780032_INSPECTIONS_20171231

IA- 4 -moo '-
Type of Visit: eFCoroutine
nce 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: Departure Time: : ] County: z -`-' Region: )���
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: /
, a
Title: _ %uh
Phone:
Onsite Representative:
f/ j�f?r
Integrator: rr��
Certified Operator:
�' ��rl
Certification Number:
Back-up Operator:
pryA�
�� ��f�c7 "
Certification Number:
GY l�
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Cnrrent
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
CattleNED—WEM6urrent
acity Pop.
Wean to Finish
I 11-ayer
I
Dairy Cow
Wean to Feeder
11
INon-Layer
I
Dairy Calf
S
Dai Heifer
Feeder to Finish
l U
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr.. P,oul
Ca aci
P,o .
Non -Dairy
Farrow to Finish
Layers
I
Beef Stocker
Gilts
Non -Layers
I
Beef Feeder
Boars
Pullets
I
Beef Brood Cow
Turke s
Other.
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
0 No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑`No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[]-No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3
21412015 Continued

a_cili Number: 7L - Date of Inspection -
Waste Collection & Treatment
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑" o ❑ 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 E�INo ❑ 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 LJ fro ❑ 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 �o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E-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 [Ejl o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Cr<o ❑ 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 10 lbs. ❑ Total Phosphorus [:3 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): /,DU
13. Soil Type(s): 1LuFS le, / xic-.B
14_ Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
D NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[I —No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[]-To
❑ 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
E]' oo
❑ 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
�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 [71-1 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 E7'N 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 21412015 Continued

■ Facility Number: - 3o'2- 1 Date of Inspection: /51-
24. Did the facility fail to calibrate waste application equipment as required by the permit? J ❑ Yes to ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [El 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? ❑ Yes Noo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑'No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
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 fo ❑NA ONE
[—]Yes No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
Flo
❑ NA
❑ NE
[] No
❑ NA
❑ NE
io
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: �D`3y3%j
Date:
21412015

Type of Visit: Q-Compliance Inspection Q Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: outline Complaint O Follow-up O Referral Q Emergency C) Other Q Denied Access
Date of Visit: f Arrival Time: Departure Time: County: 21,—IT— Region:
Farm Name: ��� �(j; ��ug� yadia�- Owner Email:
Owner Name: �� ��`�� [> Phone:
Mailing Address:
Physical Address:
Facility Contact: a�/—�� /�(Jj��per��jilo• Title: ,qPhone:
Onsite Representative: �_ Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine CPo apacity p.
Wean to Finish
11
Wet Poultry
I ILayer
Design
Capacity
Current
Pop.
Design
Cattle Capacity
Dairy Cow
Curren#
Pop.
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
jNon-Layer
7 —Dairy
Design Current
ult , Ca act P,o .
Dairy Calf
Heifer
Cow
Non -Dairy
Beef Stocker
Gilts
Boars gfrNon-Layers
Otlter
Other
Turke s
Turkey Poults
Other
Beef Feeder
Beef Brood Cow
Dischartes and Stream ImnaCts
l . Is any discharge observed from any part of the operation?
[]Yes
�jjNo
[DNA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
[] No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�&No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
UNo
❑ NA
❑ NE
of the State other than from a discharge?
Page l of 3 21412015 Continued

< Facili Number: - Date of inspection:
Waste Collection & Treatment
. 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[] Yes ['No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
D 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 JRNo
❑ 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 ja 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 Jallo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes jallo
❑ 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 [NNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes ja 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): rf �/*-� '-
13. Soil Type(s): / L %J R
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes J2 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes I& 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 10 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes [a No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes rNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes �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 E3-No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Jallo
❑ NA ❑ NE
[] Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: ?/ - 3 jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes JE� No ❑ NA ❑ NE
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes RI 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 JZ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Callo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[3,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
allo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Zj No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[A --No
❑ NA
❑ NE
Comments (refer to question 9): Explain any YES answers and/or any additionalrecommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
ReviewedInspector Sigmatur
Page 3 of 3
Phone:
Date:
21412015

ater ivision of WResources
Facility Number ®- 3�l Division of Soil and Water Conservation
O O Agency
Type of Visit: 01tompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: Owner Email:
/2/a.Owner Name: /%%Qy^517�Q Phone:
Mailing Address:
Physical Address:
Region:,
�10
Facility Contact: ae! , *?4-
tie: �1�(l�,rr _ Phone: 7,41 �F/%�L� r�
Onsite Representative: �ja.c� - Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
e
Latitude:
Certification Number: f�a�
Certification Number: �jp/�2
Longitude:
Design
Current
Design
Current111111
11111111111 Design Current
Swine Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
I
Dairy Cow
Wean to Feeder
I INon-Layer
I
Dairy Calf
ceder to Finish
Q
_, .. ... - _
...
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . Poul
C. aci
P,o ..
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
Boars
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Imaacts
1. Is any discharge observed from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
EQ 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

Facili Number: - Date of Inspection: :Z,?
— l
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes � No
a_ If yes, is waste level into the structural freeboard? [—]Yes ❑ No
Identifier:
❑ NA ❑ NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 12 Z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes tK No 0 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
Z No
0 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
S No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[-]Yes
[Z 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
[�j No
❑ NA
❑ 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 ❑ 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): �t/1 � 169
13. Soil Type(s): /� (2 / ,Aj j9X
14. Do the receiving crops differ from those designated in the CAWMP? [-]Yes ZLNo ❑ 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
[a No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[Z No
❑ NA
❑ NE
the appropriate box.
❑W11P ❑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 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [K No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 4 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA 0 NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: f - 3.� Date of Inspection: — / ,
,24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes "No ❑ NA ❑ NE
r
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? ED 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?
❑ Yes allo ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No
[:]Yes 21 No
[:]Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional naves as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: 9/0 J��L_3_*7 D`D
Date: & � Jim _g
21412014
Page 3 of 3

5 pi. -►7 15
Date of Visit: Arrival Time: Departure Time: ! County: ._ph d'_
Farm Name: ,�iia i� I ! Du�/� +O�a//�• Owner Email:
1
Owner Name: _/��-ld.�i - %�prLy Phone:
Mailing Address:
Physical Address:
Facility Contact: &Zfy,--%- //P a .7`r/y Title:
IV I
Onsite Representative:
Certified Operator: Jf ____
Back-up Operator:
Phone:
Region:
Integrator,
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
I
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Feeder to Finish
Farrow to Wean
I INon-LUer
D , P,o
Layers
I
Design.
Ca aci
Current
P.a
Dairy Calf
gy, a
Dairy Heifer
Cow
Farrow to Feeder
Non -Dairy
Beef Stocker
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
I
Turkeys
ITurkey Poults
10ther
Other I
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 ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes rMNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes j� No ❑ NA ❑ NE
of the State other than from a discharge? T
Page I of 3 21412014 Continued

+ Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
FZNo
❑ 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): 1 g
Observed Freeboard (in):3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
allo
❑ 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
mnLCJ-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
FSa"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)
_[�a
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
Z No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E2�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): %32a�i7 �` ��rs Yd
13. Soil Type(s): tt"�er l &2J /) p
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [�J.No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes [g No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Q No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ZLNo ❑ NA ❑ NE
❑ Yes 21 No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes allo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Q No ❑ NA ❑ NE
the appropriate box.
❑WUP [-]Checklists [:]Design []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 E,No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Callo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facili Number: - y Date of Inspection: L -
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30, Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33, Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [2 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑Yes ®No ❑NA ❑NE
❑ Yes [._No ❑ NA ❑ NE
❑ Yes 2 No
[:]Yes ® No
❑ Yes 24 No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Comments (refer to question f: Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:/b— y spa
Date: /11—/G .-Y";20/5—
21412011

c
hype of visit: W Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: Routine 0 Complaint Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 4-1 Arrival Time: p 2 Departure Time: !s County:
Farm Name: r ' GU's + I 1 ii tk j h bL j Owner Email:
Owner Name: rs� (n. t d D Phone:
}} L]
Mailing Address:
Physical Address:
Region:
Facility Contact: k&lhrS6J 1 V V ' I kLl, jhI Title: Phone:
Onsite Representative: f Integrator: lortflI
Certified Operator: ! I Certification Number: / Sa(ID
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
estg "'-orient, Design C►nSwine
Capacity Pop. Wet Poultry , pacttyPop Cattle Capacity Pop.
E'-
..;l.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I
INon-LaXer
I
I
Dairy Calf
Feeder to Finish
- -
Dairy Heifer
Design Current
Farrow to Wean
Dry Cow
D . Pdoul Ca act I?o g•
Farrow to Feeder
Non -Dairy
Farrow to Finish
La ers
Non -La ers
Pullets
Beef Stocker
Gilts
Beef Feeder
Boars
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
iAi:n6'YYAGi...,... .. .-...— .:::3:..•.iw h�:An:.'.,�,u
-. �'J:b.-_a.�
': -
� '—i_-...
Discharges and Stream Impacts
No
1. Is any discharge observed from any part of the operation?
[::]Yes
ED
❑ 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
❑v 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
[TNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes�YNXo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
2<0
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3
21412011 Continued

Facility Number: - 0Q3 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes D-NT ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [a_AlA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Structure 5 Structure 6
❑Yes ❑ o ❑NA ❑NE
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
[EI-Va-
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[34#u-
❑ 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
El -No' ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Q.Die-
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes EJ.Ne- ❑ 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 -_o�❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): e✓'�'' `'"� `
13. Soil Type(s): /".Jn¢_. Co Po
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E5-Ns ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ 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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes E o ❑ NA ❑ NE
❑ Yes 1" o ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E'lsio
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [—]Design [—]Maps [:]Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes
o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
El Yes
Yo
❑ 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

•
Facili Number: - jDate of Inspection: V
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes P o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes 2-I To ❑ 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 Quo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes [k o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes DINo ❑ 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 [] o ❑ 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 Q No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do su ace tile drains exist at the facility? If yes, check the appropriate box below.
es MNo ❑ NA ❑ NE
Application Field ❑ Lagoon/Storage Pond ❑Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Ejjf-es ❑ No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ED-Ko-_ ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Ealf-io ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (nse additional pages as necessary).
Ga j� b 'J'01 lob Gc l/ O�
9 -e-y 3. 3
bk4 �Ly ltaovl', F0_'VL"tn
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone., b 7c]3
Date:
21412011

Type of visit: ompliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: �outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: V Departure Time: County �!! -1_ Region
Farm Name: Owner Email:
Owner Name: mX1,Ct d6j,
4 Phone:
Mailing Address:
Physical Address:
Facility Contact:
AV,? W"li UL"
i� tle:
Onsite Representative:
Certified Operator: Z
Back-up Operator:
Location of Farm: Latitude:
Phone:
Integrator: r
Certification Number: oLe P
Certification Number: / 00
Longitude:
Design Current00.
Design
tCa
Curreat
Design Current
Swine Ca aci Po
P ty P•
Wet P©ult r3 P act
Po p•
r
Cattle M Capacity Pap.
..ty
Wean to Finish
La er
Dai Cow
Wean to Feeder
Layer
Dai Calf
Feeder to Finish
.,. -
Dairy Heifer
Farrow to Wean
Design
urren
Dry Cow
Farrow to Feeder
D , l',oult 11:Caa i
P,o P.
Non -Dairy
Beef Stocker
Farrow to Finish
La ers
Gilts
Non -La ers
Beef Feeder
Boars
jPullets
Seef Brood Cow
Turke s
}
Othe
ITurkey Poults
Other
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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)
Z. 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 !o ❑ NA ❑ NE
❑ Yes
❑ No
�]A
❑ NE
❑ Yes
[:]No
�NA
❑ NE
Yes
[:]No
EUXA
❑ NE
[] Yes
Eo,? o
❑ NA
❑ NE
[] Yes
E] No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes To ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [L'?1o_ ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes L 24-0 ❑ 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 to ❑ 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 t rest, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes to ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Aanlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EVNo ❑ 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 ManurclSludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): ev' (�
13. Soil Type(s): WA_ J2„ P _
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes [L No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes [j 4o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [21 o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes El"No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes U3"N'o ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes EUX5 ❑ NA ❑ WE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Q Ko ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps 0 Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes `i ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes io ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: -13 IDate of Ins ection:
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 Fj"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 B? No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [Blf;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 [!3-No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes 0?"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. Ekyes
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
❑ No
❑ NA
❑ NE
Q�Xo
❑ NA
❑ NE
EI.No
❑ NA
❑ NE
[J-Ko
❑ NA
❑ NE
NtW �Y �1s k4�^l d%�as t U+/ Gh�M Zb l3
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
c
Phonel(CIfE
Date:
21412011

DM ovi P110k
Type of Visit- 1 Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: I'Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
a "IVY
Date of Visit: j Arrival Time: Departure Time: County: _ Region:
Farm Name:
r
Owner Name:
rMailing Address:
Physical Address:
Owner Email:
Phone:
r i C"`'f I iJ_
Facility Contact: tj&sh?ll J j1 j1 Dwhby _Title: 0 m'?' Phone: 7 �— Q�1 -_
Onsite Representative: Integrator: pr'ef'1 a,, P_
Certified Operator: jimhad MiflovihbvCertification Number: Q081
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish
Design Current
Cattle Capacity Pop.
airy Cow
Wean to Feeder
Layer
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
" ::`
D , Foul
La ers
Design
Ca achy
Current
P,o
Dairy Heifer
Dry Cow
Non-Dai
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Broad Cow
Othe
Other
Turke s
urkey Poults
Other
Dischar es 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 Callo [] NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes allo
❑ Yes 2TNo
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

Faciti Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
(U-No
[3 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) -
Observed Freeboard (in): 3LL--
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
CR 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
0 NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�TNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[&No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Vo the receiving crops ditter trom those designated to the CAWMP?
Lf Yes
WNo
L NA
L NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
U No
0 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
[TNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Z[No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
allo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
[YNA ❑ NE
Page 2 of 3 21412011 Continued

'Facility Number: - 30 Date of Inspection: Ll
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 No ® NA NE
Other Issues
28- Did the facility fail to properly dispose of dead animals with 24 hours and/or document
Yes
Cg No
❑ NA
ONE
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
5a'No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
0 Yes
� No
❑ NA
0 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.
f-Yes
No
❑ NA
❑ NE
Ei Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
0 Yes
® No
❑ NA
❑ NE
33. Did the Reviewer/Impector fail to discuss review/inspection with an on -site representative?
0 Yes
WNo
NA
0 NE
34. Does the facility require a follow-up visit by the same agency?
0 Yes
2KrNo
NA
NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings; of facility to better explain situations (use additional pages as necessary).
a�,Or�esel�o��eccrd�- coaecW_ d w�� lllm ot7 . Goad rYcofdr my H,
31, Dra� le b ,des cnds, h-is caeHdUr� spr eve� and ne(Mally.
14 is on ca d i yve /
Good- re-Coas
PL,J� dlvr-� ,ns�ec'�717(Y
Reviewer/Inspector Name: 7DOlI ckly)�Plpr
A n A
Reviewer/Inspector Signature:
Page 3 of 3
Phone, $a33-X oolW e
Date:
21412011

