310026_INSPECTIONS_20171231

NORTH CAROLINA �
Department of Environmental Qua'

- r Division oftWater Resources ___ i E ` " `
Facility Number 3 % 2 ; O Drvision of Soil and Water•'Conservahon
Type of Visit: ompliance Inspection 0 Operati eview 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint ollow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Tittle_:
Onsite Representative:
Certified Operator:
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current , - Design €Current Design Current
Swore €g €Capgety Pp Wet Poultry Capacity Pop ;Cattle CapacityPop ;,.
Wean to Finish ILayer
an to Feeder Non -La er
Feeder to Finish .0 OD i 1
3 Farrow to Wean °s s� Mid Current�
Farrow to Feeder ,. © Poultry` Ca'aci9Po
Farrow to Finish I,.
Gilts
Boars y }� $b
Other ;
.,.,
Other
Lavers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Dai Cow
Dairy Calf
Dairy Heifer
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Caw
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 ofthe State? (Ifyes, notify DWR)
❑ Yes
❑ No ❑ NA
E] NE
- c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
NA
ro[o]
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/1015 Continued

Facili Number: - Z, Date of Ins ection:
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): 2 N 3% 1 _
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?
�es❑ 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 rest, 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 1�To ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require es ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Ej 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?
15. Does the receiving crop and/or land application site need improvement?
l6. 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.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
No
[ -'rees
❑ YesEr-No
❑ No
❑ Yes
No
❑ Yes
eNo
❑ NA ❑ NE
❑ NA [] NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes ❑ No ❑ NA giE
❑ Yes ❑ No ❑ NA
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ONE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis D Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ No ❑ NA NE
Page 2 of 3 21412015 Continued

m
Facili Number: jDateof Inspection: 7 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 ❑ 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 fTNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA [GEC
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?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application).
3 1. 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 ReviewerlInspector fail to discuss reviewlinspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA
❑ NE
❑ Yes��NZoE]
NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
❑ Yes
/ N NA
❑ NE
❑ Yes
No [] NA
❑ NE
Yes
❑ No ❑ NA
NE
f
/it L_4t Z- 1 c- t"
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c ft 6- (2 0,C+,a, I f%4 I e-% IVO. V,
Reviewer/Inspector Name: 0 AEI j tk(7. Phone:
Reviewer/Inspector Signature: Date: 7 7
Page 3 of 3 21412015

ofWaferResources .. ,
��+" x -s,,` 'P �.
Faa ty'Number - Dlrnslon"of SOil and �atBr�COtl5ervatton' e M,r
Ottier Age.Cyi.. :.E a'u"" y�.,. �;.;'n"++�:'a""yvw:. ^"sa _!tao-". t.:. >c,z•
Type of Visit: 00tompliance Inspection 0 Oper n Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: y r7 Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: /� /Title: Phone:
Onsite Representative: L f 6 r a* �'- Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
_ ., M Desagn Current Design Current Design Current
5wme - Capacrty Pop WetgPoultry "Capacity P,op s� C%le Capacity
-, �
Wean to Finish Layer Dairy Cow
Wean to Feeder Non -Layer I IDairy Calf
la eeder to Finish - o i'6 � � , « � Dairy Heifer
Farrow to Wean" Design @uire'nt - Cow
Farrow to Feeder„ -J-D _ : Roult ; , _Ca acIaPa"'y -Dairy
Farrow to Finish La ers Beef Stocker
Gilts Non -La ers Beef Feeder
Boars Pullets jBeef Brood Cow
Turkeys
" F
Other: - Turkey Poults
'.` Other Other9.
_ .:. . ; .e .,_._...,
a
---
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
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
610
❑ NA
❑ NF
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? 0 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): r`
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 Ca"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 TNo
o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2<0 ❑ 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? Ye No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? Yes ❑ No ❑ NA rN
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ No ❑ NA rN
18. Is there a lack of property operating waste application equipment? ❑ Yes ❑ No ❑ NA
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA �NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
❑ No
❑ NA �E
the appropriate box.
❑WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements
❑Other:
E
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[] No
❑ NA
❑ 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
[] No
❑ NAB
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
Page 2 of 3
21412015 Continued

Facili Number: i- 'Z, Date of Ins ection: 17
Did -the facility fail to calibrate waste application equipment as required by the permit?
[-]Yes
[:]No ❑ NA
[/] E
t2+
i
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[] Yes
[] No ❑ NA
� E
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
❑ No ❑ NA
[y1E
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No <A
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
]o ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ 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
❑ NA
P
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No ❑ NA
011NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
to ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑Yes
No ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
Yes
❑ No ❑ NA
❑ NE
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Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
✓ 1 tom" �—{. �� Phone: 710 0 7l 6 73p�
Date: : `//_/
21412015

ac>ility"Number` 1
Type of Visit: Q Com iance Inspection U Operation Review Q Structure Evaluation U Technical Assistance
Reason for Visit: g Routine O Complaint O Follow-up p Referral O Emergency O Other p Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: < Title: Phone:
Onsite Representative: J [ 1 I ro /w^ f /toy Integrator•
Certified Operator: Certification Number: 149
O 2-
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
*.. Dest n Current : Desi n
Current_ _-
Desi Current
SwmeCapacxty,Pop. Wet'Poultry Capacity
Pop
Cattle Capacity Pop. '
Layer
`
DairyCow
Non -La er
;, 4.y.
f �-
DairyCalf
Dai Heifer
" Design
C►urren"t
D Cow
D , foul tin' i
$o
Non -Dairy
Layers
Beef Stocker
Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
Turkeys
Other,
TurkeyPoults
,-
,pOther
Other
Wean to Finish
an to Feeder
Feeder to Finish
�
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
P -a
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
[] No ❑ NA
N
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[/]
NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than. from a discharge?
Page I of 3 2/4/20I5 Continued

JiFieffity Number: - Date of Inspection: 2 Z Zf
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S
Structure 2 Structure 3
Z
2 &-
Structure 4 Structure 5
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?
❑No ❑NA ❑NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or enviro ental threat, notify DWR
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes rNo❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ffNo ❑ 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
❑ 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
No [] NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[� ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
L_I too ❑ NA
❑ NE
Rea uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
c ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�rNo ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps 0 Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
ElWaste Application ❑ Weekly Freeboard ❑ Waste Analysis oil Analysis [] Waste Transfers Bather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall InspectioFN
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes El 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

r
Fncili Number: 7 1- Date of Inspection: Z 2
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
6--Yes
❑ No
❑ NA ❑ NE
the a ropnate 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?
es ❑ No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Vo
❑ 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
ZfNo
❑ 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
eNo
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
Nor
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were CAWMP?
Yes
NA NE
any additional problems noted which cause non-compliance of the permit or
❑
L`J t�
❑ ❑
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Ye
No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
Yes
[XNo
❑ NA ❑ NE
Comments refer to u- tion`�# E_xplatn auffES aiii<swersyand/orriauy additranal recommendations:or-any othercomments°
( q -
Use drawtngsY.of facility fo Better explain situations.(asevatiditional;pages as necessary).
r i� ti 1 `7.✓'n G[' ( �^-� �GQ � ! C( �a ,.mot �j � Inr � p n S i r� •
4
ye
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�-� O i� � a-lL— �nw- ^� �•L� �
Reviewer/Inspector Name:
Reviewer/Inspector Signatut
Page 3 of 3
Phone:
Date: 3 ,Nt -7
214,12015

I
ac�lify Number"
(Type of Visit: epXompfiance Inspection O Operation Review Wtructure Evaluation O Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: z7, Arrival Time: ® Departure Time: l 9 County:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Certification Number:
Longitude:
Region:
"t,� Des gnu Current ` Design Current
Design Current
,�
Somme �"Capac�tyPop Wet Pouttry Capacity Pop.
Cattle Capacity Pop.
AYµ
s Wean to Finish,
Wean to Feeder
Feeder to Finish"'
Dairy Heifer
31.' Farrow to Wean
es ign Current
Dry Cow
Farrow to Feeder,
DP�oultCa acE_ P,o ::
Non -Dairy
p: Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
beef Brood Cow
Turkeys
Other
;+ Turkey Poults
x' Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
1.�'r"�
❑ 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
Z. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
_
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
E<�o
,❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

� s
FgLORty Number, - Date of inspection: /rJ
- v
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? 0 Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: k - Z'
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): - _� Z _
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes O 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 (; "o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? [n"Yes 0 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Ej 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 io ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes No ❑ NA ICJ E
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [ <o ❑ NA ❑/ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑.Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA EINE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ No ❑ NA
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 0 NA TE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA dNE
❑ 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 ❑ No ❑ NA
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA NE
Page 2 of 3 21412015 Continued

jFacEity Number: - Date of Inspection: 2 13
lT
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
OINE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑ No
❑ NA
B
❑'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 Iagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
[:]No
❑ NA
NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
❑ NA
[ wn
Other Issues
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[�J'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
Oo
❑ 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
M No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
J
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
%[ N ] QNA
�❑
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑/No
NA
❑ NE
IV t- 09 / ':6,- �-- !J k✓ 6 �0 r e gov `� (Gc )/ +� �1 /51'1 e •-mac. n a/2j
0" rQ SlAy t..c S Ste- dC o �.�t c .— i ., �oi �►,.�IC . u �! Ivc / �ti h 1-d rkj D D �-
J� 6e. � D f
7, 1' �< V« (C'L
C.T0 cr- r 7 7'kr S L
/C Gn-�- 0 -61-1,)ur'�.�� S'^[a s��v �} I + YC f
G f I-{°
' @ 1 L 4 Tk : f SY1J 4 +Q� �jc t/cYT
Reviewer/Inspector Name: V I` `t t l Phone: t) -7 7 D y
Reviewer/inspector Signature: _ r--~ ��VI Date: Z o/7
Page 3 of 3 2/4,615

ivision of Water Resources
Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: (?Itomoiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
i2eason for Visit: aRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: L%/ Arrival Time: 10 Departure Time: 0 39 County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: JkZ''f / 5 f�c ` r S� Ll- Ike a h Integrator:
Certified Operator: Certification Number: 1 n ZZ t( f
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle
Wean to Finish
)yLan to Feeder
Feeder to Finish • SG t Q-v-o
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
La er
Non -La er
Design Current
Dry Poultry Capacity Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Design Current
Capacity Pop.
DaiEy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes �P ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
E:TNo
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facili _ Number: 26 Date of inspection: 7 b
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? es o ❑ NA 0 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: Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): `♦� 57 z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes E o ❑ 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 D<o ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes [] ❑ 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 � "o ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes E] No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ 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 I!i l"u ❑ NA ❑ NE
t5. Does the receiving crop and/or land application site need improvement? 0 Yes E(No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [: "10 ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
dNo
❑ 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
0' NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
F5No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other•
21. D record keeping need improvement? if yes, check t ppropriate 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 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

Faciti Number: Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ETNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes [:]No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes f a�Io ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes Mo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ,E N ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative? [] Yes K� "o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 0'90❑ 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-pagesas necessary).
r"-' Qa� r`( {%Pr..[ rl {„ter �� � �.,. /r r�r. S� r[ 1:• r1,� ,
Tn r-crn
A/ C / Gr► G �LV M I►-+.�. a� F% ns�xn f� • o /f 9 ✓R f $ k�L rJv- rr f.a l P ••^7
4--• t } rr �� !�'> r1 /'�'►�� : ��. .. [ ^ f l� Iol" r fr , ✓^ g •. n t � ` I ' r ] , A,
Cp ...� S � G � 1 4 /�.� .r � � 9ao✓► N ! s r� !�1 '� / L •� � • Z . � d C b�s+�cl 1�.4 S ,
1 4
c C CI ¢ ltC/'n-�.{* v ul •�a b� `jz 'r .�..c 1't s 1F� f l�G' C-
�� cl JGn P0- - d K S t—e 41 A r Ca o �� 1, 1►.e a l C nn ��r,
5�•�( C/�e�• ?� f S6a, �� 3r��e n�� rde s..... M .fd
�On��e Fs� f��v`ri'�ont /� .�• �v �o�nr.� 1a Co... �►.�•f�.r f� L, >� A1�..tq
.4R d /✓4 Q/* 5r1 `r�C'''•tk� 1-3 5.I 1 �� �•--� Sf}� N w.,a [yS. s/ S e•• �� �>< nay.
PWA( T`�f i�QS O-f lv.-4,L-/ ev-9 drLl '1 +�'/r7�[�-t •rti (lam
r^p f l o e, S n'r (f C D.•....s.r..i t T ''�� f V /� Sa .'' r �' r
i.ivt girSVo,.S mil` 5.�.��..�r1S 1a L.s� �,��I/�Z�r/� �� s �� /(��•�^�
��R L rs rt�.P(c+v. �' sr'�e /1L �- 0� G w � ?A� ` �;v�(far►
�,,.. i •+ nc L #� t,�..�y 6.rc f . SF/Y�/ 1 p �}� le f r4- n �. ►1�
so r.r. b�� �AIr�A' �r�n, {'i�GOrrs •^••fed S^1ploG.n-,,..+� !w� �++- r S r►✓�.-�
iti •f Lii4 e� �,.+ �� pvvAgpk -kC-1n
Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 o, f 3
Ou Lo�.1 Po -e (.
Phone
�// Date:
79�
7Z �6
21412014

3
2
(Type of Visit: ('Compliance Inspection U Opera ' n Review U Structure Evaluation U Technical Assistance I
Reason for Visit: O Routine O Complaint Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: z 3 + rrival Time: ' o Departure Time: ® County:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: / 1 Title:
Onsite Representative: _ S h.e �� �{ SG h (%k C At, Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Discharees and Stream Imnaets
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Region:
1. Is any discharge observed from any part of the operation?
❑ Yes
1 1qo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[] No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

c
[Facility Number: - (, Date of Inspection: 1 p
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes ❑✓'�o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 1 °\ `� 2 7
Observed Freeboard (in): /5-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E-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 e_ TC o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
es ❑ 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 El No
❑ NA
❑ NE
maintenance or im rovement?
p
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?
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
dNo
❑ NA
❑ NE
Yes
✓ No
❑ NA
[D NE
❑ Yes
❑ No
❑ NA
-E]-'ME
[:]Yes [:]No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑'NE
❑ Yes ❑ No ❑ NA [I --NE
❑ Yes []No ❑ NA D-NE
❑WUP ❑Checklists [:]Design [:]maps [:]Lease Agreements []Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. []Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [:)No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA E3-NE
❑ Weather Code
❑ Sludge Survey
[DNA Eytq'E
❑ NA FJ_NE
Page 2 of 3 . 21412014 Continued

