310777_INSPECTIONS_20171231

NUH f H GAHULINA
Department of Environmental Qual

Type of Visit: *Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ®Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: A,.1 Departure Time: County: DO PLT;j
Farm Name: ©vr �4 Owner Email:
Owner Name: CL►'►^e Phone:
Mailing Address:
Physical Address:
ew
Facility Contact: n's C(J Title:
Onsite Representative: It
Certified Operator: U
Back-up Operator:
Location of Farm:
Latitude:
Region: bor)9-0
Phone: J �1
Integrator:
Certification Number: 20�62
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder QO
Ot71 INon-Layer
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
.
D PU-u It ry, s aci P.o P.
Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Beef Brood Cow
Boars
Pullets
I-ther
Other
Turkeys
Turke Poults
Other
Discharaes and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
T
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
[] No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[�No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
V No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: - '7 Date of Inspection: 2�6
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
11;FDNo
❑ 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): �3 u
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[IT 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
allo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the pennit?
❑ 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
[�PNo
❑ 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, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑
Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable CropWindWindow Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s): Ccaga "SS CS�
1 sm, l YAoy ,
13. Soil Type(s): 6-W—" �r�a
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 o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP [:]Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑ Yes [ No
❑ Yes ® No
[:]Yes No
❑ Yes ® No
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ YesT0
❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ Yes ® No
❑NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facili umber: - 7 7 IDate of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signatut
Page 3 of 3
❑ Yes P No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes �3 No ❑ NA ❑ NE
❑ Yes �3 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Phone:
Date: 7
21412015

Date of Visit: Arrival Time: Departure Time: O County: Region:
Farm Name: IW ( me— A&I'Jew % eO- V Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone:
Title: Phone:
Location of Farm: Latitude:
Integrator: %s'1 4%�
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer
Design C*urgent
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I IN9_p:Layer
I E�]
Dairy Calf
Feeder to Finish
Design Current
Dairy Heifer
Dry Cow
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr. Poult , Ca aci P.o
Layers
Non-Dairy
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
TUrkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes prNo ❑ NA ❑ NE
❑ Yes �No
❑ Yes VJ'Vo
❑ Yes Wo
❑ Yes ETNo
❑ Yes
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
DNA ❑ NE
DNA ❑NE
Page 1 of 3 21412015 Continued

►1
f Facility Number: Date of inspection: / Z j,#
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo
a. If yes, is waste level into the structural freeboard? ❑ Yes .ENo
❑ NA ❑ NE
❑ 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
,r 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
PTNo
❑ 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
C'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Pno
❑ 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
rho'
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes 2' Vo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�f? o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
g'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑'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
[2rN0
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[30R10
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
7No
❑ 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 Ga�No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ET1,10
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes C2 o
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection: t L
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes P�No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [:2rNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name: K-tO P&__
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
Rio
❑ NA
❑ NE
❑ Yes ?o
❑ Yes ;Z No
❑ Yes C21io
❑ NA [] NE
❑NA ONE
❑ NA ❑ NE
❑ Yes 9No ❑ NA ❑ NE
❑ Yes jo No
❑ Yes Ej No
❑ Yes ❑'X6
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone:
Date:OF F
L
21412015

(Type of Visit: Compliance Inspection U Operation Review U Structure Evaluation 0 Technical Assistance I
Reason for Visit: .t?fltoutine 0 Complaint 0 Follow_up0_Referral _0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: �1 Region:
I Farm NameOwner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �(C 4l aae'-'e_,
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Deslgn Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design
Cattle C*apacity
DairyCow
Current
Pop.
Wean to Feeder
ouc
Non -La er
EE]
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D.t, P,oultr.
Ca aci
P,o ,
Non-Dairy
Farrow to Finish
La ers
Beef Stacker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
rke s
RurkeyPoults
Other
Discharves 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)?
❑ Yes ;,� No ❑ NA ❑ NE
❑ Yes .,�ff No
[] Yes/ETNo
❑ NA ❑ NE
❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [] Yes J}'No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes 'P3�o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes �Z No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3
2/4/2014 Continued

Facili plumber: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
jEf 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
o
E�'
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑Yeso
❑ 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?
T
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
�o
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
'�fNo
❑ NA
❑ NE
❑ Application Field CDLagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑Yes
o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ YesVN
o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yeso
❑ NA
❑ NE
Comiiients (refer, to question #):.Explain any�YES answers. and/or any additional�recComime2ndations,or,,anyrother comments
y -€- - y4 i'1.P, q5 : A
Use drawings of facility toC,better ex lain situations;(use;additional ages, s necessaiyj):.ypaie s t. I �;
,
ab jaiii. zrn_c.U-61.3J C'Jt AJ4 &-j
SWLeA -i8 f sby)` . ("""'Y •
(� rawerr Y\9.s f e s c-- PQ-c�, - ` 5" " �'
Kai
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone L(3 'T`-[ K} 3
Date:,j:3T 7H
IJ---
21412014

Faciii Number: Date of lns ection: o?
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes �No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 22
Observed Freeboard (in): �J
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 ONo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ?,'No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) TT
9. Does any part of the waste management system other than the waste structures require ❑ Yes �To ❑ NA ❑ NE
maintenance or improvement? T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box- ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground H vy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ ai to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s)
14. Do the receiving crops differ from those designated in the CAWMP? E] Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 'a. No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes P No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
PNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�3 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
0 No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check t appropriate box below. ❑/ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes -Efl-No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ff No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412014 Continues

Type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: !;Koutlne O Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: Z05,Arrival Time:
eparture Time: /County:
Region:
Farm Name:: D I d aaip�V
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Wet Poultry
La er
Design Current
Capacity Pop.
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
a 600Non-La
er
I
Dairy Calf
eeder to Finish
Dairy Heifer
Farrow to Wean
Design6uirxent
D Cow
Farrow to Feeder
Farrow to Finish
D.r Poultr.
Layers
Ca aci P,o ,
Non -Dairy
Beef Stocker
Gilts
Non -Layer
Beef Feeder
Boars
Other
Other
Pullets
Beef Brood Cow
Turkeys
Turkey Pouets
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ,Z'No ❑ NA ❑ NE
❑ Yes )2No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
❑ Yes E;No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
11-11
Page 1 of 3 21412014 Continued

Facility Number: - Date of Inspection: p
Waste CoNection & Treatment
4. ?s 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 ;3 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 eNo ❑ 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 ZfNo ❑ 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 j2T&o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �No [3 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 [2-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 ;2-5o ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 171 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ONo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes C2-No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
TP
❑ 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 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes fff No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EfNo
❑NA ❑NE
❑ Weather Code
❑Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