Facility No.1 E-D
FarmName
Date alillia
Permit �--'COC
c/
OIC_
NPDES (Rainbreaker PLAT Annual Cert Daily Pipe)
Lagoon Name, S forspillway
1
2
3
4
5
6
7
Design Freeboard / Last Recorded in
Observed freeboard
Sludge Survey Date
aQ
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to -Treatment Volume ifs 0.45
Date out of compliance/ POA?
NORMA M., 0 - '
Wire
MIN
Design _2�-------
Soil Test Date An66f
Crop Yield -�
Transfer Sheets
pH Fields
Wettable Acres
RAIN GAUGE 6,/
Lime Needed
WUP ��
Dead box or incinerator
Lime Applied
Weekly Freeboard ✓
Mortality Records
Cu-I i./ Zn-I�
1 in Inspections �_
Check Lists
Needs S (S-1<25)
120 min Insp. ✓
Storm Water
Needs P ��0
Weather Codes
Waste Date
- 60 Da
+ 60 Day�-
N (lb/1000 Gall
►.
.5
�. G,
..
�.
�-
Verify PHONE NUMBERS and affiliations
Date last WUP FRO FRO or Farm Records
Date last WUP at farm Lagoon #
App. Hardware Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Ib/ac-, Zn-I 3000= 213 Ib/ac

i ype or visir: w t-ompuance inspecrion v vperatlon eceview v arructure Evaluation v i eennieai Assistance
Reason for Visit: • Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: i ly 1 Arrival Time: 4: p0' 14/1 Departure Time: jQ;i ,r► County: �Ob�SyN Region: FRO
Farm Name_ MAQ�A1��}1if c�.by IFAckw­� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
FacilityContact: l I Q RSh pl l Title: O W E K Phone:
Onsite Representative: §A Integrator: QI nAf. s it
Certified Operator: C\ MV141 t _ 1�} m rtunti.b !4 Certification Number: l�aQ
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Current
Design Current
Design Current
Swi
Capanty
*.
Pop
Wet Poul by
Capacity loop.
Cattle Capacity Pop.
Wean to Finish
La er
DaiEy Cow
Wean to Feeder
Non -La er
Da' ' Calf
Feeder to Finish
444►p
T .r
Dairy Heifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
D .Poul
Ca act Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Y
Turkeys
Other
_
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 1 No ❑ NA ❑ NE
❑ Yes ❑ No ❑' NA ❑ NE
❑ Yes ❑ No g NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑Yes ❑ No [g NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes dNo ❑ NA ❑ NE
3, Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [:]No Q/IVA ❑ NE
of the State other than from a discharge?
----Page 1 of 3 21412011 Continued

IFacility Number: -718 Date of Inspection: -1 .iq ao tt
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No B NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: # �]
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Iq K
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [?rNo ❑ 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 [?jNo ❑ 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
gNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[RfNo
❑ 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
E�No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
gNo
❑ 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 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Approved Area
12. Crop Type(s): tit V Q H A �1 • G. O
13. Soil Type(s): w ago, f C 0
14_ Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ff No
❑ NA
❑ NE
15_ Does the receiving crop and/or land application site need improvement?
❑ Yes
eNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[gNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[vrNo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
[ JoNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[0 No
[] NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
[gNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes MNo
❑ 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 1dNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Ycs [—]No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
Q A ❑ NE
Page 2 of 3 21412011 Continued

Facility Num er: - 03 2 Date of Inspection: 7LIq
24, Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
gNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
g 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
Ej�No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
- ❑ Yes
[j�'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 [1 rNo ❑ NA ❑ NE
❑ Yes ErNo ❑ NA ❑ NE
❑ Yes M"No [] NA ❑.NE
❑ Yes gNo ❑ NA ❑ NE
❑ Yes [0'*No
❑ Yes Cr7 No
❑ Yes E]"No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
* Ca�sbQa�scy. by 1a1 11
X Rep aas \< tf'r I-J t' N'\
X VA(Z.r\ i onV'S yo p
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Cif . 4 33 '3 3►3 D
Date: 7 �/[1 l ao
21412011

�s s a� zoo
Type of Visit ID'Eompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �f 1/1J-�J/D Arrival Time: Q •' �Jr Departure Time: z."l.Q County: Ob Region:
Farm Name: Z/ QY,Shf ll _ �ti�_� �`w� Owner Email:
Owner Name:* �'�Llli N �J�u _ Phone:
Mailing Address:
Physical Address: /f
Facility Contact: A ttV5Aq 1/ wt /°'u Title: eW1V64e__ Phone No:
Onsite Representative: / Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [= o ❑ d = Longitude: = o ❑ 4
Design Current
Design
Current Design Current
Swine Capacity Population
Wet P,on]try
C►apacity
Population Cattle CapacityPopulation
❑ an to Finish
❑ La er
❑Dai Cow
❑ Wean to Feeder
❑ Non4 er
❑Dai Calf
Feeder to Finish AW,7,TV
Dairy Heifer
Farrow to Wean
ltry
� -❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
ElPullets
❑ Beef Brood Cowl
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State'? (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 EfNo ❑ NA ❑ NE
❑ Yes
❑ No
Cj<
❑ NE
❑ Yes
❑ No
E A
❑ NE
E19A
El NE
❑ Yes
No
El Yes
,❑l
L�f`No ❑ NA
❑ NE
El yes
B'No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: 7 —93Z 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
O<o
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
L 7No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA
❑ NE
through a waste management or closure plan'?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
355o
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
2lo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
El Yes
�/
D ivo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ETNo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes L7 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
,� I/ ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) ,... !'i+ey��hay / _ S%jfyl�lorx• N (p . $. - --
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?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[TNo ❑ NA ❑ NE
2 ]o ❑ NA ❑ NE
No❑ NA [-I NE
3 NoEl NA El NE
2<o-'-❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
AL
Reviewer/Inspector Name S Phone: /40, �.�
12ei4ewer/Inspector Signature: 7 Date: � Z / -Zolo
Page 2 of 3 12128104 Continued

Facility Number: tw ,3Z Date of inspection —Z/—/O
Required Records & Documents ,�/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes L] No ❑ NA ❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes CTNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ErNo ❑ 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
E]
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
B IVa ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Ld'1go ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No ❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No ❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ YesB'�o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
To ❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
2 o ❑ NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
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
BNo ❑ 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
ElB Yes
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
,�,�
L'fNo ❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
L?<o ❑ NA
❑ NE
Comments and/or
Page 3 of 3 12128104

RT-wt S S J S Z4 c' % 4A-
ivision of Water Quality
Facility Number Q Division of Soil and Water Conservation
O Other Agency
Type of Visit Rcompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ,`0�' IDeparture Time: ounty:
Farm Name: 1 We ct t?_4x 1 Owner Email:
Owner Name: A4,s45ZZJ tl Phone:
Mailing Address:
Region: F�
Physical Address:-a� "I
Facility Contact: & Title: Q�Uit T' Phone No: O ' DIIJZ
Onsite Representative: A4,Integrator: t
Certified Operator: &jCjL4a AFt Operator Certification Number: IF
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
W an to Feeder
ceder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: [= 0 = Longitude: = ° = = 1
1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
T 1 ❑ La er
I. � ❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkev Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Cu." I
Cattle Capacity Populatio
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: ©'
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation`?
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
J
❑ Yes R No ❑ NA ❑ NE
❑ Yes
❑ No
2<A
❑ NE
❑ Yes
❑ No
ET'NA
❑ NE
2<A
❑ NE
❑ Yes
❑ No
❑ Yes [" No r❑l, NA El NE
ElElL1
Yes No G'NA ❑ NE
12128104 Continued

N
Facility Number: Date of Inspection $
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2<o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No &<A- ❑ NE
St tune 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 0 No ❑ NA ❑ NE
through a waste management or closure plan? '
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 2-5-o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes &No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,,�
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2 o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2to ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) A # AL
/
14. Do the receiving crops differ from t ose designated in the CAWMP?
❑Yes
o
�
El NA
❑NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
(J'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
9<0
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
-
El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
,[�,
NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
f
Reviewer/Inspector Name t[e Phone: IZZ1- 4/33-33 34
Reviewer/Inspector Signature: Date: SEZZ U
1212810 Continued

