430022_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Quai

Type of Visit: 0 Compliance Inspection U Operation Review U Structure Evaluation V Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
_ttDate of Visit: III Arrival Time: 0j*,00,jjj Departure Time: ` p County: atl' Region:
Farm Name: `* 7K/, hy2�'' l , )�&y,L ft�-n4 Owner Email:
Owner Name: _ Z /& L } Phone:
Mailing Address:
Physical Address:
Facility Contact::�Sm/t/GZ. Title: Phone:
Onsite Representative: [� Integrator:
N
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: �,/R 70
Certification Number:
Longitude:
Design
Current
Design
Current
Design Current
Swine
Capacity
Pop.
Wet Poultry
Capacity
Pop „ I
C-attle Capacity Pop.
�k`
Wean to Finish
Layer
1=
Dairy Cow
ean to Feeder
Non -La er
DairyCalf
eder to Finish
Q
Q �:
DairyHeifer
to Wean
Design
Current �., '
Cow
rrow to Feeder
D ,`' Poultr
Ca aci
1?0
Non -Dairy
rrow to Finish
Layers
Beef Stocker
jFarrow
lts
Non -Layers
Beef Feeder
ars
Pullets
Beef Brood Cow
Turkeys
Turke Poults
her
10ther
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
F No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
rv"l 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
O NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
r`jNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: U1 Date of Ins ection: 20
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):
No ❑ NA ❑ NE
No NA ❑ NE
Structure 6
Observed Freeboard (in): Ll
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 0 No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes rF7n 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
❑ N E
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Ep 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 ft ❑1 Applplicationn�Outside of Approved Area
12. Crop TYpe(s): �SA! �"`+—rY G SS 4—� /f /�z, -Cr��
13. Soil Type(s):
14. Do the receiving crops di er from those designated in the CAWMP? ❑ Yes Y1No ❑ 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 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
D 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 I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 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 ❑ 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 ❑ No [:]NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [] No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: _
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?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
[—]Yes
❑ No
❑ NA
❑ NE
Phone: o: ��;V
Date: fIO
21412415

I ype of visit: 0 Compliance Inspection V Operation Review U Structure Evaluation V Technical Assistance
Reason for Visit: 00 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: /1 Arrival Time: / Departure Time: / -' qt—h County: �i�7rRegion:
Farm Name: r Ac Owner Email:
Owner Name: / !Zt g Phone:
Mailing Address:
Physical Address:
Facility Contact: _�/ J" �4 Title: Phone:
Onsite Representative: G� Integrator:
Certified Operator: I� Certification Number: 99 M-72
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Eurrent,s 4�
Design
Currentr
Design Current
Swine
Capacity Pop
Wet Po�tlfry
Capacity
Pap °
Cattle ! Capacity Pop.
_
to Finish
La er
Dairy Cow
UWean
Wean to Feeder
Non La er
Dairy Calf
Feeder to Finish
pQ
..
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D > foul s
C_a aci
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
TurkeyPoints
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ' No ❑ NA ❑ NE
[—]Yes
[] No
WA
❑ NE
❑ Yes
❑ No
r NA
❑ NE
❑ Yes ❑ No f�3NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued
<I

[Facility Number: - ZjDate of Ins ection: f/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Stru e 6
Identifier: I
Spillway?:
Designed Freeboard (in): //ll
Observed Freeboard (in): 2
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes o DNA ❑ 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 ),P
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 A No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No U 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 ❑ Evident j�f Wind Drift [:) Application Outside of Approved Area
12. Crop Type(s): `�5� F�vX ( S S� Vt,. /. �ik. (}-✓-
13. Soil Type(s):
14. Do the receiving crops diffel 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
T®
❑ 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
[kNA
❑ 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
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[� 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
21412015 Continued

Facie Number: 743 - 2,Z Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑ No
® NA
❑ NE
the appropriate bok(es) below.
`
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
[] No
A NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[] No
9 NA
[] NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes [] No X NA [] NE
❑ Yes ❑ No =-;4 NA ❑ NE
❑ Yes ❑ No rg NA [] NE
❑ Yes ❑ No t� NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [D Yes ❑ No E� 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 IV
No ❑ NA ❑ WE
Commeints ( efer to gnestiom anYES:;answers aasloa add�tonalrcommndations or any oheodemfp �n r�yj
[Ise draw Wgs:of-facility; to Bette rexplam situations (use additional�pag;"s necessary) �,
gn�jw Q�2os
600 q10-62C1-gog1
`S 5-b-11,� cote5-k4cA�l "
4F-v CXPtJa47j)ji S at-,,p ekr
�+
C.1�'a"ckorl �Lo &9t40n4kR ;9-0I7,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9/C- y.?3 ` 3345
Date: if I b
2/4/2015

Type of visit: • compliance inspection V Operation Review U Structure Evaluation () Technical Assistance I
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: dhma- T— Region: 690
Farm Name: S94_/�MOwner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: �Ga.4 C.lZ2 Title:
Onsite Representative:
Certified Operator:
Phone:
Integrator: Aq
Certification Number: /9 P.-.? -z�
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish I
Design C•nrrent
We# Poultry Capacity Pop.
JLayer
Cattle
Dairy Cow
Dairy Calf
Dairy Heifer
Design Current
Capacity Pop.
Wean to Feeder
Non -La er I
Feeder to Finish
po
O
I MMSign
Dry Poul . Ca aci P,o
ILayers
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
Non-DaiTV
Beef Stocker
Gilts
Non -Layers
Pullets
Turke s
Poults
Other
Beef Feeder
Beef Brood Cow
Boars
Otherr-rT—Urkey
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)
❑ Yes [U No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
NA ❑ NE
P 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 jFg] 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 21412014 Continued

Facility umber: Date of Inspection
p
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
No
NA
❑ NE
Struc7c 1 Structure 2 Structure 3 Structure 4
Identifier:
Structure 5
Structure
t1
6
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
`f'° No
❑ NA
❑ NE
maintenance or improvement?
T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Wiinnddow� Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): coq� f/��Y �-rC�S'S sAr� .}�.
13. Soil Type(s): k4
14. Do the receiving crops differ from 1hose 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
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 [!P'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 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
Page 2 of 3
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
21412014 Continued

