820040_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qua

Type of Visit: 0 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 0 Denied Access
Date of Visit: Arrival Time: ; Departure Time: %'J County: �j� Region:
Farm Name: A`40A FI5 Owner Email:
Owner Name: �re5-a-e✓►'� Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
11
Certified Operator: 0
Back-up Operator:
Location of Farm:
Title:
Latitude:
Integrator:
Phone:
P—vr s r� q
Certification Number: ( C ? /,6
Certification Number:
Longitude:
Design Current
DesICurrentn
Design t►urreot
Swine ,;: , Capacity Pop.
Wet Poultry,'
ity
Pop.
@tittle „ Capacity Pop.
WItUIdNll�l4i,I�CIr'.
Wean to Finish
La er
Non -La er
Design
Current
Dai Cow
Wean to Feeder
Dai Calf
eeder to Finish
Daia Heifer
Farrow to Wean
DEX Cow
Farrow to Feeder
D `.1?oulte. ,
Ca tic'
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Layers
Pullets
113eef Feeder
Boars I
113eef Brood Cow
Turkeys
"p
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
❑ 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
OVNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
11 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

I/
Type of Visit: 5 Compliance Inspection CV Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: f Departure Time: County: r` Region:
Farm Name: ! Owner Email:
Owner Name: V es 12)� t V" S
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representa
ru
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
r177,6
Design
Current J Design Gnrrent ,:
Desi n Current
g.
Swine��, Capacity
Pop Wet PUultry 4Capacity Pop.
Cattier
4 Capacity Pop.'
Ys w
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
_ M_ � -
Dairy Heifer
Design , Current
Farrow to Wean
Dry Cow
i
t
aci I',o
Farrow to Feeder
Non-Dairy
Farrow to Finish
_,
La ers
Beef Stocker
IN
Gilts
wl
Non -Layers
Beef Feeder
Boars
Pullets
113eef Brood Cow t
t':
yl�
Othe
13
Turkes
'I I „..
.. f x
9 = a �x
urksx Pouets
Other
r
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[] Yes
b No
❑ NA
[] NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
kzz
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
9NA
E] 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
[TNA
❑ NE
2_ Is there evidence of a past discharge from any pan of the operation? ;'
❑ Yes
L!1 No
❑ NA
❑ NF
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
M No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of
21412015 Continued

acili Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
to No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
P�NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): L{
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any or questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, 7_n, 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 Drjft ❑/^Appliccatii�on Outside of Approved Area
12. Crop Type(s):4/ � or 6� ) �� , 6 ` —"L'- Dve_�'�
13. Soil Type(s): _� I
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
0 Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
{
19_ Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
[] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [� No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 10 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �Q No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

acili umber: Date of Ins ection: IZJAY
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus'heayy rainfall) less than adequate? []Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [�PNA ❑ 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 [�j No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
i
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes AA � 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 0 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes FiR No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) T
9. Does any part of the waste management system other than the waste structures require [] Yes b No ❑ NA ❑ NE
maintenance or improvement? '
Waste ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
t
❑ 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 Cr p Window Evidence
�of W' Drift ❑ Application Outside of Apprrov�edd Area
12. Crop yPO T e s :
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [)q No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [ja No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E�TNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EANo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
0 Yes
f
jNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
C] Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes M No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes `t No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

FacilitvAumber: n— Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EpNo ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check
[:]Yes
rnNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
0 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?
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
No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
TTTT
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a fol low -up visit by the same agency? ❑ Yes 3
No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better explain situations (use additional pates as necessary).
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
Phone: V_
Date: 1
21412 6 S

acil' dumber: - Date of Inspection: 1,24 AM
. 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
t
EUNo
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a:phosphorus loss assessments (PLAT) certification?
❑ Yes
©r 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.
I
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
©iNo
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
1
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
MNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the ReviewerAnspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
t
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [ No ❑ NA ❑ NE
t
Comments
S answers:and/or any
Use draw nseaf.ec
tactlity t bette explain sit 'ahons rose add tional pages as nmendaons or any other commenessa
#s."
l
Reviewer/inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
PhoneA V"_f '33 ,
Date: 41111 —7
+ , .
21412015

r
Division of Water Resources
Facility Number - !- Q 0 Division of Soil and Water Conservation
/ 0 Other Agency
Type of Visit: G-007 nce Inspection Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: erRoutine O Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: ' r Arrival Time: D Departure Time: ,'� County: Region:
Farm Name:Owner Email:
Owner Name:/ p ydQ� Phone:
Mailing Address:
Physical Address:
Facility Contact: W,
I f Title: Phone:
Onsite Representative: f:=eio� UJo&, Integrator: /
Certified Operator: rn Certification Number: /O� 30p
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
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
L
ayer
Dry routtry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes. notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge'?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heiler
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes U No ❑ NA ❑ NE
[:]Yes ❑ No
❑ Yes ❑ No
[]Yes ❑ No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a_ If yes, is waste level into the structural freeboard? ❑ Yes ❑ 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?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes jKj 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'?
0 Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
®No
[DNA
❑ 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
allo
❑ 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 or improvement?
11. Is there evidence of incorrect land application'? If yes, check the appropriate box below. ❑ Yes R[No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs_ ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Types)
13. Soil Type(s): [�
14. Do the receiving crops differ from those designated in the CAWMP?
Q Yes
'2No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
S Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
0 No
❑ NA
❑ NE
acres determination?
17, Does the facility lack adequate acreage for land application?
❑ Yes
jo No
❑ NA
❑ NE
I & 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
rR) No
[] NA
❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ONo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements
❑Other:
21, Does record keeping need improvement? If ves, check the appropriate box below.
Z Yes
[:]No
❑ NA
❑ NE
'r']c Waste Application ❑ Weekly Freeboard fK Waste Analysis � Soil Analvsis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'?
❑ Yes
® No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facility Number: -yq jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes jo No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes � No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes JS 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 §�j No ❑ NA ❑ NE
❑ Yes � No ❑ NA 0 NE
❑ Yes B No ❑ NA ❑ NE
❑ Yes OLNo ❑ NA ❑ NE
❑ Yes
No
❑ Yes
Yes
Wo
❑ 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 faciility to better explain situations (use additional pages as necessary).
/ du _Srr A, frrE-L- L T�1 — c�iyt,�la
� r
�,� !U rs�Cftirr CCPT
po lb AvO47'
roar
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Phone:
Date:
Page 3 of 3 21412015

N
Type of Visit: fe-Mompliance Inspection U Operation Review U Structure Evaluation O Technical Assistance
Reason for Visit: 011 routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Dc7
Date of Visit: ,iD4-I Arrival Time: Departure Time: County: Region:
Farm Name: jam' LU Owner Email:
Owner Name: �Lp r�� f Q, f 'z- Phone:
Mailing Address:
Physical Address:
Facility Contact: ) jR6L"s__ 44rr07f-s Title: jry iy:,L Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number: 24 73 00
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Finish
Feeder
o Finish
o Wean
o Feeder
o Finish
P
Design Current
Capacity Pop.
00D
Wet Poultry
La er
Non -La er
13 , l',oul
La ers
Design
Capacity
-
Design :Current
Ca aei
Current
- -Pop.
-
z--Pa
Cattle
DairyCow
n
Desigom
Capacity
Current
Pop.
DairyCalf
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Turkeys
Other Turkey Poults
Beef Brood Cow
Other
Other
Discharges and Stream Imnacts
I _ 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
D 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
(0 No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
allo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

�r •
• Facility Number: jDateof Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
E& Yes
❑ No
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
[3 No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): % -
Observed Freeboard (in): p--7 !,S
5. Are there any immediate threats to the integrity of any of the structures observed?
[—]Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
21 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
® Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Q No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
10 No
❑ NA
❑ NE
maintenance or improvement?
I I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes M No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): (J -I K
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[] Yes
g No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ZNo
❑ 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
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.
E] Yes
❑ No
❑ NA
❑ NE
Waste Application ❑ Weekly Freeboard � Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
Q Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ®120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
D No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
[] No
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Facili Number: -tiDate of Inspection: }
24. Did the facility fail to calibrate waste application equipment as required by the permit?
® Yes
❑ No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
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 [Z No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑Yes ®No ❑NA ❑NE
❑ Yes N] No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes No
❑ Yes ® No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ONE
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).
r Q Z)� ��+ I�r a( 1471
s�
,maw
,D ,-7611
Ne e, vF-De-F i✓'eocr F:b r ?Jo
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �j0--y33-33c��
Date: — -20
21412014

OV -;;70 /1—
(Type of Visit: �Camplia a Inspection V Operation Review U Structure Evaluation (> Technical Assistance I
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County, Region:
Farm Name: Owner Email:
Owner Name: �1 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator: 42r 1 1
Certification Number:
Certification Number:
Longitude:
Design
Current
��!l
Design
Current
Design Current
Swine
Capacity
Pop:"' Wet
Capacity
Pop.
Cable Capacity Pop.
Wean to Finish
F
DairyCow
Wean to Feeder
Layer
ff
Dairy Calf
Feeder to Finish
3b00
Dairy Heifer
Farrow to Wean
"
Design
Current
Dry Cow
Farrow to Feeder
D . P.oul_t , Ca aci
P,o
Non-DaLrX
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Others,
Turkey Poults
a`
El Other
- ,.
Other
_
»- - -
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Fieid ❑ 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 10 No ❑ NA ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
ONE
❑ Yes ❑ No
❑ Yes 1Z No
[:]Yes r'M No
V3-
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA [] NE
Page I of 3 21412011 Continued