Facility Number: a — j0 3,;L Date of Inspection 5 4
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps El Other
❑ Yes R' V7o ❑ NA ❑ NE
❑ Yes EKo ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E3'1�o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑
Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
2<o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
[j No
U?<A
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ETNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
MNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes N' o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No P- A ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes B No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
BNo
❑ 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
ONo
❑ 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
Q 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
EJ o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
2No
❑ NA
❑ NE
Additional Comments and/or Drawings:
ts
12128104

S NS 7—/4i-48
Facility Number I 4
vision of Water Quality
O Division of Soil and Water Conservation
O Other Agency
Type of VisitC6om�pliance
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
C`TRoutine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: 7nb7 S Arrival Time: 9. 0� Departure Time: ��. eYI County: e &sa'✓
Farm Name: /!lQI�N4 f� y �Q�it� Owner Email.•
Owner Name: l�'u f9a Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: r:;WA1e41_ Phone No:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Operator Certification Number:
Back-up Certification Number:
Region: OHO
Latitude: 00 =' = Longitude: = ° 0 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I^I ❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current: `
Cattle Capacity`° Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non-Dairy-
0 Beef Stockez
❑ Beef Feeder
❑ Beef Brood Co
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: a'
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes ❑ No NNA
❑ NE
E
El Yes El, No Lr NA
❑ NE
❑ Yes ❑ No L NA
❑ NE
❑ Yes L2 No ❑ NA ❑ NE
❑ Yes [2 No ❑ NA ❑ NE
12128104 Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2
Identifier- # %
Spillway?: /vim
Designed Freeboard (in):
Observed Freeboard (in):
Structure 3 Structure 4
❑ Yes ' No
ElYes O No
Structure 5
❑NA El NE
❑NA ❑NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes do ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes dNNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require El Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes CfNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ElApplication Outside of Area
12. Crop type(s) SelrilGlu d a- L V--4 1 J e2, s., C 2
13. Soil types)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
B� �NN. El NA
o ❑ NA
No ❑ NA
No ❑ NA
ONo [3 NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
Comments {refer to es n #) platoyESanswers and/or any recommendations or any other comments.
Use drawings oi�facility;ta,better ezplat situations (use additional pages as necessary}:
ReviewerlInspector Name
t4� w �S'; phone: 910, V33, 3330
Reviewer/Inspector Signature:
Date: 7 -a7 2b0S
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection 7`07-
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes No ❑ NA ❑ NE
❑ Yes EfNo ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections
❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Now ❑ NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
,r
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o
T�❑ NA
❑ NE
25.
it
Did the facility fail to conduct a sludge survey as required by the perm`?
Yes
ElISN
,�
o ❑ NA
❑ NE
26_
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ErNo ❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[ No ❑ NA
❑ NE
Otherlssues
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
ETNo ❑ 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
C rNo❑ 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
ff No ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
21' o ❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

•'` e-/2 e d 01'k4-
19 Division of Water Quality
Facility Number O Division of Soil and Water Conservation
O Other Agency 11
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: -% -V 71 Arrival Time: Departure Time: County: j00brS4n/ Region: J` �
Farm Name: 'Oea- v Owner Email:
Owner Name: h ��� S Phone:
Mailing Address:
Physical Address:`-
Facility Contact:���� /t/i.l:v/�fD Title:
Onsite Representative:dell
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Integrator: G,j6 t9e*aA;"J
Operator Certification Number -
Back -up Certification Number:
Latitude: E o❑{ = u Longitude: ❑ o= I 0 u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Nan -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: Ell
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
9 No
❑ NA
❑ NE
❑ Yes
IM No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
0 No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
N No
❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [--]Yes O No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [A No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 90 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [21 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 [P No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance/improvement?
l I .
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 ❑l Application Outside of Area
12.
Crop type(s) Re.,-,Wwd0.r �/ 5� � _ �.i I c J � �r .it/ /a
13.
Soil type(s) Co N& (ftfQ $
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
[P No ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
O No ❑ NA
ElNE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
IF No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
No ❑ NA
❑ NE
18_
Is there a lack of properly operating waste application equipment? ❑ Yes
No ❑ NA
❑ NE
{ Comments (refer to question # ): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspectorName R v&-44 Phone: 9/0. 34,33.
Reviewer/inspector Signature: Date: j /y_ z UO 7
12128104 Continued

Facility Number: 78 3z Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ wup ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
10 No
❑ NA
❑ NE
23_
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
_" No
tri
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
F1 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
M No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
� No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ONo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ffNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[j No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Coiinatents and/or Drawings:
Page 3 of 3 12128104

11
0 Division of Water QuaEity
Facility Number `7'9 3 Z O Division of Soil and Water Conservation
w.- - _ Q Other Agency
Type of Visit * Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit • Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: -Z4—O Arrival 1Time; D'DO Departure Time: County: RDe5oo*1 Region:
Farm Name: Ofitrll'al% 011fOu4ltl71. Owner Email:
Owner Name:i%41-SLia/z W1��lOuG� ��., Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
//Phone//No•
Integrator: / 3_4
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = = « Longitude: [_-1 o = , =
Design Current
Design Current
Design Current
Swine Capacity Population
Wet PoWtry Capacity Population
Gettig Capacity Population
❑ Wean to Finish
❑ La er
[Ell airy Cow
❑ Wean to Feeder
on -Layer
❑ Dairy Calf
Feeder to Finish 1 4Y 10 $31
i•
❑ Dairy Heifer
El
"Dry�$oultry �'
El Dry Cow
-
�'❑
ElNon-Dairy
Layers
El Beef Stocker
ElNon-Layers
❑ Beef Feeder
El Pullets
❑ Beef Brood Cowl I
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑Other
a "'Number of Structures:
Farrow to Wean
El Farrow to Feeder.
El Farrow to Finish
❑ Gilts
❑ Boars
Discharges &Stream Impacts
I. Is any discharge observed from any part of the operation?
El Yes
®No
❑ NA
❑ NE
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
El Yes
C9 No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
®No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (]f yes, notify DWQ)
❑Yes
No
❑ NA
❑ NE
?. is there evidence of a past discharge from any part of the operation']
❑Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑Yes
� No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
I2/28/04
Continued

Facility Number: '7 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
El Yes 9No ❑NA El NE
❑ Yes [�j No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [A 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?
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
2& 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?
Comments and/or Drawings:
❑ Yes [9No ❑ NA ❑ NE
❑ Yes
[ 8 No
❑ NA
❑ NE
❑ Yes
$1 No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
MNo
❑ NA
❑ NE
❑ Yes
PO No
❑ NA
❑ NE
❑ Yes
[;j No
❑ NA
❑ NE
❑ Yes W No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes
V[ No
❑ NA
❑ NE
❑ Yes
(4 No
❑ NA
❑ NE
Page 3 of 3 12128104

Facility Number: -7 — �Z, 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
9 No
❑ NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / 9
Observed Freeboard (in): 27
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�O 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
[A No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[A No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
E6No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ft No
El NA
El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes W 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) eCi-nlydrt. /T�is, _ �atjl
13. Soil type(s) C
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes QI No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �A 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 No ❑ NA ❑ NE
18, is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
i
Reviewer/inspector Name - - _ — _ - -- Phone: i/O) e13 - Q
Reviewer/Inspector Signature: Date: 7 21,L- zdQ(o
0 1/10M4 /'....s:.......!