Facifi Number: - Date of inspection: 4 ZQ&34Lj5
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
OINE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑ No
❑ NA
O<E
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
ET�E
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
E3 A
❑ 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 ❑ NA H_�E
❑ Yes No ❑ NA ❑ NE
❑ Yes EDNo [DNA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes EfjNo ❑ NA
❑ Application Field ❑ Lagoor►/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Ea<o ❑ NA
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes <No ❑ NA
34. Does the facility require a follow-up visit by the same agency? ❑ Yes �No❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
Comments (rfer, to'questionµ #):'E"
x_m m an YES answers an or°any`additiona ;recommen ations:ar any other comments.
Use drawings of facility to t titter explain situations (use additional P g'es as necessary).'
,.
0191 L,­ ► � L-c r�� , 4 ,--, �� s4
7 / J'K5 I 1 ��� h -vu G�,C
-x j�G ►rs i -fa c I� o�sc ,'r,r►.e�«�F y
t /
CfnrKn,ti,, �Gu �� iv! �� WZ A IV c 1)
Reviewer/Inspector Name: OI- ✓,
Reviewer/Inspector Signature:
Page 3 of 3
r
Phone: W2 74 7 30
Date: ''/ Z-7�-5:,—
21412015

('Division of Water Resources
Facility Number I� - L� O Division of Soil and Water Conservation
p Other Agency
Type of Visit: ompliance Inspection O Op"era on Review Q Structure Evaluation O Technical Assistance
Reason for Visit: O Routine O Complaint Follow-up Q Referral Q Emergency O Other O Denied Access
Date of Visit: / Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: II Title:
Onsite Representative: CST +j G h P-A b a C 11
Certified Operator:
Back-up Operator:
Phone: _
Integrator:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current
Dry Poultry Capacity Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non-Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
No
1. Is any discharge observed from any part of the operation?
❑ Yes
E
❑ 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
D 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
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: Z. - - Z Date of Inspection: J
"Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E]*No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: t Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2 Q 2-7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes fNo ❑ 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 e'lgo ❑ NA ❑ NE
8. Do any of the structures 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 �o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA E]�NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ED'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 0 NE
15. Does the receiving crop and/or land application site need improvement?
2res
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
QNE
acres determination?
1❑
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
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,
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA - TE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ L'ease 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 I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? D Yes [] No ❑ NA a
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [:]No ❑ NA rN_E'
Page 2 of 3 21412015 Continued

F li j,Vumher: - Z Date of Ins ection:
V24. id the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA ED-E
Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA 01qV
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? Yes [:]No 0 NA WG
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [:]No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify'the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [:]No ❑ NA Q NE
❑ Yes
10
❑ NA
❑ NE
❑ Yes
❑ NA
[:]Yes [:]No ❑ NA EINE
❑ Yes
[]"No
❑ NA
❑ NE
❑Yes
❑NA
❑NE
[—]Yes
rNo
[] NA
❑ NE
Comments (refer to question #) Explain any YES_answers and/or any additional,recommendations or anyeother, comments
Use drawings of facility to'better.eitplain situations use additional pages as necessary)., w
e�ee rye Si�'� i u ap % I �Cb�wL` �t,r,
evf
-�P
(" y
e�QG z(215-COV-4
�9
Reviewer/Inspector Name: VA PI( p9G—E 1 )
Reviewer/Inspector Signature:
Page 3 of 3
Phone: i 1 !9 7 f � 7.3 ON
Date:Z/
214,12015

Division,of Water Quality
Facrlity Number , ©- 0Division'of.Soil and. Water, Conservation
0 Other Agency
Type of Visit; 0 Com lance Inspection Operation Review 0 Structure Evaluation 0 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: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: II r L Title:
Onsite Representative: tom' I b k. e
Certified Operator:
Back-up Operator:
Location of Farm:
Swine ..
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Wean to Finish
Wean to Feeder
Feeder to Finish
t) GO
-7jWO
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current
Dry Poultry Canacity Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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?
Longitude:
Design Current ry '-k
Cattle Capacity , Pop
Dairy Cow
Dairy Calf
Dairy Heifer
Cow
_Dry
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes El -No, ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[—]Yes ❑ No [DNA ❑ NE
[:]Yes ff No ❑ NA ❑ NE
❑ Yes FE"No ❑ NA ❑ NE
0
Page 1 of 3 21412011 Continued

Facili Number: 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 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): Z 7
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Q' io ❑ 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 QNo DNA ❑ 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? Ell"Y' es ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes alfYo ❑ 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 E11<0 ❑ 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 0 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
BNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El"Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
dNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
]n No
[] NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
E!�No
❑ NA
❑ NE
Rectuired 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 �PNo DNA ❑ 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 CE Gop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspectio;/No
'❑ 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 �No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facie Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? El"Yes ❑ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check v 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? C]"re s [-]No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [:]No C3 NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
fD 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
E]'hio
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
['No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
.11
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
eNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E j o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does facility by
s
Vyy-S
iio
❑ NA
NA
❑ NE
NE
the require afollow-up visit the same agency?
❑
❑
Comments (refer to question.#) Explain any YES$answers; andlvr,any additional eMcommendations or any other co�amenisS
[Ise;dra"wingsif facility�to;tietter explalnsituations,(use; additional°pages asrnecessary)�"` =' -»: '� - �`� �'-''�- ��`�
(2' 1 2_ �p a fit !� I�� C(
AJj ZL-e e hvj.
�rl roll o+r- , l P I n 3 1 f)
t�
OP' -q f it lr/4
(�.e4_L/a fl���t .� �s/u� � Scar' �..�°^ 30'(C' l's
Reviewer/Inspector Name: 0a- V1G Y9 it 1
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 0 796 7.?4,/'Y
Date:
2/4/2014

UDivision of Water Resources
Facility Number - Z(Q 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Compliance Inspection n Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral (( Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: FA= County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: ! ++ (Title:
Onsite Representative: S �L 1 t�` SA Ma l Da c k Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Latitude:
Phone:
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other'
Other
Design Current
Dry Poultry Capacity Pon.
Layers
Non -Layers
Pullets
Turkeys
.Turkey Poults
Other
Dischary-es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes (j No , ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: 31- Z Date of Inspection: O
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: 204
Spillway?:
Designed Freeboard (in): 11- S
Observed Freeboard (in): 1 sit
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes [alo ❑ NA
❑ NE '
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes E! !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 envir nmental 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 6o ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes El"No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
dNo
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA �NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑ No
❑ Yes 0 No
❑ NA [�N E
❑ NA F2/NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA E7 NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA FrNE
the appropriate box.
❑ WUP [:]Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
2 L 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 ❑ No ❑ NA [: N
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [:]No ❑ NA
Page 2 of 3 21412015 Continued

• Facility Number: jDate of Inspection: 1 Q
24..Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
E
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑ No
❑ NA
E<E
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
ZNE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
[/] NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No ❑ NA ENE
❑ Yes ❑ No ❑ NA U NE
❑ Yes o ❑ NA ❑ NE
❑ Yes [n"No ❑ NA ❑ NE
❑ Yes E9 o
Vs No
s [:]No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #):'-Explain any -YES AMWers and/or any additional recomiuendations,or any other'comments rt
Use drawings of facili �Mto better -ex lain situ g ty p ahons: (use additional pages: as necessa ry)::
ReI�'{Lr� n�cc1{/a�l by rr,, yr !•-L�Sr6�aiC a6o►, ih:gti -F"_�lw�.--�,
4 k a.'.-+ e I JCS �,r rr r l�� �� c • w• oc . �. �l �r' o n,
Nor{. ex 9 Q h/ ' / SK F c. a 115 �/ G S� f a., c 4--re 4e , ,.
f 1 ' fi ix'ven • /JP
-l` LAy In �j� L �i✓stl /L�i� Z- tc\T�-c� �V t/ W- 0"C-7,._< S f-phen'
dklw
30 dnI PDX 6,r- L-\3 2�_� fl- 4 r /",9 /.
�+ j_ j rr L / r
#7' C OA 1C' �oX 9h pa4`Slcc o T' `tay I►aH�G /fl !T j,
Q,� fn�Cs is feI\ ��Lr� . (a�ly<Jlt_ P► J
'�ij 5-, (KtI`' 4'� � e f j S.
/Vo V io of10141.
Reviewer/inspector Name: Y)lt —/C
Reviewer/Inspector Signature:
Page 3 of 3
,._e ((
Phone: I t o 7V rwy
Date: to/?//
21412015

(_'Division of Water Resources
Facility Number ®- 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: ZrCoMpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint ollow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: S Arrival Time: L Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: j Title:
Onsite Representative: !j �-C �t �( P C_ 5 G � n^h :x. L Integrator:
Phone:
Certified Operator: Certification Number:
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
Boars
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Pullets
Other
Poults
Design Current
Discharges and Stream Im acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
DaiEZ Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes (oNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes No ❑NA ❑NE
[]Yes ❑ No
❑ Yes No
❑ Yes io
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412015 Continued

Facili Number: '1 I Date of Inspection:
aste Collection & Treatment 11
4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ETYes ❑ 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: f7Coeyl� (�a
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [n"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 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 [3"No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes To ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect la application? If yes, check the appropriate box below. El"Yes ❑ No ❑ NA ❑ NE
❑ Excessive Pond 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 El"No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes rNo
N, ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes [7�No , ❑ NA ❑ NE
❑ Yes rNo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA E�<IE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA TE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1 ° Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? []Yes ❑ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes [:]No
❑ NA lam"'" r'
❑ Weather Code
❑ Sludge Survey
❑ NA O<E .
[] NA NE
Page 2 of 3 21412014 Continued

[Facility Number: - -24 Date of Inspection: 25
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes o ❑ NAE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? 0 Yes 0 No lA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 0 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
❑ Yes ❑ No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes Vo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes &N"o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No ❑ NA ❑ NE
Comments (refer to question #) yExplam any YES answers, and/or;anyraddrtional: recommendations orany other cortiments: `a
Use drawings;of_faciliiy;to,better explain situations (use"additiona.hpages as necessary)
C 0 �y .� Fot 57 n T C
�rl►.t C K f- S,r is r q
Sle a^e tG��rc.��+4n
J , xL C"e Jcll a¢r�SS
C"
c 4< 4 e .--v i.-, S IC- ('CA n n E "%q
Ft P 1,15
Sun►P��'S / �hOhr{� !'�c�} ��ayyrr/ -1�e►+ Lan 4r.ec,
f /
S f -a b C fA n G � ,� '} I e .6,4 , S � � � 1 � � 1 q.r,` a :+1 pr"P eAy
Li-11e j NC PAC J7r, GFc5','j t //.
✓l�^� �u� [� a r�. 0. 0. -A, A'-i F n f et en
_� V✓ i � � , p �- �T'a ��^vr Sar �.n �. 5 %o�✓ n%c 'Fta rF5/$� ��/r
Reviewer/Inspector Name: tj,.. A ✓ r 0 Fn -4-,(
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �j Q 7 Tea
Date:
21412015

W Division
a .
` Facility Number I 1 l.J O Division of Soil and Water?Conservatlon �
,d
Type of Visit: ZR",OUtille
liance Inspection Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: O ComDlaint O Follow-uD O Referral O Emereencv O Other O Denied Access
Date of Visit: ll 3 Arrival Time: Departure Time: " $ County:DVPLrW Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: S NEB 2� SPAAL.LRA(_N _ _ Integrator:
Certified Operator: Certification Number: 6?9 1 a (pa
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
[—]Yes
Longitude:
}
Design Current Design Current, �wDesign Cnrrent
- w
Swine7
Pop Wet Poultry Capacity P_op ,Cattle :� Capacity
"UDai
Wean to Fin
La er ow
m Non -La er '`alf
�eifer
F 7Design Current D Cow
D . Pouf, Ca aci -Po Non -Dairy.
La ers Beef Stocker
Non -La ers Beef Feederti
Pullets Beef Brood Cow
Turkeys
TurkeyPoults
Other
Other"
�.
-,
-
Discharges
ish
�
Wean to Feeder
Feeder to Finish
DSGp
Q00
Farrow to Wean
°
Farrow to Feeder
Farrow to Finish
s'
Gilts
Boars
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?
E�/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes F?6
o ❑ NA ❑ NE
[:]Yes ❑ NA ❑ NE
Page I of 3 2/4/20I4 Continued

Facili Number: S1 - dX0 I Date of Inspection: 11
%Waste Collection & Treatment
�4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes dNo ❑ 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: Rr )MALL Lkyed
Spillway?:
Designed Freeboard (in): 1 ell
Observed Freeboard (in): cs
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? Z'Yes [—]No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes N. ❑ 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 ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes O No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes © No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Q No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑'No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:)Yes dNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes EKNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box belo
Wil
❑ Yes ❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis Analysis
❑ Waste Transfers
Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
Mpsludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes E6o
❑ 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 21412014 Continued

Facili Number: - Date of Inspection: 1 i
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 dNo ❑ 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 VNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes to ❑ 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 ,To ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
to ❑ 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 No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[/lNo ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E<o ❑ NA
❑ NE
Comments. (refer to question:##): Explain any.YES answers and/or any additional recommendations or any-otherzcomments.-- Z;. ,
Use drawings of facility to better explain situations (use additional pages as necessary).
rj) 3a6CLsDC a( _9Lk_CPAL-1 JJ E60 C.Cfpo_ 6N oC 6Ve_X aa;,7j . R(MoVe
9,1.) Son, ANA'UKT5 N6 1a`� Eua of EAR • ,4Q?L�'•
SW06-& SWz �Ey Due 6 � Five or yeAK • L�� V E6,0(p 3
CAS BrzArt0fj DtIE 13Y CPO Dr ` EAR.
CH CC IC FT60— N 6 W
f i,Vp U 0 vtC
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Ca C AND
CAQD .
�J(ArJ fARAJ (CtL.,
Phone:C�
Date:
2/ /2014