Facili Number: �+-� - Date of Inspection:
t Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?, -
Designed Freeboard (in): ��-
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes RA No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a
❑ Yes
ED 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'?
0-,Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
DS 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
[X No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes M-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):,►/{.!t-
13. Soil Type(s):
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 �No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes 2 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
n No
❑ NA
❑ NE
18. Is there a lack of property operating waste application equipment?
❑ Yes
Z No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Eg No
❑ 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 D Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Cg No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 ° Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection:
1
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[Z Yes
❑ No
❑ NA
❑ NE
the appropriate box(es) below.
Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
[Z No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
ONo
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes `M No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes -S No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? 'Yes ❑ No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 0 No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? Eyes 'MV0 ❑ 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).
D/tizl 67� V
� l I
�y��� V iZ [� c��.-������i ✓ � � (�`� `r�`Q. %!Z-�i-!'L� t�Y`��aYi.v
�}`
Reviewer/lnspector Name:
Reviewer/Inspector Signature:
Phone: q, ' O
Date:
Page 3 of 3 21412011

n
Type of Visit Q-Mompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit routine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: S� Departure Time: ,' t717 County: Region: F
90
Farm Name: Owner Email:
Owner Name: r—L 42 Vj F Phone:
Mailing Address:
Physical Address:
Facility Contact: a cc, u Title: ,ram Phone No: '2Z94'7G-733
Onsite Representative: _ �S,.,r Integrator: , kcd�Z
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [—] o = ' E:] « Longitude: E::] o = ' ❑ u
Design Curren#
Design C►arrant
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer I
❑ Daia Cow
❑ Wean to Feeder
❑ Non -Layer
ElDai Calf
Feeder to Finish 3 � 0
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Dry )Poultry
❑ La ers
❑Non -La ers
❑ Pullets
❑ Turkeys
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Co
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 U?[No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
C&No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
Pine f of 3 12128104 Continued

Facility Number: — o Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E.No
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): q
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
J.No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
C&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?
91Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
CKNo
❑ 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
C.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 ONo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop types)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes BNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes �R 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):
r�p�,�,-.� i fl tau � �.�oss•'1 � t�'� r �r�-�t� p� i� ,sd--� 8''�
�r .�*,- �a rnns
r t� k ��f /i�►. /YI �• ,aars3 P or� 71,r /7 T b-eLrw`i
.�r� ,7�,� � rn •� ►�pr�i �-� r � wqs �dz 1 �' !� z Lcbs P��'
_a--f3AD
Reviewer/Inspector Name Phone: }jp6�
IV
Reviewer/inspector Signature: Date:
Page 2 of 3 ' 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes U�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes JZ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
®No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
MNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
fA No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EZ 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
CgNo
❑ 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
(SNo
❑ 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
J,No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
CB -No
❑ NA
❑ NE
Additional Comments and/or Drawings:
7er I-ecl4,
! F t J'r Lr�Ji'/!l �� Dom/! C— GL a ✓r/ '�-� "-'-' det,Q��rG,� fJ Lp."' 10 D I Aj
"'�"J RswG ✓ L i V L eJ I•S —� p� Av) •` p�u /`. r
l,nr. 3,,n, 7i; Ck ter. -�- /fi r•- r.
75 w, H b r- r& v; try 6r � `90 sT
F,-WL- P" w'A wjt-1v__
Page 3 of 3 12128104

.A r ,t , , . I . l
Type of Visit ',0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit QrRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: � i Oq Arrival Time: Departure Time: County:
Farm Name: �1 � FI6 Owner Entail:
Owner Nnmp• F lfi{a �Q Phnnp-
Mailing Address:
Region: f PI
Physical Address: h
Facility Contact: i70/1 B&A,! i Title: Phone No: �`�
Onsite Representative: 3 Integrator:?
Certified Operator: s ottiz)l Operator Certification NumberAyA 7306
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o E:] ' [—] W Longitude: = ° = ' E_] W
Design
Swine- - ,F Capacity
Current
Population
Design Current
Wet Poultry Capacity Popnlation
Design Current
Cattle Fapaeity Populafion
❑ Wean to Finish
❑ Layer
❑Dairy Cow
❑ Wean to Feeder
❑ Non -La er
❑Dairy Calf
Feeder to Finish
❑ Farrow to Wean
3 G6
3
Dt v Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
El Turkey Points
❑Other
❑ Dairy Heifer
❑ Dry Cow
ElNon-Dai
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Co
Number of Structures:
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
Oth r
rnzrr-"�.. .,?'�ha�i .,
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�;INo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
1;2No
❑ NA
❑ NE
other than from a discharge'?
12128104
Continued

/IhX10
Facility Number: — p -
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
❑ Yes
R No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ 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
[*No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
0 Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
allo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9_ Does any pan of the waste management system other than the waste structures require
❑ Yes
allo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EfNo ❑ NA ❑ NE
maintenance/improvement'?
11. is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
t'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s) C ania I qay . small (,
13. Soil type(s)
14. Do the receiving crops �iffer from those designated in the CAW MP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
(2 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
f.9 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
U No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
JF<fNo
❑ NA
❑ NE
Comments (refer to qu eshon`#): Explain any YSansw.ers and/or any 'recommendattons or, any other comments ,
Use_drawin s of fact if to better explain situations. (use additi6nal pages as=necessary)
Reviewer/inspector Name I ©��l SIN. Phone:+(�-7�a33
Reviewer/Inspector Signature: Date:I�,c(
'✓ 12128104 Continued

Facility Number: — Date of Inspection
Reuuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Q"No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes I No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design El Maps El Other
2 1. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes (R­No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes C`No ❑ NA ❑ NE
❑ Yes ❑ No N NA ❑ NE
❑ Yes MNo ❑ NA ❑ NE
❑ Yes N "No ❑ NA ❑ NE
❑ Yes 9—No ❑ NA ❑ NE
❑ Yes ❑ No �2 NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes
ff No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
[:]Yes
ONo
❑ NA
❑ NE
❑ Yes N No ❑ NA ❑ NE
ycc�
0,)e- 1�.�� 0� sa,b� s' � s o� I�
Spa 25�)e�s LYC mc3, Ol -�QC .SIG-S .
IS.1r+i( ro'ha b7i nq jo 11)re
�Eo .1.�V-ey L* t� u Wu rervz�c� sl��e a���
t
Y
l2, 28/04

Facility No'$I-4,S'4- Farm Name Date
Permit COC OIC� NPDES (Rainbreaker
.M.-
r
i���Q�_
FB
Drops
0
PLAT Annual Cert )
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
G%� at r) CQ6915c1
Actual Flow
Design Width
Actual Width
Soil Test Date) l Wettable Acres UGE
pH Fields WUP bo or incinerator
Lime Needed Weekly Freeboard ✓ Mortality Records
Lime Applied 1 in Inspections
Cu-1 Zn-I ✓ 120 min Insp. `1
Needs P Weather Codes
Crop Yield Transfer Sheets
-
- _ .. -
Q�Qir��:�
1 ►a
Pull/Field
Soil
Crop
Acres
PAN
Window
Max Rate
Max Amt
r
Verify PHONE NUMBERS and affiliations
Date last WUP FROa,1510S P('C Dljqlo) Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike 5W
Stop Pump
Start Pump t
Conversion- Cu-I 3000= 108 Iblac; Zn-I 3000= 213 Iblac
App. Hardware

0403
Type of Visit 'WCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: r a County: 34t Region:
Farm Name: ��qf0A F1 qtf
_r Owner Email:
Owner Name P !"QIP� Phone:
*411 124ylfJ —Co "9^
MailingAddreq'130 - 22;f 2.S'f jfzehPiM�a+r of .3
Physical Address:
Facility Contact: OrY4, Bar,g Title: CZAVA41 Phone No: 76- 7 33
Onsite Representative: Integrator: B
Certified Operator: tryal ej Operator Certification Number: AhA CO7300
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ e ='
E__1 Longitude: = ° 0 I = "
k�
Design Curren# t Desigia Current Design Current
r4eeder
r.• Captypulation W;efi P.ouEtrv;Capacity Population Cattle Opacity Population
FWean
o Finish ❑ La ero Feeder ❑ Non -Layer ❑Dai Calf
to Finish 3 QQ 3$' ❑Dai heifer
to Wean Dry,4Poult ❑ D Cow
❑ Farrow to Feeder - `� El Non -Dairy
❑ Farrow to Finish ❑ Layers
❑ Beef Stocker
❑ Gilts ❑ Non -La ers ❑ Beef Feeder
❑ Boars ❑ Pullets ❑ Beef Brood Co
❑ Turke s p -
Ot6er
.: ❑ Turkey Poults
❑Other ❑Other re-` Number of 5 ctu s
Discharges & Stream ImRacts
1. Is any discharge observed from any part of the operation?
❑ Yes
29 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
O No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
N*No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number:sDate of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 12
Observed Freeboard (in): a3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 19 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 UNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? © Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes RNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes IN No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes I'No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Da No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 tbs ❑ 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) ay;* 1 86m4k_ fflayE
13. Soil type(s) Cj _g S
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
tRNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
® Yes
❑ No
[I NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
R] No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
9No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[RNo
❑ NA
❑ NE
Comments (refer to question #,): Explain any YanswersES and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
i
7
Reviewer/Inspector Name `"r0ss:" r���g;I Phone: 10 —330OX
Reviewer/Inspector Signature: Date: Oj g a D
Page 2 of 3 v 12128104 Continued

Facility Number: $ a, -pny Date of Inspection
UF ME —
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ERNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Ca No ❑ NA ❑ NE
the approprrate box. ❑ WUP ❑ Checklists ❑ Desigm El Maps El Other
21. Does record keeping need improvement'! If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard © Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and F Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ERNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ® NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
5d No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ER NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
53 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
CRNo
❑ 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
f;� 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
R No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
allo
❑ NA
❑ NE
--.: ,.d.-e: i
Additi©nal ComuEents,andlar Drawings --
Plea, mo by el ns id e- of (a 00r)., Pleoe_ VvD,k 6,\ byre_sa,o[ s
a�
an&backs(ofe, Ynolstl ��;;d.e of l y°� hos ®c co�e� , New
`�
mil -)es') �1, i 4r���1c�,;
is, keh, feel yvax' Ca r i b r6+4 ,
i A 11kk- ;
N -so ` I somle-
(
Page 3 of 3 12128104