f`
Type of Visit d2rCompliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: a7 'Q Departure Time: ; ('� O County: Region:
Farm Name: il�lds�i�IS/ /►h.. f Owner Email:
Owner Name: _/n sa.�`S Ala � 1 IA 11 `flea-1,� Phone:
Mailing Address: 6,a.JJx 95 u!''' In D n a?_2L3 yo
Physical Address:
FacilityContact: - Title: Phone No:
Onsite Representative: ,�itra Integrator:
Certified Operator: me
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o E=I ' E=1 " Longitude: ❑ o ❑ 1 = u
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
-- - - I; .❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Po It
#,
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifej
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: E�J I
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 ZLNo ❑ NA ❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
Wo
❑ NA
❑ NE
❑ Yes
No
[INA
ElNE
❑ Yes
x No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
12128104 Continued

r
Facility Number: Date of Inspection/ 016--
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes I& No ❑ NA ❑ NE
❑ Yes &No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
R No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
R No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
XNo ❑ 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
jKNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or i 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)ZL�AZZ -IF
13. Soil type(s) �, Z if ,., Z Pe) 23
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
allo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
[KNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[]
Yes
LK No
❑ NA
❑ NE
17. 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
MNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or aay'other_ comments.
Use drawings of facility to. better explain situations. (use additional pages as necessary);
v, jgf-
Reviewer/Inspector Name ���T' W w �� a Phone: g/O—
Reviewer/ Inspector Signature: Date: —
12128104 Continued

1
• r
Facility Number: � Date of InspectionI 4a-1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes D&No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Dallo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ELNo ❑ 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 eatber Code
22,
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ZLNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
09 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
54 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
&No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
J4 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
W No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
& No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
(0 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
64 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
FONo
ElNA
ElNE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ERNo
❑ NA
❑ NE
33_
Does facility require a follow-up visit by same agency?
❑ Yes
f allo
❑ NA
❑ NE
Addi{ional Comments, and/or Drawings: ,
12128104

'�•. _--_..-... :.�.:,. .=.sax:...�e:...:.__,...,—...:._e.--�ti--.,..-.......e,,-...v�-,.+,.^._+^...ss--s,..,,....�[+exr Y.tiw..>....:._v^+�.r..:.., .. ��
Type of Visit 4§ Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit • Routine O Complaint O Follow up O Emergency Notification O Other Ej Denied Access
Facility Number 3 Z Date of Visit: /0 ZZ 0'( Time 8= 00
._.0 Not rational Below Threshold
Permitted Q Certifiedn 13 Conditio11Y Certified 0 Registered Date Last Operated or Above Threshold: _.
Farm Name: _ ... M#x:�z aL� WL���. T��.,w _ County-
Owner Name: - � �R _. w:11o S _ . Phone No: _-.--•. `f10 - -
Mailing Address: ys� C� aa�eQ...� . �� f_ - � __—W _ __�ca i �.+� �. � �______
Facility Contact: ..L�.ia��[__ Titleff f Phone No:
Onsite Representative: Integrator.IJ
Certifeed Operator: - • -�+ 0 _„ Operator Certification Number: 2 ,20,, _
Location of Farm:
CKSwine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ' " Longitude • <
_Desaga .Current . W
Nmnher�Iagoons - YY
N. h;3
Desiga CIIrreat
Discha es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated au ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
-Cattle _ - : `Po . - on
Dairy
Non -Dairy
:u' -'
ow SSM -
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
y Y1O
❑ Yes H No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes KNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes JANo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes KNo
Swctpre 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Idendfier:
Freeboard (inches): 3d
12112103 Continued

Facility Number: ;-$ — 3Z Date of Inspection t� 2
5. Are there any immediate threats to the integrity of any of the structures observed? (it/ trees, severe erosion, ❑ Yes SLNo
seepage, etc_)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes KNo
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance improvement? ❑ Yes ®,No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 1Z No
9. Do any stuca=s lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes RNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenancehmprovement? ❑ Yes CKNo
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes $LNo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground Q Copper and/or Zinc
12. Crop type & ryyt� 6#k �wi� ct rat v% ( ow�S ..
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWN P)? ❑ Yes E9 No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes [NNo
c) This facility is pended for a wettable acre determination? ❑ Yes IN No
15. Does the receiving crop need improvement? ❑ Yes ® No
16. Is there a lack of adequate waste application equipment? ❑ Yes JRNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes V,No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes R No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ®,No
Air Quality representative immediately.
. ,;,a" „x _. -,� .-. ."' '.. -,.x' ....'' a LK-:- 9v"-'4 ., ^+,..- -
(Iri tr>#O:. _ Y�'�4W![5 a kl O� l et DO `
Use do 'OFfa ty io; tes {tee ii0i i PQ Feld('�Fin �� ❑al Notes am
IS• Akr. W31o+j wAk be pla,,w-6v n, cv*-�seeA ove� v.erct coupe o� wee�kS. •
ReviewerAk spector Nameil4i
Reviewer/Inspector Signature: Date:

Facility Number: 4t — 31 I Date of ) aspecdon I U z b o
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ff yo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUi!checklisms!design, maps, etc.) ❑ Yes Iz No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes MNo
❑ Waste ApphcatioVO Freeboa&"[] Waste Analysis[] soil Sampling/
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes to No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes fia No
2.6_ Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application) ❑ Yes EgNo
27. Did ReviewerAnspector fail to discuss reviewfinspectiion with on -site representative? Cl Yes [& No
28. Does facility require a follow-up visit by same agency? ❑ Yes IffNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ILNo
NPDES Permitted Facilities
34. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) KYes ❑ No
31. If selected, did the facility fail to install and maintain rainbTeakers on irrigation equipment? ❑ Yes ® No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes P&No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes IR No
34. Did the facility fail to calibrate waste application equipment? IT& en PeA ❑ Yes 19 No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes C&No
❑ Stocking ForiiKEI Crop Yield Fonw-'O Rainfall[] Inspection After 1" Rairt,--
❑ 120 Minute InspecUoias t Annual Certification Forte
12112103

Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ®Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: 0 3 Time: LO Q rJ
Facilin Number
—Kot O eratio�ai BelnK• Threshold
Permitted ❑ Certified © Conditionally Certified ❑ Registered Date Last Operated or Above Threshold:
Farm Name: 6b Count-v: e7 Q JQA.-
Owner Name: M "' c- i t I J t O Phone No: qt D 16ag— IM41 _
Mailing Address: 4S4 � c %�a c ei C . ::kz-Y4z
F3eilitN' Contact: Q Title: d_c.-aea_­ /Phone No:
Onsite Representative: Integrator:
Certified Operator: Mrrr�bC_[I to 1 L Operator Certification Number:
Location of Farm:
Iffl Swine El Poultry [I Cattle [3 Horse Latitude Longitude
Design Current Design Current Design Current
Swine Capacity Population Poultry Ca acit`' Population Cattle Capacity Population
❑ Wean to Feeder ❑ Laver E
Dairy
Feeder to Finish tO ❑ Non -Laver Non -Dairy II
❑ Farrow to Wean
❑ Farrow- to Feeder ❑ Other
❑ Farrow to Finish 1 Total Design Capacity
❑ Gilts
El Boars Total SSLW
Number of Lagoons
Holding Ponds / Solid Traps
Discharaes B Stream Impacts
I _ is and° discharge observed from any part of the operation?
❑ Subsurface Drains Present ❑ Lagoon Area ❑ S rav Field Area
uid
Discharge orizinated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed; was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes, notifi• DWQ)
c. if discharge is observed, what is the estimated flow in eal/min?
d_ Does discharge bi•pass a lagoon system? (If ves. notifi DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4_ Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): 3:3
05103101
❑ Yes Q No
❑Yes ❑No
❑ Yes ❑ No
❑ Yes
W No
❑ Yes
P No
❑ Yes
M No
❑ Yes
[�,No
Structure 6
Continued