Division of Water Quality
Facility Number 9 ®- ® Division of Soil and Water Conservation
Q Other Agency
Type of Visit: Compliance Inspection Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O Routine O Complaint O Follow-up Q Referral Emergency O Other O Denied Access
Date of Visit: Arrival Time: rff_']� Departure Time: County: Region:
Farm Name: cfdfret I('y�^ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 5wa SC61 6fxk
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator: A
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
... g g
..Design', en=
Swine,.- Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Layer
Non -La er
Design Current
Dry Pnultry Canacity Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Dairy Cow
Dairy Calf
Dairy Heifer
DryCow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes oNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes Z No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes 21 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 4No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes No
❑ NA
0 NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

r s
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? VYes ❑ No DNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L I p�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): __1(2`
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
A 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?
to
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes ❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ❑ No
❑ NA
Z NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes A 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):
M. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ❑ No
❑ NA
NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ❑ No
❑ NA
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
Z NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[—]Yes
[:]No
❑ NA
ENE
the appropriate box.
TT
❑ WUP ❑ Checklists ❑ Design [-]maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
;6 NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
;Y...I NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
[:]No
❑ NA
E� NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did,the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ NA &EfNE
❑ NA K
NE
❑ Yes ❑.plo ❑ NA ONE
❑ Yes ❑ No ❑ NA NE
❑ Yes [-]No ❑ NA - NE
0 Yes ❑ No ❑ NA WINE
2T Yes ❑ No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems'noted which cause non-compliance of the permit or CAWMP? ❑ Yes No
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes J?j No
34. Does the facility require a follow-up visit by the same agency? :Yes ❑ No
Comments:(refer to question #): Explain any YES answers and/or any additional recon
Use drawings of facility to better explain situations (use additional pages as necessary).
ro
Amvew% co"f1X'1rA ov ` P/K f Jq.
f
Farwl _P'V' mot�ea ova
� o
eyoweAr
_
�� • X4 4 _ . of V701�
J%%KO� -6y-
Reviewer/Inspector Name:
❑ NA 4 NE
❑NA FINE
❑ NA ❑ NE
[DNA ❑NE
or:any other comments. -
&U1 Phone:
Reviewer/Inspector Signature:
Page 3 of 3
lek�.. _
Date: a �wll�
2/4/2011

r _
Division of Water Quality
Facility Number - O Division of Soil and Water Conservation
O Other Agency
Type of Visit: QfCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: grRoudne O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: ) i Arrival Time: Departure Time: County: Region:
Farm Name: G = "} E= &OmlOwner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative:
Integrator:
Certified Operator:#Pi�1��(,Y1�
j-
Certification Number:
L13
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
L
ayer
Lary Youttry
Viers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes VfNo ❑ 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
❑ Yes 4z No
❑ Yes _JZNo
[DNA FINE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

a
Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: d
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.)
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes E' No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes );�j No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes eNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes J?:TNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes )ffNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:)Yes ETNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes el -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
g'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
jZrNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ZNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�n No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[—]Yes
;;?rNo
❑ 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 ;ErNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Zj No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes FTNo
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

t
Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes '
eNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
0 No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
Z] No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[—]Yes
�'No
❑ NA ❑ NE
Other Issues
29. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
O 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
EfNo
❑ 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
W'No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
;FNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
T
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
;�!rNo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
P No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
;2rNo
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations. or any other comments.
Use'drawings of facility to better explain situations (use additional pages as necessary).
FVVV^ jv►S n . g as (� �i�n�, q VN
Reviewer/Inspector Name:tq,���GVyL�
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 913d r
Date: 5= — 13
2/4/2011

ti9RDivision of Water Quality'
Fac -ity Number 3 j - ® O Division of Soil and Water Conservation f
O Other Agency
Type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O Routine O Complaint Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: F7.0-55­1 County: Ult✓
Farm Name: (&1 Cl 17-E!E�7 (j:4Q.M s Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: ?e- rr—_*-SRe _t i;,L Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
to Finish
to Feeder
r to Finish
v to Wean
v to Feeder
v to Finish
Other
Other
Latitude:
Phone:
Certification Number:
Certification Number:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
Pullets
Other
Poults
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?
Longitude:
Cattle
Region:
Design Current`
Capacity Pop -
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
a Yes W No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Vj Yes
[:]No
❑ NA
❑ NE
❑ Yes
tN No
❑ NA
❑ NE
Page l of 3 21412011 Continued

Facility Nuniber: 31 - Date of Inspection: 1750/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �X 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: ff r 0► cx_
Spillway?: n
Designed Freeboard (in): "1 r 4
Observed Freeboard (in): 9_. OQ"—I
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures
require] Yes ❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No
❑ NA
❑ 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
IX No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes]
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ No
❑ NA
❑ NE
IS. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑Yes
❑ No
❑ NA
�] NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
aNE
❑ 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
[:]No
❑ NA
NE
Page 2 of 3
21412011 Continued

Facility Number: - Date of Inspection:J.1 167
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA �1 NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [-] Yes 0 No ❑ NA TZ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? Yes ❑ No NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? 0 Yes [] No NA NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document Yes No NA NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? Yes No NA NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
Yes
No
NA
ONE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Yes
No
NA
NE
Application Field ❑ Lagoon/Storage Pond ❑ Other:
,fir'
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes]
No
❑ NA
0 NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Yes
XNo
NA
NE
34. Does the facility require a follow-up visit by the same agency?
t Yes
No
NA
NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or, any, other comments
Use drawings oUfacility to better explain situations (use additional pages as necessa
�. `T )+CR-E 15 A yurzi&vr FEED FQoM SomGw�Ef�E /N r4Z Al7' f�j 6� D GaUt1�
(SACK TOLo
AQDS wA2wA �At C5 AUSa G!G
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S6
N � P P ����, � ,
uC gt� m oDE TO H�X'6'
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9.AI -5 a tiD�SS T NET A S W€LC
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LC- SD w+ E L�
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`r 69_0.55 )SPVT 0-5 1416H L-"o�/
Ff3 caN ��rf L_"co,,V 4 �1 tS oc��Sr�T �� owAc
F ICCDs DQk EN T
w t/V "-)LILt9!->CFUi N and TOG wEE4C/V
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: r1J6--iq& 33DL
Date: J o ID
21412011

Division of Water Quality
Facility Number' © I O Division of Soil and Water Conservation:.
a s.
O Other Agency
Reason for Visit: A Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: 3d County:
Farm Name: �� �W L +�(� - Owner Email:
Owner Name: � 11- �C1 /Vj��- jrn—t]_ _ Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Region:
Onsite Representative: ye
jO �t' _-Z-�-!e/CA :; jfC AL909C_ 71
Integrator:
Certified Operator:
L4SqE R m� c g Rct}
Certification Number:
-I c7/ 0 �/ p
Back-up Operator:
Location of Farm:
Swine
Latitude:
Certification Number:
Longitude:
Design Current Design Current Design --<Current;
Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity 'APop
Wean to Finish
Wean to Feeder
Feeder to Finish
6
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
+s
Boars
Other
Other
La er
Non -La er
Design Current'
Dry Poultry Ca aci POD.
Layers
Non -Layers
Pullets
Turkeys
U
Turkey Poults
Other
i
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Dairy Cow
Dairy Calf
Dairy Heifer
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[]Yes [:]No
❑ Yes No
❑ Yes No
❑NA ❑NE
[] NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

Wacility,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 77❑�� No ❑ NA ❑ NE
Structure 1 Strucure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I (plt
Spillway?:
Designed Freeboard (in): �9 •� C�'r
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 N No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes No ❑ NA ❑ NE
maintenance or improvement?
_Waste Aaylication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0
No ❑ NA ❑ NE
maintenance or improvement? O'No
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ 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): Sa
13. Soil Type(s):A69RO—.
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.
[]WUP ❑Checklists Ej2esign 0 Maps ❑ Lease Agreements
❑ Yes
0§ No
❑ NA
❑ NE
0 Yes
❑ No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes *9 No
0 Waste Application Q Weekly Freeboard 0 Waste Analysis Q Soil Analysis ❑ Waste Transfers
Q Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections Q Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
0 Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3
21412011 Continued

LfaOjty, Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
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 ❑ Yes No
and report mortality rates that were higher than normal? 0
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ YesNo
If yes, contact a regional Air Quality representative immediately. 0
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes 0 No
permit? (i.e., discharge, freeboard problems, over -application) CC
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes W No
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA] NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as neces"sary).
C��Ig��T►o ��,� DOIS
Q-C CvALLA i t ft L p S
t/U • A. O� N errkJ1 A V_ (�GCA I t S 711 E vv
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gl�l►r 11`-T l
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Ors -'*> l�/8
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(LIFL SIN T
A A A ROAN n 0 p�tANT 1 NA i
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coptcs of OW gL�.r7GC_ s,�Q��t�w-pLPCC l
Reviewer/Inspector Name:�WNQ& Q140 N l/E LL A Phone:
ReviewerAnspector Signature: Date: LQ
Page 3 of 3 2/4/2011

Division of Water Quality
Facility Number ?j - � O Division of Soil and Water Conservation f �M
O Other Agency
type of Visit: a Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
teason for Visit: Q Routine Q Complaint '0 Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: (1 Arrival Time: Departure Time: County: h4__xjA1 Region:
Farm Name : C,— 1 (—I RIG e �� C.. rnS Owner Email:
Owner Name: S H (r1 C H Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude: Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er I I El
Pullets
Other
Poults
Design Current
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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?
Design Current,.:
Cattle Capacity Pop.,
Dairy Cow
Dairy Calf
Dairy Heifer
Da Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
-❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ YesPq No ❑ NA ❑ NE
[—]Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

5
Facili umber: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequateT ❑ Yes N 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: SmIgC-L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 5 y V
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 A No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes allo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [XNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes W 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 V No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? V Yes [—]No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA 0 NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design 0 Maps ❑ Lease Agreements
[—]Yes [:]No ❑ NA NE
❑ Yes ❑ No ❑ NA M
NE
❑ Yes ❑ No ❑ NA IK NE
[—]Yes 0 No ❑ NA jQ'NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes [:]No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Page 2 of 3
[-]Yes [:]No
❑ Yes [:]No
❑ NA 4 NE
❑ Weather Code
❑ Sludge Survey
❑ NA NE
❑ NA 2NE
21412011 Continued

E
Facili Number: - Date of Inspection: al (-4711
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. TT
❑ 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 fast survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA [XNE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑ No ❑ NA V� 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
10 No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[] Yes
❑ No
❑ NA
XNE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
Yes
❑ No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments
Use drawings of facility to better explain situations (use additional pages as necessary)..
-AMANOA GAINCS�Duoa> / AbW00,10E/✓NEb�S(S'*lv)l cti j9(9QpNaMIS'TT1nA I-AL(j bA
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`rNE SmALL C(LA1N rape(-Ic4T1o-v
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Reviewer/Inspector Name: [n P/V C) A GA ! %
Reviewer/Inspector Signature: -
Page 3 of 3
Phone:
Jvi Date:
21412011

�} Division of Water Quality
Facility Number 3 - ® Division of Soil and Water Conservation I
0 Other Agency
type of Visit: A Compliance Inspection Z5 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint IFollow-up_ 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I Arrival Time: Departure Time: County: Region:
Farm Name: �f A(L14 Owner Email:
Owner Name: ILA' S"f-igpW$AC� Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Title:
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Swine
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Pullets
Other
Poults
Design Current
Longitude:
Cattle
Design Current
Capacity P©p.
Dairy Cow
Daiiy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
®I
id
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:0-,No
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 4
No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

i' ciliumber: ) - Date of Inspection: l
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
T Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ 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 P9 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? 36 Yes [:]No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
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
[ANE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
❑ No
❑ NA
NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ 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
❑ No
❑ NA
Q' 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

Ficility Number: - Date of Ins ectiou:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [] No ❑ NA NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
❑ No
❑ NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
❑ NA
NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
14 No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
Yes
❑ No
❑ NA
❑ NE
Comments refer to question # : Explain any YES answers and/or any additional recommendations or an other comments 4"—.'
Use drawings of facility to better explain situations (use additional pages as necessary).
r
�C.475 � E i C� F cry �� s i�9Q Cry - - V 6p�� �- A cs d
is N�t� �17� F�
566 1 P KAg H g� rr6rJT
V_V%4 d t& j b er
�-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ���J�
Date:
21412011

Division of Water Quality '
FaegAy+Number ©- 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: } Arrival Time: Departure Time:® County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: ?C—_TL &.9 riAL96 U1- _ Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design
Current
Wet Poultry
Capacity
Pop.
Layer
Non -La er
Design
Current
Dry Poultry
Canacity
Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Cattle
Design " Current
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Imoacts
1. Is any discharge observed from any part of the operation?
Yes
❑ No
❑ NA
❑ NE
Discharge originated at: ❑ Structure V Application Field ❑ Other:
]�
a. Was the conveyance man-made?
❑ Yes
0 No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
1 No
T'`
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
Yes
❑ No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: j - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: �Q,7�j
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): S�
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?
0 No ❑ NA ❑ NE
❑ No [DNA ❑ NE
Structure 6
❑ Yes 14 No ❑ NA ❑ NE
❑ Yes M 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? 0 Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require} Yes ❑ No ❑ NA ❑ NE
maintenance or improvement? T�
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. Yes No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind 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
�j No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
`Yes
❑ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[:]No
❑ NA
NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
NE
t
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
10 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
❑ No
❑ NA
NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
NE
Page 2 of 3
21412011 Continued

Facility Number: jDate of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA NE
25.Js'the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes [] No ❑ NA NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [—]No ❑ NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [::]No [:INA NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes a No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes j No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? Y'6s 7❑� No ❑ NA ❑ NE
Comments (refer to question f: Explain any YES answers and/or any additional recommendations or any other comments.;,
Use drawings of facility to better explain situations (use additional pages as necessary). t
I r .6- 15 A- L4-76t-((EN7- F SEVW"14JOAPTS
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END OC-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: (qkj --11iG 1 d
Date: 11 M/t/
2,14,12011

: Division of Water Quality
Facilie-Number ©-EM
O Division of Soil and Water Conservation' -
Q Other Agency . .
rype of Visit: A Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O Routine O Complaint )A Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: j 4 Q Arrival Time:® Departure Timed. 19- 90 _—, County:
Farm Name: eu:y F�Lea �74q_jw Owner Email:
Owner Name: E j(.r4 Hfl)1}L 1-sHC41 Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: I SG M1q<— FK-
Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude: Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Dry Poultry
Layers _
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Region:
Design. Current"
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non-Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
1
Page 1 of 3 21412011 Continued

Facility Number: jDate of Inspection: t d
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
s
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [DNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: RZCWT- kqcC '
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 ❑ YesNo
0
❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 No
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes � No
❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require Yes ❑ No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No
❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No
❑ NA ❑ 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 jNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? Yes []No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [� No ❑ NA ❑ NE
acres determination? 7A
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?
[j Yes
[ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[:]No
❑ NA
NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
NE
❑ Waste Application Weekly Freeboard Waste Analysis Soil Analysis
PP ❑ Y ❑ Y
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
❑ No
❑ NA
NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
NE
Page 2 of 3
21412011 Continued

