310835_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Type of Visit: QCo once Inspection; O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergencv 0 Other 0 Denied Access
Date of Visit: Arrival Time: o Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative: r fa (r<<-- Integrator:
Certified Operator:
Back-up Operator: .
Phone:
Certification Number: 7 7
Certification Number:
Location of Farm: ' Latitude: Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity op.
Dairy Cow
)yean to Feeder
I jNon-Layer
I
Dairy Calf
Feeder to Finish
% "">D J.Ps'
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I
dr. P.oultr,
I Layers
RDesign
Ca aci
t►urrent
In
P.o ,
I
Dry Cow
Non -Dairy
Beef Stocker
GiltsI
INon-Layers
Beef Feeder
Boars
I
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharses and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 j2'No ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
❑ No
[] NA
❑ NE
[3 Yes
�No
[] NA
❑ NE
[:]Yes
No
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E N ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�NoO
❑ 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 111 o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environme I threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ETNo
❑ 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 EfNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance 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 No ❑ NA [] NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [ErNo 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
I_J NN ❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Remuired 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
[21 o ❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes � No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [] Yes < ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: 3 1- Date of Ins ection: Z.
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Y" ❑ 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 ffNo ❑ NAB❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No �'NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
. and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or GAWMP?
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 No NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
No ' ❑ NA ❑ NE
y" - - NA ❑ NE
Callo ❑ NA ❑ NE
Reviewer/Inspector Signature: r1�{ �.�/ �t Date: '>. Z
Page 3 of 3 2/4/2014

Type of Visit: (OrZoutine
anee Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: ® County: D{/Q(1 Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: G _ i_,e kT_(J?A,r(zrGiL Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: (�
Certification Number:
Longitude:
Design Curent
Current
Design Current
Swine} f
Capacity Pop.
Wet Poultry
IlDesign
apacity
Pop.
Catt3e Capacity Pop.
�
Wean to Finish
La er
Dairy Cow
Wean to Feeder
on -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr, P,oultr,
Ca acit
P,o ,
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
on -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Q,thcr,
Turkey Points
Other
Other
Discharges and Stream Impacts
l . 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 ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
[] NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Page I of 3 21412015 Continued

r
Facility Number: " - Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: %66
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
MINo
❑ NA
ONE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or env' onmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
[Yes�No
No
❑ 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
LYJ fro
❑ 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?
t I. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
E�/No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ 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 o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
VN
❑ YesVN
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes EN
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes go
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes 21�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
0 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 GoNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspection! M Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes g�N'o
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection: t-t S w
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA [] NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [] Yes [' o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Vo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
g]�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
I3 N/o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
EJ/No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[] Yes
[ " No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[�o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to.question #):.Explain any,YES,answers and/orany additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
9,l 5AcK of DTk. WAL-4,' PJEE-QS 56MC wa�� �a�� Cove.
J
a 1, S 0 e.oP `� d Stu G-� 3oocs J Tv D w2 . o\/
Jt:,dzgC,
Reviewer/Inspector Name: FA g JE UL
Reviewer/Inspector Signature:
Page 3 of 3
Phone
0l(� �-
Date: Lf /S-//
214,1265

3
f Type of Visit: 0 Compliance Inspection O Operation Review 0 Structure Evaluation Q Technical Assistance i
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergenev 0 Other O Denied Access I
Date of Visit: Arrival Time: ZI Departure Time: o p County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: + `� y1 '� 4� �� •`t �; Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Region:
Design Current
Design Current
Design
Current•
Swine
Ca acit Po
P Y P
Wet Poultr C•a acit Po
Y P Y P•
Cattle Ca acit
p Y
Po P
Wean to Finish
La er
Dairy Cow
Wean to Feeder
11
Non -Layer
Dai Calf
,
eeder to Finish
t(o9
i5vp 5,
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Dr, 11071tr, Ca acit P,o
Non-Dair
.k
Farrow to Finish
Lavers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[s]'hfo
❑ 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
[T-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 l of 3 21412015 Continued

Facilit Dumber: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 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 Q 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 [2"No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Q No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes ❑/ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes EJ�No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [7�No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E]—No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes Ef� ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes 1__I "'o ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Q No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑"No ❑ NA ❑ NE
the appropriate box.
❑WUP [:]Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Ot r.
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes LJ "0 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [n"No ❑ NA ❑ NE
Page 2 of 3 214120I5 Continued

IlFacilitiNumber: I - 3 Date of Inspection: 2 7 �'-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [v]"No
25, is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 2_110
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 �Io
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes I_J No
[DNA ❑ NE
[3 NA ❑NE
❑NA ❑NE
C 1:A [DNE
❑ NA [] NE
❑ Yes EZrNo ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or. anyother. comments: ,
Use drawings of facilitV to better explain situations (use additional pages as'necessary)'.'
Pttv,`.Pk,s
`
Ore- 0
�— Pre " �..-s r ecvn !
SeAL L, Q Z C Clean.9, r. 11r.* 0
fCOCt 5S na/lC/,"olN t--ii(%� ele- o We s ,
�—' ax(—� 1 O �p — Z
Reviewer/Inspector Name: & , ( C & e l/ Phone: � 10 71 � 73 0
Reviewer/Inspector Signature: Date: 2 S
Page 3 of 3 21412015

Type of Visit: CAS Co pliance inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: jp Departure Time; County: DLif)L—! Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: r k4Ij GL jZO D �rCr1�
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: D „�
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultr»y eapacity Pop.
Wean to Finish Layer
11
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
INon-Layer I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
4 D
s'60
Design Current
OWNP,ouIte: Ca aci P■o ,
Dairy Heifer
Dry Cow
Non-Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other UT—urkey
Other I
Turke s
Poults
10ther t--jo
Discharees and Stream Imoacts
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
o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
V�,o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑Yes
o
❑ NA
❑ NE
of the State other than from a discharge?
Page 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 No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ NA ❑ NE
❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes [�No ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen
,tl threat, ratify 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 dNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes �No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No DNA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [3/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ 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): 1
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
go
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
fNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
fNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
fNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did tte facility fail to install and maintain a rain gauge? ❑ Yes �o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes YNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

LF40ity Number: 31 jDate of Inspection: J
24. Did the facility fail to calibrate waste application equipment as required by the permit.
[?Yes
❑ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
YNo ❑ 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
&r4o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
YNo ❑ NA ❑ NE
Other issues
�
No
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
u ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[/No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
CJ/No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
C�No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
El Yes
No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
10 CALMOIAATEAj i046 took-j' ~60 DOS,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: $ �}
2/ /2011