I
Facility Number: Date of Inspection 3 O
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes [ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7_ Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes P No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? El Yes up No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [KI No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes 0 No
12. Crop typein-T'%rV, ti Q' ,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ,a] No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15_ Does the receiving crop need improvement? ❑ Yes P No
16. Is there a lack of adequate waste application equipment? ❑ Yes FA) No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
[D'No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
Q No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
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
10
No violations or deficiencies were noted during this visit_ You will receive no further correspondence about this visit.
leq o L !-_.Q r 8 ck
Reviewer/Inspector Name I
Reviewer/Inspector Signature:
❑ Field Copy ❑ Final Notes
Date:
05103101 Continued

Facility \umber: ' . — Date of Inslivelinn e�3 Q3
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
2T Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i_e_ residue on neighboring vegetation, asphalt. ❑ Yes No
roads. building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes I` 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 91 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �LNo
32. Do the flush tanks lack a submerged fill pipe or a permanentitemporary cover? ❑ Yes ❑ No
05103101

d IL
1
Type of Visit M Compliance Inspection O Operation Review O Lagoon Evaluation
IReason for Visit A Routine 0 Complaint 0 Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number LCC I Date of Visit. Time:rO
y( Not Operational 0 Below Threshold
ik114 Permitted C] Certified ❑%Conditionally Certified D Registered Date Last Operated or Bove Threshold:
Farm Name: deckaliku a r—M I- County: So`l,--
Owner Name: , ���br4 Phone No:
Mailing Address: �
f Z i D
Facility Contact: 0 IIJ A r r Title: Ph a No:
OnsiteVRepresentative: G1 Integrator: ��S t-
Certified Operator:( Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 0 0 u Longitude • 0
-
Design Current
Design Current `
-DesiLm , , .Current .
Swine
Gaachy Po elation _ Pgvltrr
Ca acity PoiMatiob Cattle ::..
_Ca aeiity "-Pom tditioo _
❑ Wean to Feeder
10 Layer
=
El Dairy
-
Feeder to Finish
❑ Non -Laver
❑ Non -Dairy
I
?''
Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Desigt] capaciih, -
❑ Gilts
❑ Boars
= _
- . Total SSLW
-Number of Lagvoas; . I ❑ Subsurface Drains Present 110 Lagoon Area 10 S ray Field Area
H4ldiag Ponds 1 Solid Traps; ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
El Yes XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ie No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ONO
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify Dv1`Q) ❑ Yes ONO
2. Is there evidence of past discharge from any pan of the operation? ❑ Yes R�No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ yes )k3"'No
Waste Collection R Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ko
Structure 1 Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

Facility Number: 21— Date of Inspection
5. Are there anv immediate threats to the integrity of any of the structures observed? (ie/ trees. severe erosion,
❑ Yes
No
seepage. etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
❑ Yes
N0
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
o
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
ElYes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑
ANo
elevation markings?
Yes
Waste Application
10. Are there any buffers that need in
El Yes
No
11. Is there evidence of over application? ElExcessive Poonding ElPAN ❑ Hydraulic Overload
El
❑ Yes
No
12. Crop type a M. Ozwerwj
I3. Do the receiving crops differ with those desi ated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14. a) Does the facility lack adequate acreage for land application?
El Yes
No
b) Does the facility need a wettable acre determination?
El Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15. Does the receiving crop need improvement?
El Yes
No
16. Is there a lack of adequate waste application equipment?
❑Yes
No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
�No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ic/ discharge, freeboard problems, over application)
❑YesNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ll 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
0No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer.6 tiesdun #1) Explain any YES sns rers and/or any recommendations or.aoy other comments.
Use drawings of,facdrty to better,explam" situattoas (use additional pages as necessary) -
_.. _ Field Conk Final Notes
I
H.
Reviewer/Inspector Name
Reviewer/Inspector Signature: c, Date:
05103101 'X
Continued

Facility Number: 7 — Date of Inspi•ction ' O
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atior below es ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there anv dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e_ residue on neighboring vegetation, asphalt. ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes NV0
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
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes kf vO
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments and/or, Drawings,
05103101

of Visit /0 Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Vlsit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date or visit: ® Time:
FFacility Number �
0 Not Operational 2 Below Threshold
APermitted [3 Certified 0 Co diti/onnally ertiB`edd © Registered Date Last Operateer bove Threshold- ...
Farm Name: .. %.� � ...LN..r�Da..�!.` .. .................................... county: ...Ll. � ................. _
�F G `....
Owner Name:. r l,(r�.r �+ �L............ ... Ll ..� .. .1EtC Phone No: Y �Q. Lref ............... ...
Facility Contact: w i,.aI... ...... Title, .......... �... .................... - Phone No:................. �... _
Mailing Address:........(.. /._.......1. .¢d.......................................................... ....... Lat.
� vN.M.. .i . ��� ...............
Onsite Representative: --- .{,/J<.P.. Integrator: _......�f�4.'-'7
.......... ....
Certified Operator:../Votry/(► 1.................. .1...�.......� ........... Operator Certification Number:...... ... _. ,....
Location of Farm:
7 S
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �� ��
Design CnrreAt . Desigtn Current �Desiga Current .;
_
Ca cSwine Ca cPo Population CatleCa eiPo lation
Wean to Feeder 10 Layer I ❑ Dairy
❑ Feeder to Finish q 10Non-Layer ❑ Non -Dairy
❑ Farrow to Wean
Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity 2j
—13
Gilts
❑ Boars Total SSLW
Number;otI
L, 10 Subsurface Drains Present 10 Lagoon Area 10 Spray Field Area
Holdeag Ponds /Solid Traps 0 ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes �No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes o
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) ❑ Yes o
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes KNo
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 'P�No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
IdentiFier: ......................................................... ................................... ............................. ...... .............................
Freeboard (inches): („I']
5/OD (( V
❑ Yes
Structure
Continued on buck

Facility Number: S Date of Inspection LPG
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ YesNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? _ ❑Yes �'�10
(If any of questions 4-6 was answered yes, and the situation poses an \\
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes rNo
o
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes W_No
_Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes jo No
11. Is there evidence of over application? ❑ Exec ive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ONO
12. Crop type PrM 14-) a. ,silt < fni t
13. Do the receiving crops differ with those desigh(d in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16, Is there a lack of adequate waste application equipment?
Required Records & Documents
17, Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
o Yi0a ions d I f1denti�s * 'ria oof tfi�s:v�s�tt Yo>�t vv�l ree�ive titi ui'thgr' . .
cori-eden�e about this visit ....... . . .
Ch jCu,/a.jL7 aa?ri, �t O.4le �,ae+.. sisoGurC ,
�r�
Nti i g
gare
s'e/s
010ed
❑ Yes *No
❑ Yes RTo
❑ Yes WNo
❑ Yes P�No
❑ Yes U(No
❑ Yes U(No
❑ Yes 0No
❑ Yes �No
❑ Yes �� ll[�No
❑ Yes KNO
❑ Yes ® No
❑ Yes 1No
❑ Yes No .
❑ Yes No
❑ Yes 1"o
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: `S�a _ g/pQ

• Facility Number: = Date of Inspection $ . Q Printed on: 10/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below es ❑ No
liquid level of lagoon or storage pond with no agitation? A(Y
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes o
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 �N0
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 to-
32.o31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
lAddifional-Comments`an or_ .ravings: :.
�I
5100