Facili Number: - Date of Inspection: d
24. Did the Tacility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA Ix NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA )A NE
the appropriate box(es) below. 7�
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
[:]Yes 0 No ❑ NA NE
❑ Yes []No ❑ NA 4
NE
❑ Yes [XNo
❑ Yes No
❑ Yes [XNo
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Ix No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes �No
34. Does the facility require a follow-up visit by the same agency? Yes ❑ No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA N NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
,omments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Jse drawings of facility to better explain situations (use additional pages as necessary). „
ONSITE W1 �,OHN (f,0LcG_CE `t KAGt,� c��lN �5*ki> -TO S(A(LUCL� I N ) h E STA2T
4 STC-�) m A(ZlC_s V6L NeCI G R T ) ON
33 �3y. ?- -GL VISCssE1S r NSe.crl oM -t t�oQ►c t�) (n Sct>irn Qc-csAc 14 -mavC
Ni Me)v7' -TocnfnE W-K oN tit d311 1a pQ-0P Oq CZC
P�t�
c� A><�
w S PoS- P�xE16 u N� ► P
,a LA
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Q/% - T -► C�3 ��
Date: I Il/V/I
21412011

i
Division of Water'Quality ..W
F
adflty Number - J J O Division of Soil and Wafer Conservateon
O Other.Ageney
Type of Visit ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint 4Followup O Referral O Emergency O Other ❑ Denied Access
Date of Visit: �L f JT Arrival Time: I I W60 I Departure Time: County: Region:
Farm Name: �L-T i— 1�� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
o
Latitude: =
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
=" Longitude: = ° = ` = "
Design., Current Design Current - Design Current
Swine Capacity Population Wet"Poultry, ' "Capacity Populaharr Cattle y. J' Capacity Populatloti
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -Layer
Dry on try,
❑ Layers
❑ Non -Layers
El Pullets
Li Turke s
❑ Turke Poults
El Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure 0 Application Field El Other
a. Was the conveyance man-made?
El Dairy Cow
❑ Da' Calf
❑ DairyHeifer
El Dry Cow
ElNon-Dairy
El Beef Stocker
El Beef Feeder
❑ Beef Brood Co
Numbereof 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?
XYes ❑ No ❑ NA ❑ NE
❑ Yes
No
❑ NA-
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
, No
XYes
❑ No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
❑ Yes No
❑ Yes ❑ No
❑ NA - ❑ NE
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ���
Spillway?: !
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ElNE
(ie/ large trees, severe erosion, seepage, etc.) 9
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes V No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0No ❑ NA ❑ NE
maintenance or improvement?
Waste ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes XNo ❑ NA ❑ NE
maintenance/ improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes X 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
M No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
X Yes
❑ 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
t�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
)� No
❑ NA
❑ NE
Comments (refer to,question #) "Explain any YES answers and/or any, recommendations or a. py other comments PW
Usedrawingseof facility.to better.explain.situations (use arlditivnaI pages as necessary): R ;
-
1*5 jq pCLa,4 } [.tQ TO CHECLC �2EE(3ChQQ (_EUELS 14 7 Yl }E SI TE Am"oi4-
'5
a .� )HN FA
kI r~1 qvGLL w�QE Cif ECI�[N4 LA6GoN�E C-LS �}7 T C S 3 L�.
?ETC- S--am1qCed9C4� WAS C�l7i4C76� VlA (n�o �C, AC 7HATiw`
KluOc� w� we�C a�/ Trt� �i�. �1E so � N` �5 �'` Q
t Mr:_ N I S LA C00/VS t,,��CE /N 6_00b 5'4)ApF. E lQ 12L 7�G S 1.7 C Hi4 t, �
Reviewer/Inspector Name IPhone: 910 to -3
Reviewer/Inspector Signature: Date: %
Page 2 of 3 12128104 Continued

i
• Facility Number: ' [ — 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
❑ Yes ❑ No ❑ NA XNE
❑ Yes ❑ No ❑ NA X NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
I NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
XNE
23,
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
XNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
gNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
gNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
kNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
NfNE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�( 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
x10 ❑ 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
XNo ❑ 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 )kNA
❑ NE
33. Does facility require a follow-up visit by same agency?
hyes
❑ No ❑ NA
❑ NE
A(iditionai„Comments andlor.-Dr wins a .: :� a4"' ear r-- „r• �„s
DQIUt /%l `3L c i 14E (ZCEL L0<2)o+FFD LtXC Ir HA i�)ykS 157109-TED- `1 4-IA7wAS
s 70 pt"(,P)A( MI A/1A c S 63� rcoRE DwQ
F 17 HAD
TA7
APPA{►�6N r- 14 E
��50 -�+. -U�Po� In1 ��S � 1GP•11o�1� !-� wA S L
E i GA•�la�
JUL- WAS M,0L>/Nb `goo 3Zocw. NOFF Fr�o� T
JUL-
THE g I �fzC
�N�R-ANCiNF EDGE G�
wA 5 � �~ PLC uC�
1�1C�� HC_ 6f-u H o)C� 7E
T
rS '� 6EQ (�urr�Tc,+� /N ? _�' AS Ivai1-1C� OF
FCj R7► 1E4. I Nc- 0IC w
6 p1Jv6
N pFl� �2oM TO AIcC Cog F_ OF
!�S F N� wAS 7oL� �1E Nt�G���- (NC0� 0PA7-1,v�S
R D
[� y3Q AK [ x1 C, CAP 7 [�C
i N E �u -p F F LA hQ- S Tv ba �o 0 * P 1 R� 7uR�
- 1-�+� w�S � ��-TgfcCA/�
7�fC c,J�S�C• !f� plC� GAL��D S ly �rwo� g�C � c1VTHC G
7 -g
Tc) `rH�- oF�rCC-, (FAfZ.S
[-c�o1�l�cS l�T 7� F) C Lb S� 1 P� S ��cU� � 1N 70E PAS7J
�� IP 7A m Lc- 66ZA►N — 7j4+47 [� -oFF � — 7iZ AA CNic0J� 1
Page 3 of 3 t•� C �tSt7- V-nfk V r wf5k4 v--- J ' — ' 12128104
we)0G3S .

�I
FactlNumber
��vis�on of,V
erAge
Type of Visit y
Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine 0 Complaint Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Z Arrival Time: Departure Time: County:
Farm Name: 1 L-T ��cc��- �-QAA S Owner Email:
OwnerName: �CNlK�C�+4�� Phone: _
Mailing Address:
� Region:
Physical Address:
Facility Contact: p Title: Phone No:
OnsiteRepresentative: 1 '5�_-1464R'L§TAQ-) Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 6 Longitude: C
Design —Current'.. Destgn.
Swine Capacity Population Wet -Poultry. ,.mCapacit
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other—�
Dry'Poultry .
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Lame
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
o=i =ie
U Beef Stocker
❑Beef Feeder
❑ Beef Brood Cowl 11
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 ❑ No ❑ NA ANE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
PNE
❑ Yes
❑ No
❑ NA
NE
12128104 Continued

Facility Number: '� ! —
Date of Inspection ! _ /C3
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: IP&J14r &ac—
❑ Yes No ❑ NA El NE
El Yes ✓✓✓✓❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): p�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA )4NE
(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 ❑ No ❑ NA NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes ❑ No ❑ NA NE
maintenance or improvement? r ,
Waste ApDlication
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 ANE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA kE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA XNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA Jl� NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
18. Is there a lack of properly operating waste application equipment?
El Yes
❑ No
,/N�E
El NA JIZ\I-�tE
'Comments to'question #) .Explain,anyYES°answer_s andlor any recommendations or any, other comments
Use drawings.of facility to better explain situations (use°addtttonal pages as necessary) ` .a
.-w p
Reviewer/Inspector Name
pA Phone: (3/Q
I
Reviewerllnspector Signature:
Date: /VW
Page 2 of 3 12/28104 - Continued

Facility`Number: 3 1 —a(pI Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA �NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes
❑ No
❑ NA ONE
the appropriate box. ❑ WUP E] Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
[--]Yes
❑ No
❑ NA ;.RfNE
❑ 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
❑ No
❑ NA �NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA [XNE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA E64E
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
❑ No
❑ NA _�,TNE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA N(NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes No ❑ 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 XNo ❑ 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 0 No ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application) 14
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? El Yes El NA
El NE
33. Does facility require a follow-up visit by same agency? Yes ❑ No ❑ NA
❑ NE
Additional Comments and/or Drawings: .xn
came�70
CR C (4n,A/C LtA<oo?v c (z-!.L)c-c-S N6 RCS Se_7tn Oc7ogcg- N<3V.
Pe_ i E M 4DC Cc�� Q31P 1VCJ V L G, A urn N ) M LtiNr 1C- JP //LI�/o ic) 6 E7
�1/1rG H C ��X'a71�� ")`� H F Na imp R- F{ &L 7V N 6 L. A Q- , ON w I L. L S? F
-��41cf N
Page 3 of 3 12128104

Facllify Number (9
i
FI..y.
sion;of Water Qualtty s
lion of Soil and: Water,Eon!
er,Agepcy � ��
Type of Visit
Compliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
XRoutine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: i Departure Time: County: &PLIA1 Region:
Farm Name: � 1 L 1 1"2i �E � 2�1 S _ Owner Email:
Owner Name: ������ SQ+mA�_gAC// Phone: - 9 -9935
Mailing Address: - s . / 3-1 '
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: VC -Tr-- SumA LgPc"q Integrator:
aal o C) C?
Certified Operator: P�TECZ_ LAS,��t� cslmlaLBG�CN Operator Certification Number -
Back -up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: [= o [= 4 Longitude: = ° = i
Design :.Curre�nf Design Current.
y ;
Capacity' Population Wet Poultry Capacity Population Cattle_'
M.
❑ Wean to Finish T.
l
❑ Wean to Feeder
Feeder to Finish �0 `
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
E
H;
Dry Poultry
Non-L
Pullets
u
Outer ❑ Turkey Poults
❑ Other ❑ Other
- - J.
Discharp,es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
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 XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

[Facility- Number: — Date of Inspection f �i
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: CA�L�LI�I OL
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): C / . SIQ 14"
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 ElNA ❑ 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 XNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ANo ElNA ElNE
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.
❑ YesNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[--]PAN ❑ PAN > 10% or t0 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) S C �Z
13.
Soil type(s) er-o u
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes )] No
❑ NA ❑ NE
15,
Does the receiving crop and/or land application site need improvement?
Yes ❑ No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes �4 No ❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes 1A No
❑ NA ❑ NE
18.
is there a lack of properly operating waste application equipment?
❑ Yes )ANo
❑ NA ❑ NE
Comments'.,:,
(refer to question #) Explain any YES answers and/or„any E.-comments.,_
Use drawings of facility to better explain situations (use.additronal pages as necessary)"
11 jgoloq . S �. ?9_ck_X(ZL �) C-oc-) E Wpoky w(f)
SLk&&EST C3:n)C.LE.cT 1A/6 L.j SQ0,tpcss Au,EAiZ,
ONE SeV T 3 g 1 ro 4NF_ E u ESZL� S mCv,rri , o C Av s c utZC cow l
Reviewer/Inspector Name �� ,Ae� E a:o- Phone:`il0-�`1Co� �3or
Reviewer/Inspector Signature: Date: / (
I2/28104 t,onfinued

yjAA&?)A C, 0A1 S 6
�1 !S Cc�kAc.1 Hsu L 1 /xI
t� t 7 N Mc..l S upEQU1So+� T C>
DES ECZ M ENE �utz-r r> �e ACTION
Facility Number: 3 1 a Date of Inspection
Reguired
Records_& Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes A No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes XNo
❑ NA
❑ NE
the appropriate box. 0 WUP ❑ Checklists El Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes ❑ No
❑ NA
❑ NE
0 Waste Application ❑Weekly Freeboard ElWaste Analysis_ ElSoil Analysis El Waste Waste Transfers Oinual Certification
0 Rainfall ❑ Stocking [El Crop Yield [] 120 Minute Inspections El Monthly and 1"
Rain Inspections (I Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes X No
❑ NA
❑ NE
.23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes VNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes XNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ❑ No
❑ NA
VNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes 7$,No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes Y�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 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 _G�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 J�No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes 'EfNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes *0
❑ NA
❑ NE
Cn^1170 360
9- 10"(S-1 o i N L14 ri 0c>V a So
a- -10 gq"
}o (Pl 1 g f6cy"S" 1 /13f to �CPIa�
&s)
3t 3llv(PD) 101Dq/09{�� 19,0/jo cPl)
(p 5) 11 J `d 4 JO �
(90 t ti cm tP 9)
1�1�510� �� (pig)
1t c,� +113C�]o9
/ ]0 9 cr,'-� 1 a 13a1 `r `;A' 12128104

Facility Number: Date of Inspection
)VO a0o 9 S,-(AD6E //,/ F-1 CE S - cm., CT [_aPL�Cs F
P-r AI : R mm DA 6�0411NC S
Uk3i ��n I)V( rCw) X C
C% 05
� i N� - l � Tt�n11(, 14 1
C_A G aON L u LA C% o�vS
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i N T P � 4Z.-�= � - y � T � A-r }� � ��
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SST QA`'�J
i Nam- LDS �b v ISQ(Z U,DE►cE C31P Q c -C E D)ScNc C �e
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c ` r C-- plc: V4 LZE �(Z cc�.-�� 4q-0 }
�--AiXTJ CW. - A] E S -R-D7175/47

Davrstonf Wter Q.ua .oaE
Via ity NurnDO � � DtvisioiirolpSoil�and`Water ConservationA:�
� QROther,�Ag cy
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint A Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I C� Arrival Time: Departure Time: County: IJIV Region:
Farm Name: Cam; LT �C-tea N� _ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: 4E l 4--4 51Gi1L1-)!V!E}LSJC Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = 6 = Longitude: = o = f
Design
t.� ^'.
�' DesignCarrent Design Current
Swine Capacity
,Current'
Population Wet POnitry� Capacity Populat on
�,
Cattle Capacity Po ulat'on
"-` ❑ La er
ElDai Cow
❑ Non La er
El Dairy Calf
rA
C
❑ Dai Heifer
Dry Poultry y "^ .
❑ D Cow
,*v:
ElNon-Dairy
❑ Layers
❑ Beef Stocker
ElNon-Layers
❑ Beef Feeder
pEl Pullets
❑ Beef Brood Cowi
° ElTurkeys
Other.
n El Turkey Poults
ra
❑ Other
❑ Other
ber of Structures:
❑ Wean to Finish
El Wean to Feeder
El Feeder to Finish
❑Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
Discharges &Stream Impacts
Is any discharge observed from any part of the operation? El Yes �No ❑ NA ❑ NE
Discharge originated at: ❑ Structure [I Application Field [I Other
a. Was the conveyance man-made?
El 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?
El Yes kNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes �No
❑ NA
❑ NE
other than from a discharge?
I2/28/04
Continued

acility Number: -- ( Date of Inspection 31
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes XNo ❑ 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: o�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in).
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No
❑ NA ❑ NE
maintenance or improvement? JJ��
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 XNE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA ANE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA (NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ElNo
❑ NA V NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA KNE
Comments (refer to,question #) Explain any YES answers and/or any, recommendatibus or any otl<er comments
Use drawings of facilityto better explain situations. (use ,additional pages as •necessaE:y) �.
� 1 sE � f .�oH� Cc��EGI~ �rGZarM 5�►w �o �, �� �vGw IQf�ZiGA� }�! ' GSIG �
(�'C T NEta WQ379 PAS/ 51 N6 .
(4-3#R T W E 7W0k&G tT W 45 ►9 (.�-L 6'/! E M e o F- 5VVW-A� 1 E C JS 493 gC-Carr
w )TH C�C-eG i E - QE76- 'X00KRu3RcN CPGNCD I T QJL i T-7VT14i-'V&h (-J fL&S %-7AW_9_V_ wf* S
Reviewer/inspector Name AY,. //iI Y Phone:6-
Reviewer/Inspector Signature:. Date: 3�31%a
Page 2 of 3 12128104 Continued