3
Type of Visit: O pliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Co(Routine O Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: t l3 Arrival Time: l I tao Departure Time: ® County: k � PLU Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Nuck- RO.Dc'<-2S Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 2..0 2,'71
Certification Number:
Longitude:
All
Swine
Design
Capacity
Current
Pop.
Design Current
Wet ltry Capacity Po
Pouaci
p.
Design Current
Cattle gap P.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
iry Calf
Feeder to Finish
(04 CM0
iry Heifer
Farrow to Wean
Design Current
Dr, P.ouitr, C_a aei P,o
Layers
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Othe
Other
Turke s
rkey 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 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 ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes �j/j o �] NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: Date of Inspection: 011t
Waste Collection & Treatment
.4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0"'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Vq(6ra
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): "; I
5. Are there any immediate threats to the integrity of any of the structures observed? E_Y_es­,� �No[] ❑ 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 iNo ❑ 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 El No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes F� No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [%f No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [7 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o
❑ NA
[3 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
❑ YesF2/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 hTo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Ins ection: it
24: Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes LJ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [Tj� No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fait to secure a phosphorus loss assessments (PLAT) certification? [:]Yes L 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)
❑ Yes [:(No
❑ Yes (2/No
[]Yes [5/No
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
NA
NE
ICJ/No
❑
❑
dN
o
❑ NA
❑ NE
[lo
❑ NA
❑ NE
Vo
❑ NA
❑ NE
Comments (refer to question #): Explain any'YES answers and/or any additional., recommendations, or any other comments.;
Use drawings of facility to better explain situations (use additional "pages as necessary);
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ?1a1 R 6 — 73 29
Date: a
214,12011

Type of Visit: U 7Routine
pliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: D Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: CM0-c—S 'RQGeqs
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: o�
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
Cattle
Design Current
Capacity Pop.
to Finish
La er
airy Cow
LWean
Wean to Feeder
-Layer
airy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
a
Design Current
Dr, P.oultr. Ca aci P.o ,
La ers
Dai Heifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ 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)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
ff
❑ NA
❑ NE
❑ Yes
�70
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection: y
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes C� ?N'o ❑ NA [] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes [' No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes fNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/of 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)
❑ Yes tNo ❑ NA ❑ NE
❑ Yes O/No ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
]No
❑ NA
❑ NE
[:fNo
❑ NA
❑ NE
[� No
❑ NA
❑ NE
j'No
❑NA
❑NE
Comments (refer to question #): Explain any.YES answers andlor any additional")recommendations or any other comments ,t
Use,'dtawings of facility to better: explain situitionk (use additional pages as' neces'sary). `; t . i ' i ' ; ;l� p ' , YS y : ' ' :,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phond -0 " s W
Date: L
21412011

Facili Number: 31 _ Date of Inspection: 11117,
Waste Collection►& Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: LA raao
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 411-�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
YNo ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[Z/No ❑ 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 environment 1 threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ YesVNo
❑ 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
Vo ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[= /No ❑ NA
❑ NE
F] 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?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes ff, ,, No ❑ NA ❑ NE
❑ Yes 16 No ❑ NA ❑ NE
[:]Yes [ No (DNA ❑ NE
❑ Yes m' o
❑ Yes YNo
❑ Yes VNo
6
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
C]NA ❑NE
❑ NA ❑ NE
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections El Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes YNpo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

type or visa[ t9 Compliance Inspection V Operation Review V 5tructure tvaivation V Technical Assistance
Reason for Visit ©Routine O Complaint O Follow up 0 Referral O Emergency 0 Other El Denied Access
Date of Visit: t 2t Arrival Time: S Departure Time: I County: QU'PCZ%) Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: NuGIC X.4D&0(5Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = n 0 4 =61 Longitude: = o
+� a,'
-F.Y,e .r 1a .az'q -a�>•'
�Desrgn° . ,Current . C r °y :Design;
z� 'z �,+ r.. .. _.i,F`f !v�?�a�'�:..
Current .Design, . Current G; S
`,C `cityt Py 1latton '
Swine x`; ,.Canaci{`.y•
;�
Poyrtulat�oti' )W. ,et'Poultry111Capacity Populah�m `,'Cutlet 1 P p
.. p_.q,g✓i>x.•- 3.S:A eif��� i��1a,Y%5�-1 J�
xs x.a� a.5 .�
�p
t,>
a` ❑ Layer
Non -Layer
j` F
P i
` i ggge 1 ggpp
�x
'P��
sa
.r
: ?6
�����•�`S
k ' �,
-Yf
'�
(
V f-V d�
3 Dt' Point' $
:; , > p
ry
F
�.
�.
a�',
��
4
.. a
F
f
a ❑ Other
� Structures
Numbersof
Ji: `-ap.
�r:'T=tia
>
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
(o p
t} �O
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gifts
❑ Boars
❑ Layers
❑ Non -La ers
'
❑ Pullets
❑ Turke s
❑ Turkey Points
❑ Other
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
D Cow
❑
Non -Doi
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes dNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
ElNA
ElNE
❑ Yes ❑ o
❑ Yes o
❑ NA
❑ NE
ElYes ]No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: — 3s Date of Inspection ! o
Collection & Treatment
_Waste
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
LEI No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure1 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: l� foN
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[/No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
El Yes
Z ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
LI No NA NE
❑
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
2 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
/
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
011 o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
La No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Neavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Zo
❑ 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
[2/No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ld No
❑ NA
❑ NE
_ .'- '•1 ci ., _5 '- •bpi 1'.. F, Y �. [. x� -x b k
'Comments (refer tQ question #):'::Explain any YES answers and/or -any recomin'endatioris or any other:comments ` d
Use -drawings of facility to, better explain situations: (use additional pages as necessary):
i
7
Reviewer/Inspector Name e rr
4 o ',fQcl 1%a..� f;;
C1 U
x Phone: �� 7 O
:A
, x , x
Reviewer/Inspector Signature:
Date: 1IL411)
Page 2 of 3 1 12128104 Continued

Facility Number: 31 — Date of Inspection 1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑ Checklists El Design . ❑Maps El Other
❑ Yes dNo ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[; o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
YNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
jNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
90
ElNA
[INE
26.
Did the facility fail to have an activelycertified operator in charge?
ElYes
�INo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
UNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[, a
El NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
YNo
❑ 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
dNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑'No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
0 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
1W
Page 3 of 3 12128104

31 H 835
Type of Visit TRoutine
pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 2 t2. l D Arrival Time: Departure Time: County: 012121.rt1J Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: 'Title: Phone No:
Onsite Representative: CI-WCA<t 2oiD"
Certified Operator:
Back-up Operator:
Location of harm:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0= i 0« Longitude: C
o=, =il
Design
pa�city
C*urrent Design Current
Populaation Wet Poultry Capa y Population
Design Current
Cattle Capacity Population
Wean to Finish
❑ La er
❑ Dai Cow
Wean to Feeder
❑ Non -La er
❑ Dai Calf
Feeder to Finish
't4
oultry
❑ Dai Heifer
Farrow to Wean
Farrow to Feeder
[Other
❑ D Cow
❑ Non-DairyFarrow
La ers❑
to Finish
Gilts
Beef Stocker
Non -La ersPullets
❑ Beef Feeder
Boars
❑ Beef Brood CoTurke
Number of Structures:
s❑ Turke Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Ej No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c, What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ o
El NA
El NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
Zo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
WNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

tacilityNumber.- 31 - $3 Date of Inspections O
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): III
5. Are there any immediate threats to the integrity of any of the structures observed'?
(iel 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 dNo ❑ NA ❑ NE
El Yes ❑No ❑NA [I NE
Structure 5 Structure 6
❑ Yes E No ❑ NA ❑ NE
❑ Yes [!/]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 7No
o El NA ❑ NE
❑
8. Do any of the stuctures lack adequate markers as required by the permit? Yes ❑ NA ONE
(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 ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Cl No ❑ NA ❑ NE
maintenance/improvement? ,_,/
11. Is there evidence of incorrect application? if yes, check the appropriate box below. El Yes LQ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
O No
❑ NA
ElNE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E 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
ENo
❑ NA
❑ NE
18, is there a lack of properly operating waste application equipment?
❑ Yes
;;�No
❑ NA
❑ NE
Comments ref k:j iiAt ti`a •::`�i '.
( er to question #) Explain any YES,answers and/or any�recammendatwns;or. any other comments: t
Use drawings of facility to better explain aclditttonal pages -as necessary)::Y�
+ 'T 'Phone:_i �1a� 7�bReviewer/inspector Name ;
Reviewer/Inspector Signature: 3aa Date: 9
12128104 Continued

