
❑ Wean to IF
❑ La er
❑ Da Cow
Wean to to, SSa-
❑ Non -Layer
❑ Da Calf
Feeder to Finish
EINE
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Non -La ers❑
Feeder
FoGilts
Boars
Pullets❑Beef
❑ Beef Brood Cow
❑ Yes
❑ Turke s
-
Otl
❑ Other
❑ TurkeyPoults
❑ Other
Number of Structures:
�d No
❑ NA
❑ NE
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
EINE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
1P NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
M No
❑ NA
EINE
3. Were there any adverse impacts or potential adverse impacts to the Waters ofthe State
❑ Yes
�d No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128/04
Continued

4 1
J` I Facility Number: — Date of Inspection
Waste Collection & Treatment TT��
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 1PNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No T- NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
F No
❑ NA
Spillway?:
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Designed Freeboard (in):
❑ NA
❑ NE
Observed Freeboard (in): %/
[:]Yes
(P No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ yes
[� No ❑ NA
❑ NE ,
(ie/ large trees, severe erosion, seepage, etc.)
❑ Yes
RNo
R
❑ NE
6. Are there structures on-site which are not properly addressed and/or managed ❑,Yes
No ❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? r
`! El
No [I NA
El NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes
l
No ❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require❑yes
No ElNA
ElNE
maintenance or improvement?
a
Waste Application.
v
•,ti
Q
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ yes
No ` ❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
® No ❑ NA
"
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or I 0 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 CAWM P?
❑ Yes
F No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[PNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
[:]Yes
(P No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
M No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
Comments (refer to question ft Explain any. YES.an' veers and/or any iecommendations or any other4commerr
Use drawings of.facility to better explain situations: (use additional pages as necessary): 4 k
r
�YV1 f
�
Reviewer/inspector Name ;
Phone:/0.3300
Reviewer/Inspector Signature:CM lot A md UJO
Date:
Page 2 of 3 12/28104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P§No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes[� No El NA El NE
EJ the appropriate box. WUp ❑ Checklists El Design El El Desi 1
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[ 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
i No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
qNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[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
P 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
0 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
KjNo
❑ NA
❑ NE
Additional'Comments iftt or Drawmgs u
H
Page 3 of 3 11/28/04

I
Type of Visit & ompliance 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 ❑ Denied Access
Date of Visit: ® Arrival Time: `�7� Departure Time: ! County:s-"��
Farm Name: Cv� ����� �_ �afms --� Owner Email:
Owner Name: _ z, 7tt �_ —y��l! oK �ccr'ivt y X G Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative:
Certified Operator: -fi�►..t�
Sack -up Operator:
Location of Farm:
Swine
Region: 2ffzD—
Integrator: /wyL ,-, `it
Operator Certification Number:
Back-up Certification Number:
Latitude: = o ❑ , = Longitude: = c = = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
ja Wean to Feeder�,!-o ❑ Non -La et
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other_
Dry Poultry
Non -L
Pullets
U
ITurk-eyPoults
❑ 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?
Cattle
Design Current
Capacity Population_
El Dai Cow C
❑ Dairy Calf
❑ Dairy Heifej
❑ 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 [3 No ❑ NA ❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

4. Nwr
Facility Number: I — Date of Inspection ®�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes R No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [ZNo ❑ NA ❑ NE
the appropirate box. ❑ WIJp ❑ 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 I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [4 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes (4 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
W No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[3 No
❑ NA
EINE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
MNo
El NA
EINE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[4 NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWW?
❑ Yes
PQ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[klNo
❑ 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
V9 No
❑ NA
EINE
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
P 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
[4 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
4 No
❑ NA
❑ NE
Additional Comments and/or brawlq' gs:
12128/04

.jW
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): }�
❑ Yes Jc No ❑ NA ❑ NE
❑ Yes JZ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
(f r`Itti/
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
4 No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
A No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
MNo
El NA [:1 NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ NA
❑ NE
9. Does any part of the waste management system other than the waste structures require ❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
❑ NA
❑ NE
Waste Application
Does the facility lack adequate acreage for land application?
❑ Yes
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes
(� No
El NA [:]NE
maintenance/improvement?
Is there a lack of property operating waste application equipment?
❑ Yes
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
LqNo
❑ 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 Drill ❑ Application Outside of Area
12.
Crop type(s) f�1 Z eqt�fr�
(f r`Itti/
13.
Soil type(s)�Z j f�
-
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[4No
❑ 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
M No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
KNo
❑ NA
❑ NE
18.
Is there a lack of property operating waste application equipment?
❑ Yes
ONo
❑ 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):'
(f r`Itti/
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
12/28/04 Continued

