090094_INSPECTIONS_20171231

N
i ype or v isit: io t;ompuance imspection v uperanon xeview v structure r valuation V I ecnmcaI Assistance
Reason for Visit: ffiroutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: : OC7 Departure Time: , 3 County:- Region: /.�_
Farm Name: &lD,3S1Ue.' ram_ Owner Email:
Owner Name: G Phone:
Mailing Address:
Physical Address:
Facility Contact: n Title: - Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design Current
Capacity Pop.
Wet Poultry
Cacity
tal
Pop.
Ca!MMEG=aity Pop.
Wean to Finish
I ILayer
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D . P,oul
Ca aci
P,a
Non-Dauy
Farrow to Finish
[Lavers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
j
Boars
Pullets
Beef Brood Cow4
L
Other
n
Turkeys
Turkey Poults
Other
Other
NMI
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [D N ❑ NA ❑ NE
❑ Yes [—]No
[—]Yes [::]No
[:]Yes
[:]No
❑ Yes
[�"io
❑ Yes
No
❑ NA ❑ NE
❑NA ❑NE
[DNA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: - Date of inspection:
Waste Collection & Treatment
Yes
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
E
❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
allo
❑ 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
[E'No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
Ilryes
[:]No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
0 o
❑ 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
E Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[ o
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [5-Mo ❑ 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): ,� / �f_
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?
0 es
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[,io
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
O'igo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
[ o
❑ NA
❑ NE
Re aired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[D'14o
[] NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�o
❑ 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 D-114-0
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V 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 ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
' 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 provide documentation of an actively certified operator in charge? ❑ Yes Q No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �o
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?
7, 14DJ&
Reviewer/Inspector Name:
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [E No ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
❑ Yes [a —No ❑ NA ❑ NE
❑ Yes [ o ❑ NA ❑ NE
❑ Yes E3-No
Yes ❑'No
a Yes [:]No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone:
Reviewer/Inspector Signature: — Date: Ove -
Page 3 of 3 21412015

Date of Visit: Arrival Time: I 1Z .' 00 1 Departure Time:=County: �54yo - —Region:
Farm Name: mvt G.
Owner Name: "Owe
Mailing Address:
Owner Email:
Phone:
Physical Address: �L: xa7 UWK 42EO� %
Facility Contact: /j? : Gk�� ( Nl L �� y Title: W n �,.• �/ Phone:
-i
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator: r r— Me
Location of Farm: Latitude:
Certification Number: / oc7 p Y 1 .'(ram Z
Certification Number-
Longitude:
Design Current
Design
Current
� ��
Design-
Current
Swine Capacity Popp.
Wet Poultry �: Capacity
Pop.
Cattleapacity
Pop.
Wean to Finish
Layer
HNon-Layer
Dairy Cow
Wean to Feeder
Dairy Calf
Dairy Heifer
Feeder to Finish
tTc
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
ll P,oultc
Ga ac'
Po .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
Boars
IL
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
10ther
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)?
[Z Yes ❑ No ❑ NA ❑ NI:
s
❑ Yes n No ❑ NA ❑ NE
[:)Yes ®-No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) E 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 PLNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

' Facility Number: -fjDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
ElYes
❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
EZ�No
❑ NA
❑ NE .
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): ; 9
Observed Freeboard (in): %
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
EA 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
[S 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
[3No
❑ 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
�KNo
❑ NA
❑ WE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. (j Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Windo ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
:3.
2. Cro Type{s): (/r �r�V J Soil�lype(s): C
14. Do th�receiving crops differ from those designated in the CAWMP? Yes [:]No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes EjjNo ❑ 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 allo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. oes record keeping need improvement? If yes, check the appropriate box below. 01Yes ❑ 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 E�J.No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [allo
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

lFacillity Number. - Date of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M No ❑ NA ❑ NE
1
25. is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes JS 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
UNo
❑ 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
[g No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[Yes
❑ No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
E�[ 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
C,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?
f�j Yes
[] No
❑ NA
❑ NE
�a
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_ . vse;a,., _rdona pages as, necessary
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Reviewer/Inspector Name: �p _ Phone: ID-.323—off{
Reviewer/Inspector Signature:
Page 3 of 3
Date:-
2/4/20I5

`Division o#Water Resources
FacilityNu�berr_ - ® Division of Soil and Water Couservatian
- ram,- - � Other Ages �c3'
Type of Visit: GrCompliance 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: •pt_ Region:
Farm Name: -- / yi p, -T _ -7n
Owner Name: (TU h V,
Mailing Address:
Owner Email:
Phone:
Physical Address:
Facility Contact: L( Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number: A
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
= Design Current Design Cnrrent
Design C►urrenr
Swine = ;apacity Pop. Wet Pauttry Capacity Pop.
Cattle Capacity Pop.
Wean to Finish jLayer
Dairy Cow
Wean to Feeder Non -La er I I
Dairy Calf
Feeder to Finish
4.
Dairy Heifer
Design Current
D Cow
Farrow to Wean
Farrow to Feeder
a city,
Dry, P,oul 6.0i Pao .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
WM
Turkeys
Q e
H14 .,,
TurkeyPouets
Other
-
Other
Discharaes and Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes allo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ 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 I of 3 214/20I5 Continued

Facili Number: - Date of Inspection.
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Eff.No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 119,
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
J&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
Jallo
❑ 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
C4 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
[aNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
M-No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes CgNo ❑ 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):
all-"
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
® No
❑ NA
❑ NE
❑ Yes
®,No
❑ NA
❑ NE
❑ Yes
CZ No
❑ NA
❑ NE
❑ Yes JDNo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes JR] 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 [Z 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 L!-No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes 2� No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: jDate of Ins ection:
J
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA ❑ NE
+ 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
Z No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
KNo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [allo ❑ 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 R 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
[Z 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
jo_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
[E.No
❑ NA
❑ NE
Commeii.-s.
is refer to quest,o ) EB.z lo-any Y�answ.,�'&and/or any addit:tonalt mmendations ar`any othUse_ddrawmgsjflffacifetytoltietter�explain sitvatiaddihonal pagesas'necessa_ry,) _
Reviewer/Inspector Name
Phone: `r/D /�33= 33C>n
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412015

Date of Visit: Arrival Time:5/77_0_0_1 Departure Time: ; 00 County: Region:
Farm Name: n?Srr __JL_ J'—,i G, Owner Email:
Owner Name: , h"t M C., 6�p cy Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator: d
Certification Number:
Certification Number:
Longitude:
Design Current
Design Current
Design C►urrent
Swine Capacity Pop.
Wet Poultry
Capacity .:::Pop.
Cattle C►apacity Pop.
Wean to Finish
Layer
airy Cow
Wean to Feeder
Non -La er
I
a Calf
Feeder to Finish
r`-" :_
Dai Heifer
Farrow to Wean
Design­Carrent
Dry Cow
Farrow to Feeder
I) . 1?o_u1
Ca aci Po :.
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Soars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Puults
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 DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
0 Yes [SNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes No ❑NA ❑NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [:]Yes [—]No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes JK No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3
21412014 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
Yes
[] No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
V[No
❑ NA
❑ NE
Structure l 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
® 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
r" No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes „® No ❑ NA
❑ 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): 'gwlxa4! c / GV Ll
13. Soil Type(s): L _1 I- y / G
❑ NE
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
� No
❑ NA
❑ NE
l5. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
®,No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
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 ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Q No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes RNo
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of Inspection: /&)­9L-
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E2 No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[] Yes
5INo
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey El 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
0 No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
E�LNo
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E] 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
allo
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[A No
❑ NA ❑ NE
Reviewer/Inspector Name: 521,
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date: /d — v;7-6 /J-
2/412014 I