Division of Soil and=Water Conservation -,Operation Renew
- =.
Division of Soil and_Water Conservation °.Compliance litspectAon .-
O:Division of Water "Quality FCompliance Inspection yE,J
--
_ :0 Other Agency _Opeiration=Review_ - -
r
J® Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number z Date of Inspection
Time of Inspection /= 24 hr. (hh:mm)
® Permitted © Certified [3 Conditionally Certified Q Registered 0 Not O erational Date bast Operated:
Farm N. ...... ..�% S�i�l- 1��1, ��•-�6.L......���""`................ County:........ %�7d6 € : � ...------------_--- .......................
Owner Name:........... .��AX-4,C � .../!!�..: �.► .. .................-.-...-.. Phone No:.... /,/a ....`Z ..�YF ....................
Facility Contact: ...... A..���.f.71... ...l.... � . Title :............... . Phone No: ...................................................
Mailing Address:.........��f.....t7�d�.....-./���.�2,....���f.lY ..�j...... �.P���................._..
Onsite Representative: ��f/ry .........................�...�.....!.........�i:�Integrator: .,,.......
Certified Operator:........ 15 ..�... ...... !f '! Q, .... Operator Certification Number: ...........................
Location of Farm:
F..................... ............. ..........................-........... ............ ................... .......... ............... ........_.......................................... I-j
Latitude • ` Longitude u • �44
- .
Design Current:
Design
Current..,: Design Current
Swine
Capacity Population = Poultry; ,
Capaci
Po ulation Cattle Ca acity Po ulation
❑ Wean to Feeder
❑ Layer
❑ Dairy
eeder to Finish//Q
/d
❑ Non -Layer
❑ Non -Dairy
❑ Farrow to Wean
,...
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
= _
Total Design Capacity
Y
❑ Gilts,
:..
❑ Boars
Total SSLW
-
Number of.Lagoons El Subsurface Drains Present ❑ Lagoon Area ❑Spray Field Area ,
-Holdmg Ponds /Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 0 No
Discharge originated at: ❑ Lagoon [3 Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ® No
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes E] No
c. if discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon ~tern? if yes, notify DW ❑ Yes ,K No
�� >p• � y- ( yes, y Q1
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge'? ❑ Yes ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure 1 Structure'-) Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
r�
Freeboard(inches): ...................... .............. ..-................... ........ ........................... ................................... ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑Yes ERNa
seepage, etc.)
3/23/99 Continued on back

Facility Number: �'? — 3 Z I Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
14. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type �.2ti• i*(fA.4f/O.P.SrI�
f i
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
21, Did the facility fail to have a actively certified operator in charge`?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24, Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: Nd. iolaa ions:or. defciencips -mere noted• dtirr'teig this -visit' • .. u witi•reegiye iio further
corres�orideitce. about this visit. • :. : . : : : :
❑ Yes )0 No
XYes ❑ No
❑ Yes XNo
Comiirents;(refer i6 question #) .;Explain any -YES answers and/or iiyrecornin airons or any other comments
Use:drawihgs of facility to: better;explaiii_ s�tuahons -addition al;.pages as.necessary) r a
,
IZe
/s- G� 1G�% /�i�i,' �c�G'' �.��-1�
❑ Yes *No
❑ Yes No
❑ Yes No
❑ Yes XNo
❑ Yes ', No
❑ Yes 1P No
❑ Yes to No
❑ Yes P No
❑ Yes PrNo
[]Yes RNo
❑ Yes Pt -No
❑ Yes �9 No
❑ Yes ® No
❑ Yes No
❑ Yes �KNo
❑ Yes lu No
❑ Yes ),No
❑ Yes,KNo
Reviewer/Inspector Name
Reviewer/Inspector Signature: �� Date: f f Z0,—,zl

Facility Number: Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes to'No
28. Is there any evidence of wind drift during land application? O.e. residue on neighboring vegetation, asphalt, ❑ Yes J�kNo
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 2;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 [E] No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ® No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes P No
AdqiOp!!#.CoFnments•an or rawtn - - -

t
1 x
Facility Number Date of inspection
Time of Inspection ' CU 24 hr. (hh:mm)
Permitted [3 Certified/ [3 Conditionaliv llC/Iertified/ 3 Registered 0 Not Operational Date Last Operated:
Farm Name: .... %� !..l.i� ±�..Kl.. `� �t ... County:......- d.i l� �....................... .....................
)... r
Owner Name:..t• r..5.x'a.j`••.............. ...bi ... 1..04)a. 4.K. Phone No: ............ z�`.....l.. .....
Facility Contact: �GcJvRe ..-.... ..............Title:...............-•--- ........... Phone No:..........._.....---------............------......
Mailing Address:.......1..� ........ a�( ... eC �P............................................ ..L. Gerf....t7!f 2.S4 �r ... ..0 ---....I........I.. .........37d...
Z�
Onsite Representative:.................................................................... Integrator: ............74
re��-.......................................
Qf 2
Certified Operator:.......... S f ........W !. eu k6y.................. Operator Certification Number...........................................
Location of Farm:
L........................................ ......................-------- ....................................................---------------- ................-'--'-'------.................................................................... 1 v
Latitude .• Longitude • L4 n~
Design Current _;' "`.'Design Curr"grit
5 vitae Canacity Ponulatinn Poeiltry -:Ca acity Po . ulation Cattle
❑ Wean to Feeder
Feeder to Finish
/ Q
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
�_ �1vum4er.or�,agoons.• -
Holding_Pondi / Solid Traps
Discharges & Stream Impacts
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dap
❑ Other I- '
r Total Deslgn Capacity
7.
Tota1.SSLW
1. Is any discharge observed from any part of the operation?
Subsurface Drains Present 110 Lagoon Area
❑ No Liquid Waste
Discharge originated at: ❑ Lagoon El Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
h. If discharge is observed, did it reach Water of the State? (If yes, notify DW'Q)
c. If discharge is observed, what is the estimated flow in gal/min!
d. Dices discharge bypass a lagoon system? (If yes, notify DWQ)
Design Current , <
V19
Spray Field Area
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard(inches): .......................................................................................................... .............................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes ANo
❑ Yes KNo
❑ Yes gNo
❑ Yes JVNo
❑ Yes jP No
❑ Yes [�No
❑ Yes XNo
Structure 6
❑ Yes )(No
Continued on back

Facility Number: -3Z hate of Inspection
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan'?
El Yes
XNO
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
/j No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
��'No
y�
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
O(No
elevation markings?
Waste application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
[2(No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
Wo
12.
Crop type _ r tie— 4 r�
13.
Do the receiving crops differ with those designat to the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
('No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
WNo
b) Does the facility need a wettable acre determination?
❑ Yes
kNNo
c) This facility is pended for a wettable acre determination?
'9Yes
❑`` No
15.
Does the receiving crop need improvement?
❑ Yes
fV No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
KNo
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
kNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
4No
(ie/ WUP, checklists, design, maps, etc.)
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
[:]Yes
ONO
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
)5�No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
0 No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes VqNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes )VNo
24. Does facility require a follow-up visit by same agency? ❑ Yes gNO
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes R�No
�'�10 violatmis or• deficjencies •mere noted• diWi&t 4his:visit: • Y:oit :will-r' a (Oct Rio rurthgr
CO' res• ont�eitce: about. this visit. - :....:.....:. :
Comments {refer to question #) Explain -any YES answe ars nd/or any recominendat�ons or any otlter cotmtrnentsr �
Use drawtngs of factlity to_bei#er explain;sttuaiions (use addYtyonal pages as.necessary) :.. ,-�,
GZ
ly, C. Ned `F v � f a_ map ma t" Jk' czG�i.�a.f I.1JCI(�cre5 A,
N8e� 't�) 44A)e 1a. Mw Q.���� set law pa; ti4 aTr- .
49 f6°'`"yam. vnQ� �.�e� 4-
good reC'OrdS',
ReviewerAnspector Name
Reviewer/Inspector Signature:
Date:
3/23/99

Facility Number: — Date cif Inspection
Odor Issues
26_ Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below 14yes ❑ 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 ONO
28. Is there any evidence of wind drift during land application? (i_e. residue on neighboring vegetation, asphalt, ❑ Yes Wo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30, Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31, Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �Nc}
32. Do the flush tanks lack a submerged fill pipe or a permanenthemporary cover? ❑ Yes CdNo
:Addifidnal-, Comrnentsairid/or.'Drawings...
3/23/99