FaciliN mber: - Z2 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No [] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Tn No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [)I No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes r7PNo
T_
❑ Yes P No
❑ Yes F2] No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ONE
❑ NA ❑ NE
Comments (refer to question ft Expla.Wanyl'ES answers and/or any additional recommendations,or,aay athericommeuts: " ti
Use drawings of facility to better explain situations (use additional pages as necessary}."
3
61d,, paj7i'a It 7 co.s4c-Iej-
e1d5s kla( cA_yW'4)
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: A10
Date: %
2142014

r/
3 M ✓ �.
l'ype of visit: fe7Com ance Inspection V Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: Rouble 0 Complaint Q Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: u-o Arrival Time: Departure Time:1 773MIcounty 9 Regio) x� o
Farm Name: + [,i� -(/i/1 Owner Email:
Owner Name: c Phone:
Mailing Address:
Physical Address:
r
Facility Contact: Title: Phone:
t(
Onsite Representative:
Certified Operator: .0
Back-up Operator:
Location of Farm:
Latitude:
1 ntegrato r: �� j'% - 6
Certification Number: 7191L--
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
-�
Dai Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D . P�oultr
Ga aci
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
LEI
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
M =I
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No E3-Np ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No Imo' A ❑ 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 ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes I__I l".q [DNA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

FaciliNumber: - Date of lns ection: yh
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 & A ❑ 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
[;o ❑ 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 Qdo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 ❑ Yes es❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [3 ?? NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes 0-11o_ ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs_ ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[11,Nt�f ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E];< ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
NoNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
w❑
[J-Vro ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[4o ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�io ❑ 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 [j-No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes YN ❑ 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

FacilityNumber: - Date of Inspection:
-.`
24! Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes I vo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [f] No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 91�No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Fa<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?
Comments (refer,to;question ##): Explain any YES answers and/or any additional recommer
NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes EfNo ❑ NA ❑ NE
[:]Yes Ef'No ❑ NA ❑ NE
[:]Yes [/No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes Uf�o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes F21/No ❑ NA ❑ NE
Use drawings :of facility to better explain situations (use additional pages as necessary)., i5t L
C
LS f G
Reviewer/Inspector Name:
A
0-
1 )044,c,o OAF —P"o I�
O
Photl6 -1JJ 33 ?Y
Date: lb 3 U-,\. l
21412011
Reviewer/Inspector Signature:
Page 3 of 3

s
TI
Type of Visit: (_') Compliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: GrAoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency Q Other 0 Denied Access Date of Visit: Arrival Time: Departure Time: County:f" Regiof
M�_
Farm Name: (ti e'-1' �� �y�� Owner Email:
Owner Name: f - L
Mailing Address:
a
Phone:
Physical Address: J 'S PLU ( -1Y1
2-7330
Facility Contact: ^1 Ct/itJ Title:p�l Phone:
Onsite Representative: q Integrator: Z _
Certified Operator: Certification Number: L
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
•
Design Current, Design
Current
Des' n Current
_ �. tg
Swine
Capacity Pop: }Wet;Poultry`Capac�tyCattle
Capacity PoP,.
4
Wean to Finish
Wean to Feeder
La er
Non -Layer
Da' Cow
DairyCalf
Feeder to Finish
., w '
Dairy Heifer
_ Design
Current
Farrow to Wean
Dry Cow
Farrow Feeder
to
D FoulCa aei
Po .fi
Non -Dairy
Lae
Beef Stocker
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Beef Brood Cow
Other
;».
-
Other
rs
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
To
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[] No
�A
❑ 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
[D-NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[E j N0
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[�o
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/20I1 Continued

Facifi Number: JDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EJ-5-o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 93'lqo ❑ 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 LLJ ]e ❑ 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
L_1 410
❑ 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
[Z>o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Gp Ido
❑ 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
[],Ko
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2al�o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E:1.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): _e VAIL -"� a& 0
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes R—P-140
❑ Yes 11'1qo
❑ Yes [D No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes [�]Ao ❑ NA ❑ NE
❑ Yes j�, 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
C3 No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design 0 Maps ❑ Lease Agreements
[-]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
�io
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections,
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Cgj o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Q ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes �io ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes Eg� ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 2-N-6 ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
l�]�o
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ET Nro
❑ 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
GD.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
[DNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2 f4o
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ErNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
LEr�4o
❑ NA
❑ NE
Comments (refer to -questions ft Explain any YES answers and/or any additional recommendations.or•any.other comments:
Use drawings of facility to better explain situations (use additional pages as necessary).
A,
Ue4 63
b �
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
[ k i ikA- ! S— �vu
�j IV I &Aa UG I G� f -►
Phosev '
DateTa,�`-'
21412011

Type of Visit: QD Compliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: &Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: t Arrival Time: Departure Time: �County: HAQnU
Farm Name:_ M Z� C gpyy� �Owner Email:
Owner Name: m C Rgsp Phone:
Mailing Address:
Region: r2fl
Physical Address:
Facility Contact: 21 P\ _'Rca q Title: Phone:
Onsite Representative: —V:r M 0—{tg2 Integrator: _Tn U F n En 0 F n 7-
Certified Operator: C, Am Certification Number:
Back-up Operator: Certification Number:
Location or Farm: Latitude: Longitude:
Swine
Design C•nrrent
Capacity Pop.
Wet Poultry
Design
Capacity
C+urrent
Pop.
Design
Cattle Capacity
Current
Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -Layer
Design
aci
Current
P,o ,
Dairy Calf
Feeder to Finish -=
Farrow to Wean
Farrow to Feeder D ilPoul.
Farrow to Finish Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
113epf Brood Cow
Othe I
Other I
Turkeys
Turkey Poults
101her
Discharses and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ['� No ❑ NA ❑ NE
❑ Yes [] No
❑ Yes [] No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑"No
M'�lA ❑ NE
[5NA ❑ NE
[27NA
❑ NE
[5"N' A
❑ NE
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facility Number: 3 - "a Date of Inspection: 141f am
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �lo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [—]No [ A ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: '* :,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Eg4o
❑ 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
[G� No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[g" To
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑�lo ❑ NA ❑ NE
maintenance or improvement?
Waste ApFlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [30 o [DNA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [!3 No ❑ NA ❑ NE
❑ Excessive Ponding 0 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 Acce table Crop Window ❑Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s). MU A Z , G. 6.
13. Soil Type(s): EV p t
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes C9"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 [ j jlo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[:]Yes
[jRo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility �fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[Er10
❑ NA
0 NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
(1.'No
❑ NA
ONE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes Cgl<o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [—]Yes 0W ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [:]No [QAA ❑ NE
Page 2 of 3 2142011 Continued