/'
11
Facility Number: 131 - Date of inspection:
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 2 No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes U'No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes nij No
Other lssues
28. Did the facility fail to properly dispose of dead animals with 24 houfs 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)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ YesgNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ElYes o ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional' recommendations or any other comments.
Use drawinp-s of facility to better explain situations (use additional pages as necessary), . I ,
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
- ZL ye��- Y,0116Arl—
Rcviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes VI No ❑ NA ❑ NE
❑ Yes �] No ❑ NA ❑ NE
❑ Yes ["No ❑ NA ❑ NE
❑ Yes FZTNo ❑ NA ❑ NE
Phone:
Date: 6
1412 &f4

Type of Visit: �,o/mpliance Inspection Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: cC� xoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Arrival Time: Departure Time: County: Region:
— '-) Z, e y Owner Email:
Title:
Onsite Representative:�Q�
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
tl
Certification Number:
Certification Number:
Longitude:
Design
Current
Design
Current
Design Current
Swine
Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle
Capacity Pop.
Wean to Finish
La er
Dai Caw
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr, P.oultrl
Ca aci
l:o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
I
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 DWQ)
❑ Yes
[] No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ 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 214120,11 Continued

Facility Number: - Date of Inspection: A Zzy
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
❑ NA ❑ NE
❑NA ❑NE
Strucre 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �- y
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ❑ No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ONE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift []Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Required Records &_Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑NA ❑NE
[] Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: ,a
24� Did'th&facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ❑ No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes ❑ No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes ❑ No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ❑ No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes [] No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes [] No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES.answers and/or any additional recommendations or any other comments.:
Use drawings of facility to better explain situations (use additional naves as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 1
Date: le,12 x
I4412011

Type of Visit: k:7 Compliance inspection V Uperation Review V Structure Evaluation U Technical Assistance
Reason for Visit: 9111outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: eparture Time: County: /�4/ -Region:
Farm Name:% r� �CZ,-.—,� 7s' S/ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine !Q. TU- —ac 1 al EPop.
Wean to Finish
Design Current
Wet Poultry Ci t7v= Pop.
Layer
Design Current
Cattle C►apacity Pop.
DairyCow
Wean to Feeder
I
Dairy Calf
Feeder to Finish
Design Current
Dr, l;Yu- ltr, Ca aci P,o
Layers
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkcy Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes EI'No ❑ NA ❑ NE
❑ Yes O No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
[:]Yes Feno
[:]Yes 0io
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: Date of Inspection: Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ,LD'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [DINo ❑ 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 J�TNo ❑ 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 eE:j'No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ;2'No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes P�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 �o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes a —No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ZNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ,fNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �10 D NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ;3No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reuuired Records & Documents
❑ Yes, J;11No ❑ NA ❑ NE
❑ Yes etj No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ;2jNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes eNo ❑ 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. '�es 'VNo
❑ Waste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes P'No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �' o
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

7 7 -7
Facili Number: Date of Inspection:
. 2,4. Did the facility fail to calibrate waste application equipment as required by the perm t? ❑ Yes Z No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ZNo ❑ 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 PTNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes o ❑ NA ❑ NE
Other Issues T
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes �o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
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 PrNo ❑ NA ❑ NE
[] Yes CZ(No ❑ NA ❑ NE
❑ Yes 2fNo ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
❑Yes YNo
o ❑NA ❑NE
❑ Yes ❑ NA ❑ NE
Comments (reter to question #): Explain any Y E6 answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
W5-11 3 6-?6y
/ '// V/ 7-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �& Z&_7 C2
Date:
4SOH

Q
Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Rr6outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Z rrival Time: parture Time: County: u I1In Region: {i
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c =' Longitude: = ° 0 6 = !{
Design Current Design Current
Swine Capacity Population Wet Poultry (►opacity Population
Design
Cattle C•upacity
Current
Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
I JE1 Non -La er I
❑ Dairy Calf
❑ Feeder to Finish
J
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
ElNon-Dairy
❑ Farrow to Feeder
❑ Layers
❑ Farrow to Finish
❑ Beef Stocker
❑Non -La Layers
ElPullets
❑ Turkeys
—Uiurkcy Poults
❑ Other
I
❑ Gilts
El Beef Feeder
El Beef Brood Cowl
I
❑ Boars
Other
umber of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes 'E!�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 ,Z 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 o
❑ NA
El NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes "o
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes ' rNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3 12128104 Continued

Facifi ty Number: - Date of inspection: IQZ Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Pr
❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ???111 ``"�No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes �''""""''' No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes )No ❑ NA ❑ NE
maintenance or improvement?
Waste Applicatian
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA [] NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �No ❑ NA [,] NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
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 ,fNo
❑ 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?
�/'
[3 Yes 1 ifNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes J�rNo
❑ NA
❑ NE
Required Records & Documents Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ffNo ❑ NA ❑ NE
the appropriate box.
❑WUP [3 Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box b ❑ Yes Jallo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ S it Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections thly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 07140 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ezNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0" ❑ 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 ZfNo ❑ 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)
❑ Yes111110 ❑ NA ❑ NE
❑ Yes P1110
❑ Yes �No
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
1PKo
PNo
;No
o
w I(( c k0ck 661 1 �yfs an 11 ^ - * .
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Phone: & — 7 Ll —
Date: 6 Z Z
4/201

Facili Number°, { � {p ®VDivision of Sail and Watei• Conservation I '�� � �
� � Other Agency ' _
Type of Visit: 991compliance 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: } 1 Arrival Time: Departure Time: O County: T Region:
Farm Name: 1�f'l...e_ S f'4q_S %q C—`Ae In Owner Email:
WD toss-4(0sce�W
Owner Name: i�1 1rcPhone: �� 5 L� 9 t5 - Co S& - C.r Co Q} (G.)
Mailing Address: D 1 !I T /VC S s E Mawi % Ou U[ , A/C Q
Physical Address:
Facility Contact: , \ Title: Phone:
Onsite Representative: Le -sue- lJ�]"l"iTCi _ Inte rator:
_ , _.._ D DI � n
Certified Operator: Se-1 1`'� �lt[��p Certification Number: I to 1'(3 of
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design
Current Design, Current Design
Current
Swine
Capacity
Pop. Wet Poultry. Capaty Pop Cattle Capacity
Fop.
La er Dairy Cow
Layer t Dairy Calf
39 5'4 Dairy Heifer
Design. Current Dry Cow
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
D , l'oult , Ca aei $ Non -Dairy
La ers Beef Stocker
Non -Layers Beef Feeder
Pullets Beef Brood Cow
Turkeys
Farrow to Finish
Gilts
Boars
U_t Ie1007111
TurkeyPouits
Othcr
sa.a� ���a�'_ttt�.ea,Rncors�ssmrrrrsr=a�rra.r.
Other
�arrrrn.-�s�ucaa
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
x No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Na
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility �lxpmber: -3 [ - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural. plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
J %I No
777❑
❑ 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: i
Spillway?:
n
'7
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
1XNo
❑ 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
0 Yes
�LNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
DO No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? 0
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, ctc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of AcceptabblQle Crop Window L� Evidence of Wind Drift ❑ Application Outside of Approved Area
12, Crop Type(s): J 1.1 U in2, e [ i U,,� C-' 3 I
13. Soil Type(s): A6u--0L1r_
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 j� No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18, Is there a lack of properly operating waste application equipment?
❑ Yes P�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
Q WUP ElChecklists Q Design ❑ Maps ❑ Lease Agreements
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[3Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
0 Waste Application [] Weekly Freeboard 0 Waste Analysis Q Soil Analysis 0 Waste Transfers
Q Rainfall [] Stocking 0 Crop Yield 0120 Minute inspections [] Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
Q Weather Code
Q Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No [3 NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes C)kNo ❑ 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 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ YeskNo
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
"`ii7""CCC
❑ 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)
7�
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below,
❑ Yes
j No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
�C
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
&No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments Tx t
Use drawings of facility to better explain situations (use additional pages as necessary).
a'3'A.
411111 Q
S�t�o�� GkEr�Q� (A.NT►L 'ail
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 o. f 3
Phone: 9io "416 30 7
Date:
21412011