Facility No.%"0010 Farm Name P1qfol, Date
Permit COC OIC_ NPDES{Rainbreaker PLAT Annual Cert )
1, •
-ifs1111101
FB Drops
La oon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Slud a Surve Date Perm Liquid ft
o1
_1412, 1by Sludge Depth ft
3,257
Will
Actual Width
Soil Test Date Crop Yield ./1 in Inspections
pH Fields 120 min Inspections .i
Lime Needed _ Wettable Acres Weather Codes
Lime Applied WUP Transfer Sheets �lY
Cu 'rZn Weekly Freeboard -� RAIN GAUGE
Needs P Rainfall �1"
Waste Analysis Datem. IMMI"09.1111k
-
rrr IM111111
• NMI ETM
Pull/Field
Soil
Crop
RYE
PAN
Window
412
1
,56
50
Verify PHONE NUMBERS and affiliations
Date of last WUP FRO@IV� Date of last WUP at farm
.319, &
Top Dike 3p
Stop Pump qb3 =4y
Start Purdp 46.3
App. Hardware Max Rate Max Amt

b IDS Uvl as b I lb)
Division of Water Quality
Kaeffity Number L .J Q 9Division of Soil and Water Conservation
O Other Agency
Type of Visit 19 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: ( O Arrival Time: 2.30 Departure Time: County:
Farm Name: t n �44_s Owner Email:
Owner Name: 10 CL. T�. ah ntr Phone: _
l
Mailing Address:
Phvsical Address:
Region: F-
Facility Contact: Qff
VPrl rws Title: C(
Phone No:
1 (D ►^z
Onsite Representative:
J9WVVL,1 J6a_Vr1xS
Integrator:
Certified Operator:
`Cc rn QS
Operator Certification Number:
•
Back-up Operator:
Back-up Certification Number:
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
Latitude: 0 0 = Longitude: 0 ° = , ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Coy
Number of Structures: �k
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 ? No ❑ NA ❑ NE
❑ Yes
❑ No '�ZNA
❑ NE
❑ Yes
❑ No _L�YA
❑ NE
❑ No PINA
❑ NE
❑ Yes
❑ Yes
�ZNo ❑ NA
❑ NE
❑ Yes
❑ No ,uaNA
❑ NE
12128104 Continued

Facility Number:'� Q
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 ANo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): '
Observed Freeboard (in): fp
5. Are there any immediate threats to the integrity of any of the structures observed'? ❑ Yes A No ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 4No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered ves, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste ADnlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) &rr it Wa C, , O L
13. Soil type(s) cO�_ 6
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
D�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
;R No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
,� No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
� Yes
❑ No
❑ NA
[I 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):
18, Or, eZL4rt oiis..4e- . 14a-r a4-'o 4vrra.0 rG.r• QJltv:aus Owrjer'� ",&d �
�.)1 �►tirCIV"L �at� S6P � r;r�� . // o CQ
i•'G�� ��+a ilP ttin
- T c, ar"S 'had f. '2S�41's � r a S5 S4a r< c/ � ve r 4
hL70S S $Q � i : a h
2
Reviewer/Inspector Name k/ST/ A)C-r- N n- Phone: '7 n b J,3 3.:l
ReviewerAnspector Signature:
Date: Q C
12128104 Continued

Facility Number: A�p Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes'0No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes $No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. tAYes ❑ No ❑ NA ❑ NE
Taste Application ❑ Weekly Freeboard VWaste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33_ Does facility require a follow-up visit by same agency?
❑ Yes
�(No
❑ NA
❑ NE
❑ Yes
❑ No
WA
❑ NE
❑ Yes
%No
❑ NA
❑ NE
❑ Yes
;KNo
❑ NA
❑ NE
❑ Yes
17�No
❑ NA
❑ NE
❑ Yes
❑ No
KNA
❑ NE
❑ Yes N No ❑ NA ❑ NE
❑ Yes �&No ❑ NA ❑ NE
❑ Yes ANo ❑ NA ❑ NE
❑ Yes &No ❑ NA ❑ NE
❑ Yes
)QNo
❑ NA
❑ NE
El Yes
�ONo
El NA
❑NE
Additional Comments and/or Drawings:
Z%. Qrev,p,yS. owner �1Pro �ecl R2- f buf na [QQ Z �or 0t� -a`� DVcrsced
E...vt d Di - rn u(b. SW560 5 CA-)D- .0 o n a[�bar 4
,,n, ai50 n,.4 (T'DViC�2r �Y Q
at b
Q f 5-�75e,.� bC Kafue, b ► 31 0`7�� I
12128104

%Zlo\4�
Facility No. ` Time In iZ� Time Out Date
Farm Name �^ 1�� 2 Integrator
Owner Flo a.j �lr r� Site Rep pyc�
Operator 1 d- - No. 1AW� ql 0j 3 d
Back-up No.
COC Circle: Ge I or NPDBS
Design
Current
Design
Current
Wean - Feed
Farrow - Feed
-
Farrow - Finish
Gilts 1 Boars
Farrow - Wean
Others
FREE •Design
. Sludge S
Crop Yield
R'
Soil Test
Weekly Freeboard
Spray/Freeboard Drop
Weather Codes
Waste Analysis:
1
Wettable Acres
Daily Rainfall
120 min Inspections
D to Nitrogen (N)
o o .5
o •Z -L r
Observed +
Calibration/GPM
Waste Transfers
Rain Breaker�'�
PLAT
1-in Inspections
Date Nitrogen (N)
17 0�
( 2_ I L9l
Pull/Field Soil Crop Pan Window
o
f�

Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit A Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
g� y0 Date of Visit: �' 3 Time:
0 Not Operational Q Below Threshold
0-Pe"rmitted [16er 'hied © Conditionally Certified r] Registered Date Last Operated or Above Threshold: -------------
Farm Name: ...................i21. .......... .... County:...... .ft�.rt...._ ..........._. � f� ...
Owner Name: Phone No:
1laitingaddress:..._ , .G S.... _....... I__.Q.�! 11rcr �C._..._.�1 jjL_e� ...__ _..____ar0L.- - � ..._ .�2 ���' ...._.......
Facilitv Contact: ....». . ». ».. _. Title: Phone No:
Onsite Representative:......., w:.11,`aM...... 64XIL / __, integrator -
Certified Operator: ................. a ���KftL... — » PLlrufr._........................7...•-- Operator Certification Number:... .... .......»_.....
Location of Farm:
Ep.gw'ine ❑ poultry ❑ Cattle ❑ Horse Latitude • 4 4& Longitude • & 64
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes qQ No
Discharge originated at: ❑ lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
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 ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection & Treatment T'
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
IdentiGcr: ......... _../._............ ..................... - ... _ .._......». _... ....
Freeboard (inches): �(
12112103 Continued

Facility Number: 8-2 — can
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancefrmprovement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
'] Yes [Komi `�3
❑ Yes ❑WOE
❑ Yes P No
❑ Yes ❑ No
❑ Yes 0-No
❑ Yes D�No
❑ Yes 914_0�
12. Crop type Prn,ud Ste, 1 Gr
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [moo
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?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
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
Air Quality representative immediately.
❑ Yes 0-No
[des ❑ No
EI-Yes ❑ No
❑ Yes E& No
❑ Yes U. C
❑ Yes q No
❑ Yes M-IQo
❑ Yes B- 0
❑ Yes Flo

Facility Number: .7 — 0 Date of Inspection
Reauired Records & Documents
(b Fail to have Certificate of Cove Permit or other Permit readily available?
22_ Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie! WjUP, the tts, d s, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ WWft1kPPHQWiM ❑ Freebeard- ❑ Writ _UWysis ❑ Sing
s-G /. ( 5_-� � /. `i I- D3 -) r. 3
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss reviewlmspection with on -site representative?
2$_ Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
N'MES Permitted Facilities
34. Is the facility covered under a NPDES Permit? (If no, slap questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35_ Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ %aclang4�wm ❑ Crop Yield Form alL- ❑
❑ O
❑ Yes U.?B
❑ Yes
U-No'
❑ Yes
E M
❑ Yes
G-Ko
❑ Yes
EWo
❑ Yes
O-NO
❑ Yes
0-No'
❑ Yes
❑ No
❑ Yes
ONO_
& Yees ❑ No
❑ Yes Mwo'
❑ Yes ❑3N0
❑ Yes E}No
❑ Yes 0-114o
❑ Yes ❑ No
12112103

Type of Visit (D Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit U Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number 1 Date of Visit: Time:
• not O erational 0 Below Threshold
O Permitted M Ce 'fled P Con ' 'onalk C hied ❑ Registered Date Last Operat r Above Threshold:
Farm Name-. County: _
Owner Name:
Mailing Address:
Facility Contact: G
Onsite Representative:
Certified Operator:
Location of Farm:
//
/l
Title:
Phone No:
Phone No:
Intecrator:
Operator Certification Number:
U8wine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 9 " Longitude �,�0 �• ��
Design Current
Swine (-anarif . Pnnnlatinn
❑ ! can to Feeder
eederto Finish
D
❑ Farrow to Wean
❑ Farrow- to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Laver I ED
Da'
❑ Non -Laver Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons JU Subsurface Drains Present IU Lagoon Area ]U Syrey Field Area I
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1 _ Is any discharge observed from anv part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Sprav Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑Yes ❑ No
b. If discharge is obsen-ed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in eallmin.)
d. Does discharge bypass a lagoon system? (If yes. notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any pan of the operation? ❑ Yes O 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 (free totm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure Structure 2 Structure 3 Structure 4 Structure a Structure 6
Identifier: y g
Freeboard (inches): .S� LI1 Fly
05103101 Continued

w
Facility Number: — YO I Date of Inspection 3
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ 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 mai> nancelimprovemcnt? El Yes El No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? - ❑ Yes ❑ No
11. Is there evidence of over applicaft? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes 0l0
12. Crop type ( JAz
a
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 or other Permit readily available?
18. Does the facility fait 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? (ic/ 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?
(ic/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ No
❑ No
❑ No
❑ No
❑ No
❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer #o question #j: Explain any YES answers aothe nd/or any recommendations orany r comments.
Use drawings of facility to better explain situations. (use additional pages as necessary): ❑ Field Copy ❑ Final Notes
Reviewer/Inspector Name r
i
Re-viewer/Inspector Signature: Date:
05103101 Continued