1
k
Date of Visit: Arrival Time: Departure Time: County: Region: J� /7—
Farm Name: 3 In 15
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: ,gH r.' j-y Title: j Phone:
Onsite Representative: J Integrator: rr
Certified Operator: ��../l`7 Certification Number: %la 7C7
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity Pop.
Cattle Capacity Pop.
Wean to Finish
ILayer
Dairy Cow
Wean to Feeder
I INon-Layer
Daiff Calf
Feeder to Finish
Z)
^`
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
D . P,ault .
Ca aci l?04 .
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
... „
Turke s
tither
Turkey Poults
Other
Other
Discharges and Stream Imnacts
1. is any discharge observed from any part of the operation?
[:]Yes
5jNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2_ Is there evidence of a past discharge from any part of the operation?
❑ Yes
5kNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[RNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

` Facility Number: jDate of Inspection:
Waste Collection & Treatment
s 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes [4 No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? [] Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �jNo ❑ 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 21 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 [g 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 fo 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 [X No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > I0% 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): j3e,/-/4'0 e~ /n '-h / W/ r'0yL � 7� s
13. Soil Type(s):
L- .P1 -
14. Do the receiving crops differ frot� 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?
❑ Yes E] No ❑ NA
❑ Yes ®,No ❑ NA
❑ Yes [3No ❑ NA
❑ Yes No ❑ NA
[—]Yes No ❑ NA
❑ Yes 2 No
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [a No
the appropriate box.
❑WUP [—]Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �allo
❑ 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 allo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ® No
❑ NA
❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: a -I Date of Inspection: /L/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes O_No ❑ NA 0 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?
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?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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
E, No
❑ NA
❑ NE
❑ Yes
[allo
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
[:]Yes " No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes Eg No ❑ NA ❑ NE
❑ Yes [A 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 f ;,,i4.,'
Usedrawings of facility. -to better explain situations. (use additional pages as necessary).
Reviewer/Inspector Name:
Phone: 9/f
Reviewer/Inspector Signature:
Page 3 of 3
Date: /
21412011

Type of Visit: ompliance Inspection n Operation Review Q Structure Evaluation p Technical Assistance
Reason for Visit: 01 routine O Complaint O Follow-up O Referral O Emergency 0 Other 0 Denied Access
Date of Visit: I / _/ Arrival Time: p0 Departure Time: ,` D County:Region:
Farm Name: Owner Email:
Owner Name: —/ro A B /7? C p y Phone:
Mailing Address:
Physical Address:
Facility Contact: h n d &22Z Title: Phone:
Onsite Representative: _ Sly Integrator:�� �a Svc Lf
Certified Operator: ,_grq_0)'1 Certification Number: gg(aO (ate."_
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Currenf Design Current
Sw111111,111111 apacity Pop: Wet'Poultry Capacity Pop:' = Cattle Capacity Pop.
Wean to Finish Layer Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
a
Design C.
Dl. l;ault . Ca aci P,o .,
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Layers
-
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other 11IFTother
Turkeys
Turkey Poults
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[0 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b_ Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
0 No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
ZFNo
[3 NA
[] NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

jFacWty Number: 2 - jDate of Inspection:
--/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No
❑ NA
[] NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
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
0. No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or 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?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[] PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑/ Evidence of Wind Drift ❑ Application Outside/of Approved Area
12. Crop Type(s): h-&lMdee, 1DVer-�YA
13. Soil Type(s): LRo
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ELNo ❑ NA ❑ WE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes U No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes CZ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑Yes CANo ❑NA ❑NE
Required Records & Documents
l9. 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 to 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 Ej No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: --l3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes EA 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 EgNo
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 [:]Yes ® No
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
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 V) No
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 64 No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32, Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Ej No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes Q No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes Ml No
❑NA ❑NE
[] NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
JComments (refer to question #) Explain any YES answers and/or any additional recommendations or any other comments. #
U"kawings of facihtV to. better ezplam situations (use additional naves as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

type of Visit: G-evih- pliance Inspection 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: G—/ —/ Arrival Time: ? aD Departure Time: '! County:r-- Region:�
Farm Name:�LnG-
Owner Name: PI. 1%7G o y
Mailing Address:
Physical Address:
Facility Contact:Title:
Onsite Representative: ^ 5'
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: 21/:'/yr,2 �7/
Certification Number:
Location of Farm: Latitude: Longitude:
e
gllill Design CurrentCD sign Current
Design
Cnrrent
Swine Capacity Pop. Wet Poultry pacify Pop.
Cattle Capacity
ME
Pop.
.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Dairy Heifer
Feeder to Finish
I -rw
Farrow to Wean
Design Current
Cow
Farrow to Feeder
D . P,ou1 Ca aci. P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Turkeys
Other
Turkey Pouits
Other U
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[RNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[:]Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
0 No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
N 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 I of 3 21412011 Continued

[Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ® No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or 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?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): Ll. �le"� A
11
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[—]Yes
[R[No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[3-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 Q No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [] Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking [] Crop Yield ❑ t20 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [K No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: —
1
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[:]Yes
No
❑ NA [] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
Yes
❑ No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
ONon-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: Leg
..� ra
IZ)
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
[3 No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
®No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes R No ❑ NA ❑ NE
to Yes ❑ No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes FV_1 No
❑ Yes JA No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refe-r to question #): Explainany YES answers and/or any additional recommendations or any other comments.
Use drawings of facility; to"better�explain situations (use additional pages as.necessary)v `
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: 5�/'q joa--3:Tcl�'
Date:
21412011
Page 3 of 3