Facility Number: - Date of Inspection: t
i
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
C!fNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
ff No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
[] lion -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?
0 Yes
[TNo
❑ NA [] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
E�No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
ff'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
E!fNo
❑ 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
[4-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
[ o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
CEfNo
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
EfNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
RNo
❑ NA
❑ NE
Comments question to refer { q :_Explain any_ YES answers and/or any additional recommendations or any other comments:
Use drawings of facility to better explain situations (use additional. pages as necessary)OM
wo p r s r3(N, t'avacr,' A(kF_ j r, 4+,F pRoczoss o f b txr3
-A-cats au r. TL tZE p 06es-0-
�A5 C Al a IL
A P-5
�ac�� ass bAcK �n�o 0��4�-zoN ,
ipn, a? �-� CRC bR �spn N €Ens +o b z corn p ft-# e n p utj k-f 4 o R P.5u m 3r3
Q "�! O GCE An v P t 1'RO w t 1i 1`ck 9.k'uAj0
n Aitev6o A oc,rt!
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: qU3-3 og- t&Ball
Date: 44 j
21412011

Type of Visit: aCoroutine
ante Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: V, izvlD/lt Departure Time: County: 4VRegion:
Farm Name: 5-1 Owner Email:
Owner Name: 1 ! /y1 Phone:
Mailing Address: V
Physical Address:
Facility Contact: /[ /r
Onsite Representative:
Certified Operator:
Back-up Operator:
Title: �Lt l±lJ'e� Phone:
d4Integrator:
1JjY7 0/w.�' Certification Number: c15 6r7O
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity Pop.
Cattle Capacity Pap.
Wean to Finish
Layer
Dairy Cow
Dai Calf
Wean to Feeder
I INon-Layer I
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
D , P,oul_ , Ca _aci
Layers
Current
P,op.
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Turke s
Othe
lTurkey Poults
Other I
I 10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ENo [:] NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [:]Yes ❑ No El -NA ❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ) ❑ Yes ❑ No ENA ❑ 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 �No [] NA C] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes �No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ETNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No Lv 1<A ❑ 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 R-15o ❑ 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 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 k2r<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 ❑ Yes ff No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ 10 ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes n< ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops diffe om thole designated in the CAWMP?
❑ Yes
®No
❑ NA
❑ NE
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
E]No
❑ NA
❑ NE
acres detennination?
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
[?rL
❑ 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
g3<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 eNo ❑ NA 0 NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [—]Yes CJ 0 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No S NA ❑ NE
Page 2 of 3 2141201I Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Mo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes E3'<o ❑ 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30_ Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
&rN'-o
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
[0,4
❑ Yes B No ❑ NA ❑ NE
❑ Yes V�fZ [DNA ❑ NE
[:]Yes y o ❑ NA ❑ NE
❑Yes [D,Ko DNA ONE
❑ Yes 03 No
❑ Yes eNNo
❑ Yes �No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refe'rto question ##): Explain anyYESenswees and/or any additional recommendations or°any other commeats.
Use:drawings of facility to better explain situations.,(use. additiinal }rages as necessary). #t �'.,. 2
.�>
4e, yf,'Lc�
44a, -4,
40
LON
-°�C_�
oat& X4�a� G"-C' ALA
Reviewer/Inspector Name:
Reviewer/Inspector
Page 3 of 3
Phone:Oe0-53'313
Date: zz �l
1412011

Division of Water Quality
Facility Namber[:?
Q Diyision•of°Soil and Water Conservation
-� - Q Other Agenc4
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint Q Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: I S1 M 1 [0 1 Arrival Time:
Farm Name:
Owner Name: 1
Mailing Address:
Physical. Address:
Departure Time: County: 14hANEIT Region: Ef�2_
rm Owner Email:
Phone:
Facility Contact: (/1'1 'Title: Phone No:
Onsite Representative: Integrator: �n
Certified Operator: �1 Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e = ' = u Longitude: = o ❑
Design Curren# Design. Current
neulation Wet Poultry Capac sty PopulationC*apacity
Design Current
Population
to Finish
r
❑ La er❑
Dai Cow
to Feeder
r
❑Dai Calfr
❑ Dai Heifer
D Cow
to Finish
to Wean
T
$:�❑
La ers
❑ Non -La ers❑ Pullets❑
w to Feeder
w to Finish
Non-DairyEl
❑Beef Stocker
Beef Feeder
❑ Beef Brood Cowi
Turke Poults
Number of Structures: L
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
CR►No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
IN NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[PNA
❑ 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
PLNA
❑ 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
159 No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

'Facility Number: !Y -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
17�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
91No ❑ 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
0 Do any of the structures need maintenance or improvement?
Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
;[ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�No [I NA [I 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
1ANo ❑ 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) u5y a .,rN-�4aC Q (PJQ�, ) I l Ax ,
13. Soil type(s) f-uCl t.tQ
r
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes
No
[I NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[� No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Ep No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
TNo
❑ NA
❑ NE
Comments (refer to question #): Explain any x ,ES answers and/or any recommeadations,or any other comments
Use drawings of facility to better explain situations., use additional pages as necessary): s ,
f '` l a lk) rec,4- a(—' ae ea u^d l Q o V\ t,) L� 4as,Ve-
Reviewer/Inspector Name t% - Phone:
Reviewer/inspector Signature: Date:
Page 2 of'3 12128104 Continued

L
Facility Number: Date of Inspectiion U
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ( No d NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Im 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
N No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes o
J�JNA
❑ NE
V' Did the facility fail to calibrate waste application equipment as required by the permit?
xYe
* o
❑ NA
❑ NE
25_ Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ONo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
Me
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
�KNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E?No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�No
El NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
JpNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
09 No
❑ NA
❑ NE
Additional Comments and/or Drawings"
P" 4� W
cezt" eq,
Page 3 of 3 12/2&/04