�4Division of Soil and Water Conse❑ ,,�0 rvation OtherAgency
Division of Water Quality
.4 .:.,.�»�.c:.:a*re .�:I'; ,�>F�,z �wE- .�?":.' ,i �„M ,f.�,��o� �,:a� �� �, r� a•.��- �w , �"`' F �,�.�. � as.�:::
O Routine 0 Complaint 0 Fallow -up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number 3 ��
Time of inspection ,lam 24 hr. (hh:mm)
Registered XCertified
! 13 Applied for Permit 0 Permitted 0 Not.Operational Date Last Operated:..,,.....
Farm Name:..... ........... .......R. �I i ... 4 County:,.:...'..............e......
.................
] Sc��
. �s ........ itl;. Yo. ..
Owner Name: ..............!.. tc, !t'i!.�..... !4�(L.�! 1 �.... Phone Flo. �. I.......................................... EiJ .......................
U........ P
Facility Contact: � ,F'l II w �l �.dl.. .....................................................
�.. ..........f. Title:..........................:........r.. Phone No:
.. r t...............
Malin Address: ................ 454
..?......r � _.~..rra-) , O
G .......................� �y�
.................................
Onsite Representative: .... Q 1 // .......................................p............
Certified Operator. ............... ��.(.q.11..............W;lloujOp�rator Certification Number :............ a.a0
� f
Location of Farm:
Latitude �• 0' 0 �� Longitude
ry Design Current " Design # 'Current q «` Design -- Current
Swine : Capacity Populatioia "..Poultry. , Gapactty Population Cattle mg „Capacrty;1?6vulahom
❑ Wean to Feeder
Feeder to Finish
fflo
4#10
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
a
❑ Layer
10 Dairy -
[� Non -Layer
-,. ❑ Non-Dairyw'I
,. -,a .-. k.k9 <:&; ,: �wv....
WNP `x 'W;. -a 4. .+, w-",e-v� hao�'R•5}*`.� h'R`f$'+,.,
❑ Other
r
.
Total Design
Capacity p M
Total SSLW
F
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
KNo
2. Is any discharge observed from any part of the operation?
❑ Yes
K No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
J4 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
;9No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
ANo
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
O(No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
J6 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
PQ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
'O(No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
7/25/97
Continued on back /i

Jr ,
r
Facility dumber: 78 —
8. Are there lagoons or storage ponds on site which need to be properly closed.'
Cl Yes XIN0
Structures fLal„uons.lioldine Ponds, Flush fits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure Structure 2
Identifier:
Freeboard (ft):
10. Is seepage observed from any of the structures?
Structure 3 Structure 4 Structure 5
........................................................ .............................
11, Is erosion �or any other threats to the integrity of any of the structures observed?
12. Do any of.the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Annlication
XYes ❑ No
Structure 6
❑ Yes ANo
❑ Yes No
❑ Yes No
❑ Yes ANo
14. Is there physical evidence of over application? ❑ Yes JX No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .................................... ami U.... ...... ...... )/.... .... .... ...... .... .... ......L1 `e�L... - 1............................ ..
16, Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMI')? ❑ Yes P(No
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did ReviewerAnspector fail to discuss review/inspection with on -site representative'?
22. Does record keeping need improvement?
For Certified or Permitted Facilities On[F
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available"
24. Were any additional problems noted which cause noncompliance of the Certified AW,MP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0 No.violations or deficiencies were'noted daring this'visit.- .You will receive no further
coerespbndettce about this.visit.-,
❑ Yes PkNo
XYes ❑ No
❑ Yes XN`o
❑ Yes ANo
❑ Yes )gNo
❑ Yes Z No
❑ Yes JgNo
❑ Yes XNo
❑ Yes ETNo
IComments (iefeko question #): Explain any YES answers and/or any recommendations or any o"then comeni ;I
Use drawings of facility to better explain situations. (use additional pages as.necessar r
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6JQt,l AWCQJ JIV - s 1st
�fwY %W fd S 45 foL>t a S
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:

Routine O Com taint O Follow-up of DWQ inspection O Follow-ue of DSWC review O Other
Facility Number
Date of Inspection 3 z
Z
�/ Time of Inspection / : ,� Use 24 hr. time
Farm Status: C��ff/7► Total Time (in hours) Spent onReview 2
or Inspection (includes travel and processing)
Farm Name: //�,fA.s�.I+� 41111o°f.45 /.t�•� ,» County: sosv
Owner Name:�t5/f�K! ��(Ia�� Phone No:
Mailing Address: ��;, / , X fl�� /.t .o+ s.✓ �/� 2 �3 O
Onsite Representative: '�"� Integrator•.
Certified Operator: loyAa4' �" �'���"} �"��f 6 Operator Certification Number: / 8248
Location of Farm: r ! S t a 7
Latitude 0 4 Longitude 0 C ��
LQ Not O erational Date Last Operated:
Type of Operation and Design Capacity
45
Swine a �. Number Pout5.6
C ,
w
�..__. ' �� ... '_ �.., > , :NumberCattleINumber
S #
❑ Wean to Feeder, ❑ La ❑
Feeder to Finish Vly/o ❑Non er ❑ Beef ,,,�
„, �a
Farrow to wean F� 4 "�¢ �0k�
Farrow to Feeder xWyf�«
Farrow to Finish ❑Other Type of Livestocky�
Number of Lagoons f HoldEng P°adsF / , , ❑ Subsurface Drams Present_
y
all❑ Lagoon Area, ❑Spray Field Area '
General
I. Are there any buffers that need maintenancelimprovement? ❑ Yes A No
2. Is any discharge observed from any part of the operation?
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Was there any adverse impacts to the waters of the State other than from a discharge?
S. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes [Z No
❑ Yes 0 No
Continued on back

6. Is facility not in compliance with any applicable setback criteria?
7. Did the facility fail to have a certified operator in responsible charge (if inspection after 1/1/97)?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons and/or Holding Pondsl
9. Is structural freeboard less than adequate?
Freeboard (ft): Lagoon 1 Lagoon 2 Lagoon 3
—.39.L
10. Is seepage observed from any of the stnrctures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate pubtic health or environmental threat, notify DWQ)
13. Do any of the structures lack adquate markers to identify start and stop pumping levels?
Waste AAvtiCatioq
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type-
16. Do the active crops differ with those designated in the Animal Waste Management Plan?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the cover crop need improvement?
19. Is there a lack of available irrigation equipment?
For Certified Facilities Only
20. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
21. Does the facility fail to comply with the Animal Waste Management Plan in any way?
22. Does record keeping need improvement?
23. Does facility require a follow-up visit by same agency?
24. Did Reviewer/Inspector fail to discuss review/inspection with owner or operator in charge?
❑ Yes ,7 No
❑ Yes No
❑ Yes :RNo
❑ Yes ® No
Lagoon 4
❑ Yes )gNo
91 Yes ❑ No
❑ Yes ;3 No
❑ Yes Q No
❑ Yes Zj No-
RYes ❑ No
❑ Yes RNo
❑ Yes allo
❑ Yes .K No
❑ Yes R No
JO Yes ❑ No
❑ Yes R No
❑ Yes 4 No
❑ Yes 91 No
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AC/�y�•.�c��E�.
/l/iE�✓ f7?C/�� - S�X/�j1 j �C�sI�A+�AA 7A4-sr A7 loce"e- /V n< J7411'7,
Reviewer/InspectorName F�p
Reviwer/inspector Signature: Date:
ft
cc. Division of Water Quality, Water Quality Section, Facility Assessment Unit 11/14/96