Type of Visit Q-ffbmpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit if,"r'-noutine 0 Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: IfZ Arrival Time: O� Departure Time: County:
Farm Name: /�[ 62�42 Owner Email:IF
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Cv &_/J2
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator: % lZ.:?
Operator Certification Number:
Back-up Certification Number:
Region: %.&-
Location of Farm: Latitude: = a = 0 N Longitude: = ° = 6 =
16
D—esi
I 01111 Design Current
Des€gn Current
Swine Capacity
Population
wet Poultry Capacity Population
C*attle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑Dai Galf
❑ Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non-DaiEx
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
ilts
on -Layers
El Beef Feeder
Roars
❑ Pullets
�
❑Beef Brood Cowl
I
❑ Turkeys
Other
❑ Other
❑ TurkeyPoults
❑ 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 ;3'No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
El Yes
P?No
El NA
❑NE
❑ Yes
�No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number E2ZZ Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large 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?
❑ Yes fi3 No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes
qNo
❑ NA
❑ NE
❑ Yes
PNo
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes P 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 part of the waste management system other than the waste structures require ❑ Yes ZrNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes pMo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ;2No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
USIe
❑ 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
/e No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ONo
❑ NA
❑ NE
Comments (refer to question #) Explain any YC5 answers and/or any recommendations or any othencomments'
Use drawings'offacility to betteirexplain sitivation`s.juise-additional pages as necessary} 4 �
�3,�rN; 7s a'vz .e 3r� $�ti ` :i' 7'.5:; _ax �; ;.-fr._e
5ure-
so s.r)l aoi O
e, A tJee
d C�i��4�O)q r qp%o
t�r = .k
ReviewerlInspector Name. '' a $`'. r �,..� i• '.�
Phone: 6
� :.t�
Reviewer/Inspector Signature:
Date: a
Page 2 of 3 121AI04 'Continued

a
Facility Number: — Date of Inspection Z
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ZNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ZYes ❑ No [I NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ,Waste Analysis ❑ Soi] 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 1P No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ,fNo ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�allo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ONo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ONo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
UNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
;3No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�Ko
❑ 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
WNo
❑ 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
[ Ao
❑ 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
9No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
;�'No
❑ NA
❑ NE
Additional Comments and/or Drawings:1
Wed 1, I ,is-�a (3#. z 0 uVYLP)V:,�,
° Need d,o Cb 5011 'k -� i- ea [ xj� ira (-tins -(�c a,010 t
- s l use- a E,5o d�
FWI
Page 3 of 3 12128104

(Type of Visit o Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit Routine O Complaint O Fallow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: I7 O Arrival Time: Delmrture Time: County: Region:
Farm Name: 5—`Vl Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: o = I = ll Longitude: = o = 1 = {1
Design
C+urrent Design Current Design
Current
Swine
Capacity
Population Wet Poultry C Facity Population Cattle Capacity
❑ Layer ❑ DairyCow
Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
❑ Feeder to Finish
❑ DairyHeifer
Dry Poultry ❑ D Cow
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑Non -La ers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turke s
Other
❑ Turkey Poults
❑ Other I umber of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes,ZNo
❑ 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
DNo
❑ 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
17 No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: — 7 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Plq0 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ENo ❑ NA ❑ NE
Structur 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 �fNo ElNA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 7No ❑ 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 JNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Po ❑ 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 [3 NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 11*110 ❑ NA ❑ NE
maintenance/improvement? /
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [<o ❑ NA ElNE
❑ Excessive Ponding ElHydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ;rNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 014o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes Z'No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes e ZrNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [),No
❑ NA
❑ NE
r/4a/ 6"'- /r3 °rr�r�h ti
I Pe r, S "0'- / •,,
Reviewer/inspector Name Phone: 5/7O
Reviewer/Inspector Signature: Date: / 7 P
Page 2 of 3 12128104 Continued

iaacility Number: 7Z 77 Date of Inspection I ILILT!'
Required Records & Documents T�
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps [3 Other
21. Does record keeping need improvement? If yes, c the appropriate box below. 'Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard aste Analysis El Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield 0 Minute Inspections 0 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?
[f 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
Of
❑ NA
❑ NE
❑ Yes
R No
❑ NA
❑ NE
❑ Yes
�;M0
❑ NA
❑ NE
❑ Yes
/ hNo
❑ NA
[I NE
El Yes
o
❑ NA
❑ NE
❑ Yes
�*o
❑ NA
❑ NE
❑ Yes
[ o
/�jNo
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes
❑*o
❑ NA
❑ NE
❑ Yes
[�'No
/
❑ NA
❑ NE
ElYes
�TNo
❑ NA
❑ NE
❑ Yes
,rNo
❑ NA
❑ NE
❑ Yes
7No
❑ NA
❑ NE
❑ Yes
❑,io
❑ NA
❑ NE
MOW onaQC- minents and/vo`r Draw;ngs:OEM
S - A f� crKa / t %��GL' � s y1s
a_ v
Junc . L
cSG1e .-c
Page 3 of 3 12/28/04

6 Division of Water Quality
F actiity Number O Division of Soil and Water Conservation
. ,
0 Other Agency
Type of Visit
C mpliance 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: 0 ] Arrival Time: Departure Time: County: &26=61 — Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: 6DG4� 69& Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 ❑ d Longitude: = ° = 1 ❑ Ii
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
Ot3 uiGp ❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Daia Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:.
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes /No❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ N El NA
❑ NE
❑ Yes
El Yes
❑ NA
X
❑ NE
❑ Yes
❑ NA
❑ NE
12128104 Continued