Type of Visit: Compliance Inspection O Operation Review C) Structure Evaluation O Technical Assistance
Reason for Visit: Q outine 0 Complaint Q Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: �� %�� Arrival Time:Departure Time: ' O a County: Region:
Farm Name: /P23 hG . Owner Email:
Owner Name: 19 4.L- Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:/
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current
Design C*urrent
_ Swine =anNCi�WpOp.
Wet Poultry
Capacity
Pop. '
Cattle Capaci# Pop.
.,
Wean to Finish
La er
Non -La er
Da' Cow
Da Calf
Dairy Heifer
Wean to Feeder
ceder to Finish
too
Farrow to Wean
Dr, P,oult .
Design
Ca aci
Current -
Pho
Dry Cow
Non -Dairy
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Pullets
Turkeys
_
Beef Feeder
Beef Brood Cow
Boars
Other
Turkey Poults
ML
Other
Other
Discharges and Stream Imvacts
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 S No ❑ NA ❑ NE
Yes ❑ No ❑ NA ❑ NE
[] Yes ❑ No ❑ 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 El No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 54 No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: EK - Date of Inspection: fY
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?: -
Designed Freeboard (in):�
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
t2�No ❑ NA ❑ NE
❑ No [] NA ❑ NE
Structure 6
❑ Yes $allo ❑ NA D NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
ELNo
❑ 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
allo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[No
C] 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
D4No
❑ 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 FLNo ❑ 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): � ea jr4fe—e Z6�,i"Td�/"Vr'-A_ —•- —
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [5�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 0 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
❑ Yes 5g No ❑ NA ❑ NE
❑ Yes tE No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes hZj_No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes [gNo ❑ 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 FNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V 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 a No
DNA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo ❑ NA ❑ NE
25. Is the facility out of compliance with pernvi conditions related to sludge? If yes, check ❑ Yes bg-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 0 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
❑ Yes
50 No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
®, No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
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
a] No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
RA
❑ NA
❑ NE
Use drarvings of facil ty tol tiefter ezpiaincs tu�Comments (refer to question hons (use additional pages as necessary}, swers and/or mendations or any otlecomment`s�`
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: /rya
21412011

i
Type of Visit VZ�o- m`�pliance Inspection O Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit �Koutine O Complaint Q Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: b — p Arrival Time: �, a7C� Departure Time: County: _-- Region:
Farm Name: ,')r [f`T_-T7nG. Owner Email:
Owner Name: , 1 �2,1 _1S rn r f'iZY Phone:
Mailing Address:
Physical Address:
Facility Contact: fir► �f Title:
OnsiteRepresentative:
Certified Operator: V• IM n
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: R-62 ZC0
Back-up Certification Number:
Latitude: 0 0= 4 Longitude: 0°== u
Design Current
Design Current Design Current
Swine
Capacity Population 'Vet Poultry
Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
ID Non -Layer I
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
FDry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Layers
❑ Non -Dairy
❑ Farrow to Finish
❑ Non -Layers
❑ Beef Stocker
❑ Gilts
❑ Beef Feeder
❑ Boars
❑ Pullets
El Beef Brood Cowi
❑ Turke s
Other ❑Turkey Poults
❑ Other I0 Other
Number of structures:
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? (I f 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 [X No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
JX No
❑ NA
❑ NE
El Yes
®No
❑NA
❑NE
Page 1 of 3 12128104 Continued

Facility Number: — Date of Inspection c7
• 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
❑ Yes ANo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 1
Observed Freeboard (in): (�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
J,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
FK[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 El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
® No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) L-r-D �'�r� ��� � 17�1� �� l nx mci��-�
T
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[&No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[Z 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
N No
❑ NA
❑ NE
=`F. - -.•-y'k`—� T:KS'_'J.sk .lt. -.': 46 '.
Comments (defer to•ejuesfwon#} ,Explain any YESansRers and/orfany recommendations ar ady,other comments.
, tUse drawings of fact[itv3to betterexpfa�nsyti�ahons"{use add�honai pages�as?necessary)
pofC r " " D u- r D&C '4,9/19
T
Re-viewer/Inspector Name Phone: D-a
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 uonfrnueu

Facility Number: -Pr &f I Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes BNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Q 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 KNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
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
E[No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
OR No
❑ NA
❑ NE
❑ Yes
[RNo
❑ NA
❑ NE
❑ Yes
®.No
❑ NA
❑ NE
❑ Yes
9,No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ®, No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes E& No ❑ NA ❑ NE
❑ Yes
5a No
❑ NA
❑ NE
❑ Yes
59yo
❑ NA
❑ NE
-
Additional Comments aQd/or Drawt,.a s ;
AL
Page 3 of 3 12128104

,t
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up 0 Referral 0 Emergency 0 Other [I Denied Access
Date of Visit: Q Arrival Time: Departure Time: 3� County: UdP^-Region:%��
Farm Name: 3 MS 4- T )Y1C, Owner Email:
Owner Name: D-ohn _ MC K Phone:
Mailing Address:
Physical Address:
Facility Contact: n l-Title: Ek", H4494 Pi^ Phone NotZ0k Qq__ �
Onsite Representative: 4f Integrator: V�r
Certified Operator: h-e 6,1 T Operator Certification Number:
Back-up Operator: U Back-up Certification Number:
Location of Farm: Latitude: o Longitude: = ° u
Design Current{ Design Current:
Desigp Current
Swine
Capacity Populat on Wet Poultry Capacity Po elation
Cattle Ca ac't Po elation
❑ La er
❑ DairyCow
❑ Non -Layer
❑ Dai Calf
.Eg❑
DairyHeifer
Dry Poultry
❑ D Cow
❑ Non-DaiEy
❑ La ers
ElNon-La Non -Layer
Beef Stocker
El
Pullets
Beef Feeder
El Beef Brood Ca
4., ❑ Turke s
Other
(] Turke Poults
❑ Other
❑ Other
Number of Structures:
❑ Wean to Finish
El Wean to Feeder
Feeder to Finish
�
[I Farrow to Wean
El Farrow to Feeder
Farrow to Finish
❑Gilts
❑ Boars
Discharges &Stream Impacts
1.
Is any discharge observed from any part of the operation?
❑Yes
JRNo
❑ NA
❑ NE
Discharge originated at: El Structure ❑Application field El Other
a. Was the conveyance man-made?
El Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
El Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[I Yes
;@ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
CKNo
❑ NA
❑ NE
other than from a discharge?
Page l of 3
12/2$/04
Continued

1
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes PNo ❑ 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 CRNo []NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 'RNo ❑ 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? I -Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes RNo ❑ 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 DiNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 'R No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Wo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 1 o lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. uo the receiving crops aitter from [nose aestgnatea to Me UAwMF7 LJ Yes
I2d No
LJ NA
U NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
RNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
M No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
�RNo
❑ 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 answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
-
f
ReviewerlInspector Name MAU ScA Y IER — Phone: +�
Reviewer/Inspector Signature: Zk&Date: Don
V 12128104' - Continued

j
Facility Number: Oq —(j Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Dallo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes tR No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑Design ❑Maps ❑ tither
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 V Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
CR No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
5 'NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
IRNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E'No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
JRNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ERNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
5"No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Et 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
9No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
($No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[RNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
El NA
❑ NE
-7,f )e6e_ YvD- k. of 6L -fie w ba-esf04S ch �JO07 D� cc j Co�� i s' )1e bock
►, P14je'o ""a I I" ro, i ns fec- 06o
I Ov" 1l weld kept-- ter 4 M&zt5 eff0?- - 0.r pub 0bVv'e,
I212VO4