V
�. �= � DEvtsiaa of Water QEtallty �� ._-� �...� .•-4 _ ".� �-�.. T
�� -` � Di+visiaa of Soil and taster Co_nservaboa �� -.w�
� _c '�� -�=��- � Q Otber, A�eni�'-."`" '�`-' •- � � N''=��"..'.� ," �Y "�,� s __. x
Type of Visit Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
1: Facility Number Date of visit- �O ime: t=
Not erationaf 0 Below Threshold
Permitted ❑ IC,e1rtified 0 Condi ' nally Certified E3 Registered
W Farm Name: ilLa ,
Owner Name: ` )9-/ ice^-_
Mailing Address:
Date Last Operated or Above Threshold:
Count}: -5—
Phone No:
Facility Contact: 10&fn e t' Title: Phone No:
Onsite Representative: 42GJ ►—
Certified Operator: hill eL., 4Le�
Location of Farm:
Integrator: 41sa /5�
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ horse Latitude ` �" Longitude 0
-=De_sign Current
Design : - , Eufrebt.
Design
Swine
Ca achy Population :Pouf
.Cs acity -Population _, Catde
Ca 2aiv"l-Po ulation `
❑ Wean to Feeder
❑ Layer
Dairy
Feeder to Finish
6
❑ Non -Laver
Non -Dairy
❑ Farrow• to Wean
❑ Farrow to Feeder
❑ Other
_
❑ Farrow to Finish
Total Pesign Capacity
36,0n
❑ Gilts
❑ Boars
Total. SSLW
Number of Lagoons l� _ ❑Subsurface Drains Present ❑ La oon Area
Holding=Ponds 1 Solidps : ❑ No Liquid Waste Management Svstem
❑ S rsa >±ield Area
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
I�No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
QrNo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
El Yes
lWN0
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
No
2. Is there evidence of past discharge from any part of the operation?
ElTll Yes
No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
gNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
No
Structure l Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Z
Freeboard (inches):
05103101
Continued

Facility Number: 8Z —
Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do anv of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do anv stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
I I - Is there evidence of over application? ❑ Excessive Pending El PAN El Hydraulic Overload
12. Crop type a rrrt [ _0k C` 5A-1 • 4 U e.• �,E ezz
13. Do the receiving crops differ with those designated 41 tb/e 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
1T Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation. freeboard. waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes No
❑ Yes )� No
❑ Yes No
❑ Yes No
❑ Yes ANo
❑ Yes No
❑ Yes No
❑ Yes PrNo
❑ Yes o
❑ Yes No
❑ Yes o
❑ Yes zo
❑ Yes TNo
❑ Yes INO
❑ Yes 2�No
❑ Yes fNe
o
❑ Yeso
❑ Yes
❑ Yes No
❑ Yes T
No
❑ Yes 'IF No
❑ Yes 5Alo
[7 No violations or deficiencies were noted during this visit. You Rill receive no further correspondence about this visit.
Continents (refer to question hnd/ar;ani_tecodfihmdatmns oranv other commeiats. -.-
—
-
Use.drawiiigs offacdrtv d-better explain sitnations.
- �_�. _-
(tise additional pagesas necessary) _ C] Fieid Conv ❑ Final Notes
--
14ie5/4
heir
Arc
d`p
SQ7'►'1 ` 'e'�L=
LU i l in. • ti 1-i 0 `3 Y� �L� W 3 �r
f 1
Reviewer/Inspector Name 71 o
S
Reviewer/Inspector Signature:
Date: —49
05103101 V
Continued

i
I Facility Number: yo I Dateof inspection 1 Y Z4s e7
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes f�N0
roads, building structure, and/or public property) I+L
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes Iro
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 00
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
I-AdditionaL Comments an or rawutgs..
5100

e
of Visit Q Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ItRoutine Q Complaint. O Follow up O Emergency Notification O Other 1 ❑ Denied Access
Facility Number O Date of Visit: ! C ii Time: o' pp
rO—N'otOperational O Bellow Threshold
0 Permitted OiCertified p Conditionally Certified 13 Registered Date Last Operated or Above Threshold: --
Farm Name:! _. ?'ow.l< 4I... ........... County: ......... . .
Owner Name; ........ ................... Phone No: ........
Facility Contact: .... wi � !c [t �... 4?4* F.�................... Title: .......... qwfj7l ..................... .......... Phone No:..................
Mailing Address:
Onsite Representative:...... !{..�1+#4n... ,,fo W.".eA-� ............................. .................... Integrator:
Certified Operator: ..........QjI l.......................YC ...................... Operator Certification Number:.—..,!.t-q& --_....----
Location of Farm:
j Swlne ❑Poultry ❑Came ❑Horse Latitude �• �� �« '
Longitude Q• �0�
Current
B_ ;Ca cii Po uiatiou
Wean to Feeder
Feeder to Finish 00
- Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design-', :Current Design Ctirrestt
POieltry _ C�iiaesty :.Pannlatiae Cattle ' _ ...Csnscty :Pnoeita>tlee,..:
Number of i.egooas❑Subsurface Drains Present Lagoon Area ❑ Spray Field Ares
Haldeng Ponds I Solid.
Traps'. ❑ 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 ❑ No
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes [,No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes PNo
Waste Collection & Treatment lI
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes J$No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ................................................................................................................. ...........................................
........................... .
Freeboard (inches): Qco
5100 Continued on back

Facility Number: 29— Date of Inspection 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?
❑ 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 maintenancelimprovement?
Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
1%No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
14 No
Waste Application
10, Are there any buffers that need maintenancelimprovement?
❑ Yes
f AXo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
gNo
12. Crop type _.1 r1nt uL AL.. ) , S .a ! i Cat ,. Qs
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
M No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
[INo
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
gYes
❑ 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 readily available?
❑ Yes
1ANo
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
CC 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 f% No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes IP 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 yiola>kttjgs:e defciezzCies 1v re ho e# 00-t zig this:vispt! - Yoo . I-teomi Rio Putt.
cori is j omdeizce aN)ik this visit . ' _ .. ' . ... .. . ... .
Ma LG % "' Ar(lam,*,d UL fti
6ct, a • ie . f; .0 w, td ��11��I&J t.� 51W
1, �rr►x�i Uf a,~1 puce eQ{T far -kJj :&I Since_ tom. owe# is ouerseL.J11,�.��,
(1491ue Lx-,64cll_5 on �S�b4+`S4un� 0e3�twty�i,t rck;r= an
15 1ila�- 4�er �q �!1 � a J ^s o-3r u
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
5/00

` Facility Number: Sr9 — LJ& Date of inspection A
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes gNo
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 [$No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
5100

k :Division of WaQ ter aahty
Q;Divasron of Sail and Water Canservatron
Q°Other "Agency=
of Visit ®Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit ® Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
j
Facilih' Number Date or V isit: ��Tiinr: Printed on: t 0/26/2000
Q Not O erational Q Below Threshold
®Permitted ®Certified 0 Conditionally Certified 13Re.,ggisttered Date Last Operated or Above Threshold: ..............
Farm Name . �r �GJ ( County:....
......... 1................... ..... ,.........�.....-----...................�.... ..f...._.............
Owner Name: �C�.r�l� Phone No: /Gc?1 '1��//''
.........................pp .....................................
Facility Contact: ....�`......... ... ............................................ritle'............. ......... Phone No: .......... .........................................
Mailing Address• ........ `
Onstte Representative:�!t Za.4:� l� .......................... Integrator:.. / ................ s/7/ i .....
Certified Operator: .... .... :..........................i�d %/� Operator Certification Number:...................... .......
... ...........................
Location of Farm:
.I
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ° Longitude • 4 64
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ID Dairy
Feeder to Finish ❑ Non -Laver ❑ Non Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons / ❑ Subsurface Drains Present 110 Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste '10anagement System
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation? ❑ Yes 'No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. II' discharge is observed, was the conveyance man-made'? ❑ Yes P No
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ER No
c. lFdisc:harLe is observed. what is the estimated flow in galhnin'!
d. Does discharge bypass a lagoon system? (It -yes, notify DWQ) (] Yes RNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes Q No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes E9 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes A No
Su-ucturc I Structure 2 Structure 3 Structure 4 Structurr 5 Structure 6
Identifier: ....................... .................................... ................................... .................................... .................................... ....................................
Freeboard (inches).
5100 Continued on back

Facility Number: ?Z-- G Date of Inspection Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes tlNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes df 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 maintenancelimprovement? Yes ❑ No
S. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes (D'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes �§No
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes RNo.
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes IM•No
12. Crop type ✓J ?rC'�i. ud�, Si�.r���Gi/t�/�-1
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?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (i irrigatiq freeboar aste 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?
U. yi9lafioris:oi deficiencies -were poted- ftHhng this:visit: • Y:ott wiil t ooive irio further: • : • : -
:: - coriresvorideitc 'alb' k this visit. :::.::::.:.: :::::.: :
❑ Yes 19 No
❑ Yes ,M No
❑ Yes �(No
❑ Yes J�rNo
❑ Yes 3!�No
❑ Yes E2 No
[:]Yes A No
❑ Yes ;EZNo
❑ Yes ❑ No
❑ Yes PNo
❑ Yes JgNo
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes allo
Comments (re€er to`question #). Explain any YES answers and/or any recommendations or_any other'cominents = -r
Case arawnigsoi €acil�ty to bettei explain situations:,(ttse addi6orial pages as necessary} _
...
—.
Cf ��.�.— �•f� a �rs�
v� /�ari✓ ar%,�,�r
Lam'-
r
Ed
Reviewer/Inspector Name
Reviewer/Inspector Signature: ���� � : Date: 2 JC4Cs 5100