Facility Number: 31
Date of Inspection
' Waste Collection & Treatment
,�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
L� 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
Cl/No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
�
6. Are there structures on -site which are not properly addressed and/or managed
El Yes
.2 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
environmentaZN�
t, notify DWQ
7. Do any of the structures need maintenance or. improvement?
El Yes
El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
L�J"No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ONo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
r�No ❑ NA ❑ NE
❑ Excessive Pending ❑ 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 Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
[�No
I'J No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
<o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
To
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
J2 No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
5 3 31 _1V r cr i✓
w
Reviewer/Inspector Name Phone: %/d N " 3
Reviewer/Inspector Signature: Date: la o
12128104 Continued

I"Facility Number: — Date of inspection D t7
Required Records & Documents ,�
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes LI No ❑ NA ❑ NE
20. Does the facility fail to have components of the CAWMP readily available? If yes, check ❑yes ❑ No El NA El NE
the appropirate box. have
WUp ❑ Checklists ❑ Design El Maps El Other
21. 7XasteAppli
cord keeping nee�tccklyl`reeboard
ment? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE ion ❑WasteAnal sis LJ SoilAnal sis ❑Waste Transfers ❑A ual Certification
Y Y
Rainfall Crop Yield 120 Minute Inspections onthly and V 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 FNo
❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes O No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No [], A ❑ NE
Other Issues
/
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
� No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑�o
❑ 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
//
D o
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[" No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
E2'blo
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Division of Water Quality
Facility Number O Division of Soil and Water Conservation
Q Other Agency
Type of Visit fj} Compliance Inspection Q Operation Review glSlructure Evaluation O Technical Assistance
Reason for Visit QJoRoutine O Complaint O Fallow up O Referral 0 Emergency O OtF�pr ❑ Denied Access
Date of Visit: /l O Arrival Time: �0o eparture Time: County:
Farm Name: Owner Email:
Owner Name: �� ��� Phone: _
Mailing Address:
Physical Address:
Facility Contact: Title: � Phone No:
/jl
Onsite Representative: FD.o�f integrator: /� &
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
0
Latitude:
Back-up Certification Number:
Region: w•
=" Longitude: 0 0 ❑' = «
Design C►urrent
Swine C►►opacity Population
Design Current
Wet Poultry Q&opacity Population
Design
Cattle Capacity
Current
Population
❑ Wean to Finish
I
I
❑ La er
❑ Dairy Cow
Wean to Feeder
14 &OD
10 Non -Layer
I
❑ Dairy Calf
Feeder to Finish
Dry Poultry
❑ Dairy Heifer
❑ Dry Cow
❑ Non-Dai
❑ Farrow to Wean
❑ Farrow to Feeder
El Beef Stocker
El Farrow to Finish
❑ Gilts
❑ Boars
1 the
❑ Other
❑ Layers
❑Non -La Non -Layers
❑ Pullets
❑ Turkeys
10 Turkey Poults
❑ Other I
El Beef Feeder
El Beef Brood Cow
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?
Page l of 3
❑ Yes / No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes X No ElNA ❑ NE
ElYes gNo ❑ NA ❑ NE
1212//8104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Struct re l Structure 2 Structure 3 Structure 4
Identifier: x L
Spillway?: NO
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large 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?
❑ Yes )ZNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes
gNo
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
C
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 XNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes VNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes 11 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ElNE
maintenance/improvement? 14
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ;dNo ❑ NA [INE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [IHeavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acc
eptable Crop Window [I Evidence
eoof' Wind Drift [I Application Outside of Area
12. Crop type(s) `(aOZ6�
13. Soil type(s)
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? /0Yes ❑ 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 i.lJ Flo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes .0 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):
o �� ��' ar�fl ✓� �a � Miff -Gt ��/¢2s� I�i�/>! � � r/7 - �'�� �,
MA�,v -,e'v 3c- 56 44e_ A�q MA e- �Aa,
Reviewer/inspector Name I f
Reviewer/Inspector Signature:
Page 2 of 3
Phone: 4+ '
Date: lllmdo&
12/2W/04' Continued

Facility Number: —77A Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes X No
[3NA
ElNE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
Xyes [INo
[INA
❑ NE
ElWaste Application [IWeekly Freeboard Waste Analysis ElSoil Analysis El Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking Arop Yield ❑ 120 Minute Inspections El Monthly and V
Rain Inspections ❑
Weather
Code
l 22. Did the facility fail to instal and maintain a rain gauge?
❑ Yes gNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
XNA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes XNo
❑ 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 ZNo
❑I NA
ElNE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes ❑ No
FZ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes No
ElNA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yeso
❑ NA
)ZNE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes VNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
Yes ❑ No
❑ NA
❑ NE
Additional Comments and/or Drawines:
21) Jc�,* gtpaa7- 5A_ 3/— Sk3
Ic
Page 3 of 3 12128104

IType of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other El Denied Access
Date of Visit: ILI �& Arrival Time: Departure Time: County: �i 7ZJ Region: �(/
Farm Name: �� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: 2..1 � .�, Integrator: -Z 2 )W"'!p
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0
=1=,. Longitude: =0
=6 =,I
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
00 Z ❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Dis_ch_ar_es & 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 Stocker
❑ Beef Feeder
❑ Beef Brood Clow
Number of Structures: n
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
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes 6 No
❑ NA
El NE
❑ Yes XNo
❑ NA
❑ NE
12128104 Continued

11
Facility Number: — Date of Inspection Ill/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2
Identifier: e
Spillway?: 0
Designed Freeboard (in):
Observed Freeboard (in):
Structure 3 Structure 4
❑ Yes /No
❑ Yes ❑ No
Structure 5
❑NA ❑NE
❑ NA ❑ NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
El NA
El NE
(ie/ large trees, severe erosion, seepage, etc.)
to
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
/No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
( No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) '
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application_
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement'?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 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 E1 Evidence of Wind Drib Application Outside of Area
12. Crop type(s)
13. Soil type(s) �� +
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ 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,
El Yes.
JV No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
XNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
XNo
❑ NA
❑ NE
Comments.(refer to question,#) Explain atiyYES answersnnd/or,any recommendationsy+vr any,othertcommeots
Use drawings:of facility tp better explain situations ;(use additional:pages'as necessary)I� ,
. �.
/� 5,�� rr�rys,�rs `02
Zoos uv.� _Pr�2� >7R
/J'IPLz•4�C� se, f
Reviewer/Inspector Name -
7�2 TT - - _
Phone: aa 2
Reviewer/Inspector Signature:
Date: 11
12128104 Continued