Facility No. Cq-004k Farm Name 3Hsq _ _ Date
Permit COC OIC, NPDES (Rain breaker PLAT Annual Cert )
Pop.Type Design
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Ia to
Sludge Depth ft & %
Liquid Trt. Zone (ft)
IGIG14I<1. 1021
Design Rm-
Design
Lo') lat h
Soil Test Date f
pH Fields
Lime Needed
Lime Applied
Cu ✓Zn
Needs P
Crop Yield
Wettable Acres
WUP
Weekly Freeboard
Rainfall >1" &I 0) a0d�
1 in Inspections
120 min Inspections
Weather Codes
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
. Ile
IN Amt (lb/1000 Gal)
Pull/Field
Soil
Crop
RYE
PAN
Window
Max Rate
Max Amt
c)
�f
Q
[�a
F
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm
FRO or Farm Records
Lagoon #�
Top Dike
Stop Pump
Start Pump 53,
50.E
App. Hardware

Type of Visit 9 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit_W Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 0q'30 Departure Time: i t}S County: Region: Fkt)
Farm Name: T T11 Owner Email: r 3
f
Owner Name: V (�hh ,,, I �C� Phone: 9ID SS � i—,�i qz
Mailing Address: 55S NCLPda , _ 1E11Wk � N - C _ _ D933:2
Physical Address:
Facility Contact: Kkr+Clh Altr4 Title: Phone No: 0 83�O
Onsite Representative: Integrator: b1Gr_Ln'LS� _
Certified Operator: _%Ima V Operator Certification Number: >Al6a7
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [�J o [::] ' [::] Longitude: 0 o
Design Current'
Design Current,: - Design Current
Swine Capacity Population
Wet$Poultry Capacity . Populahon Cattle k Capacity Population
❑ Wean to Finish
Layer
❑Dai
Cow
El Wean to Feeder
❑Dai
Calf
eeder to Finish
JONon-Layer
y3
l
❑
❑
Dai Heifer
ElFarrow to Wean
D Cow
ElFarrow to Feeder
`"
❑
Non -Dairy
❑
❑ Farrow to Finish
❑ Layers
Beef Stocker
❑ Gilts
❑ Non -Layers
f Feeder
❑Bee
El Boars
El Pullets
El Turkeys
❑Beef
Brood Co
-
Other
❑ Turkey Poults I
ifi*
-�
❑ Other
❑ Other
Nirmber'of=Structures:
,
6.15ULL r
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes C9No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man -trade? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes &No ❑ NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes SirNo ❑ NA ❑ NE
other than from a discharge?
Page 1 of 3 12128104 Continued

r
Facility Number: — Q► Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes I] No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _ �q
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
W No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
i,
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
RNo
❑ 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? JaYes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
§4 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
W No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
N No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
10 No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 lbs ❑ 'Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
TH No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
9 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
I@ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
El No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
9 No
❑ NA
❑ NE
Reviewer/Inspector Name S I Phone:910 433-XAD X3X33
Reviewer/Inspector Signature: Date: 91U)S
-a---r -

4
Facility Number: Og — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes 5allo ❑ NA ❑ NE
the appropirate box. ❑ wup ❑ Checklists ❑ Design
g El Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. FXJ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking 51 Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes R No ❑ NA ❑ NE
23, if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No 52 NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
t3 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
29 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
RNA
❑ NE
Other lssues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
R No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
R) 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
Q9 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
N No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ONo
❑ NA
❑ NE
Additional Gommei is and/or Drawings: .� "` s"' A N
7, k�e� wkon I iaon cover, +IDs- o lc+ of wens} no'��
al. Now kfI crof yreldi Flan f411 arb-) �yr+h o-fw*reavdjo
rf}9 c hAje of'-o1c, Lef+ *ms wN'h kf_nnt*.
Dn-'hf whol? yve11 m4 1f4a &t 4mf 4 rewo
Page 3 of 3 12128104

Facility No. QQ-d04Y Time In _ _. Time Out
Farm Name 3 �'if47' _ Integrator
Owner Site Rep _
Operator
Back-up
COC
No.
No.
Circle: General or NPDES
Date aWto $
Design
Current
Design
Current
Wean — Feed
Farrow — Feed
Wean — Finish
Farrow — Finish
Feed — Finish
Gilts / Boars
Farrow — Wean
Others
FREEBOARD: Desig a jQLT=4Pj
�
Sludge Survey
Crop Yield 2.60TS
Rain Gauge
Soil Test
/
Wettable Acres
Weekly Freeboard ✓
Daily Rainfall %,/
Spray/Freeboard Drop
z
Weather Codes ��
120 min Inspections _
Waste Analysis:
Date
Nitrogen (N)
C
lab
�lq
Observed
Calibration/GPM `/" /
Waste Transfers 0 1
Rain Breaker
PLAT
1-in Inspections
Date Nitrogen (N)
Pull/Field
Soil
Cr"
Pan
17Q/�I"I.,
{/ fWindow
Ue
S6 On
l'♦�
Can
S
30d &-

vision of Water Quality Facility Number 0 Division of Soil and Water Conservation
- 0 Other Agency
Type of Visit
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
..��ompliance
rom�utine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: - -Arrival Time: Departure Time: (t717 County: Region: rKD
Farm Name: Owner Email:
Owner Name: k I C-KD Phone:
Mailing Address:
Physical Address:
Facility Contact: K Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: lvC me - Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [= 0 0 6 = « Longitude: 0 ° 0 , = "
Design Current
nwrne Capacity copulation
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish e7
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Nan -La ec
Dry Poultry
❑ Lavers
❑ 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
Cattle Capacity _1
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Neifei
❑ Dry Cow
❑ Non -Dairy_
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Co
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)?
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?
A
❑ Yes [K No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
[]Yes
ZNo
[:]Yes
E4No
❑ NA
❑ NE
❑ Yes
;R No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�K No
❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): f
Observed Freeboard (in): 3 (Q
5. Are there any inunediate 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
JZ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
J;j 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
N No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
®.No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
/
u
13. Soil type(s) A z1f14Z ZXD
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�Z No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
10 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
[2 No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
1Z 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):
CA Cawi'a-f �V�-- e-11 �.r u�L�i 1Z� { ar`ih� 0'`6�—
Reviewer/Inspector Name Teve Phone: 222t:4%33,3300
Reviewer/Inspector Signature: Date: ,T—a2 T4Apy7
12128104 Continued

a
Facility Number: — Date of Inspection —r7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JZ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes NJ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ® Yes ❑ No ❑ NA ❑ NE
XWaste 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
a 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?
❑ Yds
O No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
14 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
2T Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
64No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EZ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
JN 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
ER 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
'9 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
JR No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
J@ No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Type of Visit &tbompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ' � Arrival Time: % Departure Time: �(7 C7 County: 94 04 Region:i4:::� 0
Farm Name: S3 /�l 493 � —77/IG 4 - Owner Email-
Owner Name; Phone:
Mailing Address:
Physical Address:
Facility Contact: ►" Title:
Onsite Representative:
-
Certified Operator:
Back-up Operator:
Phone No:
Integrator -
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e = I = K Longitude: ❑ ° ❑ I ❑ u
Design Current
Design Ourreut
Design Current
Swine Capacity Population
Wet Poultry
Capacity Population
Cattle Capacity Population
❑ We;; to Finish
❑ La er
❑ DairyCow
❑ Wean to Feeder
/ %
❑ Non-LayerMEN
❑ DairyCalf
❑ DairyHeifer
S.Feeder to Finish D
❑ Farrow to Wean
Dry Poultry.
--"'
"
❑ D Cow
El Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
❑ Non -Layers
El Beef Feeder
__Pullets
Turkeys
Other
❑ Turkey Poults
1E] Other
Number of Structures:
❑ Other
}ter
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
❑jNo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
J9No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
JRLNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