Facility Number: --Q6 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA V 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 El Checklists ❑Design ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33, Does facility require a follow-up visit by same agency?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
El NA VNE
❑ NA V NE
❑ NA NE
❑ NA NE
❑NA VNE
❑ NA �NE
❑ Yes ❑ No
❑ NA ) ] NE
❑ Yes ❑ No
❑ NA i'Y NE
❑ Yes 14 No
❑ NA ❑ NE
❑ Yes] No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Additional Comments and/or
,,6H1J �C-L-EitCW��1TOUE(Z_ JrLIEcA IC / c4-WL-jO/.)VFDJ 1400c i NCt& `
�L ��N i � T �E �/EC-D Fc�� LA�Fc..1-�►— DOSE.
NEB ��P SLGKEn — CIF i CAZ1CZ1)VA.0 C-OF-)W1 RAt�r�
�1Ac.)� �C,OQcES Fo[L Nz�U--mQ f-I ES 6'_yR0
Page 3 of 3 12128104

Division of Water Quality
acility Number 3 O Division of Sod and Water Conservation"
O ort>er=Agency
'type of Visit x Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint xFollow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1 /� Arrival Time: Departure Time: County:
Farm Name: IL 1 �7p6 C P qV tA- Owner Email:
Owner Name: S 14FEC I A SCV MJU 3GACk� Phone: _
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone No:
OnsiteRepresentative: PE7r 5r-mmace4cpi Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = c = =16 Longitude: = o = . [= ,d
.Design Current
Destgit' Current.
'Swine-
Capaeity`Population Wet=Poultry
Capacia :Population Cattle" "
❑ Wean to Finish
❑ La er
❑
Dairy Cow
❑ Wean to Feeder
10 Non -Layer I
❑
Dairy Calf
::
❑ Feeder to Finish L
Lj
Dairy Heifer
❑ Farrow to Wean
Dry Poultry
ElD
Cow
❑ Farrow to Feeder
`
❑
Non -Dairy
❑ Farrow to Finish
�-. ❑ Layers
❑
Beef Stocker
❑ Gilts
Non -Layers
["_
El
Beef Feeder
r-1 n
❑ Pullets
— —
Other ❑ Turkev Poults
❑ Other ther Ndmber of Structure:
Discharces & 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?
El Yes 0No El NA ❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
WNo
❑ NA
❑ NE
❑ Yes
Do No
❑ NA
❑ NB
Page I of 3 12128104 Continued

F:Aility Number: — Date of Inspection
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 I\ Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
identifier: fir) iAtx
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
A
❑ 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
X No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
0 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
❑ No
❑ NA kNE
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.)
ro
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
10 NE
15. Does the receiving crop and/or land application site need improvement?
IN Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA V NE
IT Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
.Comments (refer to question.#):. Explain any YES answers and/or an3�recommendations or any other comments
.Use drawrngs of�facility to better explain situations {use additional pagesias,necessary) z .�
Reviewerllnspector Name A1i11fpA: Phone:
Reviewer/Inspector Signature: Date: (3)C? l/
Page 2 of 3
I' M0In4 r.... a.:.......1

'_j
-
ility Number-31 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA WE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA V NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
N NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
[(NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
KNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
5NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
�NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ 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
❑ 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
ANo
❑ 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
A No
❑ NA
❑ NE
32.
General Permit? (ie/ discharge, freeboard problems, over application)
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?
X Yes
❑ No
❑ NA
❑ NE
k
1�(TE To FOLCCw—L,p 41V LAST /At5-eECTI01V CHLCrf-AlGL 0GA2 oL
�rN L A�iesowS A� 1N C o�P�l �.vc ��
rY1�j'Zr—
A Ccz&_ Q= C� i �
wE r 6C j wCCxr [4CJU�5Gs - oic t5 G_�4iak:tIVCN cans irk FL&S c-► LI 7ff►4 i S
C�cCGC�
5`6r�GF�cIN7^ C= IEL� — Stvtpd7H ou i
wjLL C_"6CK AGAIN 1N A f6"1" AAOAi74%
Page 3 of 3 I2128104

L
i Dlvlsh
Facrltiy Numtier' Q Dnsi;
Other
Type of Visit
Compliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
Routine 0 Complaint
Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: g i Departure Time: County: Region:
Farm Name: ILA Owner Email:
Owner Name: S44CL(A SQ4mW-eAC►4 _ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: W_T& ScufnO McN
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = = 4 = Longitude: 0 ° = f = u
> 'Design "Current` }
Swine ;,.Gapac�ty Popuiatiop Wef_Poultry ,;
❑ Wean to Finish
J❑ Layer 4
1: ❑ Non -Layer
❑ Wean to Feeder
❑ Feeder to Finish
oultr
➢ yes,
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
71
❑ La ers
❑ Gilts
❑ Non -La ers
❑ Boars
Other
:5
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ 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?
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Brood
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 XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
gNo
❑ NA
❑ NE
❑ Yes ANo
❑ NA
❑ NE
12128104 Continue
It

FacilaiijNumber: — (p Date of Inspection j4
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 IoNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: j
Spillway?:
Designed Freeboard (in): ; Observed Freeboard (in): ( C9
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes XNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes XNo ❑ 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 X No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes VNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require `J 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?
1, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA )9�NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA �fNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA 9 NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA XNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA X NE
Comments (refer io question,#) Explain any YES answers and/or any'"recommendations or any otne omments ,. �t
Use drawings of facility"to better:e_xplain situations (use. additional pages as necessary).
Reviewer/Inspector Name �j �� j �S . Phone:
Reviewer/Inspector Signature: Date: '&���
Page 2 of 3 12128104 Continued

FaciL y Number:51 —go Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA f §NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [:]No ❑ NA X NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA XNE
❑ Waste Application ❑ Weekly Freeboard Cl 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
❑ No
❑ NA A NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA D'NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA ONE
25. Did the facility fail to conduct a sludge survey as required by the permit?
[:]Yes
❑ No
❑ NA ONE
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes ❑ No ❑ NA RNE
❑ Yes ❑ No ❑ NA kNE
❑ Yes ❑ No
❑ NA
kNE
❑ Yes ❑ No
❑ NA
N NE
❑ Yes )kNo
❑ NA
❑ NE
❑ Yes *o
❑ NA
❑ NE
❑ Yes ANO
TAYes ❑ No
❑ NA ❑ NE
El NA El NE
Additional:Cominents aiid/,or Drawings:.
q. U_ >> H C nj 't>Lx3(3x CAUED 7c) NQ71 OI G o F R S i 7& s r i - (DIG Nay FIB `
iju- -14, o�! G cACC wf�� ouj 0 F Ca�PU AnrCE - ,NEB Qf�
11�1 C phi Ac i Lam/ ION Z I NC f-ofYl (?'143 i4 �iZ-fcpA QE (� ppfl. %NEEDS �o B�
>wC� 6y E►Yh ar Bus►>vEss ID .
�, FLuSN LtN� �5 C(A�GEDq ���(CF_ IS A �i45E �uN 10 IFCUSy7HE Na+SE
QI✓E� rrlJ� A5 S� i95S]G3t� .
33. �ju>C W1[rl CK pQO�RESS Orr G iT IN C�G%� �uPEn �owN
Page 3 of 3 12128104

Type of Visit O-Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 611outine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: pi Lie] Arrival Time: ® Departure Time: County: �i-cQ�-IA/ Region:
Farm Name: L f?-l~ L - AiLm s Owner Email: �1
Owner Name: _sS jEJ1- 4 03c001.4 i_VAC-;N Phone:
Mailing Address: 35 f V "a0�3
93a
Physical Address:
Facility Contact: Title:
o
Onsite Representative: ` F 1 (:�)C 14 in 1 L�_ri' _ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o = L Longitude: = ° ❑ . ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
❑ Wean to Finish
❑
Wean to Feeder
®
Feeder to Finish
cJ 15 as
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dot Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �4 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[n No
❑ Yes
lNo
❑ NA
❑ NE
❑ Yes
'0 No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: 3 1 — a (p
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 10 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes A No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: n
Designed Freeboard (in): 5 p1
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ yes 14No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 4 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 ;lt.No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes EfNo ❑ 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 kNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 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
101, - y/3I 3P- tglM
12. Crop type(s) ,S C 5 4 g ESKiff ) 3'25j.'*W/9'w
13.
Soil type(s) %UDQ-r-OLY
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
ElNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
�KNo
❑ NA
❑ NE
cility to better ezplam situations: {usead
P A-S SENT �4 tN A�T(� A�V/Zt�S1 S tit - gLcT NCl F, ADC3 %
aLi. NC*- CAugcLa7S_'j�> 1N o1oa7S %tA-T 610" '3oVt--r iv,q,'•cS C�ONNCau%61E'51'U�!
AMAN oA 14)4TCNqQ_ 6VG cQdpEttu rluE Fir, �- wl e� C, 1�7 r S cr p_b"LEts.
76 G Tt=21 A m,40Q.4 r N S W — pr : 910
Reviewer/Inspector Name F—Phone: 9/8-_4 _ V4
Reviewer/Inspector Signature: GLvTl0� Date: oZ�9(91CS c!
Page 2 of 3 12128104 Continued

Faciiity`Number: f — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. 0 WUp ❑ Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Waste Application 0 Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑/aste Transfers ❑ Annual Certification
0 Rainfall ElStocking ❑i Crop Yield 0 120 Minute Inspections El Monthly and V Rain Inspections [] Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
D4No
❑ 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?
A Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
CqNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
4 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
iallo
❑ 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
0 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
9No
❑ 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
.5,6No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
PSNo
❑ NA
❑ NE
I. 5 LL► 6 M-T 0 V & V- A p p- I CA T AC�,/1! t� 1 b N T' wj D E 4Z S T4N D LA 3 WL:% S 6
WAS-<�,NLL� SG 1bS - S �^ rC.tLL$ A!GT cA7 c.1 2 9, C4"3F
aF NCAvL� CiOivTAcr 30WAI
�v D�Scc.�SS Gt�(�� � w��r�� �tarlr�rrfZ �►- R-�!~r�S� �RN�
-r_t✓l4,;u l c iQ t` ASS / S 7a ov c c
V`AlfiG_CL STl4-_ E_ C C_,A/0ZA L �G �ZN�I i AAjAjLrj9L CC4 ICR71oX/
A10T V-E��tiQE�
t�3tc _ UL 0 At W µC—TN�[Z- LA-)u�Q N ��� S
ELECT 11—
N E
Page 3 of 3 12128104

Division of Water Quality
FaC�fityNumber; #1 a Division of Soifio i and �Water�Conservan
0 OtherAgenc
"g
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: 1 v t Arrival Time: Departure Time: County: u N Region:
Farm Name: G 1 LT- —(Lr [—. �--A2m s Owner Email:
Owner Name: s lieu_pl_ Sic 14fr•' a L9 JgCH Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: PETS S cj4 f>) A L914C1-i Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 e 0 & =is Longitude: = ° = ` = "
Design . �;CurFent Design Ctt;
Swine
Capacity- Population Wet Poultry -: Capacity Popu
❑ Wean to Finish
❑Layer
❑ Wean to Feeder
Non -Layer
Feeder to Finish
S&6
El Farrow to Weany
'.Dr Poultry
❑ Farrow to Feeder
-
ElFarrow to Finish��
El Layers
❑ Gilts
❑ Non -Layers
❑ Boars
❑ Pullets
-- ❑ Turkeys
Other '' ❑ Turkey Poults
❑ Other.: ❑Other
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood C
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 MNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes xNo ❑ NA ❑ NE
12128104 Continued

Facility l�ttmber: —
Date of Inspection 1►
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
M 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: Lis
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
DO 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
ldl No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
[I 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 W NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
09 NE
15. Does the receiving crop and/or iand application site need improvement?
0 Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
ONE
Comments (refer to question #) Explain arty YES,wanswecs and/or any m recomendations or any other comments:
Use drawings of facilityto °better eYpla�n situations. (use additional'pages as necessary..)]
c3NS►Tf-- OffA/ C_C>L_LS(G E J=taM LANS 4-w {�AL
CRC-- � S°4 W IC l N EEC, ��Q -i 141 S, 9 (~ l U-r" 1 U S`i
j- OCR 1a� _V) w1 e-Au6 I c»J a4- To ct4ELK 1P-Q C F TIOlV ��S 26XI �1
)(2314AI C_0U_C E_a- Q G; E &:_ H M A L_Q3 ACH 90cF-- EDEi w HE c-A�-��,
Reviewer/Inspector Name M(� {� j �ESm Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility -Number: S 1 —a(o 1 Date of Inspection
Required Records & _Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA 1)( NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA CRrNE
the appropirate box. ❑ W`Up ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA b4 NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 ° Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA 9NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA VNE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA ONE
25, Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
KNE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
� No
El NA
El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
NNE
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
1A 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
[R 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
1%NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
V No
❑ NA
❑ NE
Additional Comments,and/or„Drawings:,',
ga
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Page 3 of 3
12128104

Faci t.v Number: S 1-- Date of Inspection ] 0
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7/25I97

JO Division of Water Quality
Facility Number 3 O Division of Soil and Water Conservation
- - — - - -- O Other Agency // 11
Type of Visit $6 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: ��/l�4a� Region: 4 29
Farm Name: �2�—G/1Dc�J _;rj'l _ Owner Email:
Owner Name: �� niN�S (l-,2� //f� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: fGuJOOp _^ �✓
Back-up Operator:
Location of Farm:
Swine
, Phone No:
Integrator: a4zy.�2 4-es
Operator Certification Number: 1:z2_VZ
Back-up Certification Number:
Latitude: 0 0 0 g Longitude: = o=.
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
4
1p
El Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other -
- -
Design Current
Cattle Capacity Population
E]Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes ?No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes RqNo ❑ NA ❑ NE
❑ Yes 10 No ❑ NA ❑ NE
12128104 Continued

of Facility Number: Date of Inspection
Waste Collection & Treatment
❑ 0No
❑
❑
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 I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: G L 2
Spillway?: ad�=
Designed Freeboard (in):
Observed Freeboard (in): 38
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?
❑ Yes ZfNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes VNo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
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 1CJ 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 Windo`w/ ❑ Evidence of Wind Drift [:]Application Outside off Area
12. Crop type(s) 646en7 440119
13. Soil type(s) //p
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
//m No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
/X No
ElNA
ElNE
17. Does the facility lack adequate acreage for land application?
ElYes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary): .
uJcp 4 &,' j /'tom G� F�j �S /�}i✓�
AL
FSuR,v i��� blaoo-L) '4�ff"5_7 -
S ate, -o s �,�o �oo.�-, C��e,� ss �fI�ZCF
.S�•e�tw
Reviewer/Inspector Name Phone: O
Reviewer/Inspector Signature: Date: 3 O
Page 2 of 3 12128104 Continued

Facility Number: — Z Date of Inspection146W-22
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 ❑ Desig
n El Maps El Other
❑ YesNo ElNA ElNE
❑Yes & El NA ❑NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
V(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
P(No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
//0 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
V]o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
XNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
INo
�[J No
El NA
Cl 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
[lNo
El NA
El 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
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104
Page 3 of 3 12128104