FTcility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes )
iNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ,ZYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking Crop Yield 120 Minute Inspections ❑ Monthly and I" Rain Inspections Weather Code
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [� No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
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
❑ Yes
❑ NA
❑ NE
❑ Yes
devNo
No
❑ NA
ElNE
❑ Yes
L,/No
❑ NA
❑ NE
❑ Yes
❑ No
XNA
❑ NE
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
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Additional Comments, And/or Drawings:
1/) 6'V1))Me^'V5 IPA-
NF�-��
�N4Fo d yD
GA-NT,O�
GH- G-00A.
12128104

IType of Visit Compliance Inspection O Operation Review O Lagoon Evaluation i
Reason for Visit tyRoutine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number .3 ' hate of Visit: Time:
Not O eratianal � Below Threshold
Permitted 0 Certified. [3 Conditionally Certified 13 Registered Date Last Ope7?0.1
Above reshold. ...
Farm Name: �L�f..... ,,`i1,,1 ... .. %,-,y. ...5:24.V County: "h........................
OwnerName: ................................................... ........................................ ............................... Phone No:.......................................................................................
MailingAddress: .......................................................................... .......................................... ..................................................................................... ..........................
Facility Contact: ........... / L
........... ......... Title:............................................................... Phone No:. ...........................................
Onsite Representative:�1��1�Gl.....r�r.... .................... Integrator:... �� ...
CertifiedOperator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 " Longitude • t 46
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes oNo
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 Wmin?
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 G-No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ZRNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ZNo
Strute 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...... .......I............................................................................................................ ................................... ..................... I ..........
...
.//....tt..........
Freeboard (inches): r
12112103 Continued

Facility Number: 3 y. Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes O Ro
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes B'No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes '0'No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes .@-No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes ErPo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes , ®'NO
11. Is there evidence of over application? If yes, check the appropriate box below.
[:]Yes -2Vo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type 9—'L-e
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes Jallo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes ❑ No
b) Does the facility need a wettable acre determination?
❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
15. Does the receiving crop need improvement?
❑ Yes ONo
16. Is there a lack of adequate waste application equipment?
❑ Yes _�PNa
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes 43wo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes 2No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes e"No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes ONO
Air Quality representative immediately.
Reviewerffi spector Name
Reviewer/inspector Signature:
Field Covv ❑ Final Notes
Date: /o
1z✓iaivJ e:oru nUed

Facility Number: ( -. Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes .-ro
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ZR.Ko
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes j2rNo
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24, is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes Jallo
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes ;D-No
25. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ❑No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes 'ONO
28. Does facility require a follow-up visit by same agency? ❑ Yes [;PNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes ETNo
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Forth ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit 16) Compliance Inspection 0 Operation Review O Lagoon Evaluation
Reason for Visit ®.Routine O Complaint O Follow up 0 Emergency Notification O Other ❑ Denied Access
Facility Number (late of Visit: Time: A'7
rQ Not O erational Below Threshold
toPermitted Cer1tif%ied 0 Conditionally Certified © Registered Date Last Operatedk rAbove Threshold:
Farm Name: __- lit 6emgs�M Count — ��_ y:
— $ 7
Owner Name:
Mailing Address:
Facility Contact: / Title:
Onsite Representative: �Yd 616
Certified Operator:
Location of Farm:
Phone No:
Phone No:
Integrator
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 6 0 « Longitude ' 4
ne
_...
Design .. .-Current I)eslgn ,. Current 1111106!1=11"�
esiCurrent
Ca aci Po elation. P�qultrt Ga acl P>o elation Cattle s Po elation
Wean to Feeder
❑ La er ❑ Dairy
❑Non -La er ❑ Non -Dairy
Other
Total De51gn Capacity
Total SSLW
Feeder to Finish
Farrow to Wean
Farrow to Feeder
JE
Farrow to Finish
Boars
Number of Lagoons
Holding Ponds / Solid Traps
®
❑Subsurface Drains Present ❑ La oon Area ❑ Spray Field Area
❑ No Li uid Waste Management Sys em
Discharges & —Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection && Treatment
4, is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): i7
05103101
❑ Yes KNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes CKNo
❑ Yes NNo
Structure 6
Continued

Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
.10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type C* /,-&c� 1 S.Wslr
❑ Yes RNo
❑ Yes 91 No
❑ Yes KNo
❑ Yes r,No
❑ Yes ®No
❑ Yes C&No
❑ Yes f3jNo
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes Z No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
R.No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
[a. No
16,
Is there a lack of adequate waste application equipment?
❑ Yes
® No
Reuuired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[SINo
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
1--rNo
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
�R_No
22,
hail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
4 No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
n No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
RNo
25,
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
KNo
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
_
;otestion# Exaany YESaswersand/oriany eec' '"endations 6r',anyher comments Commets(rferto4 lain
Usedrawings offa„ilitytobetter,explain,situiitlons(use additionalpages s` e ec ssary . :: ❑ ]d Copy ❑ Final Notes
A0h, : See
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: ryL
05103101 Continued

Facility Number: 3i — ,�� Date of Inspection
'-Odor ISsue5
• 26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
❑ Yes
V 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
KIo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
KIo
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
$2�No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
b2No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes [ Mc`
Additional�,(.,�o.mments°and/or,i)rawingsi , - + } i fiu
a
11

C. -
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit KRoutine O Complaint O FoHow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: ® Time:
Q Not Operational. Q Below Threshold
'Permitted U Certified © Conditionally Certified ID Registered Date Last Operated or Above Threshold: ...............
Farm Name: .....4=...... -............ County: ......1? 5...1...L....L..t.........................................
Owner Name: �.G..H1�1.I r l?........ ,i3f,,,7:.L�...t�G.s Is�....................... Phone No: ... r�..j...a.....��.�..R...�.�1.�l�......»»:,
FA t� �n.�
Facility Contact: � ., A..:!G?........BA. L—.' ............. Title. 1lt A�x"t A [�.................... Phone No: (q.tjQ..,..Zj3.5'..,.j3:2_G (0
MailingAddress: ....P..0..G..........t.G...... I ....... 1x 7 .i.rL. �. C ..... .. '1 n> .........2.. ?. .�.......................... ..........................
Onsite Representative: ..5_V?-.......... 1-1 ,°.I�............................................ Integrator:...V-,.�l,..f..lak:.�..................................
Certified Operator:...] .i ,,,Ham........... 1;f}'.I„—.................... I......................... Operator Certification Number:... L.O.U.S2 ..........
Location of Farm:
11 W Y 4-1 x O +fd t- OA n, C -o 3 r Q
O 11 r S
M5wine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ©4 ©64 Longitude ®e ®` ©"
Design ;" Current ` , Design, Current': r Design. Cartirent i
SC'Population a"aci h. c
Wean to Feeder r QDairy iPo Fulatioe _ ❑ Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
ris it.
❑ Farrow to Wean :
❑ Farrow to Feeder ❑Other it
❑Farrow to Finish Total'Design' Capacityji
❑ Gilts
❑ Boars Total$SIW
1 '
3 fi Numbee.of i.agoans ❑ Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
,, ��Holdfng Ponds I Solid'Traps. ❑ No Liquid Waste Management System
Discha es & 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 man-made? ❑ Yes allo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes Mo
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 gNo
2. is there evidence of past discharge from any part of the operation? ❑ Yes j&No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes PeNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ,fNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ................................................. ..................................................................3..G.........................................................................................
Freeboard (inches):
5/00 Continued on back