011K_s 'Jvf L11i5-109
_ %A"ivision of Water Quality
Facility Number 43 Q6'-f 0 Division of Soil and Water Conservation
- 0 Other Agency
Type of Visit iD Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit "Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: y o q Arrival Time: Departure Time: ! ! is County: AgM IdE Region: ��01
Farm Name: kocif Owner Email:
Owner Name: TIM C'm I L1 Phone:
Mailing Address: $l0'i NonnaCC4 �tJ� Sa,-fa�L _ CZ72wt)
Physical Address:
Facility Contact: ftl %� l' Title: lyn er Phone NkctHi 17 1-3390
t� !
Onsite Representative: VM Integrator: _ PurVIs
V
Certified Operator: Tl D _Cl�le _ Operator Certification Number: 0197,0
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ 0 ❑ 4 = Longitude: ❑ ° ❑ ' ❑
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:0.
}
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 (9 No ❑ NA ❑ NE
El Yes
El No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
El NE
El Yes
❑No
❑ Yes
P'No
❑ NA
❑ NE
❑ Yes 10cqo ❑ NA ❑ NE
12128104 Continued

Facility Number: - Date of Inspection is
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 1�[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): _ Q
Observed Freeboard (in): i
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes R 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 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? C&Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 5JNo ❑ 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 J'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?
H . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes R 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) Cn,%M I II fm.,da.A417! - S+
13. Soil type(s) is
r
14. Do the receiving crol4s differ from those designated in the CAWMP?
❑ Yes
15}No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
f5 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
W No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
&No
❑ NA
❑ NE
IComments (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):
N54e-e fl64 03— VI Lio munimi��s —aj 7 4tn,�f.YTAct bvv^d&7y In M4yaaog, •
C it
uoits a bore. addtC ftr C-14rii(A'01 OF 0h far►x-6p. C017.7.
Reviewer/Inspector Name UtAwN 5CAVEIEKPhone: k -UM
Reviewer/Inspector Signature: Date: jut
12/29/ d !'nnliniiad

Facility Number: y.3 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 9RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. -Yes ❑ No ❑ NA ❑ NE
® Waste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking 54Crop Yield ❑ 120 Minute Inspections 9 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
allo
❑ NA
❑ NE
[I Yes
❑No
RNA
ONE
l'Yes
❑ No
❑ NA
❑ NE
❑ Yes
B No
❑ NA
❑ NE
❑ Yes
E. No
❑ NA
❑ NE
❑ Yes
❑ No
PNA
❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes W No ❑ NA ❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
RrNo
❑ NA
❑ NE
KYes
❑ No
❑ NA
❑ NE
Additional Cd fiiatkaodlof Drawin s•
cut'. of Id 0&1 bMlz clo)er-f-+o Av e� u �So
T. S�f�►e }�� S
cn ou`�s I d t} e 01,16tj a7 �oo^ bo, �t'1 Mo�f C I j Cv'� .
15 . �;n � [ r0 needs iv be cv-' r/1 tie t)err -e�., e- , be Ioop�d d fo CDI'a�
N� ry��", ��ti�- tvr� GAL. �
ia,. pie leftf COY � � X�D t:� ID
�, {- t rl i 1 coo s r�a)f k! c + c� 1 44-
AS c{70^S . 1 1} Q Cro
,N 6e_ &rl'hvj-�- reel be•C-tie 110wlfv�'�
Sll►t l eel NO,- 0 l
a� 1'` �� �� ►7df i �g�;d r��el � S,�� 1��t ay�9�
3� fiOliUyv >r �i ` 0 chtk c� ca i bra-f )or) logw.1 f iOwAl
o'� re( ds-)ale ct l►�►� of Yviviie a0f,
i
Page 3 of 3 12128.104

Facility No. 43`al Farm Name Date
Permit COC OIC, NPDES (Rainbreaker
PLAT Annual Cert )
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft & %
Liquid Trt. Zone ft
Soil Test Date
pH Fields 7i7L
Lime Needed 0
Lime Applied
Cu i/ Zn ✓
Needs P
Crop Yield 0- r -a 120 min Inspections
Wettable Acres Weather Codes
WUP �� Transfer Sheets
Weekly Freeboard ✓ RAIN GAUGE
Rainfall >1" ✓ Dead box or incinerator
1 in Inspections 40 Swd4t -T7-01",
Pull/Field
Soil
Crop
RYE
PAN
Window
Max Rate
Max Amt.
08cd
D-r
-J'e
O,S
r
s M
•�
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm
FRO or Farm Records
Lagoon # I
Top Dike 27.Q
Stop Pump 3a.O
Start Pumps.)
1--?
-�A
1 - 00
#+a
qk3
Ll
4bs
qj.�o
101h
A-21
s roye ¢ d—j'°e S
App. Hardwore
of.
.3 1 71?
MA 91Y
7bj'°

% 1110� UVf
Type of Visit 00 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine 0 Complaint & Fallow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: ® ,A/yrrival Time: �. Departure Time: County: Region: ,
Farm Name: s KOC : Owner Email:
Owner Name: G"4 a Phone:
Mailing Address: <Np q CL#nni2A ��/7�- 54► Q_33
Physical Address:
Facility Contact: __ -rim � 14 _ Title: Ow'lltf'' Phone No:
Onsite Representative: Integrator: Ivf v
Certified Operator: 7l M drihx cra ! a Operator Certification Number:
Back-up Operator:
Location of Farm:
Wean to Finish
LJ Layer
Wean to Feeder
❑ Non-L:
Feeder to Finish
" s'
'.
1)'-''=Pa
❑ Layers
tEl Non-L.
❑ Pullets;
Farrow to Wean'
Farrow to Feeder
Farrow to Finish
Gilts
Boars
n Turku
.
Back-up Certification Number:
Latitude: =o E--]' =" Longitude: =° 0I ❑ u
'C-' U TurkeyPoults
Other ❑ Other
;kdvwj Nay l &Q 4 soI*S
Discharges, Stream mpacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Dairy Cow
Dairy Calf
Dairy Heifer
Dom^
Non-Dair-
Beef Stocker
Beef Feeder
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes E'No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[I Yes
❑No
El NA
El NE
❑NA
❑NE
El Yes
❑No
❑ Yes
IR No
❑ NA
❑ NE
❑ Yes
�RNo
❑ NA
❑ NE
12128104 Continued

