310789_INSPECTIONS_20171231

NUH I H LAHULINA
Department of Environmental Quaff

Type of Visit: UrCompliance Inspection U Operation Review U Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: !';' Departure Time: / ,�0 County: f Region: I 0
Farm Name: C'�ry�.-c�r�rijyL _ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: 'P2,31,7a �ar�rrt.c-�v Title: �,v�,07 Phone:
Onsite Representative
Integrator:
Certified Operator: ; ! Certification Number:J�3�
Back-up Operator: za r—/ -r_ G2 yr k c `ti Certification Number:
Location of Farm: Latitude: Longitude:
Design @ucrent
Design
Current
Design Current
Swine
Ca self 1'o
P Y P•
Wet Poult .
�'Y
Ca aac
P tY
Po P•
Cattle Ca a°Cit
P Y
Pp'
P•
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -Layer
J. I
Dairy Calf
Feeder to Finish
Daia Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D a Poult .
@a aci
P,o .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Pouets
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
®No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
12� No
❑ NA
h
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
® No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continues!

Facili Number: - Date of Ins ection: — / 7
a 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?:
Cy
Designed Freeboard (in):
,Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
®' No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
Z No
❑ NA
[] NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
21 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
®.No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[1�No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes [R No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. [] Total Phosphorus [] Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop 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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑ No ❑ NA ❑ NE
O Yes [aNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [Z No ❑ NA ❑ NE
20. Does.the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [&1Vo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes Q No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Q No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - ' Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes D3No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 2,No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes �- o
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.c., discharge, freeboard problems, over -application)
31. Do subsurface the 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/lnspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
❑ NA ❑ NE
❑ NA ONE
NA ❑ NE
NA ❑ NE
❑ Yes 12-No ❑ NA ❑ NE
❑ Yes S No ❑ NA ❑ NE
[:]Yes 2 No ❑ NA ❑ NE
[:]Yes E3�No ❑ NA ❑ NE
❑ Yes
FNo
❑ NA
❑ NE
❑ Yes
®.No
❑ NA
❑ NE
❑ Yes
Ea -No
❑ NA
❑ NE
Phone:
Date:
21412015

Type of Visit: IQibmpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
[season for Visit: 'Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 2 o Arrival Time: ,C�' h-t Departure Time: County: ��p�ir-t Region:
Farm Name: sti /,(/ Z Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative: I , w&&
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Wet Poultry
Layer
Design Current
Capacity Pop,
Cattle
Dairy Cow
Dairy Calf
Design Current
Capacity Pop.
Wean to Feeder
I INon-Layer
I
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr, loultrF
I Layers
Design Current
Ca aci P.o
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Puults
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?
[] Yes .2No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes /L[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)
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 JZNo
❑ Yes Z No
❑ Yes �o
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412015 Continued

Facili Number: IDate of Inspection: 3Q
Waste Collection & Treatment
4. It storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes La"No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes eNo ❑ NA E] NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ]�No ❑ NA E] 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 .;�rNo ❑ NA E] NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes C2'&o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 'IVo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [2'No ❑ NA ❑ NE
maintenance or improvement? r
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ;2-No ❑ NA ❑ NE
[] Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs, E] 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
T,No
[3 NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
E] Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes 'ID -No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes J2�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes J2"Ro
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes -ffNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes L 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. ❑Yeso ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ONo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E24o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

If
Facili Number: jDate of Ins ection: Z.VZ361IG
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes,_[D No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes C'1Qo ❑ 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
pen -nit? (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 JE:�A10
❑ NA
❑ NE
❑ Yes [D-Ko
❑ NA
❑ NE
❑ Yes_Q-Nb
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ~f!rNo ❑ NA ❑ NE
❑ Yes-io ❑ NA ❑ NE
❑ Yes r[;kNo
❑ Yes _2<0
❑ Yes'__ I
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
a
Reviewer/Inspector Signature: Date: C)
Page 3 of 3 /4/ O15

Type of visit: 0 Compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: C7 Arrival Time: ® Departure Time: County: ��i�lj� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: A&
Certified Operator:
Phone:
Phone:
Integrator:
Certification Number: S_­)—.r3
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design CurrentIII Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
in to Finish Layer
Design Current
Cattle Capacity Pop.
DairyCow
in to Feeder
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Design Current
D F goultr. Ca aeit P.o
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
N.
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?
❑ Yes �" o ❑ NA ❑ NE
❑ Yes Ef No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ev_rNo ❑ 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)
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 2"�o ❑ NA ❑ NE
❑ Yes F!�t' o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of'3 21412015 Continued
\1

F�
Facijity Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes P No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes 0No
❑ NA
❑ NE
St ruc I Structure 2 Structure 3 Structure 4
Identifier:
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 0 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes 0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes PJINo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[]Yes RNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes Zr No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes ZrNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes Pno
❑ 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
Hare 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 EJ No
[] NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes. ZNo
❑ 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 JZ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ff No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes FjNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: Date of Inspection: 40/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �allo
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? ❑ Yes0(No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes EjNo
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 the 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?
Commentsn(refer` to question #):,,Explain ah*WE5 answers and/or{any,adi
/ I" //jr-
G /�t /�S` /• Yq
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
[DNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes 4 No ❑ NA ❑ NE
❑ Yes 6 No ❑ NA ❑ NE
D Yes 0 No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes oNo ❑ NA ❑ NE
[—]Yes ZNo ❑ NA ❑ NE
❑ Yes FeNo ❑ NA [] NE
" kr,97 � 1worc-6 �wlz�Q
Phone: 3_1�a
Date: 4G
2/4/2014

Type of Visit: Q<ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: RrRoutine 0 Complaint 0 Follow-ue 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 0 r parture Time: County: ,f//-� Region: 6//1-LO
Farm Name: LS a� , / Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:��
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number: t'�3
Longitude:
Swine
Finish
Design Current
Capacity Pop.
Design Current
Wet Poultry Capacity 11Pop. 0Cattle
La er
Design C►urrent
Capacity Pop.
Dai Cow
Feeder
Non -La er
Dai Calf
o Finish
Dign Current
Dai Heifer
o Wean
E
D Cow
o Feeder
Dr, $oultr Ca ach P,o
Non-Dairy
o Finish
La ers
Beef Stocker
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
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 &ffNo ❑ NA ❑ NE
[:]Yes PE(No
❑ Yes [:]No
[:]Yes ONo
❑ Yes ZNo
❑ Yes �(No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page I of 3 21412014 Continued

Facility Number: Date of Inspection:
Waste. Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Z., No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes �No ❑ NA ❑ NE
Struc e l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): u,
5. Are there any immediate threats t the integrity of any of the structures observed? ❑ Yes ZNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes E!fNo ❑ 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 Z No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [TNo ❑ 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
7No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
VNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below,
❑ Yes
P3 No
[DNA
❑ 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
[a 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
�Z No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ 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 D Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes 0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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 21412014 Continued

Facility Number: I - 2 Date of Inspection:
24. 12id. he facility fail to calibrate waste application equipment as required by the permit. ❑ Yes ONo ❑ 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 allo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus toss assessments (PLAT) certification? ❑ Yes P'_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
Eallo
❑ 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
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
'C2No
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Z5No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
VNo
❑ NA
[] NE
Comments (refer to'qu6stibn flt Explain anyNES answers;and/or any additlonal'>recommen{siat(ions or'any°other c"o"mirieFnts: '' q
-1 i��•.v_ps'._if 4H ®4;•<
Use drawines, of:facility to�,b'etter explain: situations:tiuie,adaitionaI Uages as,necessary). ,
w� es'z
bl q Vy
r;
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 1
Date:
/4M14

