310034_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Division of Water Resources
Facility Number L�11� - O Division of Soil and Water Conservation
O Other Agency
C.
Type of Visit: C�ommpliance Inspection Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: (kUoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 4{ Arrival Time: ] Departure Time: County: QV1jV'V Region: 1)r
Farm Name: .s [ 1__1 Owner Email:ie I V
R�
Owner Name: Gcvt(� i t Phone:
Mailing Address: ✓(f� 2 WA
ate 1�
Physical Address:
Facility Contact: •e 4 4/t Title:
Onsite Representative:
(t
Certified Operator: _ �o�, t�y 771,g or"
Back-up Operator:
Location of Farm:
Swine
Latitude:
Phone: -v Rc'6'io`�r�o�j0ai
Integrator: � '� 6`
Certification Number: ,7140
Certification Number:
Design Current
Design Current
Capacity Pop.
Wet Poultry Capacity Pop.
La er
Non -Layer
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Non-L
Pullets
Other
Poults
Design Current
Discharzes and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes LJ 1 _o ❑ NA ❑ NE
a. Was the conveyance man-made?
[:]Yes
0 No
�A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[:]Yes
[:]No
[3-'%tA
❑ 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
�1A
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
Cjg4o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes , No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: jDate of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
.
[5,N6-
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[]-1-CA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[>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
EZ�W
❑ 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
[R'Fo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[R o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[3-No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E j 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):A,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes t9 1Vo ❑ NA ❑ NE
RDoes the receiving crop and/or land application site need improvement? Ej<es ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
in -KO'
❑ NA
❑ NE
acres determination?
17. Does the facility tack adequate acreage for land application?
❑ Yes
�Io
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�lo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[[a-Ido
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[j--do
❑ 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
3-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
O'No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
6"No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

INacil' Number: - Date of Inspection: N
'rutclt
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
Ed-Ko
❑ 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
E31�o
❑ 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
E1,14o
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
Eg<o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
EIo
❑ 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
EE[, o•
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
ER14
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
����e�
Yes
DNO
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[] Yes
6-N o
❑ NA
❑ NE
Comments (refer to qii"' ou # ) Expliiidiany YES answers and/or a©y addi o.nal rercrmmendatians�or aay other cam Tents. ` IT r:
gym& .- I
Use�drawmgs of.facility f o better;ezplain situatrogs (use additronalspages as necessary),Ij+
q_ 6
1
r
C r— Ct we) " 3 D -
W -
Reviewer/Inspector Name-
Reviewer/Inspector Signatui
Page 3 of 3
Phone: to- 3.3-33
Date: 144 , J
21412015

of Water Quality
[Facility Number �j
Mivision
O Division of Soil and Water Conservation'
.
t.- lther
�. O Agency
Type of Visit
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
,C.,00mpliance
(O Routine 0 Complaint
0 Fallow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: /, O Departure Time: County: Region:
Farm Name: . ! , kA t:sQ Pis; Pe ►,:a Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: �22h ry Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = I = Longitude: = a = 6
Design Current- Design Current --,,Design Current
Swme.gGapacity' .Population_ Wet PoultryCapacity Population: Cattle Ca ac Po ulado>i
.� �Y . t , . ..
❑ Wean to Finish
❑ La er
❑ Wean to Feeder
❑ Non -Layer
❑ Feeder to Finish
_...
❑ Farrow to Wean
Dry Poultry
. ❑ Farrow to Feeder
Layers
❑ Farrow to Finish
1 `:IL-1 Boars
Other
❑ Other
❑
❑ 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?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co l
i
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 'r-' No ❑ NA ❑ NE
❑ Yes O'No ❑ NA ❑ NE
❑ Yes ,Q No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes L_f�N ❑ NA ❑ NE
ElYes Z No ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