Facility Number: y 3 — a Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONo ❑ 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): q
Observed Freeboard (in): 3
5. ' Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
15J 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
[)kNo
❑ 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,
a
notify DWQ
7. Do any of the structures need maintenance or improvement? Ryes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
Wo
❑ 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
JRNo
[I NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
❑ No
❑ NA ]ONE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
❑ No
❑ NA t'NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
DR -NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
N 'NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑ No
❑ NA
RNE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
ONE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
8NE
tCommetzts refer to ueshon Eg fain an YE$ answers and/o'r an recommendatios an or other comments.
Use drawin'fac lity,�to�>ie # r e latn srtuattons� � � � y� nyY
ap '`{usetaddtttoaal pages as necessary):
Reviewer/Inspector Name S Phone. q(& i3 ,3W
Reviewer/Inspector Signature: Date:
Page 2 of 3 v 12/28W Continued R

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ONE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA IRNE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA (JNE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
15,No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
5ZNfA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
IRNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
to No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
EkNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
N NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 5�r,No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
WNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
&'No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
gNo
❑ 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
DiNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
FfNo
❑ NA
❑ NE
Additional Comments and/or Drawings
7, La .been rno w& on o --b ��e aC mail-ef i tv Use . loo4 mfeu . rso wv
e rnory remain j�nr icrewa 1 J �edvwn Q `R°ri r -tee ne"
C A+atC WA w$e .rf; rd, on Cam.
as . RM Woswewb rvve`}c+ " bvl not weykdj v�,
C�0g A11 a + * 11 bee COm� to do Cali 'o.,. s
r ,�`'' `y leas chPdQ. one
Ad��h'o l n04 a171 f10j- 61 *a'e e0l y:
kemd�a &i �e j, r-l�rewe refa%i� s►d>�a��, � �lca of whim�m v��
blikb
,r
SM[s%gym
addedL [ a famar<Ibf 4o- �r.
�
Page 3 of 3 12128104

h� •
Division of Water Quality l
Facility Number O Division of Soil and Water Conservation
- O Other Agency
5
Type of Visit-lrompliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit VRoutine 0 Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: 7 Arrival Time: .Jt.� Departure Time: County: Region.
Farm Name: 'Mom- �6 fix[ � �r m Owner Email:
t
Owner Dame:
Mailing Address:
Physical Address:
e
Facility Contact:
Onsite Representative: i no t
Certified Operator: 1 rn
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
i
Title:
Phone:
Phone No:
integrator: Y I '�]
Operator Certification Number: ,� !
Back-up Certification Number:
Latitude: = e a 1 011 Longitude: 0° El' = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
1 ElLayer
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
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? (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
❑ No
[) 'NA
❑ NE
❑ Yes
❑ No NA
❑ NE
t�
bi NA
❑ NE
❑ Yes
❑ No
❑ Yes 4qNo
❑ NA
• ❑ NE
❑ Yes
[55 No
❑ NA
❑ NE
12128104 Continued

�1
1
Facility Number:43 —05:5_Date of Inspection O
Waste Collection & Treatment
4.
0
❑
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
1� No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: j
Spillway?: N
Designed Freeboard (in): 1 9 it
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ yes
;a 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
CibNo
❑ 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?
1;9 Yes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
Ro
❑ 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
D�--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 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) GI (As
13. Soil type(s) i _aA
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
XNo
❑ NA
❑ NE
15_ Does the receiving crop and/or land application site need improvement?
❑ Yes
Z -No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
'�L No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
P5No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
tgNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations opa y other comments g
Use drawings.of facility to better explain situations. (use additional pages as necessary)
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: e
Page 2 of 3 1212VOA Continued

i
Facility Number: {9 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes N0 ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes F3 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 $1,No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No J4 NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA T.NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No ❑ NA 4ANE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes V No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No P§.NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes %No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes No ElNA [INE
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 VNo ❑ 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 )9No ❑ NA ❑ NE
General Permit? {ie/ discharge, freeboard problems, over application}
32. Did Reviewer/lnspector fail to discuss review/inspection with an on -site representative? ❑ Yes &No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? 2tes ❑ No ❑ NA ❑ NE
Additional Comments and/or Drawings:AL
( j
-RA, S� l 1 L�f d S Y �[JO_Y 0 _-t C,C- S oYl �Y Q4.-t ".
mU5-�' �1 av�, S � � �uf � CG�iI �rQ�u�1 C�-�`c�- ►:1 ���t�C,�.
lr 30 --(DD
— �te 1 v 10C C Cnr C ti CDr (Y C�R I Zs �
ieIds 0_V-A i
m u'� �►n Ljayks .
12128104

Facility No Time In Time Out Date
�,�.-� - �_
Farm Name C.f C Integrator r 4_4
Owner —r-� Site Rep ' -'' &,,,. Q,-
-_
Operator i T - No. _ t ►,1 ! -1 !G�
-70
Back-up No,
CO Circle: CGeneral or NPDES
Design
Current
Desi n
Current
Wean - Feed
rrow - Fee
.,
Wean -Finish
Farro - i
Feed - Finish
Gilts / Boars
Farrow - Wean
Others
FREEBOARD: Design
Observed oL
Crop Yield
Rain Gauge
Soil Test Wettable Acres
Weekly Freeboard / Daily Rainfall ✓
Spray/Freeboard Drop
Weather Codes
120 min Inspections
Waste Analysis:
Date Nitrogen (N)
Q:Lfz O'�>
Sludge Survey
Calibration/GPM 1
Waste Tra ers
Rain BreakeF___7'�"
PLA
1-in Inspections ✓
Date Nitrogen (N)
Pull/Field Soil Crop Pan Window