Facility Number: — Date of inspection 4
5."Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 1No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes KNo
(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 XNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes gNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 0:N0
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 'j(No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes RNo
12. Crop type Lv,� S
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes MNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes O�No
b) Does the facility need a wettable acre determination? ❑ Yes tg(No
c) This facility is pended for a wettable acre determination? ❑ Yes RNo
15. Does the receiving crop need improvement? ❑ Yes JZ[No
16. Is there a lack of adequate waste application equipment? ❑ Yes VNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes KNo
18, Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes AgNo
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes klo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes gNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes Wo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 'ER(No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes -%,No
24..Does facility require a follow-up visit by same agency? ❑ Yes 1No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes RNo
iigQQWn�ii�5 vvVre )named 40,66g this' visit; • Y0 wiii•#eetiiye 00 fori
corres• o Bence'. abotiti this visit:
,..I - " s .. ,._
h—�ti�-r' = l C� V> C_7/A,-S l t-ti
A C.GCa .Is�t l3 C--U I- -A ST `-� � h tz—
� � � S �t2p�`-� C b t3 `•� r � c��.) � ��i-� {.�-�C�� r1. S eta_ �J CT�-b .
� , e :� i .E ;� t � ,_.. _ 1 % ¢,, . �� I� •3f Y ^{ �.. �"ii 5 � � t9, �"r 1 � � ICi�,, u K ,� 1� � �.,,{•�
Reviewer/Inspector Name
Reviewer/Inspector Signature: rA_A ' - V .t PI . , n An n Date: Z , , �`) j 5/00

Facility Number: Date of Inspection lZ,� l ��0
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes
liquid level of lagoon or storage pond with no agitation? \
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes R(No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes )KNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes gNo
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 KNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 0,No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Yes ❑ No
AdditionaU.Conitnents an orDrawings:;_�` E,
1 ' I I"
5100

oc
+% IvlSiOf water ''Uallty i t y i r91, a �i ri
n O
Q M4
QDlvision'Of Soil and Water Conservation a
f F ' .� �.. O',Other A enc ,1 ' - �,' �' � PS ' I . r � I r{ A �� i "" s V � ,•cA � {F"r:3� ��
9 -. —�
% .L .[,: R s. ! ce .n �^r' L� ."J:`1. . 4�,tqw
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number 4-
Date or Visit: e: [] Painted on: 7/21/2000
Q Not Operational 0 Below Threshold
Permitted [] Certified ❑ Conditionally Certified © Registered Date Last Operated or Above Threshold: .............
Farm Name: 01-O..... Cd4V 14AP....�At�t 4 ...... .".0........ County:..... .5.�... ,..L i......................................
Owner Name:....i`3,.,.t...�:.t !YC -� ......�a 2. --{� -�C4LL................. Phone No:. ..i� ........ 1........ 2.0..�Q......
RA
Facility Contact: �J........ LA. A.L—.5-- S..............Title:[,-I �......... Phone No:
Mailing Address: ...... P-10D.......al o....... .. .. LA..)'4r..t�.:t -,O.t.C-5......... ...^ ,.(Z......... Z.�LE-.r.G
Onsite ltcprescntative:...... ..[?r ......... ................................... lntcgrator:....'1-lC..i..L?-P..1`T.........,.........................
Certified Operator: .... US},b............... j/.{„fir,,,,............................... Operator Certification Number:, 'tjQ.�.
Location of Farm: /
A--r t t-17"C 551Ctt O n H u) Y Lt< C XK 0 L—e C ,4�- LA� P t->-O fie D , C>-Q -3 .0
CA"AP I71-0A D '- P:""rD—� " L1Z`
l 4 0 g ® �- t-......
`Swine ❑Poultry ❑ Cattle El Horse Latitude • 41 Longitude •
Design Current
swine
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current Design , Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑Dairy
❑ Non -Layer JE1 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lagann Area 10 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System .
Discharges & Stream I. rmpacti
I. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other `�/�
a. If discharge is ohscrvcd, was the conveyance. man-made? ElYes 2No
b. If discharge is observed, did it reach Water of the State'? (11'yes, notify DWQ) ❑ Yes �o
G. li' dischar ze is ohscrved. what is the estimated flow in gal/tnin?
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? ElYes 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 (Wo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier :........................................................ i...1.3.....
Freeboard (inches):
5100 Continued on back

Facility Number: — Date of .I.uspection ��r�� Printed on. 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes X 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 JS�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 4ZfNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 'R'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes fi(No
Waste AnvliCation
10. Are there any buffers that need maintenance/improvement? []Yes rN<NO
o
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN C] Hydraulic Overload ❑ Yes
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 'N0
b) Does the facility need a wettable acre determination? ❑ Yes" \o
c) This facility is pended for a wettable acre determination? ❑ Yes A0
15. Does the receiving crop need improvement? ❑ Yes M No.
16. Is there a lack of adequate waste application equipment? ❑ Yes 5kNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes
BNo
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
9N0
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes
R'No
20. Is facility not in compliance with any.applicable setback criteria in effect at the time of design? ❑ Yes
o
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes
o
22, Fail to notify regional DWQ of emergency situations as required by General Permit'?
(ie/ discharge, freeboard problems, over application) ❑ Yes
�kNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? ❑ Yes
J<No
24. Does facility require a follow-up visit by same agency? ❑ Yes
o
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yesi4U
Q•violati#4s;oi- deficiencies 46re noted. dii-ring �his;visjt; • yo Will receive iio; fulft . . .
•
.orresorictence: a�aut: thrs :visit: :.:..... ..... .... .. .. . . . . . . .. . .:. .
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):
.U_�
G- C-0 L t,1_ C L S t-1
w r�-cr L_ C_A,- 5 � l_-) �3 Y L t I S T- /bv c_ [_ 7`C (D �
CAL 11 N C_ t+d t�-S . 1L11t-n..r&1__ t___, C_k.) t L� S
Reviewer/Inspector Name ��_� L�� LP L �j -T-
Reviewer/Inspector Signature: c a —A--L, i�a n ,, Date: L Q �Z�"� , r'y�% 5100