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0aoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 17 / Arrival Time: ,'clAob Departure Time: County:
Farm Name 04 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
AV
A
Phone:
Region:
Integrator: rh Z&
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design Current
Design Current
Swine Capacity Pop.
Wet Poultry Capacity Pop.
Cattle
Capacity Pop.
Wean to Finish
Layer
airy Cow
airy Calf
Wean to Feeder
Non -La er
Feeder to Finish
Dai Heifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
De, P,oultr. Ca aei P■o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
NJ Other
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
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 Eno ❑ NA ❑ NE
❑ Yes RNo
❑ Yes ❑Vo
❑ Yes allo
❑ Yes tJ o
❑ Yes ,No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �io ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes (� o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �L
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �No ❑ NA [] NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ;'No ❑ NA ❑ NE
waste management or closure plan? %
If any 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
o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ 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? T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need C] Yes ❑;io ❑ NA ❑ NE
maintenance or improvement? 7
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ;2�iQo ❑ 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,.allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �0'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes C2� 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?
❑ Yes (-3-hlo ❑ NA ❑ NE
❑ 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 r__ No ❑ NA ❑ NE
the appropriate box. T
❑WUP ❑Checklists [3 Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes L20No
❑ 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 � o
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

Facili Number: -C71 jDate of Inspection:
24. Qid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes I;D'No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 2No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
7o
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
E�No
❑ NA
❑ NE
❑ Yes Z No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[:]Yes o ❑ NA ❑ NE
❑ Yes TNo ❑ NA ❑ NE
Comments (refer to question 4): Explain any YES answers and/or any additional recommendations or any other comments..
Use drawings of facility to better explain situations (use additional pages as necessary). ,
w �-
? 111113
l-$
y
Reviewer/inspector Name: l Phone: — V / r
Reviewer/Inspector Signature: z Date:
Page 3 of 3 21412 6 1

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 0 Meparture Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
*nsite Representative: ` ZIP Via I,..
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: /a 6 2
Certification Number: 2 r6 23
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Cattle
Design
Capacity
Current
Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Design G►urrent
Dr. P.oultr. Ca aci P,o
Layers
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
TurkeyPoults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
EfNo
❑ NA
❑ NE
❑ Yes
LD 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 Xf"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? r
Page 1 of 3 21412011 Continued

lFacility Number: Date of Inspection:
WAste Collection & Treatment
4. ie storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
kNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
P No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): —�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
12'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
J!fNo
❑ 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
CZ'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
2�No
[DNA
❑ 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
,E!j'Vo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ZfNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
NA
[3 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
;ZrNo
❑ NA
❑ NE
R_eauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
7No
[] NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
P"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
J!J'No
❑ NA
[] NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
1:5 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:] Yes
[;2/No
T
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: 3-Date of —Inspection: 8
24. Did th *facility fail to calibrate waste application equipment as required by the perm' ? [] 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Z2 No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
EfNo
❑ NA
❑ NE
[] Yes ENo ❑ NA ❑ NE
[3 Yes VrNo ❑ NA ❑ NE
❑ Yes ZrNo ❑ NA ❑ NE
[:]Yes ZNo
❑ Yes XNo
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
V
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412011

Type of Visit: 'IcTompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency Q Otheer� 0 Denied Access
Date of Visit: Arrival Time: Q Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Irrent
CattleCapacityPop.
DairyCow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr. P.oult ,
Layers
Design
Ca aci
Current
P.o
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
113cef Feeder
Boars
Pullets
Beef Brood Cow
Oth-e—rM
Other
Turke s
key Poults
r Other
Discharees 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 I of 3 21412011 Continued

Facili Number: Lf 7 - Date of Inspection: Zr
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ZI No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: ! /�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 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 Z f 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
❑ NA
❑ NE
maintenance or improvement?
'2no
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes Ea"No
❑ NA
❑ NE
maintenance or improvement?
1 I. 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
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
'ONo
❑ Yes �!rNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes �allo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes 2-No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 25—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 I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Z�No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0<0
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

FacilityNumber: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 9`10
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 o
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ 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 ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
JVNo
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes 0No ❑ 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 ZNo ❑ 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 E;�rNo ❑ NA
❑ NE
Comments (refer'to question #): Explain any YES answers',and/or any additional�recom nendations 3oreany,other;comtnents $� h
Use'driiwingsoffacility;tobetter explain agesassnecessaryo):f
.situatiohs.(useaddiiional
re cork
160k�'�/
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
IIt�1�II����1L•L'��
Phone:
Date:
21412011

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ' ❑ Denied Access
Date of Visit: al Time: © Departure Time: County: Region:
tlo�rril
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:, (zCzO(�lri/i
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No. -
Integrator: ti-I
Operator Certification Number:
Back-up Certification Number:
Latitude: = c 0 i Longitude: = ° = 1
.�"sa'. F2�:e€s �# $ s4 Mi.
AIRS 1'd R. 't#g i h; .. # : es�gn rt�Cu'rrcntx; sr: Des rgn CurrenDes n $Current : De ; Capacity Populuhon WetPnultry;CapucityiPopulat�onvCttleis`,°ap�c�ty }Population
❑ Layer I I Dairy Cow
11 ❑ Non -Layer El Dairy Calf
€ ❑Dai Heifer
t } k ❑ D Cow
❑Nan-Dai �
El Beef Stocker
kNon-Lavers❑ Beef Feeder
. ❑ Beef Brood Cow
Ai
A.
�Numberro{{f,5tructures::
i it.s F t€= r, Asa"�fi' Mi
Layers
❑ Wean to Finish
Wean to Feeder
�ther
❑
El Feeder to Finish
❑ Farrow to Wean
El Farrow to Feeder
❑ Farrow to Finish
El Gilts
❑ Boars
❑ Other
El Turkey Poults
Discharees &Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure ❑Application Field El 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
1 of 3
❑ Yes ONO ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
�rNo
❑ Yes
P"No
❑ NA
❑ NE
❑ Yes
� No
❑ NA
❑ NE
12/28/04
Continued

Facility Number: 31 — 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 l 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 JZ1 No
❑ Yes q No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
❑ NE
❑ Yes
qNo
❑ NA
❑ Yes
�kNo
❑ 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 [ZNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ElNA ElNE
(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 2No El NA El NE
maintenance or improvement? /
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �'No ElNA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes FNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 9 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes XNo ❑ NA ❑ NE
t 6. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes Zf No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes �No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [(No ❑ NA ❑ NE
Comments {refer, to guestigri #) Fxplaln anyYES''answers;and/or any�recommendahons1. ojrther.cgmments. h
Use drawings of facility to better`6xplain'sitirations (use"addrt�onal pages.as necessary,) t
a
Reviewer/inspector Name � .L.- "
Phone: Q G
�7
ReviewerAnspector Signature:
Date:
12AC8104 Continued