�ivision of Water Quality
Facility Number:::�
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine Xcomplaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Time: �� Q Departure Time: �, County: Region:
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
Owner Email:
Phone:
Phone o:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ c = ; = is Longitude: [= o ❑ d = If
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ 1 ❑ La er
�1 - - -
. ❑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
❑ Dairy Cow
❑ Dairy 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?
Page I of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
d '
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):
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
s'ie
64r/74?
AF:ii1 m
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3
12/28/04 Continued
/,

Z�O&/v 43
qI& - 73a�
d-7 �-2

'Iw .16
Facility Number
0 Division of Water Quality
O Division of Soil and Water Conservation
O Other Agency
Type of Visit Jj Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine Q Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access /�
Date of Visit: 10 Q Arrival Time: '�s Departure Time: ' County: Z Region: ( #_62
Farm Name: /��nQD[J _^ Owner Email:
Owner Name: V 1�,�,J�L:0C_g*4m_,,,, Phone:
Mailing Address:
Physical Address:
Facility Contact: ,Title: Phone No:
Onsite Representative: /1",(i►t/�/Tf.Z r/`J�01� Inator: _%Qnc1�+%
Certified Operator: ��� S �nR40.4/- AA.C_µ Operator Certification Number: Z-92 :7a
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o ❑ ` = Longitude: = ° 0 ' =
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ 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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: ©i
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes No ❑ NA ❑ NE
El Yes
El No
El NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
ElYes
Ld No
❑ NA
❑ NE
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 No ❑ NA ❑ NE
12128104 Continued

lw.
`.---,/�
Facility Number: - Date of Inspection
Waste Collection & Treatment 7�
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.1 L ?-
❑ Yes jo No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in): HS
Observed Freeboard (in): _57
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 WfNo ❑ 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? Cl Yes 0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No [INA ❑ 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 VN o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PfNo ❑ 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 l0 lbs ❑Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ EEvideen�nceeA of Wind Drift ❑/A�ppliiccaation Outside of ea
12. Crop type(s) l/'J��P.nl1/)A ! A- iJXi4ZI�� L-/.V /®r//�����1�
13. Soil type(s) djr3
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?
9Yes
❑ No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ONo ❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
f 5) ����v.7 ��!' 7 ��PO%ZT ✓IfDV�F- �O �/�LdS �,�—�`�
21)
Reviewer/Inspector Name i Phone: /Fp-'j(r?-UPIF
Reviewer/Inspector Signature: Date: p
Page 2 of 3 12128104 Continued

Facility Number: 3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes�eNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
PfNo
❑ 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
;dNo
❑ NA ❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
XNo
El NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
�No
❑ NA ❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA ❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
'ONo
❑ NA ❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA ONE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? Yes ❑ No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
if yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
(INo
El NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
/
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
VrNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
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a Age 47,v ��us S, ( /, z� 3 toe
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Id
Page 3 of 3 -1--- ._-1-07` , L yof
� I2/28/04

s_
Division of Water Qualit F
Facility Number - Q Division of Soil and Water Conservation
-- Q Other. Agency
r
f Visit (�f Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
n for Visit 'Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access Q�
Date of Visit: Arrival Time: fDO Departure Time: County: 6"Region:
Farm Name: _ /'..�7;f _7l{A1 / Owner Email:
% lF�Wl Owner Name: _ ,�S r&lf4/in 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
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = I = 11
Longitude: 0 0 =' E__1 „
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ Layer
❑ Non -La er
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharges & 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?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood -Cowl
I
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
9No
❑ NA
❑ NE
❑ Yes
JZ No
❑ NA
❑ NE
12128104 Continued

rr�
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes Wo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I St cture 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
21 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
gNo ❑ 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
VNo ❑ 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
V1 No ❑ NA ❑ NE
maintenance or improvement?
Waste ARplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
VfNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
A 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 El Evidence of Wind Drift ❑ Ap lication Outside of Area
12. Crop typeCA
s) E �50,
13. Soil type(s) N9,6F0G-L-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
/VNo
ONo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
ONo
❑ 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
Id
ONo
❑ NA
❑ NE
41) ZIVoo O d 2 &5o X*s A f/.,4W l';if F4 crow P� � jr.� %us ll 6 &o
F,004- 6oAko Zs 2 �7_ A, n'l*Zk
�GSo FoA
f�,�-✓�.- /� s?D� ���`/Lev � �•� (�2,," �-��� frJ� �/ �°ct ao
Reviewer/Inspector Name r S Phone: t7%0- 3 Z�v
Reviewer/Inspector Signature: Date: p�
12/28/0 rantinued

Facility Number: 3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes iA No ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
0 No
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate below.
0 Yes
El No
❑ NA
El NE
r,br�Sox
El Waste Application ❑ Weekly Freeboard El Waste Analysis FI Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking O 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
VNo
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
XYes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
oNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
,fNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes to 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
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
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
'VNo
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
/P No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
Pf No
❑ NA
❑ NE
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1212VO4

ANIMAL FACILITY ANNUAL CERTIFICATION FORM
llV
Certificate of Coverage or Permit Number T 1CA,2?%j9, County : � � Y ar 200
Facility Name (as shown. on Certificate of Coverage or Permit) t !`/�- EB �` T�C-
I �.
Operator in Charge for this Facility-6•Se x-iet e c f- n tP Z %&
Land application of animal waste as allowed by the above permit occurred during the past calendar year
_�_ YES NO. If NO, skip Part I and Part Il and proceed to the certification. • Also, if animal was -
was generated but not land applied, please attach an explanation on how the animal waste was handled.
Part I : Facility Information:
1 _ Total number of application Fields ❑ or Pulls ❑ (please check the appropriate box) in the Certified Anima
Waste Management Plan (CAWMP): f Total Useable Acres approved in the CAWMP
2. Total number of Fields ❑ or Pulls ❑ (please check the appropriate box) on which land application
occurred during the year: I Total Acres on which waste was applied �.
3. Total pounds of Plant AvaiIable Nitrogen (PAN) applied during the year for all application sites:
4..,:Tot_al pounds of Plant Available Nitrogen (PAN) aIfowed to be -land applies; anriiially by the CAWMP and
the perinit:
5. Estimated amount of total man4re, litter and.. process�'wastewatersold or given.to:oth'er: persons aiid taken
off site during the year tons;.:i],-or-,gallons ❑ (please:check the appropriate,box)
5. ' Annual average number of animals b e-facil __.._ y type -at -this at:this ity during the pr?vious year:
Largest�and--srnallest.number'ofaniinals by, type at this'facility at any one iime during the previous year
Largest . :qI _ .
-/�----_
Srriallest
(These numbers are for informational purposes only since the only permit limit on the number of animals
at the facility is the annual average numbers) t ��
$. Facility's Integrator if applicable: 1)7r11,0SU — Iernyw L _
Part II: Facility Status:
IF THE ANSWER TO ANY STATEMENT BELOW IS "NO", PLEASE PROVIDE A WRITTEN
DESCRIPTION AS TO WHY THE FACILITY WAS NOT COMPLIANT, THE DATES OF ANY NON
COMPLIANCE, AND EXPLAIN CORRECTIVE ACTION TAKEN OR PROPOSED TO BE TAKEN TO
BRING THIS FACILITY BACK INTO COMPLIANCE.
1. Only animal waste generated at this facility was applied to the permitted', sites- during. _ . :Yes ❑ No
the past calendar year."
AFACF 3-14-03

2.
The facility was operated in such a way that there was no direct runoff of waste from
es ❑ No
the facility (including the houses, lagoons/storage ponds and the application sites) during
the past calendar year.
3_
There was no discharge of waste to surface water from this facility during the past
Yes ❑ N
calendar year.
//
4.
There was no freeboard violation in any lagoons or storage ponds at this facility during
Ey ' es ❑ No
the past calendar year.
/,
5.
There was no PAN application to any fields or crops at this facility greater than the
IJ�'Yes ❑ No
levels specified in this facility's CAW MP . during the past calendar year.
6.
All land application equipment was calibrated at least once during the past calendar year.
M Yes ❑ No
7.
Sludge accumulation in all lagoons did not exceed the volume for which the lagoon
1 Yes ❑ No
was designed or reduce the lagoon's minimum treatment volume to less than the volume
for which the lagoon was designed.
S.
A copy of the Annual Sludge Survey Form for this facility is attached to this Certification.
R es ❑ No
9.
Annual soils analysis were performed on each field receiving animal waste during the
Lq'Yes ❑ No
past calendar year.
10. Soil pH was maintained as specified in the permit during the past calendar Year?
!' Yes ❑ No
11. All required monitoring and reporting was performed in accordance with. the facility's ; .. _ Q�es .❑ No
ermit-durin the ast calendar ear: - -
P g P Y
12. All operations and maintenance requirements in the :permit were complied with during . L!' Yes El No
the past calendar year. or, in the case of a deviation, prior authorization was received
from the Division of Water Quality. _ • . .
13.' Crops as specified in the CAWMP were maintained during. the past calendar.year-on.all„ fJ Yes _❑ N
-sites receiving animal waste and the crops grown were removed in accordance.witlz_: -
the facility's permit_
14:,-AI1 buffer requirements as specified on the permit and the_CAWN1P for. this facility. were.. Yes ❑ No
_'_, triaintaiiieidduring each application of anii ial waste during the:past calendar -year.
"I certify under penalty of law that this document and all attachments were prepared under my direction or
supervision in accordance with a system designed to assure that qualified personnel properly gather and
evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of .
my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for
submitting false information, including the possibility of fines and imprisonment for knowing violations."
�41Na
ame and Title (type or print
Signature -of Perifuttee
mature or uperator in un
different from Pernuttee)
Date
k6s
Date
AFACF 3-14-03 2

1111 I�ECEIVE
Lot#
Grower# Grower Name
House
Permit Head
Avg Inv.
613912
95028 AGR GROW INC
9
880
F ER61 8 �-U0
614113
95028 AGR GROW INC
10
880
868
615092
95028 AGR GROW INC
4
880
BY:-
615298
95028 AGR GROW INC
9
880
903
617025
95028 AGR GROW INC
12
880
852
617472
95028 AGR GROW INC
1
880
794
617538
95028 AGR GROW INC
11
880
529
617704
95028 AGR GROW INC
2
880
455
617871
95028 AGR GROW INC
10
880
747
618047
95028 AGR GROW INC
3
880
510
619041
95028 AGR GROW INC
4
880
750
619042
95028 AGR GROW INC
9
880
767
621105
95028 AGR GROW INC
12
880
788
621337
95028 AGR GROW INC
1
880
764
621550
95028 AGR GROW INC
11
880
786
621774
95028 AGR GROW INC
2
880
803
621995
95028 AGR GROW INC
10
880
834
622215
95028 AGR GROW INC
3
880
809
623307
95028 AGR GROW INC
4
880
866
623541
95028 AGR GROW INC
9
880
768
615499
96446 GRAHAM FARMS
5
880
864
615674
96446 GRAHAM FARMS
6
880
892
615675
96446 GRAHAM FARMS
7
880
849
616068
96446 GRAHAM FARMS
8
880
802
619225
96446 GRAHAM FARMS
5
880
728
619418
96446 GRAHAM FARMS
6
880
750
619621
96446 GRAHAM FARMS
7
880
803
619818
96446 GRAHAM FARMS
8
880
803
623704
96446 GRAHAM FARMS
5
880
835
623920
96446 GRAHAM FARMS
6
880
793
623921
96446 GRAHAM FARMS
7
880
854
95028 Average
880
784
Ho ses i i sM; 12�-N� 12
7056M.,4
�_R:94i2

Appendix 1. Lagoon Sludge Survey Forth
A. Farm Permit or DWQ Identification Number 3 �'�—�Tdi�i�✓1�
B. Lagoon Identification _ at -1
C. Person(s) Taking i\leasurerr,ents QE NjiV iS Gr-Ptii Ft—
D. Date of Measurements _ -� g)a I OL
E.'deihods!De%-ices Used for -Measurement of:
a. Distance from the lagoon liquid surface to the top of the sludge la) ev
PV (.. P IPA- r"I u t ktT L i C - �+ �+ X NC_(Ltir-ve - - --
b. Distance from the lagoon liquid surface to the bottom (soil) of the lagoon:
c. Thickness of the sludge layer if making a direct measurement with "core sampler"_
V. Lagoon Surface Area (using dimensions at inside top of bank): ti_l+ , l -N (acres)
(Draw a sketch of the lagoon on a separate sheet, list dimensions, and calculate surface area.)
G. Estimate number of sampling points:
a. Less than 1.33 acres: Use 8 points
b. if more than l.33 acres, `i.i'1 acre; x 5 =_,Z _, wit" maximum of'.I.
(Using sketch and dimensions, develop a uniform grits that has the sarne number of intersections as th;
estimaied number ol'sampLing points needled. Number the imersection points on the lagoon grid so that data
recorded at each can )e easiiy matched.}
IA. Conduct sludge sure), and record data on "Sludge Survey Data Sheet" (AppendiK 2).
L At the time of the sludge survey, also measure the distance from the Maximum liquid Level s rr
to the Present Liquid Level (measure at the lagoon gauge pole):
J. Determine the distance from the Maximum Liquid Level to the Minimum Liquid Levei
(use lagoon management pian or other lagoon records):
Ell. Calculate the distance from the present liquid surface level to the Minimum Liquid Level
(Itern J minus Item 1, assuming the present liquid level is bellow the Maximum LiquiJ Level):
1- Record from the Sludge Survey Data Sheet the distance from the present liquid surface level
to the lagoon. bottom (average for 0 the measurement points):
M. Record from the Sludge Survey Data Sheet the distance from the present liquid surface level
to the top of the sludge layer (average for all the measurement points):
N. Record front tare Sludge Survey Data Sheet the average thickness of the sludge layer:
r
O. Calcuiate the thickness of the existing Liquid Treatment Zone (Item N1 miners Item K): 31f 3
`ore: If Item O is less than d feet, a sludge removal and utihzstion plan may be required by
N.U. DWQ. See }on` specific permit or contact DWQ for more information.)
P, Proceed to the Sludge Volume Worksheet if you desire to calculate sludge volume for a rectangular -
shaped lagoon ;with uniform side slopes.
Completed by: d(Lr—s_C�► _�. Date:z
Prini ti`ame ignature
14

Appendix 3. Sludge Survey Data Sheet*
Lagoon identification:
Sludge Survey ata Si,eet Of 4
Completed by: 1* S -Date:
Print Name Signatur
(A) (a) (C) �C) minus (B)
Grid
Pcint
No. Distance from liquid surface Distance from liquid surface Thickness of sludge
to top of sludge I to lagoon bottom soil layer
Ft. & in. Ft. (tenths) Ft. & in. Ft. tenths Ft. Un Ft. ltenths
7' G /_
s
'.411 grid Points and corre-sponding stud e layer thicknesses must be shown on a sketch artac&!a to fh;s
Sh,d,ge S'urvei, Data Sheer.
.See'Ippendix a for inches to teinhs of a foot.
15