Facility Number: Date of lwspection i2 G Printed on: 7/21/2000
Odor Issues
25. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below VYes ❑ 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 j 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 allo
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 R'No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes b'No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? f Yes ❑ No
Additional :Comments and/orDrawings: -
J
5100

Facility Number 5/Li Date of Inspection nn
Time of Inspection 24 hr. (hh:mm}
Permitted ® Certified� © Conditionally Certified 13 Registered 10 Not Operational Date Last Operated:
Farm Name: 15wN�✓ .""" County �t��....'*'?� o.......................................................
...................................•-----.............. ...------
Owner Name:...............�/Till
Phone No:
........................................................................................................
Facility Contact: ....... &�i"1......... .:..4��.............. Title: ......... I ........................................ Phone No:
Mailing Address: ........... ..........
Onsite Representative: ..............
....................i............
.............. .....................
//
Certified Operator:,,••••,•; ,llf !!h.......... , •,o�............
...... .........................
Location of Farm:
f,"./ ..yyy.....
..... Integrator:......... j3.l.,D............................................1.
Operator Certification Number :...............
Latitude �° �'� Longitude
:.; Design Current Design Current_; Design Current
._ .
Swine 'Capacity Po elation poultry . -Ca achy Po elation Cattle" ". Capacity Po oulation
❑ Wean to Feeder <_; ❑Layer ❑Dairy
Feeder to Finish dt" ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean w
❑ ❑ Other
Farrow to Feeder
❑Farrow to Finish - Total DesignCapaeity
❑ Gilts,
❑ soars , _ Total'.SSLW
S-Number of.Lagoons=- ent❑ ❑ ❑ Subsurface Drains PresLagoon Area Spray Field Area
_ - �'-
r .Holdrng Ponds I Solid Traps L� ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes VNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance than -made? ❑ Yes Wo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ;.No
c. If discharge is observed. what is the estimated (low in gal/min?
d. Docs discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ® No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 9 No
3. Were there any adverse impacts or. potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes XNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes CRNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ........... ..... . ...........................- ...............................................................................................
................. ............................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 9 No
seepage, etc.)
3/23/99 Continued on back

Cj Division of Soil and -Water Conservation • ,..Operation Review r
?] Division of Soil and Water_Cvnservatio>4 :Compliance Dnspechun s '„
.--- -
_ Div>Esian of Water QualEiy CooQghance Inspection d -
- rv.
[lOterAgenc O eratinoReview
LO Routine O Complaint O Follow-upofDWQ inspection O Follow-up of DSWC review Q Other
Facility Number ,Z =fv Date of Inspection
Time of Inspection 24 hr. (hh:mm)
© Permitted J3 Certified 0 Conditionally Certified 0 Registered Not Operational Date Last Operated:
Farm Name: ....W. fpwi< ..�8� County :......... r....
Owner Name:...---- Phone No: --.............
................................................................................................. ......... ................
FacilityContact: ._.....----`- .............. ........�.�./.......................... Title: ......... .......... ............................................. Phone No: .....................................
..............
Mailing Address: ....'1� ...,�P..�+.R. ...... .1......................,4G�r� ..C. i...� ........... ..........................
Onsite Representative: ............. ............_................................................................ Integrator:.........,ew'`..............................................
Certified Operator:........ f�..:....---•----�����..................................... Operator Certification Number:... ...........................
Location of Farm:
F.....................................................................................................................................................................................................................................................I................----1 T
Latitude �• �� �. Longitude �' �'
-.Design Current Design .. Corr"ent Design Current:.-
Swine ..:: Point ...
Ca acit Population rY. Capacity I'opulatiion Cattle Capacity Po ulation
❑ Wean to Feeder - ❑Layer ❑ Dairy
Ej Feeder to Finish 6,j,_0 ❑ Non -Layer I ❑ Non -Dairy
❑ Farrow to Wean -..
El Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts -
❑ Boars Total.SSLW
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 1❑ No
Discharge originated at: El Lagoon El Spray Field ❑ Other Tree
a. If discharge is observed, was the conveyance man-made? ❑ Yes ,❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed. what is the estimated flow in gal/min? 7�
d. Duet discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes X0 No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ......... .................................................... .
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ;-.10 No
seepage, etc.)
3/23/99 Continued on back

Facility Number: 91- — (J Date of inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes O&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? XYes dwo
8. Does any part of the waste management system other than waste structures require main tenarice/improvement? ❑ Yes PRNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes A No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? N Excessive Ponding ❑ PAN 7R Yes ❑ No
12. Crop type J'ez— « "
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
RNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
tS No
b) Does the facility need a wettable acre determination?
❑ Yes
J No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15. Does the receiving crop need improvement? o
wYes
4�lwo
16. Is there a lack of adequate waste application equipment?
❑ Yes
19 No
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?
(iel 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?
vi6laiioris:or• def eitzndies were pgted. during this;visit; - Yoi� Will-t&ove do further
.�•-correspondence.a�autthisvisit:-.�. .-. .-.�• .......-.�.�....-.� ;-'�;� ;-;-'--.-.-•-.-•�•-
-�
: - - _� T
[wings of facility to _bitter expiarn situations (use additional pages as necessary)
///�r� �e� .!/.�� IC'�.f/•� �¢,.✓d A�/���`�//� p.GlrSf Cas��+rt,
ljil.¢� !✓�-r O�•�ri�dJ��' .v� J�i� /�F-+�3'�i[.4+Q �p t., f�i. �p��
Reviewer/Inspector Name
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Mt3
Reviewer/Inspector Signature:
Date:
3/23/99

!-2=
Facility Number: gx — f/o Date of Inspection
6. Arc 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)
❑ Yes ®'No
7. Do any of the structures need maintenance/improvement? Ryes WO
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ® No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 11 ® No
Waste application
10. Are there any buffers that need maintenance/improvement? ❑ Yes E,�[No
11. Is there evidence of over application? P Excessive Ponding ❑ PAN ;@ Yes ❑ No
12-
Crop type--
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
®-No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
INNo
b) Does the facility need a wettable acre determination?
ElYes
(9 No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15.
Does the receiving crop need improvement?
Yes
E 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 readily available?
18. Does the facility Dail 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?
0: N6—. &1htidds oe deficiencies'were h6fed- d>grWig Ois:visit: - Voit will-r"eoeiye fib furtI.hI.er
.......................... ....... corresponnence. about this .visit.
ecorn iueid
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
!44 � !✓.s-r c7�.r7�ll,�� �r ri�� !�F'�i�'.ti,�.� �p •-r /��.�,v�vs� .�r�i�y
•�5�.�/ �f .�,�,�-.�./ia%/� �®`n���•...,�, . �I//`
�%• G�� ,s� air �/ dal V4 /ram �- P r4 KF..rQ ��d�r•� T'PJ/y
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
3/23/99

0 Division of Sod and Water Conservation -Operation Review
Division of Sail acid 13Vater-Conservatioin .Compliance iiispect,on
Division of Water QualityCompliance Iiespec4on 7 _ r = = �'•
Other Agency Operahoti Revie k
® Routine 0 Complaint 0 Follow-up of DWQ ins ection 0 Follow -tip of DSWC review 0 Other
Facility Number Date of Inspection V1919
C3
Time of Inspection ; 4-0 24 hr. (hh:mm)
® Permitted [3 Certified 0 Conditionally Certified © Registered 0 Not O erational Date Last Operated:
Count ......................:�' ..........................
Farm Name: l.. r7.... !`` �.- �rt ......................................... y- ��°` �' '...........................................
Owner Name: .-•....... ....A " "'"................................. Phone No: ..... L... � �.....SY2. . ..............-..
Facility Contact: ....... /... .. .................. ........ Title: . Phone No:........................---.--.....
Mailing Address: ...... 7 1..:......fr�! ... �!�...... �.�C....�:�Tr....................... ................. ..........................
— /'
Onsite Representative: ,,,.,, ,�.. Integrator: ,,,,,,, , ..,,�%,i !..
s
Certified Operator:....... „,............................................................. Operator Certification Number:..........................................
Location of Farm:
.................................................................. ............................................................................................................... .........F
L✓/!P' t .... ......................... ...........
Latitude 0 ' �•• Longitude • 4 66
"Design Current '- Design _' °: _current - Design Current
Swine Capacity Population Poultry - .:. Capacity Population Cattle Capacity Popiilahon '
❑ Wean to Feeder
Ig Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation? ❑ Yes XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes PtNo
h. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes jg3 No
c. I I' discharge is observed. what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes ff No
❑ Yes ® No
❑ Yes ® No
8[Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
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
k
❑ Yes 10 No
Continued on back

0 Division of Soil a>adVatetr,Cotnservarton 00era>tron Review
Division of Soil and Water Conservat><on Compliance37nspec4on
,MDivision.of Water QualityCompliance Inspection
Other Agency Operatbon Revt�ew x
10Routine Q Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number Date of Inspection 'flJ
Time of Inspection ; pTj 24 hr. (hh:mm)
© Permitted Q Certified © Conditionally Certified 0 Registered 113,Not Operational Date Last Operated:
Farm Name: .........../.. ....! ?...�it..�w�................................................ County:......../..... `^''''......... ........... .......................
Owner Name:._........ ``1 Phone No:-...1...1 u� �32 — ��2
-- .................
Facility Contact: ..__...�a'J Title :.............. Phone iio:
.................. ..................... ................---.---•...................................................
Mailing Address: .......7....lr��/...rf+�,..................................... ..........................
Onsite Representative:.,,..,,..../ .... Integrator: �'� S fr1,L .......................
Certified Operator: �r>i�^� Operator Certification Number:
..........................................................................................................................................
Location of Farm:
................. ...... ......... ...... M.—I.....—I ............ M-M--M .......... M.m ........ MM ...... M.--M ....... ...... — .........
Latitude Longitude • 4 .4 -"—�
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes )�fNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ElOther
a. if discharge is observed, was the conveyance man-made'? [:]Yes gNo
h. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated flow in gallmin?
d. Dues discharge bypass a lagoon systent"I (Il'yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storin storage) less than adequate? ❑ Spillway
❑ Yes Ej`No
❑ Yes 0 No
❑ Yes 0 No
KYes ❑ No
Struciure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): .......... �1;!'F..�......_.....................................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes No
seepage, etc.)
3/23/99 Continued on back