Facility Number: Date of inspection
r
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes XNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes VNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes XNo
❑ NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes ff No
ElNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ZNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes �No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes g(No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ;z No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes (WNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes ;ZNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 l .
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes VfNo
❑ 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 4 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes [/No
❑ NA
❑ NE
Additional Comments and/or Drawings:
/e
Page 3 of 3 12128104

fi 31 P.
Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit-O'ktoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: if G Arrival Time: . C U Departure Time: County: r r sue. Region: wz&'
Farm Name: tr`/rO- �yP/C c'[� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: 'Title: Phone No:
Onsite Representative: CIntegrator:— Z"Z
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = = 1{ Longitude: = o = 1 = „
CurrenCurrent
jjDesign
apacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
rii,
nto Finish
❑ La er
❑ Dai Cow
n to Feeder
❑ Non -Layer
❑ DairyCalf
❑ Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
D. Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
Non -La ers
❑ Beef Feeder
po Boars
❑ Pullets
❑Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Poults
❑Other
Number of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�o
❑ 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
Q'No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
F,,�Ko
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[P*o
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
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 ❑'Ro ❑ NA ❑ NE
❑ Yes [-No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes �Qo ❑ NA ❑ NE
❑ Yes 2-&o ❑ 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 j2-No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ONo ❑ 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 [3'No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 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
❑-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 acre determination?[] Yes
_2No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
L2-No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2'4Vo
❑ NA
❑ NE
Comments (rei'er to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary}:
i
Reviewer/Inspector Name I , % y s '' _ 5 f a `; � a I e' = is Phone:
Reviewer/Inspector Signature: Date: % C%
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection C
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
❑ Yes ZI No ❑ NA ❑ NE
❑ Yes 6No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
Pf'Jo
❑ NA
❑ NE
❑ Yes
Po
ElNA
❑ NE
El Yes
/ No
❑ NA
❑ NE
❑ Yes
,0 No
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
ETNo
❑ NA
❑ NE
❑ Yes
2No
❑ NA
❑ NE
❑ Yes
OJ No
❑ NA
❑ NE
❑ Yes
EfNo
❑ NA
❑ NE
❑ Yes
O No
❑ NA
❑ NE
[:]Yes
J3No
❑ NA
❑ NE
❑ Yes
'�2'No
❑ NA
❑ NE
Page 3 of 3 12128104

3l 0 7f
Type of Visit Q'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Tirne:F/07OL77 Departure Time: County: Region: LZi9C.1
Farm Name: _ Sy7`!!� ✓ a! 7* Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: III --)a le
7
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
'Feeder to Finish
S P C
e
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
i
Other
❑ Other
Phone:
Phone No:
Integrator: _=1%
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = t = Longitude: = ° = 4 0 "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer '
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ 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
El Yes ❑No [I NA El NE
❑ Yes E:fNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

Facility Number: 1 — Date of Inspection / / 41
Recittired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available`? ❑ Yes D No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes I -No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 12'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑"No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ErNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
.0 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
El -No
❑ 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
❑ No
❑ NA
ONE
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
EYNo
❑ 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
12 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility Fail to notify the regional office of emergency situations as required by
❑ Yes
ZNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32,
Did Reviewcrllnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ZNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
L?o
❑ NA•
❑ NE
Additional Comments and/or Draw.higs.
12128104
12128104

Facility Number: 3 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 Zo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
[--]Yes EfNo ❑ NA ❑ NE
❑ Yes O'No ❑ 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 [2rNo ❑ 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 ,FNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes J5No ❑ NA ❑ NE
maintenance/improvement? ,,��
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s) 1ik7
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
, 3-No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
,] No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination:
❑ Yes
-No.
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
❑-No
❑ NA
❑ NE
a x t n w :, r, c
Reviewer/Inspector Name ev�� c�./ s bF F �'", Phone:
l/-7p'E �. �d
r.
Reviewer/Inspector Signature: , Date:
1161.60/V4 UUnurruea

r PS tale of Visit: L_KJ.r7J.fL.1.J Time:
Ypermitted.J20tertified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .........................
FarmName:............................................................................................................................... County:........; f..' ,t`.................................................
OwnerName: ..... r i A .l................. C:r±... ....................... Phone No:.......................................................................................
MailingAddress; ............................................................. . . . ........................................
FacilityContact: ................................................. ......... J...... Title:................................................................ Phhoonie No:...................................................
Onsite Representative- ....i 1. . ? ........� !'. Y%a......................... Integrator:.......... �✓!! 0Ljd.'j .......................................... ..
Certified Operator:................................................................................................................ Operator Certification Number: .......... ................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ' 64 Longitude • 4 64
Discharges - Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [(No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes [2N
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 INNo
. Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier. ................................. ..................... ...........................................................................................................................................................
Freeboard (inches): T�
12112103 Continued

• Facility Number: 31 — T Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
[71No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
' 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
NNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
[2(N
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
No
elevation markings?
Waste Application
Yes
10. Are there any buffers that need maintenance/improvement?
❑
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
;7No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑Yes
I�p!
14, a) Does the facility lack adequate acreage for land application?
❑ Yes
[J
b) Does the facility need a wettable acre determination?
❑ Yes
CJ No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15. Does the receiving crop need improvement?
❑ Yes
[N
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes /No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes o
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 7NO
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes /No
Air Quality representative immediately.
i.
;rameratsE(re1fer to questMonEE#1) Explaun any;YFS answpeprsland/oraay reco:nmendatiaas�;ar any ather comments'',, ,e{{C.{'{`i;( i�"'
Ca
N 6yF"p: C i.LI3d„,i.i 5 �£: E il.:..d wdi.1'.�R.�n-.
�;,.�P�i�_.�
. p8 j-0 � xti i� 9<•0l..B'-_� �...._ �}iY, i {p 8°xit�€.- i{ 1[Ii.��.A.�..,WnLr..Cvr...:.++ F;1L.,..W:.w.�$i.v�iEvk.5�iF3
i3eraYsd{ • ;i •">.. ti& �. , ..' i E.I
.'�i: v E 7�`e33.25-, .� ,. 3 .� • v.
wg�l�Ags o! facivty to better explatn situations (aseadditYottl pages,,asnecessary):� ii, ❑Field COPY ❑ Finat Notes, ;,
OWriER To. Do hvpc-1E Su(bAV 4T A*R- 2A
�w13fc0. TO UPoAYL CRop 1f�t6c.D Foltal�l
0ta►tjER
�o�t.lp S Look
Reviewer/Ins ector Name 5 ',! j;n(i 1 .
Reviewer/Inspector Signature: Date:
12112103 Continued

Facility Number: Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes /No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? ZN
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes
o
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes
❑ 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
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes j�N
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
28. Does facility require a follow-up visit by same agency? ❑ Yes
24. 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)
eYes
❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
i0 N
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
113
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

Type of Visit Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit -0'1Zoutine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number 3 r Date of Visit: 2 d lime: 1 OS
Nat O erationaI Betow Threshold
0 Permitted 0 Certified [3 Conditionally Certified �� Registered Date Last Operated or Above Threshold:
Farm Name: S�-lA J, jo 21 G' A Ve+z � ti �j t's� r r-y�Z County : � I ' ',
Owner Name: -� �G h �� L* �Ve�1's'��1 Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: e �V �>rLQ V Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' " Longitude 0 • 0 "`
:13csign '; Current'.
Design Current :
Destgn ; Currcut
r!Po
Swine.. Ca, icity Population'
. 'Poultry.
Ca"acity. Po ulatton +Cattie Ca' acstf that on
ElWean to Feed
Ii ' ❑ Layer
„' ❑ Dairy
❑ Feeder to Finish
�' ❑ Non -Layer
I,' ❑ Non -Dairy
1-
Farrow to Wean
k
❑ Farrow to Feeder
� ❑ Other I t
❑ Farrow to Finish
Tc►talYDesign Capacity";
❑.
Gilts
❑ Boars
„
t ` l ,TotalIsSM;
€ Nusrtber of Lagoons i ' i § , ffi E `f� ❑ Subsurface Drains Present ❑ La oon Area
10 S rav Field Area sij`
E-
Holdirtg..Potrds'/ Soitd Traps'' �$ f ° ❑ No Waste S stem
i
IEi .,Liquidi•'3'
€ s'
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):
05103101
33
❑ Yes .Efr'No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ZNo
❑ Yes ZNo
❑ Yesl�.ZNo
Structure 6
Continued