❑ Yes dNo ❑ NA ❑ NE
❑ Yes E�No ❑ NA ❑ NE
UFaciliit�y
Number: 3 —$3,fl Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
L�J
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
C3"'No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
2No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�(No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ffNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
dNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes UNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
_0"'No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
eNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 I. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
❑
N
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Yes
E2
[INA
❑ NE
33. Does facility require afollow-up visit by same agency?
❑ Yes
ld No
❑ NA
❑ NE
12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance !
Reason for Visit 16Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access I
Date of Visit
Farm Name:
Owner Name:
Mailing Address:
Arrival Time: ® Departure Time: County: 0UPLX0 Region:
Owner Email:
Phone:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: PIULO- i4OCr kS
Certified Operator:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 0 = 4 = u Longitude: = o
Design Current
Design Current
Design Current
Swine Capacity
Population
Wet Poultry Capacity Population
Cattle. Capacity Population
❑ Wean to Finish
❑ Layer
❑Dai Cow
❑ Wean to Feeder
❑ Non -La er
❑Dai Calf
Feeder to Finish
LAO
❑ Dai Heifer
❑ Farrow to Wean
Dr>y Poultry
❑ D Cow
❑ Farrow to Feeder
El Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
❑ Non -Layers
❑ Beef Feeder
�El
Boars
❑ Pullets
❑Beef Brood Cow
❑ Turke s
Other
❑ Turke Pouets
❑ Other
❑Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
JNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
2�) o
El NA
[I NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
[I Yes
Ll No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

r.
Facility Number: [ — 3 Date of Inspection S D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
04o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
StructureI Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: Lke_moa j
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
El Yes
,�(
RJ No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes dNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 9"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 1J No ❑ NA ❑ NE
maintenance/improvement?
11. 1s there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes EZNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
Elld Yes
,6
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
E4
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
YNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
V No
❑ NA
❑ NE
� -.. t..'.. `ia
Comments {refer to.questioti #) Explain any�YES answers ands&or any recommendations or<any otherrcommygents
Use drawings o'i tacilify to'better situahons'.:(use additiongal pages as necessary) a y .�, � ,
Reviewer/Inspector Name p F�.L Phone:
b) 776
Reviewer/Inspector Signature: Date:
S 7 G
Page 2 of 3 r 12128104 - ' Continued

Facility Number: — Date of Inspection e
Ite uired 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 Mans El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. LiYes 1_/ 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 InspectionVNo
Weather Code
22. Did the facility fail to install and maintain a rain gauge`? El Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes L/J o ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ElYes LZ N El NA El NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes Q No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes zio ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ZN o ❑ NA ❑ NE
❑ Yes Z-o ❑ NA ❑ NE
❑ Yes WNo ❑ NA ❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
To
,2No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
WNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
El Yes
VNo
❑ NA
❑ NE
Additional Comments and/or DrawingS,«
7
Page 3 of 3 12128104

0 Division of Water Quality
Facility Number 3 + S 3 S O Division of Soil and Water Conservation
0 Other Agency
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: Arrival Time: Departure Time: County: IV Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: C NtACIC `t G 1 L OR RG aJEC R 5 _ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 0 I= Longitude: = n= 6
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish Itokdoo I (P300
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dai Cow
❑
Daia Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
12128104 Continued

Facility Number: 3 — S 3 51 Date of Inspection !Gr d
Waste Collection & Treatment
MNo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ 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: (AGOO /J
Spillway?:
Designed Freeboard (in): l�•q'S
Observed Freeboard (in): 3 1
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[9 No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
0 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
[]Yes
UNo
❑ 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
G� No
❑ NA ❑ NE
maintenance or improvement`?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[X No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
QqNo
❑ 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 Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
D9 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
DO No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?❑ Yes
[V No
El
El
17. Does the facility lack adequate acreage for land application?
❑ Yes
,
tJYNo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment'?
❑ Yes
M No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name -, NEs O fUv�c Phone: 5)a-`T6-43M
Reviewer/Inspector Signature: Date: j Z (0
12128104 Continued

Facility Number: Date of Inspection I T d
Required Records &_Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes D3 No ❑ NA ❑ NE
the approprrate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[51 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[3 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[,T No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[21 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
tNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
t.No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
M No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
M 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
En No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104
12128104

A0 Division of Water
Facility Number ---� 35 O Division ofS 1 and Watt
r Conservation
O Other Agency
Type of Visit Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason far Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ti @ Arrival Time: Departure Time: County:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone No:
Onsite Representative: C auuL 4 GXu Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o Longitude: = °
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish 16400 1 G7,40
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Region:
Design, Current
Capacity.. Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:' �1
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [7/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[INA
ElNE
❑ Yes
El No
❑ Yes
EI/No
ElNA
❑ NE
ElYes
[3/No
❑ NA
❑ NE
12128104 Continued

Facility Number: 31 Date of Inspection
Waste Collection & Treatment
4� Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
t No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: (A&vo).1
Spillway?:
Designed Freeboard (in): 11,5
Observed Freeboard (in):,
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2 !Vo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
ElE Yes
�
No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
0"No
[]NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'?
❑ Yes
2No
❑ 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
ETNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
dNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[TNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
[]PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ 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
El NA ❑ NE
15. Does the receiving crop and/or land application site need improvement'?
El Yes
,3/No
L� No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
D 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
L—d No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
T
Reviewer/Inspector Name J a 14 N PA SW�_-( U Phone: ib ff — 3
Reviewer/Inspector Signature: Date: d
12128104 Continued

Facility Number: 3 Date of Inspection a�
Re uired 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 appropiiate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes L!1 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
❑ Yes dNo ❑ NA ❑ NE
❑ Yes 2(No ❑ NA ❑ NE
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes LI No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes N ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes [3 No ElNA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ElYes CT/No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes E No ❑ NA ❑ NE
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 Reviewerllnspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
❑ Yes Ld No ❑ NA ❑ NE
❑ Yes L7 No ❑ NA ❑ NE
❑ Yes El No ❑ NA ❑ NE
❑ Yes eNo ❑ NA ❑ NE
❑ Yes [Z*No ❑ NA ❑ NE
❑ Yes [2 No ❑ NA ❑ NE
12128104