O Ihviston of 5otl°and W_ afar Caaservaaaa � � -�
,'" ��� a.- ,� r Q�Uthel•�i$FaCy-� � a a? � e-+�",� e'`"°a mom'.'.-F���' � � �' �'"- a `�
a
e.
v
Type of Visit 3 C`ompliance inspection Q Operation Review p Lagoon Evaluation
Reason for Visit' Routine Q Complaint Q Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: `l Zo u Tune: Dd
Q Not Operational O Below Threshold
f�lermitted�Certified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold:
/Farm Name: County:
Owner Name: ............ . .. . ....................... ........ ..... ............ . ........ .. . .... Phone No:.......
Mailing Address: ...... . ...................................................
Facility Contact: ........ _.... __._____............. ..... ......... ...... ...... ......... _Title: Phone No:
Onsite Representative:_ 1..,C.NN'r A Integrator;
Certified Operator:.._ ..... .................... ..... -•-........... _.._............�............... ..... Operator Certification Number: ---••---_......_.......................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �` �"
Destgni Cnrrei�t Destgaff
Curreal
Swine [`anarrtir;P`Pnnnlann.a-:,,Poultry, .. ["an$rwty. Pnrirrl9b
Wean to Feeder
: ❑Layer
eeder to Finish
10660
1054 m
Non -Layer
Farrow to Wean
_
Farrow to Feeder
`=`
Other
Farrow to Finish
x` Tattal Deli;
s
Gilts
_
Boars
Dqs', r
Longitude 0 4 64
Discharges & Stream I_mnaets
1. Is any discharge observed from any part of the operation? ❑ Yes /No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gallmin?
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 �/�70
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes o
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier: ......... ..... I................... .......... ..... Z.... --------•-------- ............... ......... ...... --•.................... -... ......................................................................
Freeboard (inches): Z,Jr 3
12112103 Continued

Facility Number: 31 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes 2 No
seepage, etc.)
6_ Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ;Ng,
8. Does any part of the waste management system other than waste structures require maintenan�mprovement? ❑ Yes
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ElYes 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
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type lgc�m (µ) 3EQMUOK CO SGO
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20_ At the time of the inspection did the facility pose an odor or air duality concern? If yes, contact a regional
Air Quality representative immediately.
SOU o C-C 4amvef To m CbOE LSY AP IZ, 7-4 1 -Lod �
�Aar,\ APD REGaa_DS LJCLL-
Reviewer/Inspector Name
Reviewer/Inspector Signature:
MRTJ4 7A T1\J 6D,
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes 0 No
❑ Yes Blro
❑ Yes hdO
❑ Yes 01
❑ Yes L�'No
❑ Yes
�r_-any�orner<<commenu. =� -ro•
Field -Copy ❑ Ftnal Notes'
Date:
ivrvni
rn..I:..lind

Facility Number: 3, — 2 Date of Inspection I y�
Required Records & Documents
21. Fail to have Certificate of Coverage c& 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 ❑ Soil 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?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
U
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes /No
❑ Yes
❑ Yes �I�NNO
❑ Yes <No
❑ Yes 4o
ElYes No
❑ Yes
❑ Yes 561
❑ Yes 5No
❑ Yes ❑ No
❑ Yes [No
❑ Yes L
❑Yes 7No
❑ Yes
❑ Yes ❑ No
12112103

0
Type of Visit 0 Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit 0. Routine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facilit}' Number Date of Visit: ,P3 D Tine:
0 Not Operational O Below Threshold
Permitted 13 Cert red 13 Conditionally Certified Q Registered Date Last Operated or Above Threshold: ...........
__ ._
r County: . �ly
Farm Name:
Owner Name: .......... n1,N ...... ... l/%Cj�!�.......................... Phone No:
Mailinb Address:
FacilityContact: .............................................................. ......... Title: ......... ...................................................... Phone No:..................................................
Onsite Representative: ..-:,f F[''i s........... . ........ Integrator:.-644K � `a
Certified Operator: ............................................................. Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitudes
❑ Wean to Feeder
eeder to Finish 105&e $
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish '
❑ Gilts
❑ Boars
Discha & Stream Impacts
1. Is any discharge observed from any part of the operation? Cl Yes 'XNo
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 gallmin?
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 JZNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes RfNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
S cture 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _........ ........ ........... .Z . r......... .......... ...... ............ .... ...�....
Freeboard(inches): ..........�fl �_............ ....... 2--_............ .............. .............. I .... ...................................

Facility Number: — (p Date of Inspection OZ
5. Are there any immediate threats to the integrity of any of the structures observed? Oe/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
Immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste strictures require maintenancchmprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application?, ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload,
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (C"AWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(W WUP, checklists, design, maps, etc-)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
.21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(let discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/mspection with on -site representative?
.24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? .
❑ Yes �No
❑ Yes ❑1No
❑ Yes No
❑ Yes VNo
❑ Yes ?"No
j] Yes � o
❑ Yes VNo
❑ Yes A No
❑ Yes No
❑ Yes . ❑ No
❑ Yes ❑ No
❑ YesNo
❑ Yes J[} No
❑ Yes VNo
❑ Yes [Z No
❑ Yes No
❑ Yes No
❑ Yes VNo
0 Yes VNo
❑ Yes XNo
❑ Yes No
❑ Yes �No
j3 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
'�E3', �: `.' �= �3�fF?<-:�dill�:#�'y���@�P!', E�z=k? 'n3zxz> :::xiit•<<?;;c'.,u<;�-
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.}: }:.�. .:},.:--::. t::.. :R.:-:: :.:.i'.i...: v. -:::Y::t:'..:.a:::-•:-::-'_.:'-T`-::: --: -: is ryy'.y i{i{.:::: ::..::.. .. ..... :. .... -.::s•W:....
.....t.h:.. _,::La,y,,,,..-....c.,. _}: y,t:,.....--..'-..-�---::::::...yYt.-.,... k.,......::.....,.: y,,....: }:::::: -`•----• `:y,„ {;3c,. Field Co Fin Notes
:.r. Copy - ❑ Fi
rji`ivi-•Y:v `.�}H ,:?.: :f4:'�: v:$L' ..3 ^^)�`t ::5:.
s E)(T F )? ecn} rn
AL
+.:iS'' 4.T.:.'.:i•'Ly::�v:ii!i::+:r.�.•�5;:.::::'�:}.:'.:'{i ;.::.+::::.:�::':..
Revi ewerliP
ns ectarNam v.:..,::-. - � .• ,;ss<
Reviewer/lnspector Signature: Date: ��

Facility Number: —Z(p I Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
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 ❑ No
❑ Yes A No
❑ Yes dNo
❑ Yes P(No
❑ Yes ZfNo
❑ Yes ONO
❑ Yes ❑ No
NOT
rV �►V �J a �)o 03 t,57r-_ AN NLgs - Cvv FF
REAo L mwo o I 49,vv:; Z f-op- LKMO (�S StWU) J
Do L N'C'00 0 S �cc�
OOT-E .
V �� rn��y�rc�Z��p. IlFco2Ps
0R_pCR' � �� �RA��S �AS � F-r=A Cum �No
BA-c-ffo. .brRMUOf� 5rrPtR<z0C-
051031VI

- d DivisiW on of ater lity
Q
. E ^Q Division of Soil and Water.Conservation
Q _Uther:Agency ;
Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit U Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number J 2 Date of Visit:
Permitted [3 Certified 0 Conditionally Certified 0 Registered
FarmName: ........../.............II..................................................................
Owner Name: ......... n ! 5..." �t ►lc. r-.....................................................
El Time: f Q :1�Printed on: 7/21/2000
Not Operational Q Below Threshold
Date Last Operated or Above Threshold: .........................
Count`: D v %,1%
.............�......................................... .... I................
Phone No:
Facility Contact:.................................................................... .Title. Phone No
MailingAddress:........................................................................ .................
Onsite Representative: ?e r i Gr "1az.
............................................................I..............................
Certified Operator:
Location 'of Farm:
Integrator:....... G 1'/'GI
..............................................................................
Operator Certification Number:
Pf Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �' 64 Longitude • d «
'Design. Current
Svyitac -• - . Cannaty Ponulatian
"= Wean to Feeder
Feeder to Finish
Farrow to Wean
r= Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design .. Current Design'; Ci r-rent
Poultry Capacity Po ulation Cattle Capgaty. Popwation
❑ Layer 11 1 ID Dairy
❑ Non -Layer I 1 10 Non -Dairy
❑ Other
Total Design Capacity-
Total SSLW
Number of Ligoons ❑Subsurface Drains Present ❑ Lag, Area ❑Spray Field Area
Ho1ngPonds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the Stale? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ............. .................... ................z.................................................. .................................... ....... ............................. ....
Freeboard (inches): 32- Z [3
5100
❑ Yes ONO
❑ Yes
/9f No
❑ Yes No
El ❑ Yes No
❑ Yes No
❑ Yes _VNo
❑ Yes ONO
Structure 6
Continued on back

Facility Number: ,31 — Z(o Date of Inspection 2r1 D Printed on: 7/21/2000
5. Are thie any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes IeNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes )E:(No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes ONO
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes gNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes �No
Waste Application
10, Are there any buffers that need maintenance/improvement? ❑ Yes /EfNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes 'P�No
12. Crop type C r^� v G{9 �'l a 17 1 Sma � r G e-0
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes JYNo
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? lwYes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes JffNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes ONO
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 ONO
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ONO
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes2TNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes j2NNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes_-J:(No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes �❑i No
24. Does facility require a follow-up visit by same agency? ❑ Yes Ef No
25. Were any additional problems noted which cause noncompliance of the Certified AV'rMP? ❑ Yes_4:�No
E..�o•yiolatioris;or• &riciencibs were hbtea• during this:visit; • , oi>f will•reeeiye tio: her ;
correspondence. abiruf this visit::: :
Comments (refer to -question'#): Explain7any YES answers`and/or any recot nendations or_any:ather comments'
Uie:drarvu gs of facility to:beiter explain situaiions (use aatlitional;pages as necessary) 4
JS. s ad! J�a;ho+��fSeec need1 fa 6e r^errfo✓e6(; r6(,6L+Cj . tie sirc 40
rrlZ►'-►OV'Q
19 1. 8 e su r e �ol Esc a was -fie h na t s;f dc,-�ed U✓:4 4 : 6o da f of
Reviewer/Inspector Name
Reviewer/Inspector Signature: _ Date: 2 r% Q 1
AL
5/00

Facility Number: 3 —2 Date of Inspection Zrl Printed on: 7/21/2000
Odor Is` es
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes �[]i No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ,3"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 J'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 01No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes -,6No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additionall'Comments and/orDrawings: ,.
1'4-tsre 64 ('on W a.s CD"O(vc+et( I^n'- .two
4k-,+ Y-,\oee k0i L-,o A, .5 were beirtr� 6 v� If a4 4e �a✓ ��
Ge i vt q L u e f CAI;-0 - kQ rO Lt,4 ►.t i a vt
5100

rnvastan or '3 � an _S
�d
Evsron 0 f Water
,A 9p
A Otliie�r.
Routine 0 Complaint 0 Follow-up of DWO inspection
ofDSWCreview 00ther -
Facility Number Date of Inspection Lpz_z' '*
Time of Inspection 3U 24 hr. (hh:mm)
Permitted (`Certified [3 Conditionally Certified [3 Registered JE3 Not Oper;t=ioal Date Last Operated: ..........................
Farm Name: ............. ... . ... / ......... . .... ... ..... County . ...................... . .......................
2.1 ....
Phone No.
.................................... .......................................................................................
Owner Namet .......... ... ..
Facility Contact: ...... �/ -) a ...... . . . ..... Title:....61Z4k1110'K . ............................. Phone No . ...................................................
MailingAddress: .............. ......... ....... .................................................. ............................. ..........................
Onsite Representative:......... -�7M&A.,,.� . . ................. Integrator: ........... .......... L60 0�
A'-- ... ­­­:.....:....................
.................. .... .................................
Certified Operator: .................................................... ............................................................. Operator Certification Number: ..........................................
Location of Farm:
......................... ................................................................................ I .............................................................. I .................................................................................
..... . . . ............... - - ------ .................... . .. . ......................................... ...................... . ...................................... I'V
Latitude Longitude
Design. 'Curr6t- Design -Current' DesignJ Cuiivht
Swine Capacity-7 Population Poultry Capacity -Population -Cattle ':Ca0ace tY' -rQ;0ulatioW.'
D Wean to Feeder E] Layer ❑ Dairy
ff Feeder to Finish 0 Non -Layer El Non -Dairy
❑ Farrow to Wean
❑ 1I I K.
7
Farrow to Feeder [:] Other
El Farrow to Finish Total -Design Capacity;'; pie-ty,
I[] Gilts
Q Boars Total,$SL- W,
Number of Lagoons JE1 Subsurface Drains Present
Holding Ponds'/, Solid tra'piE1 No Liquid Waste Managen
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: E] Lagoon El Spray Field El Other
a. If discharge is observed, was the conveyance man-made?
Area ❑ Spray Field Area
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
0
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? El Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: /144­1 V/ "t
Freeboard(inches): ............ '/.7 ... .......... ............... ...... ................................... ............. I ...................... ............. ...................... .......
El Yes �iO
El Yes gNo
El Yes ONO
Q
• Yes JRNo
• Yes ZNO
El Yes 11' 0
0 Yes P'1N0_
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, El Yes R No
seepage, etc.)
3/23/99 Continued on back

Facility Number: — Date of Inspection / Q
6. ATe theretructur s on-site/which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes e<'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?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9- Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11- Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily -available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: o yiolaii gs;or, &!ficie.h es •were noted• during this:visit: • Y'oit widl.t& iW iio fufther
corres}7orideitce.a OU this Visit. .. • . • . • . . . . . . . • . . .
❑ Yes No
❑ Yes AFe—
❑ Yes No
❑ Yes `[�No
El Yes ' �ie
❑ Yes _'
❑ Yes LOrKo
❑ Yes E�Wo
❑ Yes Zf Vo
❑ Yes *0
❑ Yes 50
❑ Yes Pf_No
❑ Yes Ktvo
❑ Yes 4No
❑ Yes WTo
❑ Yes -
❑ Yes VNo
❑ Yes 'UNo
❑ Yes 1,7214o
❑ Yes &o
Cotamenis (refer-tq gaeshon #):" 'Explain'any -YES ataswers and/or any recommendations or;any- other comments
Use drawings of facility to bettei explain situations (use addthonal pages as necessary) -a-
�.
t���� �i fC r S 6�i` Okrp7 ter eW —42 �C
D� " Y
�J eL-
Reviewer/Inspector Namei _ e
Reviewer/Inspector Signature: Date:
t

Facility Number: — Date of Inspection ��j
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes VNNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes VNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property) ,� _
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes NLNo
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 ;4<o
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes gNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes k(No
Jfobvry w/ (�'�dls
�rmda�--
s{�4T. Wes.
G��i - `GG�� �✓•
i
'5/lou'PoC�
W r6wv
U
�i� �i /�+/D.�✓ C( Uz� �e P CORS��
3/23/99