Facility Number: 31 Date of Inspection Z? 02
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes No
seepage, etc.)
/
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes ZNo
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 ONO
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes 1p'l10
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes ,ZNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes &No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes PrNo
12. Crop type .'o eA to r e C/�d 2.c
I3, Do the receiving crops differ with those designated in the Certified Animal Waste Managem nt Plan (CAWMP)?
❑ Yes 2�No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes ONo
b) Does the facility need a wettable acre determination?
[:]Yes ONo
c) This facility is pended for a wettable acre determination?
❑ Yes j2rNo
15. Does the receiving crop need improvement?
Yes ❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes ,Z No
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
[:]Yes •E'No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
WUP, design,
❑ Yes,211No
(ie/ checklists, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes Afl 0
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
El Yes A No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes ,ONO
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
(ie/ discharge, freeboard problems, over application)
7No
23. Did ReviewerlInspector fail to discuss review/inspection with on -site representative?
❑ Yes LB"No
24. Does facility require a follow-up visit by same agency?
❑ Yes . EWN.
25, Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes —2 No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comriients (refer to,question 0) Expiain any W§.ansr�ers.-andlo,e ihy recombiindatiGn`s air anv--ather"comments.'! r' : T,1:
t}se.drawin s of factlity to�better explain situations {use add33itional pages ¢a¢`s necessary) E °9 ❑Field Conv ❑ Final Notes a i
,jJ �_P 9I
be ?'e%5 well rn��'n�g r.�.Q�'[ - � F %r�'Gor�� S U(.-C
Ver. well s , TL,e�e a e��J 4a �e Q pod Goo c�'so �,zqy,s.
f 1°J° 5 ,r I
-rAe szv ► i s well man
tag oon r no( P 40'rt r e a�cr �'cv✓ec�.
-rile,-c t'S A n�Qed fa rese e rri �'esc. vc
1 �f �+
i� T 1"1 iWd l e opiL o�44,e -�SGi/� iel/il 4 e oS e
jp4l'J
n
�€a¢•t h si",y ark
Reviewer/Inspector Name "'1 ._. Y)en' G �� �.�' _tk��
Reviewer/Inspector Signature: Date: 22OZ
05103101 Continued

Facility Humber: 3 f - -
Date of Inspcetion 0 -
dor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
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.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanentitemporary cover?
❑ Yes XNo
❑ Yes -No
❑ Yes'ONo
❑ Yes �NO
❑ Yes 10 No
❑ Yes C?No
❑ Yes ❑ No
Additional Comments,an &or, Drawings:'a �` �1 ''3 3' ,<i€} �a ¢ r e: �ti I
-;-e 1 f � 'S'i It:. - 3. ���.. e �;3t F . �3": �13� A1 sod PIC05e be sure LtQ� l,'npe wets aejpl,'ed 40 -'ow G.VI
C:e[ds.
05103101

Type of Visit compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit"O'noutine O Complaint O Fonow up O Emergency Notification Q Other 0 Denied Access
Facility Number Dale of Visit: Q% Time: S
Q Not Operational Q Below Threshold
Permitted 0 Certified 0 Conditionally Certified 0 Registered Date Last Operated or !Above Threshold: ..............
FarmName: ........... ii. .... V l�! Ya v .� !..... ., L................ County: ... D.U.Pl.n................................ ........................
OwnerName:. ............. ..... li. v.......................................... Phone No:.......................................................................................
FacilityContact: .............................................................................. Title:.............................,.................................. Phone No:...................................................
MailingAddress: .................................................................................................................................................................................................... ........................
Onsite Representative: ..... L'��.. �2.....L!. Q.!,j..................................... Integrator: ,'^ey w✓l.s...... fit �l'.!1.4..............
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle [3 Horse Latitude ' t it Longitude • 6 64
Design k" Current Design Current ` Design
Ca aci ' Po elation Poultry„ ;.Capaci_Pnpul:itidin_ :,Cattle:'',...:... _ ._Capacitp
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
NumWr of Lagooms [] Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds'/ Sohd Traps3T :i ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ,dNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes Q(No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed. what is the estimated flow in gal/min? 14 re,
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes oNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �No
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes )dNo
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ......................... ......................................................................................................................................................................................I.......
Freeboard (inches): .74
5/00 Continued on hack

Facility'Number: Date of Inspection 1D 0
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes P!rNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes jdNo
(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 ONO
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes gfNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ZNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes tErNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes 9No
12. Crop type e!!657 tie9 , Se:1bey, kS , ryeCC, U e &a -I-t
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan {CAWMP}? ❑Yes ONO
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ONo
b) Does the facility need a wettable acre determination? ❑ Yes PfNo
c) This facility is pended for a wettable acre determination? ❑ Yes J'No
15. Does the receiving crop need improvement? Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes EfNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes ,!j No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑
Yes ;�No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ONO
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes JZ No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ONO
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ZNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes INo
24, Does facility require a follow-up visit by same agency? ❑ Yes ONO
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 0 No
i Q •YiAijaii lls:off` "0r1Ciej1�i� wire 0004. 00}ag this' • :Y:o0 w51i •xeoito 4o futtil$r,
coriesporideim& about this' '
1 S• IV aed 4a resetd -4veve in ^1'Iddl a poe*o,y, ac Aeo
60"aotdlepw weerd� �ti -F4s Frclof� 0.11,Q,.w.se foe
ktt4•
gbld eon4-oj
4'1ta ,:jl ; s n'el Hy
AL
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
5/00

rFacility Number: ,�� �$ Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ONO
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes m No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes 9No
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 /ONO
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes JZNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional i Commentsan or Drawings:
5100

3 1 a ,;.j' tr '.O;Dzvision ofSoil'and.W er,Conservahon 'Uperation Review* 3 y 1 l��ih �'Sy* r ir�a5 ?t 3' 'E ki �y SAVs;lE 5, r.
Qom+ ;Di*ision'of Sol] and;Water Conservation ,Compliance WpeCtion
D1vigio. Of,Water QUAhty -. Compliance 16SpeCt10I1 ` r i r , g
©Other Agency Operation Revrewi f k .r 4 w, t �4} y? ti m 44
3�.�.i _���.e.W ..... ......-_. .,- -. r F b.M,., �S i'ri,.-�:�`i.,.
10 Routine 0 Complaint AD Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number 3 1 Date of Inspection I SIR ee
Time of Inspection ES 4 24 hr. (hh:mm)
0 Permitted [3 Certified 0 Conditionally Certified [a Registered Not O erationaf Date Last Operated:
Farm Name: .......
J..F9.....................................
01 County:..
....................... Y. .......................... .......................................
OwnerName :............. ST..A.Ik...'{........ ...... C.A.-vc.h.a:x�}.l^........................ Phone No:.......................................................................................
FacilityContact: .......................................................... .................... Title:................................................................ Phone No:...................................................
MailingAddress:.......................................................................................................................................................................................................... ..........................
k
Onsite Representative:...... .............. .... .... .. ............ . Integrator:..... .t a.lzl.'^5........................................ I...........
Certified Operator;,,,,,,,,,,,,,,,,,,•,, .. Operator Certification Number:
Location of Farm:
J
........ ... .......... ......... ............. ............. ........ ...
Latitude • ' '° Longitude • 6 «
!'.Destgn''r ' i Current
Swine Ca acit" Po' ulation Poultry
❑ Wean to Feeder ❑ Laver
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoon`s `
Holding Ponds/ Solid Traps"
Design Current ;E
,apacity Population :Cattle
1❑ i :j❑ on -Dairy
Non -Layer ••• , ..., , N•,._
3 ':a
❑ Other
a1 TotD ;eslgn Capacity<:•-�
Total SSLW ,C
❑ Subsurface Drains Present ❑Lagoon Area
' ❑ No liquid Waste Management System
urre'nt
-f Spray Field Area
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ElLagoon ❑ 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? (I1' yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes, ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes JK No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1
Freeboard (inches): � Z.......................................................................
................................................................................................................................................ .
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes []No
seepage, etc.)
3/23/99 Continued on back