Facility Number 3 ( S
(Division of Wafer`Qual[ty
Q. Drvtsion of Soil and Water Conservation
0 Other'Agency
Type of Visit Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit U Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: M(—X?J Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: G_SLOA `F C 9UC4,L i2oC�R..S . Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 1 Longitude: = o =
i,
Design Current Design Current" Design:; Currentx
Swine:" Capacity Population Wet Poultry Capacity Population Cattle. Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
41*
S1�
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La er Ii.
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures ,1s., �, l
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑Yes 2!No El NA ❑NE
[]Yes
[]No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ o ❑ NA
ElNE
❑ Yes
ElYes
❑ NA
❑ NE
❑ Yes
rNo ❑ NA
❑ NE
12128104 Continued

Facility Number: '3
�5
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: i,A6"t-J
Spillway?:
Designed Freeboard (in): M.5
Observed Freeboard (in): 31'�_
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 ENo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes YNo ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentalat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Ko ❑ 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 {CJ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes fNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes CJ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l O 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) 13C-R-'vt,uDit Go
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 2No ❑ 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 21 ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes o ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
R rt wt k N p (;�CCo"i Lo* tt_ G oo1>
ReviewerlInspector Name C170A0 -4 _. Phone: ,Q1_b *1
Reviewer/Inspector Signature: Date:
rage z of s «ilsiva t,onnnuea

Facility Number: 31 -SDate of Inspection '=��
.G'
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ff�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes YNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ElOther
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[2fNo
❑ 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?
El Yes
� /El
L�J No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
dN o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
u No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ENo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E o
❑ NA
❑ NE
Other Issues ,—,/
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ 3 Yes No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[] No
❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
,�/
L�J 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
�
21 No
❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ErNo
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
ONo
❑ NA ❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

I Type of Visit Qf Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
1 Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: // Q Arrival Time: Departure Time: County:
Farm Name: Owner Email:
Owner Name: l . I� uC {'�ULZLOPt \1 2 GEIZ_5 ____ _ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title::
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Region: �"I Aa
//�� ,�,, Phone No:
Integrator: ZQK 5 _
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 01 ❑ Longitude: 0 0 = ` = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non --Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Qaity Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Da 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 ZNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
A No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
12128104 ' Continued

Facility Number: — Date of Inspection N
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: '#
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 5
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes JZ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes ZI No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ,❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) AfR/1jmm (/Ll
13. Soil type(s) 4: '6 /
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
VNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[Z No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[]
Yes
VNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ZNo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
Z No
❑ NA
❑ NE
rJ� � - .ems fl�� G��� /�9����✓�D.
Jf
Reviewer/inspector Name I r r �, . f� ";=6,¢„ Phone:
Reviewer/Inspector Signature: Date:
12/28/04 Continued

Facility Number: —$ Date of Inspection JE 1!
Required Records & Documents
19. Did the facility fail to have Certificate ol'Coverage & Permit readily available? ❑ Yes V1 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 appropirate box. ❑ WCP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
EL No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
V(No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
V1 No
❑ NA
❑ NE
26.
Did the facility tail to have an actively certified operator in charge?
❑ Yes
JZ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
P1 NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
;a No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Z No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
O No
❑ NA
❑ NE
f yes, contact a regional Air Quality representative immediately
31,
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
O No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
;6 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ZNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

(Type of Visit AMompliance Inspection p Operation Review O Lagoon Evaluation I
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number rj
late of Visit: Time:
O Not Operational O Below Threshold
�Oerniitted Certified © Conditionally Certified [3Registered Date Last Operated or Above Threshold: .........................
FarmName: J....... Am......fie, ................................................................. County:....�5!.....................................................
Owner Name:
Mailing Address:
Phone No:
FacilityContact:.............................................................................. Title:....................... Phone No:
Onsite Representative:....C' i%.�r �.... ...11! s ....... K i!j................... Integrator:.... r.l ll ..s................................................
Certified Operator:
Location of Farm:
Operator Certification Number: ..........................................
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 41 Longitude • 4 44
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes INO
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 INO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? [-_]Yes ONo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ANo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ........ ... ..................................».........................................................................................................................................
...........................
Freeboard (inches): qo
12112103 Continued

Facility Number: — Date of Inspection Z
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes INO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or 0 Yes INO
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ YesNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes �No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes /No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type K�fi 1 ,,O 0 kH \1 SM A e.L �42A
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 214o
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 1 No
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? ❑ Yes X.No
15. Does the receiving crop need improvement? ❑ Yes ;Ao
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 attor below ❑ Yes �10
liquid level of lagoon or storage pond with no agitation? '
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes VNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes XNo
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 JNo
Air Quality representative immediately.
.SP.r,: `4 ..:_:it3iwp,•.'ti. h.:.;1.di€'Er .`li t��1.. EtC ..•..9t,Y so'. t'1';!':�'i. ";`"'"-g. ..E�, 2:z.:f.•ir i.,..:. �:--ia.4,3"Jlw;:;l?.'°.i�r:?i"VOIliiE_,�'t'1:•E'+aetE:a:tii„,-Y".i3 .,.-"tN�df 9rsi �.,.4:}b9'!. •",!:'. �i,:, !4# ,re•:I
;Comments (refer,itu quiiiddiiy#):'[Cxplam any YES a0nswers`and/or;.. ' , recominendadons`oi any�other comments tTly, it 111U i „tE�'l,E,,
E
i ,: ..1.E ESti .A_(it•B.r acle2}. 3ti, .�•:J,K' .ii .#.rfry 1 ,,.r �; 5.6[_ i..➢ tLii.E�,. �- }e ..-�`i{i!'.�€4lie ,i{ 'Ii� E=S •. .K¢t..h��:c.w.:•J:...-.:.",•I.k.Jeic4'�il.�li+i..,.f�i,w{..#
USeEdrawings of iaciluy to better} exglam situatsioas .,(use additional pages ss necessary) ❑Field Copy [FinalNotes
. �� E�i S r: `° E E:Fi i FiPP '�':'.6 i �^i �ilf < l€ 1��I �j :5��.: Lh j
o
x}� :.F�k E; tf-!v��•}t�-, f€f .•,ti:t,
a fit-; F._ !t ! ?•v >. h e �.•E£# :..f e.s: i a .ii f(f rri:�F€E 6` - ' ., rt' ,tiliff
' 1,?• fa,i,F3 i ! �`..',ei.; i k •N a'. P #>t a; ��sy' € .�3� uF€-. to+. �sG' ! �,!-
�.I�..�i-E .1•.:�� Y., :. +ser+�-.. aM.Ehx ��ats§L w. .: u�.tn. :[a�E. IEi.S° .ef.tiAin. l._ �. �i�v..�'u.�.�k.v . N .i.. E..ixP. E �iN ,t< : ss�.€ ��. !,� IEh �.�!kil.,i� �i ... _. �€.._._ x �ni�� f. +�. EH � �,.�.����Sh�i14,.Ef
&-CofZ-Ds AND rkafy\
SwD&C .s KgC-e To 13C DOOC-- ''3y A92,
Zoc) Qw%.s.0 CAGIZ9-A1E9 NEED to DO 110 G/MDJ A �L_y
Reviewer/Inspector Name ��
.;V171
22
Reviewer/Inspector Signature: Date: 3 a
12112103 Continued