Permitted Certified ©Conditionally Certified Registered 0 Not O erational Date Last Operated:
& G 1Y�.f County.......... ....-...... Farm Name: .................G---...-•--•---......................................---........................................ -.. k! {� �..`...... ............
Owner Name: - ....................
PhoneNo: .............................. :.................
FacilityContact: ........................ Title:........................----..----.............................. Phone No:...................................................
MailingAddress: ...................................... .............................. .......... ............................................................................................................................ ..........................
Onsite Representative: .... rS G ��! ....... Integrator: ....AP-�-�l
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
.................................................................................................................................................:;................ice
Latitude Longitude �• �'°=
Design Current Desi
Swine Capacity Population `Poultry Cap
❑ Wean to Feeder
❑ Feeder to Finish
tC2 b to
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Current ^
Design. Current
,apacity Population-;'
Number -of Lagoons=mrt ❑ Subsurface Drains Present ©Lagoon Area ❑Spray Field Area
-
Holding.Ponds / Solid Traps ❑ No Liquid Waste iilanagement System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes E Fvo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes .❑'NIo
h. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ,ZNo
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 P'11To
2. Is there evidence of past discharge from any part of the operation? ❑ Yes P140
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ;2rNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? illway ❑ Yes P(No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
.Identifier:
M arm r-�R- APF�r 1��.,� T-A •S Y Ij�S
Freeboard (inches): .............37i .......... .......r
...................... ................ .................... ................ .:...... .................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �No
seepage, etc.)
3/23/99 Continued on back

r�
Facility Number: 3r — zC Date of Inspection Z7
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
9
closure plan?
❑Yes ❑�1Vo
(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?
El Yes N
8. Does any pan of the waste management system other than waste structures require maintenarice/improvement?
❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes XNO
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes � No
11 _ Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes ONo
12. Crop type C_ _ e, CA -A IJbJb,- �-*- G9-c\' rJ
13. Do the receiving crops differ with those(designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes ONO
14. a) Does the facility lack adequate acreage for land application?
❑ Yes PNo
b) Does the facility need a wettable acre determination?
Oyes ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
15. Does the receiving crop need improvement?
❑ Yes eNo
16. Is there a lack of adequate waste application equipment?
❑ Yes ;21NO
Required Records & Documents
17. Fail have Certificate Coverage & General Permit
�No
to of readily available?
❑ Yes
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
WUP,
❑ Yes'ZNo
(ie/ checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
WYes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes /`--` No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes [ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes JZ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes eNo
24. Does facility require a follow-up visit by same agency?
❑ Yes ,E]"No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes 12fito
V: Rio.yiolafiQris:or• deficiencies -were notes -during this:visit: • Y:oi) will-r:eceiye iio further -. • .
• correspondence. about this .visit.
Comments= refer;to_question #) Explain :any YES answers and/or any recomrmendat�ons or any other comments.-
W
Use drawings of facility forbetter explatti situations (use additionalpages"as necessary)
�A it p t,p6
�.1a�rE �y3rtwPt,�s SIZE t7-£Q�Iii�-p W�'t'43�rf (.0 DQ�tS A1Pils�cA'3-,'�r�
,(t.r� 61 t `�s w�srfr A��u'�-� �a.i nA>tk�crc
L As Y SA nn P[� 5 n/vi!_ �►" 6 r
/�% 6 5 � � L .T',4� PV�S S: �CJ� t5'f S� � M ciS' F- �So% L SA MP (�E 14^l� V � LL`� I► �p L� a tfG L.
A s c. J/j4j_ V Ar tr"o. 4d t AK- - )G 'r0 "S Jr s i �� T� a c e- 'A E� 7bA9`�
o�� To 2,ti�+t�3 ��TGt� `� r •J sTf�tlt �3� �p�r�,�c,i PR Wi Q� 4lti 3-? S - 3 t +
Reviewerllns ector Name
Reviewer/Inspector Signature: V f1___ ( N 114- Date: -7h_-7 [99)
3/23199

�Y.
Facility Number: j — ?-X. Date of I"spection 7 Z?
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 ,fNo
28. Is there any evidence of wind drift during land application? (i_e, residue on neighboring vegetation, asphalt, ❑ Yes -6No
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 Z-No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan bladc(s), inoperable shutters, etc.) []Yes ;21<o
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ZNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes 2No
AdditionaLCommentsand/or Drawings:
A
3123/99

0 Division of Soil and Water Conservation ❑ Other Agency
P Division of Water Quality
f Routine O Com laint O Follow-up of DWQ ins action O
t
Facility Number 2G
J
i (a Registered 0 Certified M Applied for Permit P Permitted
Farm Name: •........ - �..-.:israW...}. `.".�:...........
Owner Name: .............bciani,............................ 6. 6.r...............
Follow-up of DSWC review O Other
A 1
Date of inspection
Time of Inspection Z: ti 24 hr. (hh:mm)
Not O erational I Date Last Operated: ..........................
County: ...... B.V.?Iil............................................ .......... I............
Phone No:..N.Ai..744..&...........................................
FacilityContact:.............................................................................. Title:..........................
Mairing Address:...3 ?. .......NaY:4Aa�..... M.............................
OnsiteRepresentative :.........te--fxyl-1S....... .... xrn curr........... I_............................
Certified Operator-,...... �. ..... .......... � kc (CAA-ra ►'i2.
Location of Farm:
Phone No:.. ....................................
.iA yu— J.A.T" A k............................................... 3R.........
1
Integrator:...........5 ......................c...............................
Operator Certification Number ;.---_(17k..-4.............
�?�.-----wn±......�% s............... �,...1��6. i.,..�....rk,��s�....�nor..........q...... 5[�,..).3�1...................................................................... -.....................
s....
................... ......... ......... ............ ........--.... ......... ....
Latitude ®• ©' ®" Longitude ®• ®' ©"
Design .Current Design .. Current
Capacity: Population Ponliry Capacity `Population Catt
❑ Wean to Feeder
Feeder to Finish
p
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish.
❑ Gilts
❑ Boars
❑ Subsurface Drains Present ❑ Lagoon Area IM Spray Field Area
6.
❑ No Liquid Waste Management Syste
M== 1x
General
1. Are there any buffers that need maintenance improvement? ❑ Yes M 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 1D No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes W 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 M No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes 00 No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ' ❑ Yes ®No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes El No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ® No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes WNo
7/25/97 Continued on back

Facility Num r: 3E — L
8. Are there lagoons or storage ponds on site which need to be properly closed? Yes ❑ No
Structures (La oons Holdin Ponds Flush Pits etc)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ig No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...................................
........... ........................................................................................................................................
Freeboard(ft):...........2..................................Z.:. ........... ...... I ............................ .................................... ...
10. is seepage observed from any of the structures'? Yes CA No
11. Is erosion, or any ,ether threats to the integrity of any of the structures observed'? IM Yes ❑ No
12., Do any of the structures need maintenance/improvement?
® Yes
[I No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
E
B. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
® No
Waste Application
14. Is there physical evidence of over application?
El Yes
U] No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ) _
15. Crop type ............. bglr,l'-LIlb-_.... ................ C l ..0 Crl"N�-.--- .,.-..--......... ...............................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
f}No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
(4 No
18. Does the receiving crop need improvement?
,
Yes
❑ No
19. Is there a tack of available waste application equipment?
❑ Yes
[3 No
20. Does facility require a follow-up visit by same agency?
(X Yes
0 No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative''
❑ Yes
® No
t
22. Does record keeping need improvement?}
Yes
❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Permit?
Yes
❑ No
0 No.violations or de'ficiertcies.were noted -during this. visit.-.Yoir.will receive no ftirtlier
correspondence about this.visit:
C&ruments;(refer to gaestion #) lxplain,any Y`ES answers and/or any recornmendattons or anym _odier'"c©ments ,
C?se,drawings of facility -to betterexplain situations.(tiseadditional pages .isnetessary)
T Pt*p t-r C.EOStM �t[�r- SkOVO b e 5, . Ul 'tl - p} J (OLIPIA .
l6-roSt JoT
�
1i'4 L. .,-( , ' `
6 f\ axcag o r% 1 r�rVar c4 o O; I-•- wo�j( f Cj wt^ %�Z - 6 ht� t�f� S �S� 4n
ov� Wak1 s�+otliC� ;0W. t ,� rc.See co J t a 11
ntuY WWII arec� SI,n��t} 6e �' I(.tj c.1I� e I �- tr�K cif
&x cr-tcrs an Wt, ([%cons SVodbQ OE-SeJeJ. f
1 v �o ber-n%Je_ , V, IV"
z, ft7uS - SQ,n.��t Laino g�5 -kodd bQ- U�aW. tRR-2 fora. 56�3O 6e va,c 6'r e.act� cv-1
cQY hQaU i'tCi eY i C� I Ol-. 6 EnovcJ tDe cons 5 Fella
pars i s �l
7/25/97
T
Reviewer/Inspector Name fl� y
Reviewer/Inspector Signature: 1A Date: S
a

r.-
❑ DSWC Animal Feedlot Operation Review _
l® DWQ Animal Feedlot Operation Site Inspection
T law
® Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of IISWC review 0 Other
Date of Inspection )O 2
Facility Number
Time of inspection :2G 24 hr. (hh:mm}
© Registered CI Certified Cl Applied for Permit [3 Permitted 0 Not Operational I Date Last Operated:.....
Farm Name: �r+ - g�ttn ...--- County: ..... D.4A................................................................
Owner Name:....... ..... G.+Cj. ..... ... Phone No: &14MLMI;iz......................................................
Facility Contact: ..... .t! r."vf y...... .......I ......................... Title: ...... Qlr. ku..........................................,. Phone No:..�°��Q�. 4 L, ...............
Nlailing Address:„35z1......81Cj/_'ft.li.t........�:.......................................................... ..... Gu ars,t.i....A%C........................ ...Ma.......
OnsiteRepresentative:_...... ........................................................ Integrator: ..... 6UMI5...............................---...........................
Certified Operator t..... 3.QkVx....... 31"61pt-f,........................................................... Operator Certification Number:
........ ........ ....... ............. ..
Location of Farm:
any.... 1.e�4--ar................
...
...swe---..ue_.r..�).,..................
Latitude Longitude
1 Swine Capacity Population
❑ Wean to Feeder
IN Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gifts
❑ Boars
Design Current Design.. Current.,
Poultry Capacity Population Cattle Capacity, Population
❑ Layer I I Cl Dairy
❑ Non -Layer I ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons / Holding Ponds ❑ Subsurface Drains Present ❑Lagoon Area ID Spray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
2- is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed. wa.� the conveyance man-made?
b. if discharge is observed, did it reach Surface Water? (If yes. notify DWQ)
c. If discharge is observed, what is the estimated flow in 1-al/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes 1gNo
❑ Yes fa No
❑ Yes ®' No
❑ Yes
P No
❑ Yes
No
❑ Yes
No
❑ Yes ® No
❑ Yes 1A No
❑ Yes M No
❑ Yes 0 No
Continued on back

1
Facility Number: 3j —Zfp
8. Are there lagoons or storage ponds on site which need to be properly closed? JX Yes ❑ No
Structures_ fLaeoons,Ilolding_Ponds, FluslrPits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? El Yes fS No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: W 01 -#
...................... .................................... ...................... -..................................................................................
Freeboard(ft):'8..................................................................................................................................................................
................... ....
W. Is seepage observed from any of the structures? ❑ Yes No
11. Is erosion, or any other threats to the integrity of any of the structures observed? Yes ❑ No
12. Do any of the structures need maintenance/improvement?
(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 rmu& .. ...................... ...........................-............. Sept`guV........ ...............
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.violations or deficiencies. were -noted during this.visit.- .You will receive. no further
: correspondence about this'. visit.
JK Yes ❑ No
❑ Yes .IM No
❑ Yes ®. No
.......................................
R Yes
❑ No
Yes
❑ No
Yes
❑ No
❑ Yes
19 No
191 Yes
❑ No
❑ Yes
W No
® Yes
❑ No
❑ Yes ® No
❑ Yes No
❑ Yes No
Comments (refer to question #): Explain -,any YES answers and/or any recotritnendatton`s or any other comments,
Use-drawiin s.of_facilit _to better ex lat[t situations. use additional a es as necessa� ..
y P, ( P g E7}
I. 01d laTo;N skovla be clos4 ovt Con4tc4 1 ts4r, Soij,f Wc�iw firn asSis ce
It -Az • arvO lov, on tnx+r/0-j aw tva115 of jagao., -wz- S64a 6� fitlit01 0144,JAY .0 rr-se,detl. Ert5'Si0n om-a�
rrxu-� P 1pos of i"yo., do, c.,d raided. Bart areas oA bfi,. iaaw5 shaad
p i ii i 1 ' -r
b`•���ezr3 �iw•�tcti to }-{ Js 6{e3i�i�o.W for .lter►J#.. L wer f-0y hana1 JLpro✓41 Of Cer4i cOcn,!_ 'Adak
S�etild ve 5�tned try �DQS-YI►U0�0. � - _'""J f1 I f.J;l."�7+ SY101�1�' 'ItG�' k1e
`wrO s 4 h-,4 i S t s & kI eth� Sl l�itj tOK 4J
..
IT. rn1 �pt S�cr� �u it►�QYoik'�.
56� a be in to5 tZtosJ�t� sae- fa6c�.tt] -0�� ta�lYrt
. L �a' � W aa� 5ar,•� am,ys S � . n• � ��r tJ% s
j � rtum bares 7125l97
Reviewer/Inspector Name
Reviewer/Inspector Signature: �� �A� Date:

L�
•
Site Requires Immediate Attention: O
Facility No. _3 Q
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIIVIAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 8 09 , 1995
Time: 1 O 11-1 O
Farm Name/Owner: A,*/I�_ G-fLo ..3 - n s (-9 CA1 , 1-8
Mailing Address: A J, G-�rn �� T� c 3 S q T _ -n�9 � n L
County: o � a ro39 'o
Integrator: Cr,4 I Is _ /t it_ Phone: 2 93 ` :7 Y 4 (y
On Site Representative: Phone:a 9 7 01 / a- CF
Physical Address/Location: Ste. Iy L,i , 13 Lf c7
Type of Operation: Swine i--- Poultry Cattle
Design Capacity: 66 O _X V -96Vb Number of Animals on Site: 0V O
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:'S_' 00 ' SS.�" Longitude: " 4B ` d� Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) 0 or No Actual Freeboard-" y+ Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or N Was any erosion observed?Cs r No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria?. 200 Feet from Dwellings? (a� or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Scream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man -Made devices? Yes or 19 If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? G or No
Additional Comments: -' `10A- � -hn ter. 4' S 'A�Q --X
(�L j jC:Z
Inspector Name
cc: Facility Assessment Unit
SI,crnatA
Use Attachments if Needed-
M