Facility Number: '3Date of Inspection
6. Are6zSere 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
12. Crop type 4tJ h ece� Pe 5 r—
v
S Do
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Rev iewerllnspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
yiQl'at�igns'o� 4hicjencies •i re apt ........ * , •th . * •York .............�. .
:: corresporit�ence: about: this visit:
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes H No
❑ Yes ❑ No
❑ Yes ❑ No
3? 3 151' 1� I Y'. i '' li I I ! " H•I bS "I 'lll3-' I - ry 4 }
amntents°(refer toa,question #) Explain,any YES answers and/or any recommendations or,any other
4 E.. I (2E d - ii !. '1'. '�. � I: 5 11
Jse drawings`of facjltty to better explain situations (use addtttonalPpages'aslnecessary) >,�al
e,s�ocG+.,oh Pe---(anl AS.�,a-Q/jowv f 4o /asI..DWQ..*0e.4'�r�s.
SprA.�;r.c} o)) % '�1�� t.1b1ea4 t;e14 w;4� !+tvo -rfr4 �vitSN"_V,.
d c ►mot A +^ A T �t � °F i ►1.c)pe 0,',, Af r 3 n �.� a rt .r yr e k r
*10 Ce 3 alJMq we U..
Reviewer/Inspector Name
Reviewer/Inspector Signature: �A'A% Date: S V2d4d ��
I&

Facility Number 3 $ Date of Inspection Z zadp
Time or Inspection ! 3pd 24 hr. (hh:mm)
0 Permitted [3 Certified © Conditionally Certified 13 Registered Not O erational Date Last Operated:
Farm Name: P• ! K i e � ✓c h a u t✓y t'ccr�^�t �t z County: v;0...!'.................................................I......
................................................
Owner Name: C ctV Q h q. Vq Phone No:
.............................................V ......
........................
.
FacilityContact: .............................................................................. Title:.............. I................................................. Phone No:...................................................
MailingAddress: ................................................................
Onsite Representative:.....f CqV � � 4..V 1 r1 ....................I........ Integrator: ?foW `'.. ..0'!....Ca�.a.1.�.n .................. ........ ......................... ..........
Certified Operator: .........................
Location of Farm:
............................................................. Operator Certification Number..........................
..................................................................................................................................I......................... 'W
Latitude Longitude • �� �"
Design Current
Swine Canacity Ponulation
❑ 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 ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
-`I Number of Lagoons ( :;::: ❑ Subsurface Drains Present ❑Lagoon Area ❑ Spray Field Area
Holding Ponds /Solid Traps :.`• _ ❑ No Liquid Waste Management System
Discharges & Stream InWacts
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 convevance man-made?
b. if discharge is observed, did it reach Water of the State'? ([ryes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Dees discharge bypass a lagoon system? (Ifyes, notify DWQ)
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
[]Yes [:]No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway JR Yes ❑ No
Structure I Structure 3 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: i
Freeboard(inches): ............C....................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
3/23/99 Continued on back
r

Facility Number: 3 1 Date of Inspection
2 2[b0
6{ Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7, Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
[]No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Yes
❑ No
W,i%te application
10. Are there any buffers that need main tenancelimprovement?
❑ Yes
❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes
❑ No
14, a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ 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?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
�S10 viola60ris'or def ciencip4 •ire jiOf d r>tng �his'visat: Yoix will ;ee lye Rio ' u�t r
corres�6fidence: abouf this visit.
❑ Yes ❑ No
(? Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
1K Yes ❑ No
Comments (refer to questton #) '-Explain ahy YES answers and/or any recommendations er any other continents - Y
ty to better explatn :{ sttuattons use additional pages as necessary): = `+ Use drawings of facili i
_ChslocG-}roh Gonduc4ed ;r1 r'esPe-1se �o A CQ1
0',( il�ot-, frrcbogrd level..
q, Lat,Oooh level sL1e�ic� to f o4-, cr�e� i+� of rgsponS� �Ie� %rn.ely ,�-�gn�c
Gave o� s;�•e. r'e),ore.sen�'a��ve �Iq� a.�' �G�� ov, r'C�Uire✓�'�Gyt-�-S aYld
1 ✓t 5 � v C �c O{ � 1 t� � -l-l� C � be,
q, Lagorn k-1Ar'ker' r7eed s !a 6e re se+ 4,, Gtdejui4eI 4 uen
l g9aon I y,4 leve) . !
Reviewer/Inspector Name S40 r3 e w ti
Reviewer/Inspector Signature: Date:
3/23/99

Facility Number: Date of Inspection 2 zan
Odor Issues
r
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? []Yes ❑ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ❑ No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes [--]No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
A.......itiona Comments -and/or rawingsc...
16. ®�'� 1 "^�?� snot o'ie reel 6e4weQ_n 4,-x
T61S ;S no� 2de_10 -ie; mare arp1; cmgion-, e.c����o,.,-t��-}
s�a�,�ot �e qc�v�red. (� .
1 n s�i'e ,�e,presE✓l �-��ve 1v-r6g11� p��fear �,E� -�1ha� wv,r. pl yvad
6ee;,q qr 1 iled Ta row c rodq F`.e1d. �V� 1�'�'rgq ri6Y1 /�Gn✓dS
wc✓'e SLAaw-1 -ro,r *ke rot„/ er•a� �✓e[d - A11 r�' 5a iaj1
env e,i +s should 6e o ►^
S. T4c 4/-q/#n oiea.ds be ep r31rr1r)eryrY4 ./Tl�e�e�'r
4;-4�-or'� o�4ree6cgro( Pi jj¢ `,S A+ 4, fqr^'`- �'fGcerd;✓1c� �-v
i r f q ot-� row records,., I4L'er,c- aeas 1,41e
spray•'-�� da�,�✓r'n i9`%B
0111d l q q . -TA; f
l.9ct�; s si3OE4d be ' odor+ed n ro.n6;nci4"6h
�6c W,,S4e V4;lizi4,or Df•,n -�o �iel� �/'eve��9 -�C'c� >re ro�fe x
1 � i
_ .-ee bdgrd 41,AA o �crw�sQ.
A,1
c
3/23/99

Facility Number 3 i Date or Inspection 2 2 2
Time or lnspectiou 5 I % 24 hr. (hh:mm)
[3 Permitted 0 Certified © Conditionally Certified [3 Registered 113 Not O erational Date Last Operated:
Farm Name: SFa 1 e C" .� e ►� q County: .... �.! `................................... ................ I ......
Owner Name: � �! �. e ..C.`.... V ... .. �'.� .... .............................. Phone No:.......................................................................................
Facility Contact: ..............................................................................Title: ..................... Phone No:
Mailing Address:
Onsite Representative:... O V,Q, C�veNav 1 La`l on .:1! i�orpf... Integrator: ,,13"oW�;1T..0:�...Cq✓6,1.,.��................
.....
Certified Operator: ..................................................... ............................................................. Operator Certification Number:.........................................
Location of Farm:
w
---------------------------------- ........ ....... ....................... ....--.. T
Latitude 4 '` Longitude ' 6 A&
Design Current r :µ' <`..Design Current Design Current
Swine— Capacity Population Poultry='=v^:`Capacity Population ~.Cattle Capacity Population
❑Wean to Feeder ❑Layer ❑ Dairy
❑ Feeder to Finish , ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
Farrow to Finish
4:,... ,., .. :..Total Design Capacity
❑ Gilts -- - - - -
❑ Boars Total SSLW
iNumber of Lagoons 1 ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
:..::: Holdinig Ponds /Solid Traps I Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: [ILagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was die 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 y
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard(inches): ................'........I...........................................................................................................1..... ...............................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
V Yes ❑ No
Structure 6
❑ Yes ❑ No
Continued on back
3/23/99