Facility Number: 3� —
Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ SoiI Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPI)ES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes 4o
❑ Yes
❑ Yes 4IS
❑ Yes <O
❑ Yes <0
❑ Yes <
❑ Yes No
❑ Yes .QJ No
❑ Yes Vo
Yes Wo
❑ Yes
❑ Yes 7140
❑ 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 �To
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine O Complaint O Fallow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3 Date of Visit: 7 d2 Time:
O Not Operational O Below Threshold
M Permitted B Certified [3 Conditionally Certified [3Registered Date Last Operated or Above Threshold: .. ..
5yr....l,.d!'r.i.................................................... County: _.-- .......................... .................
Farm Name:........,���.
OwnerName: •---------------------• -------------------------------------- Phone No: ------------------------------------------ -
Mailing Address:
Facility Contact: ...........................................................Title:.................................. I............ Phone No:
Onsite Representative:._�.!ZQ . fK!ZPK----------- Integrator:_-
.----------_.----_ - - -
Certified Operator: .................................... ............. ......... ........ 1-1. ............. 11.1 ................. Operator Certification Number:.........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude ` 4
Sw' Design Trent Design Current Design' Current
'ne r . „ :Ca acit Pa ulation I?oultry Capacity SPvpulatiori Cattle Ca aci .'Population
A ty' P
❑ Wean to Feeder
i) Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Discharges & Stream Impacts ,
1. Is any discharge observed from any part of the operation? ❑ Yes ikj 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 ANo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes VNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes C*o
Structure I Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier: -- -• ----�-/ .. .............................. .......................... .................. -........ ........................... ...........................
Freeboard (inches): 3 to

Facility Number: 3
Date of Inspection �' Z
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenanr.e/improvement?
S. 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 Analication
uunrinuea
❑ Yes ZNo
❑ Yes 91 No
❑ Yes 9M
❑ Yes KNo
❑ Yes K No
10. Are there any buffers that need maintenance/improvement? ❑ Yes CgNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes E$No
12. Crop type v-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes E[No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ®.No
b) Does the facility need a wettable acre determination? ❑ Yes E7 No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
❑ Yes
SNo
16. Is there a lack of adequate waste application equipment?
[]Yes
&No
Required Records & Documents
17. Fail to have Certificate of Coverage& General Permit or other Permit readily available?
❑ Yes
1ENo
18. Does the facility fail to have all coinpori mts of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
t No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
193 No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
EgNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
P No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
ER No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ER No
24. Does facility require a follow-up visit by same agency?
❑ Yes
® No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
119 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
•dR�4aut4;si6�"+]-'V<idttdi:�:^�ui-n��a- �9wgF' "R ... 7€€NaAHiigi4ia"""'.AhklWie "3'lNdOldiP ;9tli18tli 5�&9i9�k�;?f" fiw+ RAl7CICiICiBisidea�'f���f its ai�l8 v g13 I r�l,r,li
Comments (refer to.questlanl#): Explai"n an YES answerstand/or any:recommendations' oraany other co§mmemm 1 a }l �i �b
"a4°'s i k 64p k !iE'8a he 8 @•... f�97 "°1d 'C $�P . $i�; .�Y R e! !4H �! 'ay."iY ;'r�` 610 INC. t'.3i ���:Hi i�e9.c �!$�:! ..t'. '!4.`I:.IC''; iM ¢°9.i$.'"j 1`14' PAS '::m'�m:,�i$ ,SL. 3 # �Q
.<9 ae!43 . # t I .�. f
Use drawingsaftacility�tojbettesr'expiain situations. use additional pages asnecessary):
t "o , �. �. Field Cop Final Notes
Y
7 � i . t� � €.. 0 O r f .
A� p
-AW -r �vo,-4 dh A�rk:a�ef � drElt ai�pd/t�C 6; `#ooef fd allay, }//oar
,b,xbt
/VeeW to
Nib
Reviewer/Inspector Name FCCI�`Yi '�! {{�� !" ' !, $:/:�/€ ' _�! n, r
{.,?1. F ^.� .H ,"9+> i 11 i:. E
Reviewer/InspectorSignature: Date: 7 OZ

Facility Number: 3l — Date of Inspection Printed on: 7/21/2000
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 gj No
28. Is there any evidence of wind drift during land application? (ix, residue on neighboring vegetation, asphalt, ❑ Yes J5 No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes M No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ® No
31. Do the animals feed storage bins fail to have'appropriate cover? ❑ Yes E9No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes QSNo
Additional Comments and/or Drawings: ,
.&t
J
5/00

Facility Number Date of Visit: ©Time:
Q Not Operational Q Below Threshold
#Permitted p Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
FarmName: ..... Y....��. ............................. County:...... ...^...........................—.. .... I..................
OwnerName: ................................................... ....................................................................Phone No:.....................................................................................:.
FacilityContact:...................................,........................................... Title:................,............................................... Phone No:...................................................
MailingAddress: ............................................................................................................................................................................................................... ..........................
ative: Q 4 �! -g... ................... Integrator: .... R............. .................................................
OnsiteRepresent
.................
Certified Operator; ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Norse Latitude • 4 it Longitude • 4 «
„F Design " Current Design Current:
:Capacity Paoulation, . P99 ry „ s:.Caaacity _Population e
❑ Wean to Feeder
Feeder to Finish
tip
❑ Farrow to Wean
-; ❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Holdin
;of Lagoons
as ! Sollld Traps
❑ Other
TotaISSLW of
❑ Subsurface Drains Present ❑Lagoon Area ❑ Spray Field Area
4
❑ No Liquid Waste Management System
Discharees & 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. It'discharge is observed, what is the estimated flow in gallrnin'?
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 1 Structure 2 Structure 3- Structure 4 Structure 5
Identifier: ...........................................................................................................
Freeboard (inches): 313
5100
❑ Yes ONo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes to No
❑ Yes gNo
❑ Yes J�TNo
Structure 6
Continued on back

"Facilify Number: I — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes &No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 14 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? CKYes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ONo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ONO
Waste APRlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes 014o
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes PgNo
12. Crop type ►�v�L.�� / Soy _
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes CRNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15,
Does the receiving crop need improvement?
Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
to No
Renuired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
NNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
(ie/ WUP, checklists, design, maps, etc.)
❑
ONo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
IgNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
81 No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
XNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
;9No
23,
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
CKNo
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
NrNo
. *'*10 a[i0tls:ot, d0rjCjejR0 •rare hoed• ft1609 Ns' visit; • Y00 w��i �ee�iye 1r�ti i`l� hi'r
corresp6fideike, about this visit.
C0u66etits (refeir to question #). ! Explain.any" YES answers and/or any recommendations or ,any other comments � ' �' :� 1A
Use drawings of facHi to better ez Iaini sitttattons, (use additional pages%S necessary):
w"py� f�
1
Reviewer/Inspector NameT. " r�
Reviewer/Inspector Signature: Date: 5100