if
Facility Number Q
— --- o I
Division of Water Quality m
O Division of Soil and Water Conservation
O Other Agency . l i O� G
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint �A Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: -3 a 1 Arrival Time: Departure Time: County:
Farm Name: �i . ne a Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator: 1 n /
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Design Current
'� Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other..
Back-up Certification Number:
Region:
Latitude: = o ❑ I = Longitude: ❑ o = 1 ="
Design Current
'-Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharses & 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?
D
Cattle
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non-Dai
❑ Beef Stocker
❑ Beef Feeder
Beef Brood Cowl
Number of cturesi.
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes 19No ❑ NA ❑ NE
❑ Yes
❑ No
1� NA
❑ NE
❑ Yes
❑ No
�N-NA
❑ NE
❑ NA
❑ NE
❑ Yes FtNo
❑ Yes
�D to
❑ NA
❑ NE
❑ Yes
�rNo
❑ NA
❑ NE
12128104 Continued

acility Number-t Date of Inspection G
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes �No
❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes ❑ No
Q14A ❑ 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 kNo
❑ 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 46 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 2t No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes )dNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes [;A No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ❑ No
❑ NA X�E
maintenance/improvement?
11. Is there evidence of incorrect 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 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
E
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
E
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
NE
l7_ Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
PQE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
ONE
Comments (refer to question ft Explain any YES.answers and/or any recommendationsg r�auy,,other comments
rn
,Use drawings;of facility to better explain situations: (use: additional pages as necessary):
Reviewer/Inspector Name ���{ Q j "~ L I Phone: `] X 136A4 0z)
Reviewer/Inspector Signature: Date: r -"
Page 2 of 12128104 Continrie

1
Facility Number: 3 Q Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes KNo ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Othery
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA UVE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
(% No
❑ NA ❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA WE
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?
AYes
❑ No
❑ NA ❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
KNo
❑ NA ❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA ')E)NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes t%No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No ❑ NA
11 E
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No ❑ NA
[,�INE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No ❑ NA
NNE
General Permit? (ie/ discharge, freeboard problems, over application)
6NE
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No ❑ NA
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No ❑ NA
*-TE
Additional Comments and/or Drawings: ,��
ri �{e t��.la ��lYlO�r2� �if 6`rr�1- 4�kri �►� j .vt7� !"7 Ca �` w.�, 0.S f%t 3 iT�S /tc� U W{1Qr
1 Q� C1rl\ i {kCC �U t(�W y C�'�" `r Ot�-0.vt ���u�� ✓io1 '*�ir�4'f' 'tt7
I v� f h S r U ( Lqt% C.Y1 r}CGY - PO4, �1 i rLg-C an
W'4k
'-L' ozi c_{,Lrr e.rL L J'- ,
C, + s nMA3 an
`*
g�pr� rc�►�u�c�[� -tSTabl•S�
Fp�{ v..XA. C
l
Page 3 of 3 12128104

Type of Visit ® Compliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit V Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: cl 7 07 Arrival Time: Departure Time: County:
Farm Name: Sai.oau J► _Qt� FOjw--, Owner Email:
nwnnr Namv I i M• J C r0l_it Q/ Phnnr-
Mailing Address:
Physical Address:
Facility Contact: ' ' m C.raL,'y Title oex Phone No:
Region: F►2�
Onsite Representative: l t /► l 1'0-4 0 Integrator: / f1
Certified Operator: r
no Operator Certification Number: at' 17O
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [� e Longitude: = ° 0
Design Current
Design Current
Design Current
Swine
Capacity .Population
Wet Poultry
Capacity Popula-''on
Cable C►acity Population
FP -
El Wean to Finish
t
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
on -Layer
❑ Dairy Calf
❑ Feeder to Finish
T
❑ Dairy Heifer
❑ Farrow to Wean
Dory Poultr,}•
r''`"-�
Ili
❑ Dry Caw
Farrow to Feeder
(0Jab
❑ La ers
"
El
Farrow to Finish
❑Beef Stocker
ElEl
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowl
Other
- -
❑ Turkeys
❑ Other
by
❑ Turkey Poults
❑Other
Number of Structures-
..
-
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes 4No
❑ 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
.1�iNA
❑ 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
1:�JNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes 4INo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes No
❑ NA
❑ NE
other than from a discharge'?
Im
Page I of 3
12128104
Continued

FaciIity.Number: — OZZ Date of Inspection 7 P
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? XYes ,N No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes XNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1
Spillway?:
Designed Freeboard (in):
r�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes X 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 [XNo ❑ 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 envir
onmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ElNo ElNA ElNE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �0 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 XNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes %�&o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes NNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [I Evidence ofWind Drift ❑ Application Outside of Area
l2. Crop type(s) &rm U d- (f ._ Lm —'-r 0 L — — —
l3.
Soil type(s) F(L
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
LpA No
❑ NA
❑ NE
l7_
Does the facility lack adequate acreage for land application?
❑ Yes
'KNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
�(No
❑ NA
❑ NE
Comments refer to uestion.# ): Explain an YES answers and/or an recommendations or an other comments
(., q p y y Y
Use drawings of facility to better explain situations. (use additional pages as necessary):
b L L ►rYl uSA S." `ram
1 UL Z r rn i ct C n c� o 5e r 01
Reviewer/Inspector NameI
Phone:
Z�jod
Reviewer inspector Signature:
Date:
"" ���
-cr,�
-]
rage Z u1 -Y 1-1iZoivIf wnunueu

Facility Number: — Date of Inspection 7
Ryguired 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
[A No
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
)q Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard )K 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
19DNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
(I NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
A Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
2(Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
XNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
*o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ANo
❑ 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
�YNo
❑ 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
KN o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
❑
At
❑
❑
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Yes
No
NA
NE
33.
Does facility require a follow-up visit by same agency'?
Yes
❑ No
❑ NA
❑ NE
Uditiional Comments and/or. Drawings:
;=
— �-I�s CoC na��Jly ,, fturn.4 �ns;e, •
kA u s+ Ir awf_ Vol ; d r 0_1I P"ryl e.ver A . Sxmf le
C r D da.Aare 4- r Sa m f le alp
ir]o So : s rceof 4 1�v Z:M (D oweL'- lo,6le .
.. Co.- ! : 6 f of an � S ! LA,8 Se- SU i veAj4-0 6jz- Cp ry p lc-W w y
racer
o,.,1dl d"o flaw V — ensure. s-Lrvc.laraI n r='
Cw4'n IA*
�Jm
— 1>Jo0 4_6 iM YDvC. ubP 0.vL
9 L,
Page 3 of 3
W101-1r�►rj