Facility Number: 3 l - 81 Date of Inspection
6.'' Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7, Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level.
elevation markings?
Waste Al2plication
10'. Are there any buffers that need maintenance/improvement? '
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. 'Crop type
❑ Yes ❑ No .
❑ Yes ❑ No
❑ Yes ❑ No
X Yes [:]No
[:]Yes ❑ No
❑ Yes ❑ No
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 ❑ 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?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
�' 1�10 viola igris'o� def ciencie r re pO ed- Ootittg t is'visit' • Y:oir :will-feed*ci do fug tho •'
correspon ence. aut t � visit.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes JO No
❑ Yes ❑ No
jo Yes ❑ No
Comments (refer to ;question #): Explaiii aay YES {answers andlor any recommendations or any other comments y
Use drawings of facility to better explain seation�(._ eand.ditinalpcessary):
.agesasne�
-
�stpccccrnd i,clod ct s a-Foffow vlo o� ccccn+ 'DW q ;hSte r-C ins. •
[.�gaon (a"� v�'d eve, s1�ot�lG/ be [oL✓e✓'e.d lY+ r�r7anfI� E1tj wtcn�14r'.
L?, C-a�oo+� 1 ;� �*;d lev e-( ✓vla,� kev- i'leectJ 4-o 6e rese4 4o ac(.u,-c4e114 rer'Iec4
A level' I
a15. Hays are Curre'-' -L7 i1.1 proee<f o.F 6eine, res-ocked a-[' 41,e rac;lt+
On s;♦e ra �eSe►?rat�; ✓e s�rY ��ut{ Ct sli',�l e�t� of ")s c,,aS reeer ✓edlo»
2/zl/zo06 01v\-d 2/3z/�000 a�td A*\o+�Iey' Sh ta-Ae4 rre-xPer4cd 4odtiyz,/z�/oo,
1zeS4cc, ki a.Fgn; �t1s wilt +4e,ke i�.vtore o��fFicUtk40 �jst;n r-re/;Ante, T
Reviewer/Inspector Name ��p►� CWq t [-a-� i3 1
RevieNver/Inspector Signature: Date: Z/DO
3/23199
f

ODivisio'n',o`f Water Qi alitf
Q Division of Soil and ,Water Conservatiotn
Other Agency,
t.
Type of Visit ,6Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit )6 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
F- Facility Number 3 B Date of Visit
----]
QPermittedXCe)rtified` © Conditionally Ce]r,.tifieedd © Registered
Farm Name: `S7 'i.] ...... �-'�' Ye A Vl�." '.. J?tr.....!.....Z
Owner Name:
Printed on: 10/26/2000
Q Not Operational Q Below Threshold
Date Last Operated or Above Threshold: .........................
County:.. vel.........................................................
Phone No:
FacilityContact: ..............................................................................Title:.................................... ..... Phone No:
MailingAddress: ..................................................................................................................... ..................................................................................... ..........................
Onsite Representative: „ Q ��?:...,rq�+g qvy ... .... Integrator: �''OL±rI f'1 T 4 � r �inG
r
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
w
Swine ❑ Poultry ❑ Cattle ❑ Morse Latitude �• �' ��� Longitude
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder IM I ayer I I ❑ Dairy
Feeder to Finish 2S8Q ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons PWubsurface Drains Present 10 Lagoon Area Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impack5
1. Is any discharge observed from any part of the operation? ❑ Yes 0No
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 now in gal/iron" � Q
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
2. is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? [:]Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate'?
StrUCtUre I Structure 2 Structure 3
Identifier: ................. .............................................................
Freeboard (inches): Z�
5100
❑ Spillway ❑ Yes $ No
Structure 4 Structure 5 Structure 6
Continued on back

Facility Number: 7 r — 9 Date of Inspection Z 40 Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 5jNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes V No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 0No
11. Is there evidence of over application? ❑ Excessive Ponding ,�❑ PAN ❑ Hydraulic Overload ❑ Yes 06 No
12. Crop type Ca� il &Ne , i- eS/e GI
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 9 No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes fgNo
b) Does the facility need a wettable acre determination? ❑ Yes RNo
c) This facility is pended for a wettable acre determination? ❑ Yes f No
15. Does the receiving crop need improvement? ❑ Yes f No
16. Is there a lack of adequate waste application equipment? ❑ Yes .5 No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available'?
❑ Yes
f No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement'? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
15Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
J6 No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
$No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
Jj No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
gNo
E.. Yiola�iQrjs:oj .. j . ertt... r.. noted- cltx:ing �l��s:visit; Yo�x :w'ii� l eeQiye �o fu�th�r"
cor'res�aridence. about this visit. . .
Comniients (eefeif; to question #}• Explain` any YES answer's and/or any recommendations 'or any other eamriients.
:Use drawings of facility to better explain situations. (use.additional pages as necessary}: a
g.. 4C1, A k x OY► J6to Sett ` .
5• ein S v r e 1 e- SG U e e54'ot t I ; .tilt► rvt e_0 +I'1 e rre v .s tA ► ck ,ere- !'ece4lh JBGco e/1:
0. DwY,ev, _b raw, n e r need[ 40 Si J:� -> ciot-�e tv C c4 e P JA n `l ri ke c, [Jn
le rev n-%1VV1 4j' and vse et wgs4e an olI r i s 44-JeA
604' .1 o.( Ah6n4lop, A - ca1Gvt041`&'7S Qvi -4%R z7 r.J>,s;S>1e4e
4 �'rig er e or on sail scrWtr k-f �DY sOiI . --rabsev,�vcd sires ;
4-4 1,0 mw � VA 4.11erte ; r ►?a i1t@LD ' ;-r�'; be s Vrc �a rrtarll a l S hay -1''"� s • 'T
Reviewer/Inspector Name _<4o n �-t4 q i I M et ; 3
Reviewer/Inspector Signature: Date: 17-1 14WOQ 5100

Facility Number:Date of Inspection Z O Printed on: 10/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge 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 ONO
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29, Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31, Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
Additional'Comments and/or Drawings,
J
5100

' H [3 Division of Soil 'and Water Conservation Operation Review { t�
s Q Division Of S01I and, Water COnseryaty0n Connphance �1�11SpeCtloAt
E ,� h�ision of Wa ter Q.�u,_ ali�sy.. ,C.,.onp.€Laktncae; ! n..sgpar ection �NOderAgency-O eratton'RevieW M,�i`
.. �R
Routine OComplaint Q Follow-up of DWQ inspection O Follow -tip of DSWC review Q Other
Facility Number q Date of Inspection j/-
'l'ime of Inspection ® 24 hr. (hh:mm)
�—Per
mitted ertified [] Cond' ' �nally Certified © Registered [3 Not O erational Date Last Operated:
} P
Farm Name: :.. .� ............ .....�R.d!i.g . h.......................................... C.ounty:............ .!A.l.'jz.............
...........
�.
Q
OwnerName: ........................ ......................... ........................................................................ Phone No:.....�/,.��rSl�..... .....ss�Z
Facility Contact: .f ......q!�".
... Title:.......t.... —..illo
....Phone No: ...................................................
MailingAddress: .................................. ........
....31...,.G....'���......................��.:...,.....,.,............i� �.
Onsite Representative..!?h{ . 4r�6/R........ .�1 1 .. Integr.rtor:....`Z�c........................................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
r
............................... ....................... ..... ........................................................................................ ....................
Latitude �` �" Longitude �
,CuDesin Current Dein rrenDesign Crien
e CttlSwinPoultry Ca acit Population
Capacity Population
❑ Wean to Feeder , ❑ Layer ;'` ❑Dairy '''•'
Feeder to Finish ❑ Non -Layer 1E] Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder JE1 Other
_❑
Farrow to Fin
ish Total Design Capacity
❑ Gilts.
❑``
Boars ;k ` '` Total �SSL• W
Number of Lagoons JE1 Subsurface Drains Present ❑Lagoon Area
iHolding,'Ponds'/: Solid Traps 0 ' " ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge ori8inated 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 galhnin?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
Spray Fictd Area
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes 4 No
❑ Yes $�No
❑ Yes P No
,V/A
❑ YeS No
❑ Yes No
❑ Yes 7`
❑ Yes K No
Structure b
Identifier:
Freeboard(inches): ....�1 ............................ .......................... ................ ..1-............... -1....................... I......... ......................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
3/23/99 Continued on back