. Facility Number: Date of Inspection r�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [3,No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes allo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / f
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
allo
❑ 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
129 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
19 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[XNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
® No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
G
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
9No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
10 Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Vallo
❑ NA
❑ NE
.Comments (refer to question E.x lain an YES answers and/or an recommendat,ons or Any "other,comments'
q� p Y Y �. sy a h
Use drawings of:facility to better explain situations. (use additional pages as necessary]
Reviewer/Inspector Name
,T gw Phone:
Reviewer/Inspector Signature:
Date:
/ J 1— D G
Page 2 of 3 12128104 Continued

s
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes SNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
KNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[KNo
❑ 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
ff No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[gNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
JgNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ERNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EN 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
CR 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
E 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
ER No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
fallo
❑ NA
❑ NE
Additional'Comments and/or Drawngs
....: _ V �F�12 4 0
Page 3 of 3 12128104

Type of Visit Ifompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Foliow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ILJ Arrival Time: ® Departure Time: t9 ',3 1J I County: Region: FE7D
Farm Name: -L- G Owner Email:
Owner Name: ri P1 ' _._ /%'l �' ISO y Phone:
Mailing Address: ���, L ��..�_ d�% e-
Physical Address:-�— __-
Facility Contact: _ k m n n e 74it.�E -f Title:
Onsite Representative: srr
Certified Operator: JD,-- L a2a r
Back-up Operator:
Location of Farm:
/PhoneNo:
Integrator: r sir oll.el
Operator Certification Number:
Back-up Certification Number:
Latitude: [= e = = u Longitude: E__1 ° Q 1 = "
Design
C►urrent
Design Gurrent Design Current
f ,
et Poultry Cla 'on Cattle Capacity Population
❑ La er Dai Cow
❑ Non -La et ❑ DairyCalf
<:' ❑ Dairyheifer
w
❑ D Cow
Dry Poultry }.. ��.�
'`� ❑ Non -Dairy
❑ Layers
❑ Beef Stocker
Non -La ers ElBeef Feeder
❑ Pullets
El Turke s ❑Beef Brood Cowl
❑ Turkey Poults
❑Other Number of Structures:t'
an toFinish
r
an to Feeder
[Feeder to Finish
p�
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Gilts
PCI Boars
-
O_ tl
-
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
W No
❑ NA
[]NE
❑ Yes
9LNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
® No
[--]Yes J4No ❑ NA ❑ NE
[:]Yes O No ❑ NA ❑ NE
11/18104 Continued

Facility Number: — Date of Inspection — 3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes R No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [fjNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): q
Observed Freeboard (in): oZ
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
[L 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
E4 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
EqNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
0 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
Vq No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
ER No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) x�rrn,ud� tta- /f"�scuY ft�/wly "/SDKs /�S1�a-GtC�,�a; t /Gam
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
4 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
❑ No
❑ NA
❑ NE
i 6. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`
❑ Yes
rq No
El NA
El NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
MNo
❑ NA
❑ NE
0 T-. I_ion .-- a,5
Reviewer/Inspector Name �STr�r r� u e t ,' Phone:
Reviewer/InspectorSignature- Date:
12128104 Continued

r
1 �
Facility Number: — Date of Inspection
Required Records & Documents
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 5jNo ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design
g ❑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 V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
L,No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
(9 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
[9 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
[KNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
M No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[9 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
KNo
❑ 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
LRI 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
EQ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
'Z No
❑ NA
❑ NE
l2/28/04

v
(Type of Visit 40 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit • Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: i t - _59f70 Time: /
O Not Operational Q Below Threshold
Weruaitted WCertified © Conditionally Certified 13 Registered Date -Last Operated or Above Threshold:
Farm Name: _ 3 /i_..._...f. T.^c . County.
Owner Name: rs /j?G �oY _ Phone No:
Mailing Address:.. SS S Ine- L ca R ae.
Facility Contact: _ Lmar ___—_ 4e Title: Phone No:
If
Omite Representative: iai...��/1�.. /Q .7 Integrator: , 1:�,a rl, a
Certified Operator.. Q_, t�� G .& Operator Certification Number:%4 =2r;,
Location of Farm:
A.
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• Imo" Du
Discharges & Stream fmpacLS
1. Is any discharge observed from any part of the operation? ❑ Yes QNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes [moo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes o
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes [tNb
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 9i'CvO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes aDlo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ello
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Idenrifier I _
Freeboard (inches):
12112103 Continued

• I Facility Number: j - ,Jq Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
0-K'o
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
®.Nd'
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
MWO
❑ ❑ FTcebecd ❑-Sei pli -
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑o-
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
9N10
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
(ie/ discharge, freeboard problems, over application)
KKK
27, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[- ITO
28. Does facility require a follow-up visit by same agency?
❑ Yes
ONO
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
014'o
NI MES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
51-w
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
l2/I2tO3

Facility Number: qj —Cfy Date of Inspection ! -u
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [.}
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes EWO
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!unprovement? ❑ Yes 0o
S. Does any part of the waste management system other than waste structures require maintenaneelimprovement? ❑ Yes & Wo
9. Do any sawtuures lack adequate, gauged markers with required maximum and minhinurn liquid level
❑ Yes
Q'Ro
elevation markings?
Waste APRhCdtiOA
10. Are there any buffers that need maintenance/improvement?
❑ Yes
[y Ko
1 I . Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
03'No
❑ Excessive Ponding PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
//❑
12. Crop type ���..� FCs�t/r, (ISo"Zo,_, c 0 ofa�`,.,
vd/
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
eico
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
Eli
16. Is there a lack of adequate waste application equipment?
❑ Yes
EW6
Odor issues
17. 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?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
M�lo
19. Is there any evidence of wind drift daring land applicaiian? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
ff 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.
;lit drawsuags c�F>►-xo iE*� so�s..(�se �-p�s�s Syr. � p.Y�iela copy p �inat xotes "-
•
E
iewer/)�tor Name
iewer/Inspector Signature: Date: Y-
12112M Continued