..a ... - -� --�: _ �_..�....��... �-�� �- ._ .. .� ��. , : �::.-_ • ..„_.• .:-mss-- - �ro - _ -�, __�.: � --
Type of Visit ® Compliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility. Number Date rot Visit: �Time:
- r—717—Operational 0 Below �Lj
® Permitted ® Certified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: - County:
Owner -Name: �{ u h (e ti -ire, C-0. cyvt Ea ryiS- , 1A C . Phone No: . —
Mailing Address: _ 0, e3, l3, 5Cw A i/ja..d e S hr ro At Sc, a g (tea
�4r� J�Nn
Facility Contact-. ' Title: Phone No:
Onsite Representative: fig e la 1! eriLa-^_ _ Integrator-
Certified Operator: t n.rT. Operator Certification Number: 1� 1
Location of Farm:
®Swine ❑ Poultry ❑ Cattle ❑Horse Latitude ' ` " Longitude a
Design Current
Swine Canarity Pnmilatinn
Wean to Feeder 3 DG
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrov- to Feeder
IEl Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry capacity Population Cattle Capacity Population
❑ Laver I 1 11:1 Dairy
❑ Non -Laver I I ❑ Non -Dairy
❑ ether
Total Design Capacity
Total SSLW
I Number of Lagoons I i I ILl Subsurface Drains Present IILJ Lagoon Area ILJ Spray Field Area i
Il Holding Ponds / Solid Traps I❑ no Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
is_ 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 eal/min?
d. Does discharge bypass a Iagoon system? (If ves, notify DWQ)
?. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure ? Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): 2 5
05103101
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
P No
❑ Yes
No
❑ Yes
[� No
Structure 6
Continued

IF,
Facility Number: — Date of Inspection f G
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 arc 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 14 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes PNo
Waste Anolication
10. Are there any buffers that need maintenance/improvement? ❑ Yes P No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ® No
12. Crop type CBur--"A,-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [P No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
Cl Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
[ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
® No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
�3No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
❑ Yes
91 No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
91No
20_
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
B No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
E9 No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes [S No
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑ Yes No
24. Does facility require a follow-up visit by same agency? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes [ No
Q No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Field Copy ❑ Final Notes
Reviewer/Inspector Name I
Reviewer/Inspector Signature:
05/03/07
Date:
Continued

4
Facility Number: / — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 4 No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation. asphalt, ❑ Yes W 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 E4 No
30. 'Here 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 CA No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments and/or Drawitt--s:
05/03/01

Site Requires Immediate Attention:
Facility No. o 4 = 9
DIVISION OF ENVIRONhUNTAL MANAGEMENT
ANAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 7 z , 1995
Time: i l : oo
Farm Name/Ow►oer: t�un�iy - I�iprnnn /-�.�_� _ yv'% 6(, ,
-Mailing Address:
Cotmty: Antsg-d — -- - -_
Integrator: i �, kaa j k _ __. , Phone:
On Site Representative: Phone:
Physical Addressl1ocation: 6R i i .z:f
Type of Operation: Swine g Poultry Cattle
Design Capacity: Number of Animals on Site: sss�
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 34 ° s-1 ' ,I.? Longitude:_ZQ. " oL' 36 •
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard:__.&_Ft. Inches
Was any seepage observed from the lagoon(s)? Yes o1QWWas any erosion observed? Yes or Seepage was
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No Not Evaluated)
Crop(s) being utilized:, (Spray Field or cover crop was not evaluated)_
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Igor No
_ 100 Feet from Wells? Qor No
k Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yet ori
+� Is animal waste land applied or spray irrigated within 25- Feet of a USGS Map Blue line: Yes or No
Is animal waste discharged into water of.the state by man-made ditch, flushing system, orbther
similar man-made devices? Yes or( i& If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover cmp)? Yes or No(waste management records were not
Additional Comments: reviewed)
This was a very brief inspection, a more thorough inspection will be conducted in the mature.
Please contact -.DEM should any condition arise that poses a danger to surface waters.
* This farm was not located on a USGS TOPO map to determine `.'Blue Line" status.
If you have questions concerning this report please do not hesitate to .contact the inspector
at [phone]. Please contact the inspector if the above information is incorrect.
/�J�l 0,__2
Signature
Cc: Facility Assessment Unit Use Attachments if Needed.