Facility Number: — Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(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
12. Crop type
r-
13. Do the receiving crops-giffer with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Ell*Io yiala>Gipttjs'o j dui c�enctes iv re jngted><rririg thi<s visit} Yoh )ij - ee ipe no: further '
core- s�orideh e: about: this visit: .:. ' . ' . ' . ' .
❑ Yes ANo
XYes ❑ No
❑ Yes No
❑ Yes fi4 No
❑ Yes g No
❑ Yes X No
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
9Yes ❑ No
,Yes ❑ No
❑ Yes No
❑ Yes k(No
❑ Yes 1A No
Yes ❑ No
❑ Yes No
❑ Yes No
El Yes RNo
❑ Yes P No
❑ Yes No
❑ Yes No
Comments (.refer to question ;r): any xhz�j answers ancuor any recommengattons or!any othertcomments... b
Use!drawings of.facilrty iihetter,_expiam Atuaih (use' additiotial.pages,as�nec6giiiy) 11U..' t'K' � `lL �f,
N e-) WeAjle
�ro�vGY w; ll G C� �k, cR,� s�rc:w 1, �� +- s•� k,y� a C �, �+ �,- 4A' %'&^e a PlAr K .
-7) 44,1 A& t64,,t-� ol� � i�,s ec-� �{i�� t,��l� �kv Aj4&1`tA4ej( a.vW[ ro,,,/r h_Af
�
gv�v,`s 'q- -j1tt n_� v-F- �-FLu� s-h-►,�c- ,-. t+-L tvx� s r�l� R rrDQ,r
a1i l� -L �GrP9 r�aC•kt, s �o w b7.0 WD"d t_ /4 ► wail* yAn a-f ZcvD
w► "fl, I i w wejeks). ire irL ty���
%row't:r l* 4 over-st•.�� �wt+ev� c�hal:���-,.s r � �c —
d 4o r'['
Reviewer/Inspector Name
Reviewer/Inspector Signature"
Date:
— 3/23/99

Bate of Inspection / 3
Facility Number: 3
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
0 No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
�No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
ZNo
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
ONo
31.
Do'the animals feed storage bins fail to have appropriate cover?
❑ Yes
A No
32.
Do the flush tanks lack a submerged fill pipe or a pertnanent/temporary cover?
❑ Yes
/IrNo
Additional omments an or, rawmvps
b '-'• �.� si -b. .Is }! } :.j EE.:..�•,l3 a.. €. v,i asa,e. to
3/23/99

itr[3.Division of Soil ana`Water-Conservation ,Operation Rei'iewS;
(3 Division of Soil and Water Conservation -;compliance liispection
®.Division of Water n
Quality-`Cotttphatce Inspectio,` s �` ; sd''�
-i... E �i,
Q'Ot€ler Agency 0perati6n RiAi
•Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review Other
Facility Number Date of .Inspection
Time of Inspection F-N & 0 24 hr. (hh:in
© Permitted 0 Certified ❑ Conditionally Certified © Registered JE3 Not Operational I Date Last Operated:
Farm Name: ...........4Jt i�AVe,Pmv9lt..�gew. 2— County:.....................................................................................
Owner Name: S-� � qIG C. Ve Al ek k) A Phone No
.... ............................................................................
Facility Contact: .............................................................................. Title: ..... Phone No:
........................................................... ....
MailingAddress: ........................................................................................................................................................................................................... ...
Onsite Representative:.. t"i'.�j�it.k'. �at ✓�NGr U Integrator:... �Y'Qtr.......................................................
..
Certified Operator: ................................................... ............................................................. Operator Certification Number:.....................................
Location of Farm:
Latitude
Design Current
Swine A: Canacity Pnnulatian
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
............................................................... ..1,V
Longitude �• �� ���
Design Current v Design Current
Poultry Capacity _po 6lation Cattle Capacity Population.,
❑ Layer I 1 1[:] Dairy
❑ Non -Layer ❑ Non -Dairy
?!.
1❑ Other
Total De"sign Capacity
16
SLW
TotaLS-°
Number'of Lagoons, 1 ; s ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Are- ,
H ,.
solding'Poiids / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Lagoon El Spray Field ❑ Other
a. lt' 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): .............0.................................................... .................................... .................. I ............. I .. ................................... ..
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23199
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
M Yes ❑ No
Structure 6
X Yes ❑ No
Continued on back

Facility Number: ?/ Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(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
12. Crop type
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
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 ❑ 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?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
.... yi.. (iQns:oi'• deficiendiag `:►=ere hofpd• 00ring •this visit' -:Y:o will-�'eceMy iia futtbo • ..
.. ...
coeres onciertce.a'b' ' f this visit ... .
Cor ments' (refer to.questivn #):: Explainany YES answers i
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes, ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
Ik„ r22
Use diaw�n s of factht , o'.b'etteriex latnsituatrons use addtttonal a esas;necessa t- ` € t t�l� I,' t
IT,.
► S. LOIpon kets '0, %.lGhel F✓eeba.l"d ael•( i.s ,/
�ras ah aj 5 s�ur-}Cd in T��S Qreq q+1D� w� ��hee(�s 4b 6e r�''►oved
i �yyttl�ra�"8r ' ��1r1''n'1�r Gvr�'2h.�'� LwS �o
POVKP Of ?`eel 1 [ie r7-r I'1 1'9S�/✓�/Gt�al�, r c✓
e .t A,, u ►tit ► r1. 01- -
z F_,q,,b-,vew- t jo,,_k,d +4a d;4cko 4�Rt .dye
Reviewer/Inspector Name E'i!'.
Reviewer/Inspector Signature:
Date: Z z
e4t, Hunkd,t, e r. Zo?
61euY 410Vi(_kdf
3123199

Facility Number: 3 f -- 9 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 ❑ No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ❑ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ❑ No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ❑ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments 'an' or row ..
+1
�' Giro 1.;,.t�, is 90'�'� �b b���y �� q �Ovmp a�� [xy►'� 101i1',�'�"�i
�t4 a Oeel . IPVO%f
�RYId A14+emp4 m4ke zs',Pme ,pV11S. rAr✓he.v' S4DuId 10iver 14,0b11
f eve ii fb ] 41 H q S re'Po"S r'b Aslass ► ble.
�a�,,,e,- �. k�t� ��� .n�a�wt�r( of Iq�PO)J 4'-Fqr'J61 S�Wvr.