Facility Number hate of Visit: -Z3 -0 Time: 2%�
rO Not Operational 0 Below Threshold
Xpermitted [3 Certified C] Conditionally Certified [3 Registered Date Last Operated Above Threshold:
Farm Name: I`s / / 4y'+"L County:
c- yyz3
Owner Name: _. �� Phone No:
Mailing Address: " 'rs-S L' e _ �li Z��e Lrlw,r.AAZ ZF-3—?7
Facility Contact: „ �eais[_et� Title:
Onsite Representative: d/ d e
Certified Operator:
Location of Farm:
CPhone
[No: �j r
Integrator: �r�l es1 _M/I_�- _C�rs
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • � �" Longitude 0 °
Design
Cur ntg Design Curient Design Current
Swine CIon ci
- Ca_tile Ca aci Po elation
i?o Mahon P,oulfry Ca acity P,o nlatioIt
Wean to Feeder
❑ Layer ❑ Da"
Feeder to Finish zi
;,; ❑Non -Layer I 1 10Nan-Dai
-"
❑ Other
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
_-. = Tot P esign Capacity.:. pZlj
❑ Gilts
_ s
rT[►tal SSLW
❑ Boars
Number of Lagoons I� ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
-- Drains .
Holding Ponds / Solid Traps ❑ No Liquid Waste Management S stem
Discharges & Stream Imoacts
1. is any discharge observed from any part of the operation? ❑ Yes PNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 1�No
2. is there evidence of past discharge from any part of the operation? ❑ Yes FZNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes N No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure G
Identifier:
Freeboard (inches): 3
05103101 Continued

Facility Number: N 2 -ZLI Date of Inspection
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste AnolicatiQn
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive PorW ing ❑ PAN ❑ Hydraulic gverload
12. Crop type
13. Do the receiving crops differ with those de gn (ed in the Certi
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
Plan (CAWMP)?
16. Is there a lack of adequate waste application equipment?
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(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?
❑ Yes [(No
❑ Yes go No
Oyes
❑ Yes D(No
❑ Yes jK No
❑ Yes )<No
❑ Yes ❑No
❑ Yes OKNo
❑ Yes to
o
ElYes
Xyes ❑ No
❑ Yes No
❑ Yes ;KNo
❑ Yes 4 No
❑ Yes J9 No
❑ Yes V No
❑ Yes 0 No
❑ Yes V No
❑ Yes No
[IYes lNo
❑ Yes ❑ No
10 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
�,e¢
Comments (refer to question � Expiam any�YES answers�and/or any recommendahans or any otherycomments; .
Use draRzngsof tactility to better ezplam srtaai ans.(nse addrtennal�pages as necessary)
�g ❑Field Copy ❑Final Notes
107 New 4 e,4tKke s -{a emir frs�e-- G- �cr �� �. ���.
rs •sf- .�� tr�1kt k0.s a-(ZaI sad -Me-re ;T (�I.11a la of
\4
Qas..p�&4a'ii�1► WIA- �r 4�s4 wlceatr. (C rQ!-ft aQJe4rTA tft-1
'L �11i-i
LIA Y►RS Very 1 t ff lG berwi wdcZ c LL,4 4 doq i e'f C a e !
Kp
Sp: ke
nv
Reviewer/Inspector Name .:? k- 4L6,
Reviewer/Inspector Signature: t 71 Date: JAP23
05103101 V f Continued

Facility Number: Q — Date of Inspection
Odor Issues
X Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes [INo
liquid level of lagoon or storage pond with no agitation? "''���CCCC\\
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ANo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes —
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes 1KNo
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 zo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments and/or Drawings.,
e,
�tie�e is u� b�.. u.oC� mot,; - : ,� ¢ � .� j� • N
05103101

C.. — —. \
W�
2
.-WADUWsionof aterQuality
0 Drv�sion of Sort and Water Conservation
ohi�e
-00thirAgency.1—
Type of Visit *Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit &Routine OComplaint OFollow up 0 Emergency Notification 00ther 0 Denied Access
Facility Number Date of Visit: 1�� Time: 1� Printed on: 7/21/2000
rO Not Operational OBelow Threshold I
IPPermittedECertified El Conditionally Certified 13Registered Date Last Operated or Above Threshold: .........................
FarmName: ........ ; /.....—....... .....7 Z;� .....................................................countv: ....... ........................ .......................
Owner Name: ......... Phone No: ..................
. .... ...... . ........... .........................................................
......... .
Facility Contact:
Title:
Mailing Address: ...... S- ... .. ....... d—lez'
Onsite Representative:.... .................................................
Certified Operator:........ ....... /0154� .......................................
Location of Farm:
PhoneNo: ...................................................
..........
Integrator:
Operator Certification Number:
[3 Swine [3 Poultry 0 Cattle 0 Horse Latitude Longitude
DtAgn Cuiiie6t -C&fteimt Deii6i urrent. t
Sivineillation
_Calikaty, ftpi
Wean to Feeder
Feeder to Finish
1-,9.2o
Fazmw to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? []Yes JU No
Discharge originated at: C] Lagoon E] Spray Field E] Other
C�
a. If discharge is observed, was the conveyance man-made? ❑ Yes 9[No
b. If discharge is observed. did it reach Water of the State? (if yes, notify DWQ)
El Yes No
c. li'dischaT.-c 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? E) Spillway
Structure I Structure 2 Structure 3 Structure 4
Identifier: .... 11-1-27.1 ....... .................................... ................................... .............................
I ... .... .....
Structure 5
0 Yes RNo
[-] Yes x No
0 Yes XNo
Ej Yes allo
Structure 6
Freeboard
5/00
Continued on back

r
i
Facility Number: Q g— Date of Inspection 0 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 KNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ELNo
(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
*0
8.
Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
,kNo
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
RNo
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
allo
12.
Crop type �.Elcits 5_ �t4 �iP.P/.✓ --
— ..
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
PKNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
jjallo
b) Does the facility need a wettable acre determination?
❑ Yes
RNo
c) This facility is pended for a wettable acre determination?
❑Yes
allo
15.
Does the receiving crop need improvement?
XYes
❑ No
16.
Is there a Iack of adequate waste application equipment?
❑ Yes
9No
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.)
ement?
❑ Yes
B No
19,
Does record keeping need impr (ie/ irrigati�free'board, waste ana sis &soil samp el reports)
El Yes
®No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
5@ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
Eh No
22"
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
KNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[RNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
t9No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
;!�No
; NOM61atidris;ok- defieiene�ies -were noted ditririg this'visitt - Y;oo will-teeeive tit tutther - ....
corres};t deice. ahout. this .visit. .... " . • • • . • • • • .. . • • • • .
Comments (trier to question #) .any YES answers and/or any recomrmendations or any other cometents.
se,;of racility to. better:explata situations (use: additional:pages as necessary) r _'� t -'
......,.
7/v
/dam/f/ r///��
Oql Ors lea
Reviewer/inspector Name
Reviewer/inspector Signature:
Date: smo

Facility Number: 09 — 9 Date of inspection / 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 ❑ 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 jro
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes Wo
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 �Wo
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 gNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes IRNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes J�FNo
AdditioComments and/orDrawings:-- _ - - —
AL.
5100