Facility Number: Date 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
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 main ten ancelimprovement?
Cl Yes
>P No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
XNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes/XNo
12. Crop type �,Q,d�i!!� M
13. Do the receiving crops differ wi those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
XYes
16No
c) This facility is pended for a wettable acre determination?
❑ Yes
N No
15. Does the receiving crop need improvement?
Xyes
[:]No
16. Is there a lack of adequate waste application equipment?
❑ Yes
XNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ 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
9No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
KNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ic/ 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?
'KYes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
0: �'Vo •violations :or• def ciencies •were noted diH`ing phis: visit; • Yoi} will •t•eceive Rio: futG-ther - : - ; •
corres�ondertce. a'batut tM .visit_
/c.rf%�hip C�y�• �,� �icl�S
,/05,�G-'i
Reviewer/Inspector Name ; !;J� r `` r'_ -
Reviewer/Inspector Signature: ,1..�� Date:
3/23/99

�y-.� `�rt�s•_ .. y'�. .ilw'�,Y�'.�,__-is.X%ti•'��' -,� :`l;, ... �ri � .� -y! -_ _ .c M _.
Facility Number: Z — yU Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management o
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
r
❑ Yes No
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9- Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type fj9ZA-444,14
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?
(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?
. �'Vo •yio1atioris;or defickhgies mere noted• dikring this -visit'. - Y:ou 'Will •reeei*e yid further
correspondence. alh of this VISI .: • . .. .... _ .... . .
*Yes ❑ No
❑ Yes �11 No
❑ Yes �No
❑ Yes N(No
❑ Yes ANo
❑ Yes No
❑ Yes XNo
NYes eNo
❑ Yes Wo
Xyes ❑ No
❑ Yes )j(No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes gNo
❑ Yes gNo
Yes
y Yes
'Yes
❑ Yes
❑ No
❑ No
❑ No
® No
Use°dravtings of facility to better explain sttuatrons (use additi nil pages as necessary) - °
- --
l �` 6�/ate ,� ,�-.r� .�r/.M.��`d>�'.� •�-�`a�l/�- e�Jr./,ce ,�.ls:
�6�r b7r . /+ �u!►f �ic���.9�+'� �� //� Ax
��� ro�C � p ,�� �.�d/.mod !�'•` /�+�y 9'.f /�� ��,r..-.�.e .�.rrj. h�✓�
ReviewerlInspector Name = " r r ,�},` r - Reviewer/Inspector Signature: ..�I`�f � Date: '15;1Y,57

Facility Number yD Date of Inspection
Time of Inspection eOr3 U 24 hr. (hh:mm)
® Permitted [3 Certified [3 Conditionally Certified 0 Registered JE3 Not O eralional Date Last Operated: P -
Farm Name: ............�a........._��. . 4-�!f''/_._..r6............................................County:... ..., aA.r ^�.........._..................................
...............
Owner Name : ..............�...�..... .0 t✓,�.�...... ._.......
J r Phone No : ......................
Facility Contact � Title- ......................... Phone No:...................................................
Mailing Address: ...... ..��Y...._.lr��.�A.�RC`....... f10 .....I7h`.�t... ......N..C.......�.F"'! .............................. ..........................
Onsite Representative: ................
A -)IA ............................................................................ Integrator:......... jg.g...v...............
Certified Operator:...... �D �!� ...a.... �G cJE�✓ Operator Certification Number :..........................................
............ ............. ........................ ............
Location of Farm:
.....................v 7'.........................................._._. o ............................._.............. ..............................
._..........leJ.r......................l��Q ._.......�...1.y...7.............................................................._.................................................................................................;__. T
Latitude Longitude • �' �'=
- Design Current • ;,: ...- ___ . g - ... , .,.�_ Design Current ,,, ....: Design Current
Swine - Capacity Population. -oilpacity Population Cattle _' Capacity Population.
❑ Wean to Feeder ❑ Layer ❑ Dairy
® Feeder to Finish 3eaD __' ❑ Non -Layer ❑ Non -Dairy I-
❑ Farrow to Wean-
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total DesigmCapacity
❑ Gilts, _
❑ soars Total sgiLw
a
Number of Lagoons. ❑❑ 1,a�oo
Subsurface Drains Present n Area ❑ Spray Field Area ._
Hold ij PAi ds / Solid Traps / Y ❑ 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 2-No
b. If discharge is observed, did it reach Water of the State"? (If yes, notify DWQ) ❑ Yes 5allo
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 ERNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes Zj 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 [a Yes ❑ No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ......... .......................... ...........................................................................................
5- Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 10 No
seepage, etc.}
3/23/99 Continued on back

© Division of Soil and;Water Conservat,on Qpeiation Review
© Division of Soil and -Water Conservation -Compliance Inspection s" f416
>♦v�sion of Water Qeealtty Compiance Inspection LAP_
Other Agency. Operation Review;
r
10 Routine 0 Complaint 0 Follow-up of DWQ inspection Follow-up of DSWC review 0 Other
Facility Number Date of [nspection
Time of Inspection / 24 hr. (hh:mm)
i
Wermitted 0 Certified © Conditionally Certified 0 Registered 10 Not O erational Date Last Operated:
Farm Name: 1 ...T36, C,/. , r...................................... County: --._..........! ,.,�...............---...---
Owner Name: 4 jo r�E:�l................................................................ Phone No: /Q .... .��— � QZ ../....
FacilityContact: {3 Title:................................................................ Phone No: ........ ...............................
Mailing Address: ..... .-J?-,9..-...-i)�ft3 1' ...,Ca �.-...4", /1......../ 1..�'....... .0."��i'..r..
Onsite Representative: „• f Integrator
........................................................................ • .............. ;+e:�,w: ....¢ �r
Certified Operator: ....... .......
o4..... �..',.....;�,�-16A.✓................................... Operator Certification Number :...............................
...........
Location of Farm:
...................... ... ..........................................................................................•--.-----..------.................-•-.-----.--..............---•.....................
.. ...... ...... .....
rt ..... ,�r......... ..r.,r...................................................................................................................................................................
Latitude �' �` C� Longitude C� • �� C�"
Design Current Design.. Design 'Current
Swine ;- __� _ PoultrYj'
-,--Capacity Population �J Ca achy Po iilation Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
eeder to Finish 1[] Non -Layer ❑ Non -Dairy
act
❑ Farrow to Wean T"
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish = Total Design Capacity
❑ Gilts y
❑ Boars T©tal SSLW
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. Il' discharge is observed, was the conveyance man-made? ❑ Yes Q-No
h. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated flow in gallruin?
d. Doc.s discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes [RNo
2_ Is there evidence of past discharge from any part of the operation? ❑ Yes 0 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes R No
Waste Collection & Treatment
4_ Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway [ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ................................. .................................................... ............................................ ................................... ........
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes Wo
seepage, etc.)
3/23/99 Continued on back

Iaaciiity Number: — YO Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes (N-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? +Ves ❑ No
8_ Does any part of the waste management system other than waste structures require maintenarice/improvement? ❑ Yes XJ No
9.' Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? [-]Yes to(No
Waste ADoIlCatiOn
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
o
1.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
No
12.
Crop type
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
Yes
❑ No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
W No
b) Does the facility need a wettable acre determination?
❑ Yes
® No
c) This facility is pended for a wettable acre determination?
❑ Yes
O No
15.
Does the receiving crop need improvement?
XYes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
,�j No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ 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
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
❑ No
(ic/ discharge, freeboard problems, over application)
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
j❑'
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
Yes
❑ No
0_ 10 vioiaticjris or .... eri... were ngte dt rtng �his:vis. .....wit/ receive Rio fu.thor
correspondence abnnit. this .visit_
7 zz /�ve*..i 6 a .� �>✓ �J.F�[/ •�•✓� �.G:2 .�/s�.�! /�•���G a v. �i .n S7 �� .�
•�• !' Q/ � �(�� +� lli�.��j�i-� (itru G �S� /l�.t� j� bi�"�.-✓`i'' G
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
3/23/99

Facility Number. Z — fl(J Date u1' Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? I ❑ 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? XYes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes j No
9. Do any siuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes XNo
Waste Anolication
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
No
12.
Crop type
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
Yes
❑ No
14,
a) Does the facility lack adequate acreage for land application?
❑ Yes
m No
b) Does the facility need a wettable acre determination?
❑ Yes
® No
c) This facility is pended for a wettable acre determination?
❑ Yes
91 No
15,
Does the receiving crop need improvement?
Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
>Q No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ 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
❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
❑ No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
Yes
❑ No
24, Does facility require a follow-up visit by same agency?
Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
0; o violafitjris;or deticienc;ies wzere noted during ihis:viS. ! Yoir will reoeiye o: further ;
.�:�corresponderrce:aboti>t_this:visit.::-•-:- -'-•.•.•.•.• ....:.:.:...::�:•.- .- .�.•..•.�••:•:•
recom nt
/zz
744
�"r �/
���.►L�` �,Qa.fl /G''Od�JC • / /fc-��J�isltd
c cam/ N'.F/r cu e• 6.4 �R�is L �'� G fie, -, �-+-�-�� �- "--�
,5,,
Reviewer/Inspector Name �-" `
Reviewer/Inspector Signature.��y Date: 9�99 V
3123/99