[Facility Number: IDate of inspection:
Waste Collection & Treatment
4. Is storage'dapacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [a'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 [2'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 Z] No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes P�No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes 9Ao
❑ 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 0o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes �jNo
❑ 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'0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ,j No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes [6No
❑ NA
❑ NE,
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes JZ'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ff No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes f�'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
[:]Yes ICJ 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 �ZNo
❑ 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 E] No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Q No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facifity Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA ❑ NE
t
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
r],No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
PNo
❑ 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 ;2filo ❑ NA ❑ NE
[:]Yes �] o ❑ NA ❑ NE
❑ Yes '[:�-No ❑ NA ❑ NE
❑ Yes 2-'No [] NA ❑ NE
❑ Yes P�'No ❑ NA ❑ NE
❑ Yes EI'No ❑ NA ❑ NE
❑ Yes Rio ❑ NA ❑ NE
a
ReviewerlInspector Signature: Date:
Page 3 of 3 21412015

I
V Divisionbf Water Resources
Facility Number ®- 4 0
Diyisjon,of.Soil and. Water Conservation
e Q Other Agency
Type of Visit: Q Compliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: O Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ® Departure Time: County:
Farm Name: ��,����n��^ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: �f� j.,', q P kn Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design Current Design . Current,
Swine Capacity Pop. Wet=Poultry Capacity ` Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
Other
La er
Non -La er
Design. Current
Dry Poultry Capacity Pa
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Region:
Design,- Currenf. '
Cattle Capacity.: Pop
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
iNon-Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
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 [E�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 .Ea No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes JD -No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes lJ No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

f
Facili umber: jDate of Inspection:
Waste Collp tion & Treatment
4. Is Aorage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�allo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
2-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?
❑ YesLJNo
❑ 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
'
❑ NA
❑ NE
waste management or closure plan?
JC2
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 _L=-] No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 13-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 r>o ❑ 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? T
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
L
'� J vo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[:]Yes
PNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[;LNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
. M No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes [3-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 -E]-No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes ❑'No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes [E go
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

V
•=�.� ��;;-x� �„�� �. �� ..�`-��':-_��.��. *' ��#�� � ion of Water�Resorirces��-�� - �_
-: acdity Number � © '•� � � Drv�s�on of So�E and Water°Conservat,nn� �` �� ���� 1,
�� a F,��^� rr.��a = s.* �,>' e°« .,•„v� OtllCr AgCYIe� r � "'� x�� �'`'ji°,� �`,,, rr�.�"''�-! 4w.�:��'r ` �
Type of Visit: B-Mmpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1,4 / Arrival Time: Q�p' Departure Time: County Region:C
r
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
i^� <".'+a ;•"-"'�..- ,w .r�s%,.".d;`� :'m..:�"`.s..="r"s.?s�-'�a".... „..,,.,.,
'Z OUesign CurrentM - �Desi �-,Gurrentit li ram* Dell n Current
�, ",em r= �,,,� *. e
Capacity,Pop o� Wet PonEtry CapacityPop��..Cattle Capacity Pop.
�j �, La er .. 4
�' Non La er �T
-. �Vesign Current
' "D Poul Ca aci Pag ..
La ers
NA
Non -La ers „a
Pullets"
y �eys . r �
>' Other, TurkeyPoults
Other Other
�
Wean to Finish
Wean to Feeder
,
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Discharges and Stream Imnacts
Da' Cow
Dai Calf
Dai Heifer
D Cow
Non -Da'
Beef Stocker
Beef Feeder
Beef Brood Cow
1. Is any discharge observed from any part of the operation? ❑ Yes ZNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ONo ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes ZNo
❑ 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 _Z o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes �o
❑ 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 2/4/20I4 Continued