Facility No. ` 3 d y Jime In Time Outer Date I U
Farm Name Integrator !`
Owner w Site Rep /' C
Operator 1 •r • G g6d _ __ No. -70
Back-up No. _
COC V Circle: �ener or NPDES
Design
Current
Design
Current
Wean — Feed
Farrow — F
Wean -- Finish
arrow —Fit-ties
Feed —Finish
Gilts 1 Boars
Farrow — Wean
Others
FREEBOARD: Design
Sludge Survey
Observed
Calibration/GPM 1
Crop Yield Waste Transfers ��—
Rain Gauge Rain Breaker
Soil Test Q ' PLAT Wettable Acres
Weekly Freeboard Daily Rainfall L/
Spray/Freeboard Drop
Weather Codes 120 min Inspections _
Waste Analysis:
Date Nitrogen (N)
&Ax f 1 .�
1-in Inspections
Date Nitrogen (N)
Pull/Field Soil Crop Pan Window
Ir—
i
�- 3 �'
� 4
7

k Division of Water Quality f
Facility Number a a O Division of Soil and Water Conservation
_.J — ----- 0 Other Agency
Type of Visit Q Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit O Routine O Complaint 0 Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: 0 Z Arrival Time: 21 ; 20 t Departure Timp: i County: dam e++
f • X0Prh
Farm Name: W-, Lo c- Rwv,, Owner Email:
Owner Name: l CI�GY; Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region: j-JQ4
Latitude: = 0 = ' = Longitude: = o = 1
,Design Current Design Current"
Capacity Populating, Wet Poultry Capacity Population, Cattle
LJ Boars
Other
❑ Other__
❑ Layer I
❑ Non -Layer
Dry Poultry
Non-L
Pullets
Turkey Poults
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes ,9 No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
59 No
❑ NA
❑ NE
12128104 Continued

Facility Number: qi> — 12� �L I Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
`P" No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
® No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): tq
Observed Freeboard (in):.t
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
X 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'?
4 Yes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
0 Yes
❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, El Yes
)01 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
59 No
❑ NA ❑ NE
1, MOW lacgootn baAk.s C14, t.,�&ds, smaU 4,-.f-e W(I oyk b¢
s 4,� sags
I o vv ba n k � N� kex needs ,-o ire
i i 4� , pia.,r k,j, r`.s ka-,-d 4-o ready
1 tld trS.r�-'7r`s rru`n�fVQf1 P �S, P;Can �
Reviewer/Inspector Name ! M 7 Phone: 1D tig6_(
Reviewer/Inspector Signature: Date: b 13 '�
12128104 Continued

Facility Number: q — a Date of Inspection 10
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 04 Yes ❑ No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ® Design
g ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
14 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
14 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
Q9 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
R5 NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes (A No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33_ Does facility require a follow --up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
'Addtho al C mments and/or Drgwirtgs j
;
pitact -6 jr�
N Recw& kaef ka.s t%-,,pr"ed si',X� ,Tz, . 2COt, Co, I,bL ice_
l212&04

Type of Visit &Cbmpliance Inspection Q Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit Routine Q Complaint O Follow up Q Referral O Emergency O Other ❑Denied Access
Date of Visit: �! Arrival Time: D Departure Time: i County: 11,96 ,11—
Farm Name: _5G .., A:Xz �y� _65e ,02.1 Owner Email:
Owner Name: rYi �;�"Lr: Phone:
Mailing Address:
Physical Address:
Facility Contact: .7—j rrt_ e� � Title:
Onsite Representative: _
Certified Operator:
Back-up Operator:
FR C)
Phone No:
Integrator:-,��Dfz�/l�vr L T(� e-y;5
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ O 0 6 F--I ae Longitude: ° I=] I ❑ "
t. Design Current" 4 ° Design Curren # Design Current
Swine , ~Capacity
Popula o
oultry Capacity
-Population Cattic,Capacity Population
❑ Wean to Finish
❑ La er
❑ Wean to Feeder
❑Non -La et
❑ Feeder to Finish
Farrow to Wean
D0�
Dry Poultry
❑ Farrow to Feeder
.
a=
❑ Farrow to Finish
❑ La ers
❑ Gilts
on -Layers
❑ Boars
❑Pullets
Other. #
n
_s «€
❑ Turkeys
❑ TurkeyPoults
❑ Other
❑Other
Number of Structures:
Region:
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[allo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
FZNo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (lfyes, notify DWQ)
❑ Yes
ZNo
❑ 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
W No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
9No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[4 No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: —
Date of Inspection / O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes P.No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 120 IUv kfiey'V 42tS i#
Observed Freeboard (in): � 5-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
SNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property 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?
0 Yes
❑ No
❑ NA
❑ NE
8. Do any oft he stuctures lack adequate markers as required by the permit?
❑ Yes
Ri4o
❑ NA
Cl 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
Qd No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �9 No ❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [Z No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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)
i
13. Soil type(s) f�_ Z` 72,
14. Do the receiving crops differ from those designated in the CA WMP? ❑ Yes Z No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
W Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, El Yes
ZNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
[W No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
RNo
❑ NA
❑ NE
� >,�i�- uG� .✓L� J�li%s�Cd %�7 to uJ r` tea- Y�,�} � Dr'��s /�ia� !�i • � •f ��� in
7 4pe ;
La.-#f t 44:d .�'.r &1;VC-1 9W11,
/.J /u6f-..$lord:v e Al rLra W as btj fSleirro �;ra���Y
a yc
ReviewerlInspector Name �(/Y �' /gLA Phone: r
Reviewer/Inspector Signature: Date: /p�s
121151U4 Conhuuert

1
Facility Number: — Date of Inspection / a
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes EgNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [X Yes ❑ No ❑ NA ❑ NE
the approprrate box. ❑ WUP ❑ Checklists ® Desig
n El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. aYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking 7Wrop Yield ❑ 120 Minute Inspections ®-Monthly and V Rain Inspections ERWeather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
54No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
RNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P -No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[A No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Dg.No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
t4 NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
53No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[.No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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
RNo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
D�No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
EINo
❑ NA
❑ NE
MWEA
'AAdditioual Comments an/or Drawings /��
e /Dp is /� L'ClJ`���1� Ypi r W /LZ I /� ��Ip�QGL�715=�5,,d f i 1 a ��
(Y c)%i. /12-r, i4 ,,5 w`tA P
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I j
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12128104