1.FacilftX Number: —
Date of Inspection Printed on: 7/21/2000
r
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor below
'1Yes
""
[I 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
0
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)
9
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
5No
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
I�No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
IRNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
Additional: Uorriments and/orDrawings-
0 C-\ L 7- L`L�C �j \.! C= l-J.-0
G O t-
LV t L-- -_ �G�.a t-z S t-�`z.0 7 C`� t
J
5100

]I
E3 Division of Soil and :Water Conserva4on Operation Review
Coervation inspeetlon
13 Division of Soil and,Water ns
,Compliance
5 L!i ! - SEpE 3 i i 4
Division of Water QWahty CoutphancetInspecttoti'
y L 4 lk
„t§
`Operahon'R'ev�ew[
;
[3,Other Agency
��'f€ f
Routine Q Com laint O Follow-up of DWQ inspection Q Follow-u of DSWC review Q Other
Facility Number Date of Inspection A Cjf
Time of Inspection EE 24 hr. (hh:mm)
Permitted 0 Certified [3Conditionally Certified © Registered © P
Not U erational Date Last Operated:
I.
Farm Name: ..O.Lm-D...... C../. IIAZ.LIP....�7AA-,x'=.lrtrL....''%1Q.s - Cc►unty:... .f.�..��.L .�.........................................
Owner Name: 4G.c!-.L�..... .3U..................Phone No:..i �i..�...,.t..�.....� .4 ...........
Facility Contact: UT:L.Z`.0:>........�fA.l _75Z. ............Title: ..... Phone Na:
MailingAddress:...I.au..... 19..I.G........................................................................... 4.a..1,C�.1,,..�-z��.� .7"'-1A...;.C'...
Onsitc Representative:.. .t [?.............i-k.. Integrator: ,,,. .H-2--e. ................
Certified Operator:........��..L�, r4.C7.............. .L.. ............................ Operator Certification Number:....k.E3..Q.S�.2 .,......
Location of Farm:
a.:r7...-il.... X......0--t-0 .....:Q.M~z........
D..I......... 1......�. '� - .t'...�. .....�.. ......0....l. 1.....I..^.� ..C'"
1.. _. .. " W H- L Tom.
l..,atlt"" I... ,54.-..]- 18--lgn
— U1191tuue F U-4 1er-
�!::� - I Li t"
esgn
sresgnCurre
'Current DeignCurent
PoultrY aactCit Pulti'
.....,,. i>
ulation Capacity Po ulation
o CateSwine
'Wean to Feeder
❑ Layer
❑ Dairy
❑ Feeder to Finish
10Non-Layer
.
❑ Non -Dairy
❑ Farrow to Wean
«'.
❑ Farrow to Feeder
❑Other
F.
Farrow to Finish
Total Design Capacity
3"
Gilts
�;,, , ;,. 1 :. i �<< .�,,
,`, .. otal''`'SSLW
El Boars
4 S�Number of Lagoons [] Subsurface Drains Present 10 Lagoon Area ❑ Spray Field Area
liolding�Ponds / Solid Traps ❑ No Liquid Waste Management System
0
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes 0j(No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes KNo
b. Ir discharge is observed, did it reach Water of the State? (If ycs, notify DWQ) ❑ Yes 1KNo
c. If discharge is observed, what is the estimated flow in gal/ruin?
d. Does discharge bypass a lagoon system? (II'yes, notify DWQ) ❑ Yes �`N0
2. Is there evidence of past discharge from any part of the operation? ❑ Yes - o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes o
Waste Collection & Treatment R7
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Rio
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
u
Freeboard(inches): ...................................................................... .................................... ........:`? ..L................................................................. I.................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, []Yes XNo
seepage, etc.)
3/23/99 Continued on back

Facility Number:13 Date of Inspection
6, Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? 1 ❑ 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 VNo
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 No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes K'Vo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes ' ZNo
12. Crop type C. r-) A• C r-Az- I— n r [-IL--IA^ { I [7 P. l !?—Y 5 b V-fr)..S'CC,
13. Do the receiving crops differ with those designated in the Certified'rAniinal Waste Management Plan (CAWMP)?
❑-Yes
VfNo
14. a) Does the facility lack adequate acreage for land application'?
❑ Yes
gNo
b) Does the facility need a wettable acre determination?
❑ Yes
`No
,,
c) This facility is pended for a wettable acre determination?
❑ Yes
``�No
15. Does the receiving crop need improvement?
❑ Yes
KNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
VrNo
Reauired 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? (ic/ 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 N No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes 'ZNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ YesSur
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 i4No
N6 i i6laticjtis:or deficiencies -Were potpo. ftring fh}sMsit' • Y:oii will �eeeiye 01'urther
�corres orirtence. about: this visit ~ .. • .
.. E, F E I' P P F ' 3 ..... , i
`Goniments (refer to uestioia # Ex latn`'an ,YES answers and/or an 'recommendations ot,an other coanments i , �I
q ) `�p y y �.;; yiE ;P
rc . F
Us Afawirigs of faci[tty to hetter;explain situations (use additipnal pages'as 'necessary) , ;, 'ti E t l ,
I1
RCV1eWer/nSpeCtOC Name P 1Ztl.. v` �., ��- �.1 A.L: 11 E,�.I °.t eo �i,"ii_� < t a...i[ 'i{�u �� i ti I _N5j s: -, � i
Reviewer/Inspector Signature: bl� r—tA_ A 1.4 i A A n.11 Date: (? l G, , G g
3/23/99

Y
Faeiiity Number:3 Date of Inspection
Odor .Issue's
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 ZNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
&"o
roads, building structure, and/or public property)
II ``
29.
is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
V(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
KVo
I'�\\
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
KY
❑ No
tlonai�'ornments'an or IaW1I1�S:
—+A-t-)-- n-L-V 1,S
o Cain— i C�
C_0 — -wt.A l t-i T ,Ac L Lz C I-3 Ac- r-�- t>
.&1
3/23/99