(1) Division of Water Quality
Q Division of Soil and Water Conservation
_ Q Other Agency
Type of Visit ® Compliance Inspection Q 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 of Visit: p 3G2a7d Time: 8 %r'� Printed on: 7/21/2000
p
Q Not O erational Q Below Threshold
® Permitted ® Certified (] Conditionally Certified 0 Registered Date Last Operated or above Threshold: .........................
FarmName: ......... : ... .. ........................................................... County: ...... 1.3.L4.........."1...............................................
Owner Name: ............ Z. ... ..... C �................... .......... ............. I..................... Phone No: !a ...s �lff3.............................
L ..
I~acilitr Contact: 0- �� Z.
_ ............ ..................
......Title:
Phone No: ...............
19ailing Address: S�i� %7%�j1.��0
��asdl�.0 , i�
p
�O ���
........................ ........... .........
Onsite Representative: ... Integrator: L7 �i5+ie/4 .....
Certified Operator:!.c Operator Certification Number: ........... ............ _ ...............
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' Imo` �� Longitude
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder Zd ZV ❑ Layer ❑ Dairy
Feeder to Finish ❑ Non -Layer I ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons I ❑ Subsurface Drains Present ❑ Lagtwm Area ❑ Spray Field Area
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacks
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. lI'discharge is observed, was the conveyance man-made?
b. If discharge is observed. did it teach Water of the State" (If yes, noid—y DWQ)
c. If discharge is observed. what is the estimated Ilow in gal/ruin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes 0 No
❑ Yes RNo
❑ Yes ,® No
❑ Yes allo
2- Is there evidence of past discharge from any part of the operation? ❑ Yes Q No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? []Yes ®-No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate'? ❑ Spillway ❑ Yes OiNo
Structure I Structure 2 Structure Structure 4 Structure 5 Structure G
Identifier: ......... ...............................................................................................................................................
............... ....
Freehoard finches):
5100 Continued on back

A
Facility Number: Date of Inspection I Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed'? (ic/ trees, severe erosion, El Yes ®No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes J 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 P3No
8. Does any part of the waste management system other than waste structures require main tenance/improvement? ❑ Yes JR No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings'? ❑ Yes 9 No
Waste Application
10- Are there any buffers that need maintenance/improvement'! ❑ Yes Y9 No
11. Is there evidence of over application'? ❑ Excessive Ponding El PAN [I Hydraulic Overload El Yes P4 No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes N 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
WNo
15.
Does the receiving crop need improvement'?
Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
�'No
Reuuiml
Records & Documents
IT
Fail to have Certificate of Coverage & General Permit readily available?
Yes
❑ No
19.
Does the facility fail to have all components of the Certified Animal Waste Management.Pian readily available?
(ie/ WUP, checklists, design, maps, etc.)
10Yes
❑ No
19..
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
$Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
K No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
Ja 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 0 No
24. Does facility require a follow-up visit by same agency? ❑ Yes 20 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes t3No
:: �o violaliicjns:oi ifeficiencies wLere ngteci dikring ihis.visit' • Y64 will- . &bye fid fui-thtf
,correspondence: about. this vi' 't ' : :
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):
-sJ �'% li/55S/L /Sz
.d ,�by
Reviewer/Inspector Name
Reviewer/Inspector Signature: ,, il,. `~ ��` Date: e1j��2Q,0d 5/00

Facility Number: 5?- Date of Inspection 4 Z 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 ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 6No
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 54 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes CAM
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes RNo
lAdditionalCorn ents or Drawings:
5100

3 Division of $oel and`W
13 Dtvtston of $oiiI and W
_
Dii sion of Water Qua
_ t
Other Agency Opera
41
10 Routine Q Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review er
Facility Number Date of Inspection �nl
Time of Inspection 24 hr. (hh:mm)
[3 Permitted 0 Certified © Conditionally Certified [] Registered [3 Not Operational Date Last Operated:
Farm Name: ................ ....`.0 t�......a r! !r�..........................-........................-..- County:....:.......{�J-4.+�......'.�.........�....
Owner Name. -.--................11..!1.................... .............,�/fC............. .......... q� . 5gio'l
h /. ` .................... Phone No:..................�.......................................................
Facility Contact: ............ 05gi? I ................ Title:......... ---.......... Phone No:.................... -
Mailing Address: .7 r� /neLeQ �� ... ............... ............. ...............................................................1. ..
Onsite Representative: ...............Q................ Integrator: ................... r.........
Certified Operator:......... % /. t(......... V ........... Operator Certification Number:... .......................................
Location of Farm:
..................................................................................................................................................
J
Latitude Longitude ` =1 =I.
Design Current 4 Design CWirreot, Design :Current
:•Swine .. :.
Capacity Po ulatton ;' Poultry Ca achy. Po `ulation Cattle Capacity Pop,wagon,
❑ Wean to Feeder I[] Layer ❑ Dairy
`r
Feeder to Finish O.10Non-Layer ❑ Non -Dairy
Ej Farrow to Wean
❑ Farrow to Feeder ❑Other '
❑ Farrow to Finish - Total j1e5t C7 "_7cit oZD
El Gilts, P _ .Y : 9
° Boars
FTotal SSLW '
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: []Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes �] No
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes �No
e. If discharge is observed. what is the estimated flow in gal/min'? fffff14-
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I Structure ? Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ,I
Freeboard(inches): .............RI.................................................. .................................... ................................... ................................... ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes j No
seepage, etc.)
3/23/99 Continued on back

Facility Number: Q - Date of Inspection �S-
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes WNo
(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?
klYes
❑ No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
IKNo
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
No
1 I .
Is there evidence of over application? ❑ Excessive Pondin ❑ PAN
'
❑ Yes
Y(No
12.
Crop typece�j 4
13.
Do the receiving crops differ with those designated in the Certified knimal Waste Management Pl4n (CAWMP)?
❑ Yes
[/No
14.
a) Does the facility lack adequate acreage for land application?
VYes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
RNo
c) This facility is pended for a wettable acre determination?
❑ Yes
EXNo
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
9�No
RequiredAecords
& 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
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sam le re orts)
X Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[ArNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
[XNo
22
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes No
(ie/discharge, freeboard problems, over application) 19
23. Did ReviewerA n Spector fail to discuss review/inspection with on -site representative? ❑ Yes allo
24. Does facility require a follow-up visit by same agency? ❑ Yes [XNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ra%s �'No
0: Ito yWatidzis :or ft . ciencies -wire pgtea• d hfig t)lis;visit. • ;Y;oir .wi I •rebd*4e lid fui th�r • : • ; . /
corre5 &idence. about. this vlslt. '
a,
Comments; {refer to�questton #) .Ex}�latn any YES ansiwers and/or any recommendado s or any other eomiments"
Use drawings of facilityto;-better explaiin situations (use adcLtional pages as necessary)LL
6 vtt s#.w a tuark. An ems.
$ 14�vl ot Im
�JPP'41_ gtr
1q • ��NYI!j ►1 s Pcrn't .� iS ire. D t- re q a i �-C l�7enOro, Pew i r rwla`h
Reviewer/Inspector Name a '
+�trl
Reviewer/Inspector Signature: Q
Date: 6-Z-r- 9p I
3/23/99