,cam_
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit ® Routine 0 Complaint 0 Fallow up 0 Emergency Notification 0 Other ❑ Denied Access
i Facility- lumber Date of Visit: 3 3 o Time:
t - I�ot O erationa! Below Threshold
M Permitted ®Certified ©Conditionally Certified ❑ Registered pate Last Operated or Above Threshold:
Farm Name: _ (, nP,� �D c-A, f 'an.n County: — _ :Lr_ns�
Owner -Name: 1 ` jLr
Phone No: cj:Fo l i�r
Mailing Address: 4 ro!f t ��n n ock �r+�
Facility Contact: Title: Phone No:
OnsiteRepresentative: integrator: rrudC4
Certified Operator: a m T C r Operator Certification Number: rZ t 1 -+a
Location of Farm:
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' �` �` Longitude a �• �"
Design Current
Swine C2nacity Ponulation
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
® Farrow- to Feeder4-
❑ Farrow to Finish
El Gifts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
Laver ❑ Dairy
❑ Non -Laver ❑Non-Dair
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ subsurface Drains Present ❑ Lagoon Area " ❑ Spray Field Area
Holding Ponds / Solid Traps _ ❑ No Liquid;t'aste Management System
Discharges 8 Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Fie€d ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach % ater of the State? (If yes, notif}v DWQ} ❑ Yes ❑ No
c, if discharge is observed, what is the estimated flow in eal/rnin?
d. Does discharge bypass a lagoon system? (If ves. 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 J�L No
Waste Collec ' n 8- Treatment
4. Is storage capacity (freeboard plus storm storage) €ess than adequate? ❑ Spillway ❑ Yes UQ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
03103101 Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes ® No
❑ Yes ( No
❑ Yes No
❑ Yes Q No
❑ Yes P No
❑ Yes Jallo
I I . Is there evidence of over application? ❑ Excessive Pondmg ❑ PAN ❑ Hydraulic Overload ❑ Yes [RNo
12. Crop type j3 ey— ^/-, ..C_� J .., Q
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP). ❑ Yes EQ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes Q No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes [ No
16. Is there a lack of adequate waste application equipment? ❑ Yes [[No
Renuired Records & Documents
IT
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[RNo
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
NNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
kNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
CQy4o
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
RbNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit'?
❑ Yes
Q No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
�BNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
ER No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
O No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Co mettt5 (;refer to'questiori #): Eaplaiu ariyYTSrsandlor any recorxtmeedaiions or any other commen
Use:drawangs of facility to better explatn sttuade addthonal pages as tiecessary) ❑Field Copy ❑Final Notes
�c
Reviewer/Inspector Name
ReviewertInspector Signature:
Date: 3 x O
0510.3101 Continued

Facility Number: Date of Inspection 3 3 0
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 5D 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 M 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 O 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 permaneniftemporary cover? ❑ Yes ❑ No
�Additioual Commeots.and/or Drawings „ _ ,� � .;._;. e�- �
A6
05103101

of Visit Corn liance Inspection 0 Operation Review
Lagoon Evaluation
Reason for Visit i outine {Complaint 0 Follow up 0 Emergency Notification
0 Other ❑ Denied Access
Faeilitti Number Dale of ViOt: I Time:L 10
Not Operational 0 Below Threshold
❑ Permitted ZCertified M Condition�all"Certified 0 Registered Date Last Operated or above Threshold:
Farm Name: �J" 1iDi�r p r--1`t�w` _ - County: _
Owner Name: _l Mp V C kk r Phone No:
! l r Z-7
Mailing Address: � � L f�►it LG _ ;i�'ipt/ �[�> A/C- 2, 7 ?Se
Facility- Contact: _ T�►t1}�r�$� _ Title: JS. 1��0.q�" Phone No: 9�7
Onsite Representative- /3%KE �i �iJ Intecrator. �ND��E1�]paE FJT
Certified Operator: Operator Certification number:
Location of Farm:
ESwine ❑ Poultry ❑ Cattle ❑ horse Latitude �' �� Longitude
Design Current Design Current Design Current
Swine Ca acift Population Poultry Capacity Population Cattle Ca acity Po ulation
❑ wean to Feeder I IQ Laver I I 1 ❑ Da'
❑ Feeder to Finish I 1E] Non -Laver L I Non -Dairy
❑ Farrow to wean
Farrow to Feeder Other
❑ Farrow to Finish Total Design Capacity
❑ Csilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Eagooa Area ❑ S ray Field Area
Holding Ponds I Solid Traps ❑ No Liquid Waste Management System -
Discharges S Stream lmnacts
1" Is any discharge observed from any part of the operation?
❑ Yes ICJ No
Dischar,e 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 Rater of the State? (If ves, notify D`wVQ) ❑ yes ❑ No
c. If discharge is observed, what is the estimated flow in galimin?
d. Does discharge bypass a lagoon system? (If ves, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑yes —J N/o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑Yes ❑ No
Wa a Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Svillway ❑ Yes g<o
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier:
Freeboard (inches): i 2
05103101 Confinued

Facility Number: — Z 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, a m li uid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. 1s there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement? 4 K_
16. is there a lack of adequate waste application equipment?
Re uired 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/ WiJP, 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?
Cl Yesia
❑ Yes No
Yes ❑ No
❑ Yes No
AT-y"Is ❑ No
❑ Yes 43
❑ Yes No
❑ Yes 2 No
❑ Yes 2rNo
❑ Yes ❑ No
❑ Yes ❑ No
Yes ❑ No
❑ Yes 0_N_0
wo—r-M-1
,
❑ Yes [--]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
(ie/ discharge, freeboard problems, over application) ❑ Yes ❑ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ❑ No
24. Does facility require a follow-up visit by same agency? ❑ Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
0 No violations or deficiencies were noted during this visit. You wiill receive no further correspondence about this visit
t .��'�" I�J,,,�Q ►- tit � 1�--����r�
Reviewerflospector Name A ✓�i� f. (
ReviewertInspector Signai
❑ Field Copy ❑ Final Notes
Date:
05103101
Continued