Facility Number: — Date of InspectionOP
rCl
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 9No
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 permanent/temporary cover?
❑ Yes �j No
❑ Yes No
❑ Yes No
❑ Yes WNo
❑ Yes gNo
❑ Yes xNo
Additional Comments afl or is ngs; F } I { j•'i . u;i-s 1 i r t 3� la L: 3
--, Pc�-�� o.�p►-ax .. s� c1 rw�,\e �c�.- �.� �G c �,,.e�- � �c.-s �-� .
�-.'fit-�c.,e � -�-�-� �c, 1�►�-�'t' ��� � w- � b���--�'11�� �Gs.
�S�,evr.eQd
J
5/00

1�i�1^tt .„ x, f 4. 4 f I I♦fti �.� .. IC I�_:XF
Divisjon of Water Qua hty I
1. l Y,- 4'.: Y'�E��I. rI +a �+�/
IPA - �
a
f li //
Q_Divisivn of Soil and Water{ Conservat,on
V 1 dp' {'♦ .' k' � I I Y Y 1 w`•� I
A I rl � R�! IS
'
{v)E�'
T �� �w Itl �,� 111 �I II
1 jl 6f ➢' Ni..
�n
��_..:�
d f t i l 'Y
''a'd3�a61 }'il
Type of Visit XCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O(Routine O Complaint O Foliow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: /D ZO p Time: lAD Painted on: 7/21/200t)
Facility Number 3i
Q Not operational Q Below Threshold
Permitted 0 Certified © Conditionally Certified 0 Registered Date bast Operated or Above Threshold: .........................
ye,rh -f Count J
FarmName: 'r.............................I.............................................................................................. y= ? .tl...h................................ .......................
Owner Name: G t'1 v �k ���. 2� ers Phone No:........................................................:..............................
FacilityContact: ........ Title: ................................................................ Phone No:...................................................
MailingAddress: ................... ...................................................................................................................................................................................... ..........................
/� r Integrator: E/^ f0) ++
Onsite Representative: &.0dP.1...( Fib.e.......�2'I�t.....��nn.r�f.,..1......... P..{�.+�`�..�..f.P�.......1..1...........................
Certified Operator : ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �° ��• Longitude �• ��«
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑Dairy
Feeder to Finish aQ Qbl`Q ❑ Non -Layer I I IE] Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder JE1Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons f1 ❑ Subsurface Drains Present ❑ Lagl,nn Area 10 Spray Field Area
Holding Ponds / Solid Traps I ❑ 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-madc''
b. li' discharge is observed. did it reach Water cif the State? (If yes, notify DWQ)
c. 11 disc:har c is observed, what is the estimated flow in gal/inin"?
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?
Su-ut uru I Structure 2 Structure3
Identificr:.................................. ..........................
Freehoard (inches): 3Z
5100
❑ Yes ONo
❑ Yes No
❑ Yes No
n
❑ Yes ONo
❑ Yes I'No
❑ Yes '0No
❑ Spillway ❑ Yes No
Structure 4 Structure 5 Structure 6
Continued on back

Facility Number: S1 --83J`Date of Inspection d D Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
ONo
(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
f, 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
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
$No
11. Is there evidence of over application? ❑ Excessive Pondingg} ❑ PAN ❑ Hydraulic Overload
❑ Yes
RNo
12. Crop type Ern i n.
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
JgNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
ErNo
b) Does the facility need a wettable acre determination?
❑ Yes
j6No
c) This facility is pended for a wettable acre determination?
❑ Yes
6No
15. Does the receiving crop need improvement?
❑ Yes
ffNo .
16. Is there a lack of adequate waste application equipment?
❑ Yes
ONO
Required Records & Documents
t7. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
XNo
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
ZNo
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
['No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ONO
21. Did the facility fail to have a actively certified operator in charge'?
❑ Yes
;gNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit'?
Oe/ discharge, freeboard problems, over application) ❑ Yes 425No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? ❑ Yes ;RNo
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 K No
yiol;aticjris;or deficiencies were noted ditr;itig this;visit' • Y;ott will-t, eceiye do rutthee • : • :
ctirres'D61 idene'e: about: this :visit. : :.:::::::::..:::::::.:::. ' :: • : • :.. • . .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
A,
11. Fe, ry � e 4o Use Fran/ y aYet4eot t,�,kxl c q ha /+ s; s ah IN
Nye = .8e ,lure 4AcJ -newer sec4;arn &/ berriuotr, •r;eld es c iJ�s�csf
IV
Reviewer/Inspector Name '->40 h G'txJ 1111 kl ICt�h ►l r
Reviewer/Inspector Signature: ,t Date: Q -W A9 �_ _ 5100

Facility Number: ;3 j —835 I)ate of Iuspertion 11 4 7D OD Printed on: 7/21/2000
„Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge allor below ❑ Yes �gNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours'? ❑ Yes 5'No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes JoNo
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 XNo
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 '59'No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ONo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes 9 No
Additional Comments and/orDrawings:
i
7
5100

..1
© Division of Soil and Water Conservation Operation Review. ,
n„
1[3.Division of Soil and Water( onservation ., rComphane'e Inspection 1 7t
y A t ® Division -of Water Quality = Compliance Ipe'choii �; ' F ',' it W °� r r'
r . Other Agency- Operation Review )! r
12 Routine 0 Complaint Q Follow-up of DW2 inspection Q Follow -tip of DSWC review Q Other
Facility Number Date of Inspection % ,�
Time of Inspection SCl 24 hr. (hh:mm)
OPermitted © Certified ❑ Conditionally Certified [3 Registered 113 Not Operational Date Last Operated .
FarmName: ................... .:1. ......................................................................... County: ....... bq.jlY........................................ .......................
Owner Name: ... k4�CN......G1Id......... ... M...................................................... Phone No:....��..R.�a...(}t.......................,.,................
FacilityContact: .............................................................................. Title:................................................................ Phone No:
Mailing Address: ��.�1+ ........�AY1 '.x' ,......1�.11�:C....... .y................................ 4 .............,.
` 1 `................ ... �.. A6
Onsite Representative:......`.._.�_1l.LR�S.....;;S�yr:a............................................................. Lttegrator:....,,„,~�....�1!Z?4a!1 .......................... ........
Certified Operator:.......C.v'lt t..........1?.,...................................................... Operator Certification Number:..........................................
Location of Farm:
.............. K..... CAA ...... si f ....7.......... ....�.4 .y...4..-L-t n.i.�xs.......5c� ........ ......5. ...i.5�? E...................................,...........,.......... I........................ A
.........f...................................................................................................... ............. .
Latitude �' �' r--�1• Longitude �� �1 �«
Design Current -Design Cuirrent
Swine Ca acit Po ulation Poultry Capacity Population Cattle
❑ Wean to Feeder
Feeder to Finish
Qp
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non-Dair
❑ Other '
t + Total Design Capacity
1 ;
-TotafSSLW
Design Current -
,apacity Population
c
Number of Lagoons ❑ent Subsurface Drains Pres❑Lagoon Area ❑Spray Feld Area ¢'
_
i
Holding Pands [S
olid Traps ❑ q g y No Liquid Waste Management S stem-°;;
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated au 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? (If yes, notify DWQ) ❑ Yes [A No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Dues 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 P No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 SIrUCLure 5 Structure 6
Identifier:
Freeboard(inches): ............S.1..................................................... .................................... .................................... .................... I.............. ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes TRNo
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? ❑ Yes RNo
(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? CR 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 19 No
Waste Annlication
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
W No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
® No
12.
Crop type Ilo-exmi a
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
99 No
b) Does the facility need a wettable acre determination?
❑ Yes
® No
c) This facility is pended for a wettable acre determination?
❑ Yes
® No
15.
Does the receiving crop need improvement?
❑ Yes
® No
16,
Is there a lack of adequate waste application equipment?
❑ Yes
�RNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
W No
18.
Does the facility fail to have all.components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
❑ Yes
L3�No
19.
Does record keeping need improvement? (iel irrigation, Freeboard, waste analysis & soil sample reports)
❑ Yes
r" No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
O No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes
PNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
F No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
0' �V&i�.boyerho•ilatiOhs:odefeentkWho ed• 00ting this* • YoWitt •reiofutgg t
;cor'res• oiidence' about: this visit.
61 _... -n- - -r1! : s i . `k "' 11 t i I 'I !F P F 1 I . 1 I �. r
Comments (refer to question;#): 'Explain:anyYS!answers and/or any recommendations or, any otter comments',';
Use,drawings of facility, to (fetter explain situati6ns (use:addt4ional pages as necessary) t a ' 1st ', '), Ii
y
C6 �OAvL 44(115 +a ve.y�'.� t0.a oa,� aill e wc.l1. A,
CX" SUbmi 4kt � yyC��- "cy esi 6 Sue 4-�tit�:kwaoa 't r, �o 40�%,A 41 (e
t-oQi�iovvA &t Cer' Pi cF- on () %COV4 4c A6 $r15��}9. yki5 WO(J16 .0*
w
Reviewer/Inspector Name I 1
Reviewer/Inspector Signature: Date: /?,A g
3123/99