0 Division of Soil and Water Conservation ❑ Other Agency
® Division of Water Quality
lCkRoutine • O Complaint O Follow-uti of DWO insPmtion O Follow• -up of DSWC review O Other l
Facility Number
13 Registered Certified © Applied for Permit' © Permitted
Farm Name: ............. (?1r�....co>► ......
.. w�!n'......"......I..........................
�1
Owner Name: f
Date of Inspection 9
Time of Inspection 24 hr. (hh:mm)
113 Not Opera Date Last Operated: ..........................
County:......... 4!.0...........................................................
.......... Phone No* ................................................................................
Facility Contact: ......... ........ t................................... Title:.........`:.". !!'!.' 9, gc ............................ Phone No: „
Mailing Address:......... 1 !. .................................. WA�i Ls.l.....i....................................... .........
Onsite Representative:.............�,....... �:yn,6.......................................... Integrator: ......... N&w.
Certified Operator,. Clzbk-�k, 2—
.................................................. .............................................................p...
Location of Farm:
n....5 c�[tS........ i .f.......A........... .....Li a:...t�t.l. �...l�n�r .un)e.S.:.....ct. SLR... .�......................... �....
.................................................................... .................................... F,
Latitude '.'=11 Longitude �* EM,
Design „';,Current Design Current y Design Curreraf
Swine Ca' act Po ulation Poult ,•
i, i P y p ry Capacity Population Cattle Capacity. Population
Wean to Feeder 10 Layer ❑ Dairy
El Feeder to Finish < ❑ Non -Layer I ❑Non -Dairy
❑ Farrow, to Wean '
'< ❑Farrow to Feeder ❑ Other a
. ❑Farrow to Finish Total Design,Capacity;` 0&po
R
Gilts
Boars r. Total SSLW;,EE
S p�
Number of Laeoons-l-HoI na Ponds. �� ❑Subsurface Drains Present ❑Lagoon Area ©Spray Field Area
No Liouid Waste
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon'. ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
t Svstem .
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes j No
❑ Yes No
❑ Yes [ No
❑ Yes [j No
r
❑ Yes [ No
❑ Yes [j No
❑ Yes [V No
1P Yes ❑ No
❑ Yes P No
❑ Yes [P No
Continued on back

acilityNumber:
�
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (I,atsootts.liolditii! fonds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure l Structure 2 Structure 3 Structure 4
Identifier: ...........
Freeboard(ft):.............................................................................................................................
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'?
❑ Yes M No
❑ Yes (S No
Structure 5 Structure 6
................ .... ....................... I............
❑ Yes 4No
❑ Yes 0 No
12.
Do any of the structures need maintenance/improvement'?
Yes
❑ 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_ Annlicatiott
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 ................................................................................:.........
.. Y ............ . ..
.....................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWV11")?
❑ Yes
f� No
17.
Does the. facility have a lack of adequate acreage for land application?
❑ Yes
O No
18.
Does the receiving crop need improvement?
Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
rn No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
�fNo
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 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'? C� Yes ❑ No
0 No violations or deficiencies. were noted during this: visit.- :You.will receive no further
Oerespbndence a4oitt this'.visit:.:.
Comments.(refer tof.guestion #): ExpJAn anyYES:—answers and/nr any rc�commendattans ttr any other catrumettts: y
�seedrawittgs of facility to better explatn`siivatians (usc`additional Pakes as necessary
,...
�.5}�r-r. wc.�r aivers;��. �sl�ovlt) b� v-e.�o�t„•c . h
t7�ntet+�C � inouscs .
arQo. SY+c�v� U` lae.. ek4r>'cte d _ i3k Q. i " YJ 2rm(._Oda- �. l�to�U �a2 t^f.4"Ovee),
rIZtF%LS no�t,� 6JC NfS S1' zj�r �X i-coY�eC! C�r�� COJ tJo T�i!
Vt�u�C��a a vrs�`t1^c� 1't,� , U,,�s &j 4L G1I;)� Mhon15� rec,9rdLe1
�or �-iw evr,rcc t^e Ce�v`r uroi . � � CnA(CV(a�r1 CVVy s g 6VW be rnat `lam 't L--
Wt 7/25/97
Reviewer/Inspector lame
p �. fJitInV'.
Reviewer/Inspector Signature: / 4&t � . /t Date:

IIERoutine O Com taint O Follow-ug of DW2 inspection Q Follow-up of DSWC review O Other
L 2-
Facility Number Date of Inspection �} 77_'j�
Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:.i.25 for I hr 15 min)) Spent on Review t�J
R Certified ❑ Permitted or Inspection includes travel and processinQ
❑ Not Operational Date Last Operated: .................................. ................ ........................................... ...... .. ..... ..................................
FarmName: ...Pib..C, ... } t-4........................................................................... County: ...... D421.................................. .... .......................
Land Owner Name: 7'% :!�7G(k...zua tL.l s.........._............................................ Phone No: .... 04... Q.........................................
Facility Conctact:...... ......1011S ....................................... ... Title: .......... ............... .........r...{....... Phone NO: .1:ALd�... .^3...4..............
MailingAddress:........ Ql:�... k.X..... �. k..............................................................................�1�L1ru.+.1.q.L................ ........ ... b0..... ..................
OnsiteRepresentative: ..... ..JZ'i�....EW41.................................................................. Integrator:..................................................................
CertifiedOperator: .............. &...... 1J4'L% .... .............................................................. Operator Certification Number:.........................................
Location of Farm:
......rals. .R,... l.1PIL ...1.0ja-t... irai........ . !.:.... �aoc�.... r ........... .l�sX�x.Faram...i ....sr?,, 5..m!US.......Q:►... �4 .,...st z.... Q
..:................................................................................................................................................................................................................................. a
Latitude �' 4 i�S4J44 Longitude • Q f�6 '6
Gengral
1. Are there any buffers that need maintenance/improvement? ❑ Yes 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 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gal/min? _ ty14
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes t4 No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes Co 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 No
maintenance/improvement?
4/34/97 Continued on back

Facility Number:...i.._._ �.7..Z.
f). 'Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes JRNo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes No
Structures (Lagoons andlor 11olding Pitlids)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 18 No
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
as......... _ ................ ................ .. ...............
10. Is seepage observed from any of the structures? ❑ Yes JR No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes P No
12. Do any of the structures need maintenance/improvement? M Yes ❑ 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 gNo
Wa
14.
Is there physical evidence of over application?
❑ Yes
0 No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type:............... C4 �... l;........................... ........................... Sir kk..5yp t.......... ...................
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?
❑ Yes
[&No
19.
Is there a lack of available waste application equipment?
❑ Yes
UNo
20.
Does facility require a follow-up visit by same agency?
❑ Yes
Z No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
%No
for
22.
Certified Facilities Only
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
CUNo
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
O No
24.
Does record keeping need improvement?
Yes
❑ No
Comments (refer to'question`#) Explainany YES answersand/or any recommendations or any other comments
Use draw�ngs,of facility to better explain situations (use addthonal`pages as necessary): f ':t
p {{ qt t ` ]]- l _ 55
12. &Tt Gtre0.S SYLOVI[J �� me e-W , � vw r t..W I 0 � 10gron -s 6dO � mowe 1. P YVzn. CW\ In 4
Sim rvo�tr Shoold loc l'Aad of rtsBeW or rc-Qacrec} W; d lno�� 44(1,
2-4. 5�Oj vt cor6s 4,&A eomaPor�� uJ� AA) AuA r-n It 41t, CAWAO. Cel(- W �6i
Aoult VNCWQ. 10loor, k!Y_ r , riser& a.J ojer coy4r'o l ) M0'44t" � i
. a
cc: urvision of water vuaury, water vuattry.3ecrion, racutty Assessment unit 413U/9 /