Facility Number. Date oI' Inspection ' Y
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below Yes ElNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28, Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes 0 No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? `( ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? N ❑ Yes No
-- ttona I. omments an or- raw
% vac i1A1` 6 bew
lG% Wte
Aa" PJV
- �,;5 L �Y D {ire - vz-►n .
as S�ecc-�i OJ
IV
QS SP ec; t7~-q,-A Lbt
3/23/99

Division of Soil and Water Conservation ❑ 0ther A enc
Division of of Water Quality
O Routine O Complaint O Follow-up of DWO insptvtion O Follow-up of DSWC review O Other
Date of Inspection
Facility Number O
Time of Inspection : 24 hr. (hh:mm)
Registered IM Certified 13 Applied for Permit [3 Permitted 113 Not Operational. Date Last Operated:
JJ--11
Farm Name:.........%% ..�.o......2�`" County: ................... ..................
.................................................. Y� .................
Owner Name: %%ff jj J p UU !3
{„Gt� ... Phone No........ r ...... ........ .............��....... ............
Facility Contact: If' o ...... Title:
Mailing Address:
Onsite Representative: ....... ATTIC-A-0 .0.....
%,> ! ,rawL.....................................
Certified Operator ;..... �f.1.. I/° J
Location of Farm:
................................. Phone No: ...................................................
............ ...............
..............�.,
Integrator:......-.
Operator Certification Number:
Latitude •' " Longitude ' 61
;Design Current _.: Design Current Destgn> Currents:
Capacity.rPopulanon _ Poultry ..{ 'Capacity. Popuiati6n Cattle , . ~Capacity Populati6fi;
❑ Wean to Feeder
4❑
Layer
Feeder to Finish
Non -Layer
Fk
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
- g Tota[ Deli
❑ Farrow to Finish
❑ Gilts
wh. a
Boars
.........
JU Nan -Dairy) I
:a a
n Cavadt <N
�IVumber of � Doris 1 H61����i Ponds„ ❑Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area ., �,y.H.�.. �<...,. �; .,.�.,� . � x . � . � ���; .._. � a ,r� k ❑ No Liquid Waste Management System .�a f . ,. � . .
General
L
Are there any buffers that need maintenance improvement?
❑ Yes
,WNo
2.
Is any discharge observed from any part of the operation?
❑ Yes
QkNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
WVo
XKNo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
c. If discharge is observed, what is the estimated flaw in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
Q7No
3.
Is there evidence of past discharge from any part of the operation?
❑ Yes
KNo
4.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
KNo
S.
Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
''No
maintenance/improvement?
6.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Wo
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
OfNo
7/2SI97

i
- i►
Facility Number: d —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (LaQoons.11olding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1
Identifier.
Freeboard (ft): ... _.... 37
Structure 2 Structure 3 Structure 4
10, Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenancelimprovement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Structure 5
Waste Application
14, Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ......O....Riwk....-�in.�'�!/.�.........................................................................................
Y...................... .....
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0; No.violations_or. deficiencies.were:noted during this.visit.• Yo'U"Will recei'ye.no.ftirttier ::
corresppndenee about this:visit.• : . . . ....... .
❑ Yes , 'No
❑ Yes NrNo
Structure 6
❑ Yes EWWo
❑ Yes P No
WYes ❑ No
❑ Yes JrNo
❑ Yes KNo
❑ Yes -WO
❑ Yes kNo
❑ Yes WNo
❑ Yes ;KNo
❑ Yes A(No
❑ Yes X No
KYes ❑ No
❑ Yes kNo
❑ Yes 9 No
❑ Yes ❑ No
7/25/97

Division of Soil and Water Conservation ❑ Other Agency
® Division of Water Quality
it Routine O Coninlaint O Follow-up rrf l)« O inspc;ction O Follow-up of DSWC review O Other
dq— gy] Date of Inspection 1! l Q7
Facility NumberO Z l '
Time of Inspection L =36 24 hr. (hh:rnm)
M Registered 0 Certified © Applied for Permit 13 Permitted Not Operational I Date Last Operated.
.................
Farm Name: ..................�?!L!`�.....lf .c.!4,D. /lr�.- ..!"f�...! ��,c ► County: ................3.................................................
OwnerName: ...........�,lAF 4e.....,W_G.?................................................................ Phone No: .................
Facility Contact: ................ !.:......... ...... ..Title: Phone No:
Mailing Address:
Onsite Representative:...._....1�E..�r
Certified Operator:.__.... ..................
Location of Farm. ��,�,� --.4 .,
Integrator:...... .. .r�h...
Operator Certification Number,
Latitude Longitude
❑ Wean to Feeder
" (] Layer 1 'EU t-n F% t
kFeeder
ElNon Layer 1
to Finish
❑ Farrow to Wean
m :. - . Ct ( !CLd
a ❑Other
❑ Farrow to Feeder
r
k
❑ Farrow to Finish
W W
❑ Gilts
❑ Boars
4
s
se Is-/
mV, It. L ftV wiry
u�
ion Dairy
�14r�
�aCttj�b
M32
b H*
i 2'xAf,?Yd%y0 4
g
LJj bnl
Subsui 5L W . j 1 M r41CC--1 agoon Area P Spray Field Area
No Li ` stem
YY�Q Q n a w 8%a�4 w a
v
j'�'+-
tsenerat
1. Are there any buffers that need maintenance/improvement?
2. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field
a. If discharge is observed, was the conveyance man-
•[�
b. If discharge is observed, did it reach Surface Wate
c. If discharge is observed, what is the estimated tlov
A. Does discharge by�)ass a lagoon system? (If yes, n
3. is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes No
❑ Yes KNo
❑ Yes ERNo
❑ Yes (g'No
❑ Yes :9 No
❑ Yes kNo
❑ Yes WNo
❑ Yes P'No
❑ Yes ;ff No
❑ Yes A No
Continued on back

Facility Number: p 9 — 91
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes J[ No
Structures (La2oons.Holdin2 Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ERNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure. 5 Structure 6
Identifier.
d
Freeboard(ft):........... 32.....(2cs?.................................. ................................... ........................ I ......... I. ................................ ........................................
10. Is seepage observed from any of the structures? ❑ Yes O(No
11. Is erosion, or any other threats to the integrity of any of the structures observed? D$Yes i] No
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(if in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .........b rf. ...................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/"inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
$Yes ❑ No
❑ Yes 19 No
❑ Yes Wo
❑ Yes IM No
Ye Qi No
❑ Yes QtNo
❑ Yes RNo
❑ Yes IgNo
❑ Yes
No
KYes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
[;]-No.violations-orddideitde's.were-noted-during this:visit:-.Y.ou:will receive no'Airfher-:
:�:•correspondenceatioutlthis:visit:�:-:�:�:�:�•- �.�;:::-:-:::.::::::::.:�::•:.:::-::�:. .:- :-
� - - r^
phn any YES,answers andlor any rero>emdarions�or anyoherctsnts;
ComnmtE(referto�queshon#}EgOW
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7/25/97
H
Reviewer/Inspector Name
Reviewer/Inspector Signature: r Date:
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