.,
Facility Number:
Date of Lispection
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
1P No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
jN 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
�J No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
EP No
32.
Do the flush tanks lack a submerged fill pipe or a pennanent/temporary cover?
❑ Yes
71 No
Additiona omments an or h rawings ,..: .•• • �, , .;� •, ,..
e
3/23/99

J
Date of Inspection
Facility Number - 3 3S
Time of Inspection a7. 24 hr. (hh:mm)
0 Registered aCertified [3 Applied for Permit Ji Permitted 113 Not O erational Date Last Operated:
Farm Name: hM 4.... County: ,�D tom. ......................
OwnerName: ................. C6'r-k ..... ...iJ.! 4,............. 4? GkS.............................. Phone No: ...... 1. ► .Z` 1�..IJi.Qci.........................................
Facility Contact: .............................................................. ... Title: Phone No:
.......................................................................................................................
Mailing Address: . ......
,.�..�4{}....... Aa........................................... ............ .....�1�.t►ll r...1..1J................................ a ]~..
Onsite Representative:.............. qa..... XS.................................................. Integrator:........... ts7+a.........................................................
Certified Operator:............................................................................................................... Operator Certification Number:............................
Location of Farm:
Latitude 000' " Longitude • 4 46
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes No
2. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes fp No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gaVmin?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes No
3. is there evidence of past discharge from any part of the operation? ❑ Yes No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes (ANo
S. Does any part of the waste management system (other than lagoons/holding ponds) require Q9 Yes ❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 0 No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes 94 No
7/25/97

e Facility Number: 3 —g
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (LagoonsZolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I
Identifier:
Freeboard (ft): ..............&
Structure 2
.................................
10. Is seepage observed from any of the structures?
Structure 3
Structure 4 Structure 5
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15 Crop type'(lp'I1llJ,.
❑ Yes PJ No
❑ Yes (9 No
Structure 6
❑ Yes No
❑ Yes No
Yes ❑ No
❑ Yes q No
❑ Yes 0 No
..................... ......+................................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
No.vialations,or. deficiencies.rvere-noted-duringthis:visit:-:Y.ou:rvill receive.Ro-further,:
..•correspQndei�ce,alioutt�tis:visit:•:•:�,�:�;��•: .•:•..-.:�: ..�: ,-.�:. .:::�: :�:.: .•
❑ Yes 0 No
❑ Yes V] No
K Yes ❑ No
❑ Yes P No
[4 Yes ❑ No
❑ Yes J] No
Yes ❑ No
❑ Yes P No
Yes ❑ No
Yes ❑ No

Im Routine O Complaint O Follow-up of DWO inspection O Follow-un of DSWC review O Other I
Date of Inspection /
Facility Number Time of Inspection ; Q 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ez:1.25 for 1 hr 15 min)) Spent on Review
[Certified ❑ Permitted 1 or Inspection includes travel andprocessing)
❑1NotryOperatienal Date Last Operated: .........................................._..........................�............................................................................
FarmName: .......]l.&i.A).y............ ��p��.... .................................................... County:...,.j._.)U.P..b.!i,�..............._...........................
Land Owner Na/me: G. ..............K&C,.».......................... ...... Phone No:.....fl ... Z .... l ..........................
Facility Conctact:.. ...r�,r� .-..-.��`' �.!2:7.................. Title:..Q.4�.? ... .............. Phone No:
Mailing Address: ..... 1.14.0....... 3k.k1.VL..f.M.......... ...................................1..0 LI S.......................
Onsite Representative: Sr'N! 4GE.... �v.E(55................................._....._ Integrator:....5_60W/�g......... ............................. �........ ...
Certified Operator: ..,,.L2........................................�...�Cx.�2r�s.......................... Operator Certification Number:..?_.1.9z W...............
Location of Farm:
Latitude ©• �4 ©" Longitude ®• ®• ®"
Type of Operation and Design Capacity
a «f
Design , Current a I)esign� Current, � � DesiSiavaciyft6ul
Current
SwioeZ,_ E, x +r
Ca aci Po tian Poultry , ahon Cattle ; .,Ca aPa ulatton .F.
❑ Wean to Feeder` 1❑ Layer :EQNon-r
a'
Feeder to Finish yDO Gi, Non- La er irvi
Farrow to Wean05
'�> ;
�F k�• a a ,�` �� 3:
Farrow to Feeder k &m Totau es12W3_ paVIores 7700
Farrow to Finish.a
�❑ other a .Total S51;W`6�&�
a
j F rW k /d?' S Mg t `nab, 6 x i. S`; 's '.:' �5 ..................
x. f
i`:'� P W _..... - ,S
Nuber ofs'La oonsrl�Hioldin Pondsvi.1/ � ❑Subsurface Drains Present
m:
❑.js
PA
Lagoon Area ❑Spray Field Area
General
1. Are there any buffers that need maintenance/improvement? B-Ves ❑ No
2. Is any discharge observed from any part of the operation? ❑ Yes [36
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes B'Ro
b. If diseharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes B' o
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes M-No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ONO
4. Were there any adverse impacts to the waters of the State other than from a discharge? [:]Yes UTo
5. Does any part of the waste management system (other than lagoons/holding ponds) require U'Yes ❑ No
4/30/97 maintenancelimprovement? Continued on back