1'. D Division of Soil ana Water Conservation'-" Operation Review-
.{ a I
f'bivision of. Soil and Water'Conservation - Contpliance:Lnspeetion
Division of Water Quality'- Compliance Inspection 1.='
0 Other Agency .Operation Review ` t "
.',;
ip—Routine O Complaint O Follo tv-up of 1)WQ inspection O Follow-up of USWC. review O Other f
Facility Number Date. of Inspection
'I'inie of Inspection EZFLM24 hr. (hh:mm)
© Permitted © Certified © Conditionally Certified E3 Registered 10 Not Opel-atj()7j_ajj Date Last Operated:
Farm Name: [/l[iHt-i'x.F ..t�l...... .................................................
Owner Nantc:............ ... ./. ........../pry.Z�..,...'.....2......^..Z
a. ... .. onto
......................
Eacilily Contact:Title: ................. ...............................
Phone No: .....��r ............. '[7.........
iilailiug Address: ..,...`'......1Iu�,i` �.kfr.�......... !%.k'.lR:..............................................�(r(/...
.. ............
Onsite Representative:......1...5.2.:....................................................... Integrator:........�...................................................
Certified Operator:....J�..�......................Cf'`:. ................. Operator Certification Number:..Za/?3 ........................................
I..ocation of Farm:
..................................... .................... .................................................................... 7
Latitude r �' �" Longitude ° 66
Swine Capacity Population
❑ Wean to Feeder
Feeder to Finish
- N
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I 11[:] Dairy
❑ Non -Layer I I JE1 Non -Dairy
❑ Other
Total Design Capacity
Total SSL W
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)? ❑ Yes )] No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. [I'discharge is observed, was the conveyance man-inacle?
h. It'discharge is observed, did it reach; ❑ Surface Waters ❑ Waters of the State
c. If discharge is observed. what is the estimated How in gal/tnin?
d. Does discharge bypass a lagoon systcnl?
2. Is there evidence of past discharge from any part of the operation'?
3. Were there any 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?
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier; J
Freeboard (inches): [........................................................
1 /6/99
❑ Yes
ZNo
❑ Yes
f!!�No
❑ Yes
ZH No
❑ Yes
W No
❑ Yes
W No
❑ Yes
VNo
StructurC 6
................................
Continued on back

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ 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 taintenance/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 top of dike, maximum and minimum
liquid level elevation markings'?
l;_LS_L.Z'ZJ
❑ Yes JZ No
❑ Yes 4No
❑ Yes R] No
❑ Yes [R No
❑ Yes 0) No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes IR No
11. Is there evidence of over application? ❑ Ponding ❑ Nitrogen
❑ Yes ZNo
12. Crop type ��r�?..:.�.........................��G9 ...................w..`.."".�`................., ,...:.....................,.,.,............................................................
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. Does the facility lack wettable acreage for land application? (footprint) L44 A .
15. Does the receiving crop need improvement'?
16. Is there a lack of adequate waste application equipment?
Required Records &Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
19, Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the Facility fail to have a certified operator in responsible charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
❑ Yes WNo
ALYes ❑ No
❑ Yes ® No
❑ Yes 0 No
❑ Yes ED No
❑ Yes j9 No
❑ Yes Jj No
❑ Yes ® No
❑ Yes ®'No
❑ Yes J;�No
❑ Yes BNo
❑ Yes �Ai -o
LJ' .Nox1Ulatlons'or. UeIlcleI cies were norea auring .ffi!s-vlslt. - -Y-ou will receive no Iurtlter .' .
QOI'1 e5.]QI][.@I] . . Ali. . . ifZiS VI,Stf..:.:.. . .
Continents (refei''to question #)`: Explain any YES answers and/or any recommendations or any other comments s 1 ,r
Use drawings of facility;: to better explain situations. (use additional pages asp ecessary)
1�. ICI `� p , w��..�' •� � �%
rV �'�• y,�,,, �,�
I-1
Reviewer/Inspector Name ,
Reviewer/Inspector Signature: Date:
11/6/99

i Q Division of Soil and Water Conservation 'Operation Review
i
Division ofSOiU ajid,Wat6r,Consei;vkion'-.CUE
s . y ` 3 Other A encv Up�rahoiY RCVICW p,,.
pp pAter aft Com hence Ins ection. { :
O Y,
10 Routine 0 Complaint ip Follow-up of DWQ inspection Q Follow-up of DSWC-review Q Other
Facility Number Date of Inspection �Q
Time of Inspection 20 24 hr. (hh:mm)
0 Permitted 13 Certified ]][] Conditionally Certified © Registered10 Not O erationalDate Last Operated:
Form Name: ............S�r1
�AZ County: .... pl holm.........................................................
Owner : Name: ..............s g 1 ¢ CAVert4r,+��-, Phone No......................................................................... .
y..............................................................................
Facility Contact: ... :.......................................................................... Title: Phone No:
MailingAddress: .......... .......................... I ................... I... .........
............................................................................................. .................
r
OnsiteRepresentative:.... 0 U2 I.,alverl[yu!�l!}.�7 .;;. t.�"""�anS Integrator: ..6!'.L A1.,f......" •....L�AYUI� .........
Certified Operator: ............ ...................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
............................... .... .... ............................................................................... .... ..... ............................... ....
Latitude ���� '� Longitude �• �� ���
Design Current Current
Swine « Design' ' Design Current Ca acit Population! CCPo ulnC3
"tE
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
❑ Layer I ❑ Dairy '
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW;,
;. IlNumber of;Lagoons �; ` ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
HoldErigPonds .II Solid Traps ❑ No Liquid Waste Management System
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'?
h. Udischarge is ohserved, did it reach Water of the State? (If yes, notify DWQ)
c. Ir discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If ycs, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: N
Freeboard(inches): ' r .............. ............................. .................................... ............. I..................... ................ I.................. ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
3/23/99 Continued on hack

Facility Number: e1 — 8 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
I0. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
1TUM"
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
,9 Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
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 ❑ 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?
16. Is there a lack of adequate waste application equipment?
Required_ Records & Documents
17. Pail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Io viol'a�iotis'oe ftficje'nfies •gre nofe�1 dtrririg �h�s:visit; Yoir ;will eeeiye Q fu�t gr
corresPoncXeire. about this visit. . . .. . • . c
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 9 No
❑ Yes ❑ No
❑ Yes ❑ No
minents (refer to, uesti6n # : Ex Iai� an YES answers an' Co q ) p y doe. any recommendations t1ar any otlier comments
3�.�,: Ij dl 1 ,• - ,
.:Use drawings of facility to, yFbetter, explain situations #(use;addthonal pages as;neees$ary)FE, {„c;, ,r #,ls�4t_'d, t,R3, E(: ,,"FI l',s> ,, 133,E 1t.°}'3..; i
L 1 iv ;Lona OuOi�'- d j r 0 l y\ f t e S247Q`l) v 4$
f0 d %SG,VTS Go►'1t�+�i e1'} o•� la9oor� �� k t W4rf �W �e�e o va�feP�i
GCe,uered, � ��td ��.a� �'4Pa,rs �k1r� �ew�ada - fhe ,rppr+''^ p�24QJ.
�P raxi ej y� -to b 4 -ro'4 Se e4 i as, w ; i1 h., ire Ue e4Q4 o h r M d Ye
kv,' ll be Gat �i' t'f' I' a re rake ca+^�► aG�;�q Ma-��r �4r� w i 1 f be breu f
q yt d ,g ,^ad e4 fa a R ra"r i A-zq f G 3 c / �/a e .f� o�e.�"; ke d d 0e- save 1 r�
Reviewer/Inspector Name[
T'"{_�^..: 1)"T! �r s ....."r.y" I , fi`"4"a "�`";. c• •. rv11S F' �..
s F ,t .s7'oYl�
Reviewer/Inspector Signature: Date:
3/23199

I�
Facility Number: 31 —%,qdq Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ❑ 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, ctc.) • ❑ Yes ❑ No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ❑ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
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3/23199