0 Division of Soil and Water Conservation ❑ Other Agency
0 Division of Water Quality
10 Routine O Complaint O Follow-up of DWO inspection 0 Follow-up of DSWC review O Other 1
Facility Number
Registered [3 Certified © Applied for Permit © Permitted
Farm Name: .....................,�.--- ? ``.'.. t'........................
Owner Name: l3:4/1 1
Date of Inspection
Time of Inspection $L LXO J 24 hr. (hh:mm)
10 Nut O eratianal Date Last Operated:
....... County:......../.....................................
....................................................................................................................... Phone Na:...........��...... �........L..S� 2 <.........
Facility Contact: ....... I..........Z.4 .-•--..A.7o, j,�............ Title: ----.. Phone No: ...
Mailing Address:........... 1(�....ZJ.f/ f �..f.Y..... ... L y7 ..........................
Onsite Representative: .......................... 1 . Integrator: ........
..�f�
.....................................................................
Certified Operator; ............... !........!d L ..--.- ..30 ......l�..................... .. Operator Certification Number ;.........................................
Location of Farm:
�� f w..,.....................................................................................................................................,.........
a
lei[' lk �1.!1................... ...... ..... .......... .................................................................
Latitude 0 4 Gf Longitude • 04 "
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes )(No
2. Is any discharge observed from any part of the operation? ❑ Yes KNo
Discharge originated at: ❑ Lagoon ❑ Spray Field []Other
a- If discharge is observed, was the conveyance man-made? ❑ Yes PO No
b. If discharge is observed, did it reach Surface: Water? (If yes, notify DWQ) ❑ Yes gNo
c. If discharge is observed, what is the estimated flow in ;aUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes xNo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes )<No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes )(No
5. Does any part of the waste management system (other than lagoons/holding ponds) require Yes
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes kNo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes �No
7/25/97

pa 4:a.i �+• Y t r+b. � r3-,: : .+%'r. �.. ,t �-. r�_ _ ` c.., �fi." •!.p � N'4-i' •� t'�wr' - v"�3t . ,
+ r' `+Y a.`Pi', T,}�c E'.4C:8 ;sl�'!7+ •��tt { n-Sy '.Y4f`rv+,I�++]YM •� ^: -,d� "�"Q'.",�'. .��+�`i�-`�i^ir".`arr'�,i:'h..«r•6 S.+�i '
I 0 Division of Soil and Water Conservation ❑ Other Agency
0 Division of Water Quality
10 Routine O Complaint O Follow-up of DWQ inspection 0 Follow-up of DSWC review O Other I
Facility Number Date of Inspection
Time of Inspection Q = 3 24 hr. (hh:mm)
0 Registered 0 Certified 0 Applied for Permit 0 Permitted 10 Not O erational I Date Last Operated :.................:
1?arnt Name: ..... ..................`..'`.....................- County:..........
.......-. ........... ........ ......................... ...
OwnerName:................................-..J,c......................................... Phone No:....... ................................... �J.1.... .
Facility Contact: •-.-, .. Phone No:
...................L...---............ �".�......---.... Title..............................------ ...................... ........................................... -.......
Mailing Address:.......... .I.........Gt/! f/ wr rNq . ... I ..& &Y c... . e;�4...��,�.. ..........................
Onsite Representative: .......................... � . Integrator:..........,7"��4
--- -----------------------------------------------------------------
Certified Operator ;..-.--.... � o. ...... ..... / 1% .... Operator Certification NumberL...................•....
Location of Farm:
........... ... _._...-----
...!_�. . ....
......---------------------------------------_........----....---.........................................................................................................................
Latitude C • C ` " Longitude 0. 04 46
Desrgtz
Current Design A `1WCurrent NUes�gn Cnrreat
,Sivine=! Ca actt P alation Pou - r, -„
R Y «b n Capacity .Population Cattle, �CapacityPop>tlahon
❑Wean to Feeder
:.aP.
❑ Layer ,' ❑ Dairy
10
Feeder to Finish _C
Non -Layer ❑Non -Dairy
Z„ ❑Farrow to Wean
❑ Farrow to Feeder
�z
❑ Other
❑ Farrow to Finish
- � Design Capacity
�tb
❑Gilts
x� ,Total
u
❑ Boars
kr A T otal L
,
' Subsurface Drains Present 1I❑ Lagoon Area 10 Spray Field Area
°I❑ No Liquid Waste
General
1. Are there any buffers that need maintenancelimprovement'? ❑ Yes XNo
2. Is any discharge observed from any part of the operation? ❑ Yes P(No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes W No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes tRfNo
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 RNo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes KN0
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes KNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require Yes
maintenance/improvement? X,
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes kNo
,..�
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes p!, No
7/25/97
a

Facility Number: 2- d
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
XNo
Structures (LagoonsAolding, Ponds Flush Pits. etc.)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
0(yes
❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard(ft):..............�X................
10.
Is seepage observed from any of the structures?
❑ Yes
No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
No
12.
Do any of the structures need maintenance/improvement?
(NYes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type.....................................................................................................................................
I&
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
KNo
17.
Does the facility have a lack of adequate acreage for Iand application?
❑ Yes
kNo
18.
Does the receiving crop need improvement?
"KYes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
�No
20.
Does facility require a follow-up visit by same agency?
es
❑ No
21.
Did Reviewer/inspector fail to discuss reviewrnspection with on -site representative?
ryes
❑ No
22.
Does record keeping need improvement?
❑ Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
❑ No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
❑ No
[3- No. violations -or. dePlciencies'were-noted-during' this -.visit.- .You4i11ieceive-no ftirtlier : -
S_ , S,c,✓x� del /�-f ;�is�,a� �- �� ��s_ ,���,�.�.t- �.. �.�
01
Zz 5/97 —
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: //Z

.r�•;uNrYSh_.,�ti�il*'�t.�-f"��•+..'M�: ter. t*'; .j��, v.4E., .-.+.�w�T Yi: Si"��,,;`.:.r�� - ,. .,��: - .. �.:'. ,n?r. �.:i .. . ,. :�..':3;.ti-•..-..
Facility Number: 27
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes XNo
Structures (Lagoons,Hnlding_Ponds. Flush Pits etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? [(Yes ❑ No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft): .................................... ................................................................--.---.... -.....................
..:....................... •..............
10. 1s seepage observed from any of the structures? ❑ Yes No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes No
12. Do any of the structures need maintenance/improvement? LXYes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes No
Waste Application
14. Is there physical evidence of over application? ❑ Yes No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ......... .�c!di r.....� ! ........................................................ -..................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes jSfNo
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes h
18. Does the receiving crop need improvement? )Ayes ❑ No
19. Is there a lack of available waste application equipment? ❑ Yes *No
20. Does facility require a follow-up visit by same agency? es ❑ No
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative? rtyes ❑ No
22. Does record keeping need improvement? ❑ Yes ❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes ❑ No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes ❑ No
O— No.violationssor deficiencies wereni &t d-during this :visit.- YOu,will recei'Ve-ira,f4r ie_r `
etirres iDhdence ,A out this.visit.
6,
S. SrG-✓.�.c� � cfr.-rAlf I�-.rt�-t �C�"/.S� ,a,/�'" f�� a>� 1c.0 � suers . �E�.¢�.CL" ca..� .wo1'f �
ew
Reviewer/Inspector Name
ReviewerAnspector Signati

le Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Q Date of Inspection
Time of Inspection of : !7 24 hr. (hh:mm)
Permitted OCertified [3 Conditionally Certified 13 Registered 113 Not O erational Date Last Operated:
Farm Name: ...a� ......................
County
Owner Name:........... %. f.�lr�Y`'Yi........� ......... Phone No:............1,D...�...�v...a....`....T......'.�..............
Ant.
.- ..... .........Facility Contact: ..............Title Phone No: ............................................. .....:...................................._........................_
Mailing Address: .......................L.......�... ......... ............. a�?...T...?" ......... % `,/._ aC
Onsite Representative: .................... �..................................................... Integrator: ........ .lei.- 5.... ....."�
Certified Operator: t iO ,,,1�/T7..........„-„ ...................... Operator Certification Number:
..........................................
Location of Farm:
..................................................................................................................................................................................................................................................................... =1
Latitude �' �' 0.� Longitude '
:.: Desrgn r Currenf ...i Design Current DcSign Current .
"y f
nCCattlSwine apaciw, CatY.
' aci Po' elation'
❑ Wean to Feeder ❑ Layer 1 ❑ Dairy
Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
Farrow to Wean
❑ s r
❑ Farrow to Feeder Other r
❑ Farrow to Finish Total'Design Capacity
❑ Gilts = —
❑ soars Total SSLW
Numberof Lagoons ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holdrng°Ponds / S61rd Traps ❑ No Liquid Waste Management Systemr ;
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
RNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance than -made?
❑ Yes
[i;}, 0
b. If discharge is observed, did it reach Water of the State'? (Il' yes, notify DWQ)
❑ Yes
//I No
c. If discharge is observed. what is the estimated flow in gal/min?
AIJRR
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
[A No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes '
No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
1
Identifier: r�
� r �1
Freeboard (inches):
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
❑ Yes
JJ No
seepage, etc.)
+1 1
3/23/99
Continued on back

Facility Number: U—
Date of Inspection
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑Yes
No
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement? t;, �raim�pnry
Yes
❑ No
8.
Does an art of the waste management system other than waste structures require maintenan e ?
Y P g Y qelm n
❑ Yes
No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level G
❑ Yes
elevation markings? _
E�No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
[No
11.
Is there evidence of over ap lication? Excessive Ponding PAN
El Yes
VTo
12. Crop type 6
13. Do the receiving crops differ with those designated in the Certified A tmal Waste
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?
Plan (CAWMP)? ❑ Yes
VNo
❑ Yes
No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18- Does the facility -l-tt5 have II components of the Certified Animal Waste Management Plan readily available?
(ie/ W the lists, desin,mapg�etc.)
19. Does record keeping need improvement? (ie/ irrigation, freed, waste analysis & soil 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?
yibla40r,is;ot, def ge.ncles -Were noted• Ott- iing �his:visit: - Yoit will-r'&6i a Rio' futther
Tories• once_& ab**f this .visit. .. • . • . • . • . • . • .
Connments (refer fn:question #) Explain anyYE$ answers and/or,any recommendations or ar
Use drawings of facility to_better _i-xplarn7setuat►ons (use, addifional pages as necessary) f -
r al"e t u �
❑ Yes 9 No
WYes ❑ No
❑ Yes
No
(Yes
❑ No
❑ Yes
19No
❑ Yes
VNo
❑ Yes ❑ No
❑ Yes [XNo
❑ Yes ❑ No
❑ Yes No
Rey cwer/Inspector Name
Reviewer/Inspector Signature:
Date:
3/23/99