l Facility Number: .3 1.......—1935�. 7
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes R o
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structure5fliagoons and/grdolling Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure I Structure 2 Structure 3
......�1�...... ............................ ............................
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes M-Ko
❑ Yes &No
Structure 5 Structure 6
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste plitin
14. Is there physical evidence of over application?
Of in excess of WMP, or runoff entering waters of the State, notify DWQ)
.`?15. Crop type aterr 4N 5.... ....�. ..1�1.......................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes (J,I�o
@'!res ❑ No
L! Yes [:IN,)
❑ Yes E 'Na
❑ Yes Q'o
es ❑ No
❑ Yes 2 No
GKes ❑ No
('Yes ❑ No
Bales ❑ No
❑ Yes A10
❑ Yes ® 1KO
❑ Yes 275No
❑ Yes Rio
Comments„(refer to, question #) Explain ar y YES answers'and/or any recommendations'or'any, other comments
Use.drawingsof facility to'tietter explain situations: (use'addrtional pages as necessary)
:,.. .
:>
44 ADS Q
Q ✓`✓ , g c a�sJh. �Tj �.� rJ�, _ 5 C . *XP-T t C44 i>tP 171 My t WA5
5-/ - � M rh�� �2oG- - w� f� w3�-�'+G�r✓Cy -,-Y� -5-s4e.6I.S L , Ace eee,Lc[
Calf-k cep AISAP, VVUL t.,&U4 f%S A &,1>v 2Act f'..n,blry
r� 5" , & a 7 M �,� v �tiP�-[-. L �1G-awn �, L � 5 ri a � w� ,
a
Reviewer/Inspector Name 7f � . ��'
Reviewer/Inspector Signature: Date: T/i Z2
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

�-F YSk ', ",e/ ❑ 3 __ Y'x :.1 4 .+.� nY'^�' '.26$
DS1NC Anrmal Fe6d16 perairon R'e.View9 `}g
� �, � � ' ! ,., x �+ u ,s -�3 ,C' '""' � �"^�,��'� y' x ,� x ��n j, ,"y � ¢E u g y. Ss• 3 u' >� x ���,.'��,� •t+a yt � ;ro
- � Date of Inspection ,ro Mer off `'',Inspection
Faclltty�Nutnber ,
.., Use 24 hr.�time'
Farm Status: ........._� .. _........... G !` `.... ❑Routine" I&Com saint ❑ Follow-u
Farm Name:. f-AS.Abq......,x1k5................... ......... ..._..... � ....__.. _. County:.... .1 [ ..............................
Owner Name: 111a ...J.... . _ !s phone Na: ......_...._...... ............... ......... .... .......
Mailing Address:
Onsite representative: 6__1Z2A__... .fir ...� _...._ Integrator: � 1�! jS ..... _... ... ._...
Certified Operator Name: .�'.q`,�.._.... _. .. _�......_ ...r _.. _ ... ...... .
Location of Farm: -
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
Latitude �" p? " Longitude
[Not OEeratfonal Date Last Operated:
Type of Operation and Design Capacity
"' '"� w€F, � urn t ,� .� �� ^-
Swirfe .$ Number«:. Pou.Itr�Y,Nirm6es.; _ att.le_.�= Number
Wean to Feeder L
aver Dairy4.5
12 Feeder to Finish a � � Beef
Farrow to Wean
F oC"�R xF.cµ ri. oyN +w: —' ' '".c44. 1;•Xfr�+v`�,.. xi.n,
Farrow to Finish ❑Other Type of Livestock1001
a�b
Nfrnbef L"ag ansaldngPortds 1 ��❑Subsurface Drains Presen#
•
�. F�' � ��� � ��,��" k'"����.���: � �:�� ❑ � ❑Spray Reid Area
Lagoon Area
General
1. Are there any buffers that need maintenance/improvement?
Yes
❑ No
2. Is any discharge observed from any part of the operation?
❑ Yes
® No
a. If discharge is observed, was the conveyance man-made?
❑ Yes
%
b, If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
® No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
® IVo
4. Was there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
[0 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
® Yes
❑ No
mai ntenance/improvement?
Continued
on back

6. Is facility not in compliance with any applicable setback criteria? ❑ Yes No
i 7, Did the facility fail to have a certified operator in responsible charge (if inspection after 1/1/97)? [:]Yes ®No
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes 21 No
Structures {Lagoons and/or Holding Pandsl
9. Is structural freeboard less than adequate? ❑ Yes ❑ No
Freeboard (ft): Lagoon 1 Lagoon 2 Lagoon 3 Lagoon 4
... .,._.......
�.. _.._ .. . ' _....._...._ W. _ ..........
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
Immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adquate markers to identify start and stop pumping levels?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type . .._......._ _ _._..........___�_ . _ _... .
16. Do the active crops differ with those designated in the Animal Waste Management Plan?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the cover crop need improvement?
19. Is there a lack of available irrigation equipment?
For Certified Facilities Oniv
20. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
21. Does the facility fail to comply with the Animal Waste Management flan in any way?
22. Does record keeping need improvement?
23. Does facility require a follow-up visit by same agency?
24. Did Reviewer/Inspector fail to discuss review/inspection with owner or operator in charge?
❑ Yes ® No
❑ Yes [A Na
❑ Yes ® Na
❑ Yes RJ No
❑ Yes ®' No -
❑ Yes ® No
❑ Yes R1 %
❑ Yes [Z No
❑ Yes m No
❑ Yes (9 No
❑ Yes ® No
❑ Yes ® No
❑ Yes No
❑ Yes ® No
i
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�•,ei y �Y =� £^i4., etl �yS H : 2, � �. p i rw,�- 3 4A.'S� ��95 ! 3Y "1 aL 'h "1 , S •vQ Nv F � ( _
Revtwerllnspector
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 11/14/96

N. C. DIVISION OF ENVIRONMENTAL MANAGEMENT
COMPLAINT/EMERGENCY REPORT FORM
WILMINGTON REGIONAL OFFICE
Received by:_�Q 'ice H C� „� err I- 1?= Date/Tim:
agency: cmplaint: County: ' ., lAl
Report Received 'S
Agency: i� C� l �J Phone No. ? *j- 3'T o )
Ccuplainant: •AnlDtz2
Address: /V121 Phone No.
Ccuplaint or Incident:_�A
Time and Date Oiccu=ed: Um. 1,9YAA, 1 _ /G
Location of Area Affected:�sn�ii S t%L 1���!{1f1%1i/n �/•
r v
Surface Waters Involved: Groundwater Involved: Other:
Other Agencies/Sections Notified:
Investigation Details: 0 U t /` c 4-0 C-1
Investigator:
w'
�S Date:
EPA Region IV (404)3474M2
Pesticides 733-3556
Emergency Management 733-3867
WtTd c Resources 733-7291
Solid and Hazardous Waste 733-2178
Marine Fisheries 726-7021
Water Supply Branch 733-2321
U.S. Coast Guard MSO 343.4881
127 Cardinal Drive Extension, Wilmington. N.C. 28405-3845 • Telephone [phone] • Fax [phone]
An Equal Opportunity Affirmative Action Employer
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