Facility Number: $ — 17 Date of Inspection I I—T—W-
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 QfN0
Il
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 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
31. Do the animals feed storage bins fail to have appropriate cover? [IYes;No
No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover'? ❑ Yes ❑ No
it1oR : omlmen&;an Or "vWin s: _ YSv .v7t7,s
QJPJVWWCW-
-
r!
W.'O tud s ,
Ln
{ t. tar- /Ie�
All
CW
3/23/99

Routine O Complaint O Follow-up of DWQ inspection O Follow-uE of DSWC review O Other,
Facility Number d Date of Inspection //
Time of Inspection J :3D j 24 hr. (hh:MM)
E3 Registered ® Certified 0 Applied for Permit 0 Permitted 113 Not O erational Date Last Operated:
Farm Name•iwc../ f.4- t.2.�- County:......6..osn� .......................
...................................... ......------...........I.......--------
Owner Name:................................................... a�E"J Phone Na: /D Z
/..................................................................... .... 5 ......................... ..
Facility Contact:.......,f od •...... J Title: Phone No:
Mailing Address: ,3 %�y � W �o'A...... 2tyyy ............. .........
W.
�f
OnsiteRepresentative:.......19r�!`� ....................... ......................................................... Integrator:-.......`... . . IC........... ......................... ........................
Certified Operator ............. Z1 ...-. .C-(.5) - 'cation on Number:...... ... ................................ Operator Certif./.�....�...` �c�
Y ...1........ ....
Location of Farm:
..................................... ................................................................� ...................**"--......................_..............---................-....................-.....
Latitude • 4 « Longitude • 6 C�44
6' ',DeStgn; Current,
�s
DeSlgm ', Current �:DestgnCtlrC@IIt;.
,.,;,, a '�f
..
Somme Capacity` Popnlatioir
_ �;• ;.ter ,'„�, -, „
YPoultry kACapactty .'Population Cattle. ' ;Cartty`PopWahon'n"
fn fi ❑ Wean to Feeder
10 Layer ❑ Dairy
Feeder to Finish aG �
❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
ElFarrow to Feeder
❑ Other ,
❑ Farrow to Finish
u » '' Total Design ity
g
❑Gilts
,Cape
[]
B
v ' ❑ oars
SS Total S iW
k
Nttmberof Lagooasl.Holdtng Ponris /
❑Subsurface Drains Present ❑Lagoon Area
❑Spray Field Area
� m: `
❑ No Liquid Waste Management System
xi
r x' ¢ _-kmh
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes )Q No
2. Is any discharge observed from any part of the operation? ❑ Yes BNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes MNo
b. If discharge is observed, did it reach Surface Water? (If yes. notify DWQ) ❑ Yes Wo
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 No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ,RNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes R No
5. Does any part of the waste management system (other than lagoons/holding ponds) require V'Yes ❑ No
maintenancelimprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes -9 No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes PNo
7/25/97
Continued on back

Facility Number: ?2
8. Are there lagoons or storage ponds on site which need to be properly closed?
Stmctures (Lagoons.Holdina Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identifier.
Freeboard(ft): ............ f y...................................... ....... .................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
❑ Yes IX No
❑ Yes
® No
Structure 5 Structure 6
❑ Yes
[I No
❑ Yes
B No
Yes
❑ No
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes (UNo
Waste Application
14. Is there physical evidence of over application? ❑ Yes A? No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type r r�i�f _... 11. �.... ,Xl.................. ---...
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes ❑ No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
❑ No
18.
Does the receiving crop need improvement?
P Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
-0 No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
(M No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
22.
Does record keeping need improvement?
❑ Yes
❑ No
For
Certified or Permitted Facilities UWy
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
M No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
❑ No
[3-No.vioNtions'vr. deficiencies.were' noted -during this:visit.- Yo_ u:w'ill irecei've no°ftirther
. coerespbndence about this: visit:
a A�4� xr'_01!o� X/Aw /1C �f - fJ� G'DGf�.C�.l ��•cJ
7/25/97

. ...... . . ... ...
DSWC Animal Feedlot Operation Review d
,y® DWQ Animal Feedlot Operation Site Inspection;,,
14D Routine O Complaint O Follow-up of MVQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number Time of Inspection 24 hr. (hh:mm)
&Registered © Certified 13 Applied for Permit © Permitted Q Not Operational I Date Last Operated :...............
Farm Name. &.6.....!Jt�.ua.4 �.................. County: ........ 4 .i 19j'1:..............................................
Owner Name:.......... f� ... Phone No: � 0.2
Facility Contact. .......t`CAAk...... Title: : - I< r ..... Phone No: ...................................................
Mailing Address: ...........3`78`....... r...�:: ' 14 cG4^................................ ...3�1:...
... ...................... ........ ....... f...... ....
Onsite Representative:........ RL&+1.VC..... V. Integrator: ..........-J'.K...........................................................
Certified Operator................................................................................................................ Operator Certification Number:.........................................
Location of Farm:
Turn W off 421 ono Rwy go - 4 - -
..........................................................................................................................................................................................................................................................................
............................................................................................................................................................
Latitude • ®1 ® 44 Longitude 78 • 1$ 4 ® 4
: Swine
Design Current
Capacity Population
❑ Wean to Feeder
Feed r to Finish
%ODd
ppp
❑ Farrow to Wean
EJ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design :::Current
Poultry Capacity Population Cattle v..Capacity, Population
❑ Layer JE1 Dairy
❑ Non -Layer 1 10 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons /Holding Ponds ❑Subsurface Drains Present ❑ t dR�wR Area ❑ Sprar' Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes IN No
2. 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 JRNo
b. If discharge is observed, did it reach Sort -ace Water? (If yes, notify DWQ) ❑ Yes IM No
c. If discharge is observed, what is the estimated flow in gal/min? '�—
d. Does clischarg;e bypass a lagoon system? (If yes, notify DWQ) ❑ Yes A9 No
3- is there evidence of past discharge from any part of the operation? ❑ Yes L] No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5. Does any pan of the waste management system (other than lagoons/holding ponds) require Yes ❑ No
maintenance/improvement ?
6- Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ® No
1
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ® No
7/25/97 Continued on back

Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,11olding Ponds, Flush Pits. etc.1
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ............i4...... ........................ .......... .................... ............
Freeboard (It): .............a) r� ..............
i.9..��.......... I ...
10. Is seepage observed from any of the structures`?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an inunediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14- Is there physical evidence of over application?
(If in excess of W MP, or runoff entering waters of the State, notify DWQ)
15- Crop type........L�.¢...t..!f.l✓ti+!1t![,...t.,�Q
"0 '..............................................................................................
16- Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17, Does the facility have a lack of adequate acreage for land application?
❑ Yes 4No
0-Yes ❑ No
Structure 0
❑ Yes ® No
❑ Yes ® No
alb' Yes ❑ No
❑ Yes No
❑ Yes ® No
*Yes ❑ No
❑ Yes IgNo
t_8. Does the receiving crop need improvement?
9-Yes
❑ No
19. Is there a lack of available waste application equipment?
❑ Yes
®.No
20. Does facility require a follow-up visit by same agency?
❑ Yes
E9No
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
4No
22. Does record keeping need improvement?
❑Yes
AIV 11 No
For Certified or Permitted Facilities -Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
❑ No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Permit'!
❑ Yes
❑ No
0 No.violations or deficiencies were noted during this'visit. -You will receive no further
correspondence about this visit.:
Corrunent;�(refer to question #):.Explain any YES answers andlor.._ariy 'recommendattons,or an} other �otnments.
H ..,
LJse drawings of &6 ity to better, explain situations '(use additional pages as necessary}.
4COn4k=tfo1A
,t, alr AuMS , Vedd c` � term s_
}
N� S 4 v�
JL u
121 ,Jriu).1v:
N e-J S 1, (y_ AF'
54 I le►►J4 ca^
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: t Date:�{o.�5i']

Site Requires Immediate Attention: NO
Facility No. 82 - *0
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 7 - 1--7 , 1995
Time: 11:40
Farm Name/Owner: 91 L t 3 o &j +_
Mailing Address:_ iZ,�. 1 8� z$� /-1�,��.e11s �1.C_ 2_$Y#Si
County: SAr3Ps,5,J
Integrator:_ S"P K 5 - Phone: g e- �3 Z ff 7 Z�
On Site Representative: _-x4A,.1 k Gwa - - - - Phone: -
Physical Address/Location: Doaetr1' ^ r, dwysk -- + KF-kv S4,,O;p. L /e, A+EsL
Q, loft 7 -
Type of Operation: Swine Poultry Cattle
Design Capacity: _ 12-a -a Number of Animals on Site: 'foa
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Yes or No Actual Freeboard: `f Ft. Inches 3.5
Was any seepage observed from the la n(s)9 Yes o No Was any erosion opse�ved? Yes o No
Is adequate land available for spray. fir No the cover crop adequate? es r No
Crop(s) being utilized: Co CAAA-
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellit
es r No
100 Feet from Wells?oro
Is the animal waste stockpiled within 100 Feet of USGS Blue -Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or & If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? es r No
Additional Comments:_- �&o Q? &&O,�� �s r.ajE2 rAlr. E _4nc
9rGK"
Inspector Name
1?evtCS n• R._-
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

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