Facility Number: - Date of Ins ection:
Waite Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes "[allo
a. If yes, is waste level into the structural freeboard? ❑ Yes Eq'No
Structure
Identifier: 1
Spillway?:
Designed Freeboard (in):
Structure 2 Structure 3 Structure 4
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.)
❑ NA ❑ NE
❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes /�No ❑ NA ONE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [2fo ❑ NA ❑ NE
waste management or closure plan? T
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) T
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 ?I No ❑ NA ❑ NE
maintenance or improvement?
I I . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes /No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ZjNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes �5No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes ZNo
❑ 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 VNo
❑ NA
❑ NE
the appropriate box.
OWLIP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0
❑ 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 WNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes VN0
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facq 73
ity Number: � - Date of Ins ection:
24. Did the.facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ;2"'No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes T�' o ❑ 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
ONO
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
ONo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
;3"No
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
FIlo
If yes, contact a regional Air Quality representative immediately.
T
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
eN 0
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
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
[—]Yes �2No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
op- re'601-ck's'
<'?
Reviewer/Inspector Signature: ----- '`
Page 3 of 3
Phone: ql0 7—K 3'�72~3
Date: 3 S
21412014

"Division of Water Quality
Facility Number j� '3 Division of Soil and Water Conservation -
0 Other Agency z
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Eteason for Visit: A Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: -7A I PM
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator: Certification Number: IkZ_187
Certification Number:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish [Tayer
Wean to Feeder on -Layer
Feeder to Finish
Farrow to Wean
_ Farrow to Feeder
Farrow to Finish
Other
Other
LNU11-1-
Pullets
Other
Poults
Design Current
Longitude:
Design F Current'
Cattle Capacity'' Pop
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes JTNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) []Yes ❑ No ❑ NA [[] NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes E!rNo ❑ 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 jrN ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: jDate of inspection: J
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 3-No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 21 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 /r 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 all,
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes N o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 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 6No ❑ 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 ZORo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ;21—No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes r❑'_ ❑ NA ❑ NE
acres determination? T
17. Does the facility lack adequate acreage for land application?
❑ Yes 2011 o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ��o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes' ZNo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Wacitity Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? []Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes KNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ,6No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes KNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
6No
❑ 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
O'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
F0 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
(6No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
j�
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
ZNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawinss of facility to better exvlain situations (use additional pages as necessarv).
Reviewer/Inspector Name: Phone: ' '
Reviewer/Inspector Signature: ~� Date: �It' I4
Page 3 of 3 21412011

- w
Ficility Number'
Division of Water. Quality
Division of Soil and Water Conservation
D Other Agency
(Type of Visit: compliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: �T
Farm Name:�Owner Email:
Owner Name: �Z.j% (AL ! y J e-, n ct Phone:
Region:
CRqr
Mailing Address:? .3. �- R _YXf V��CACAV t CLE f 1G C 0u S l(
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: �-A�AGP C- 4m e I n ` Inte rator:
Certified Operator: A/D(A L F{1( ��%1i Ce 'Gcation Number: y
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current - Design Current De"sign` Swine Capacity, 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
Other
Other
La er
Non -La er
DesignCurrent
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?
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non-Dai
Beef Stocker
Beef Feeder
Beef Brood Cow.
❑ Yes y No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: -'3 115ate of Inspection:
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: i pC
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
lL•- 113.5
7d y 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?
❑ Yes
9No
❑ NA
❑ NE
❑ Yes
O�o
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes X No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes X 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 gNo ❑ 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 M No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Yesallo
o ❑ NA ❑ NE
❑ Yes No
❑ Yes o
❑ Yes No
❑ Yes No
[DNA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
Q Waste Application Q Weekly Freeboard Q Waste Analysis 0 Soil Analysis ❑Vlcx
ante Transfers [] Weather Code
0 Rainfall ❑Stocking 0 Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections El Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 14 No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: —11 - 'Z 14 1 jDate of Inspection:
IF
24. Dfd the f3bility 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 No
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
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
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 V3,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
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.'
Use drawings of facility to better explain situations (use additional pages as necessary). '`.„ ��
CAu6W7/0/r � aa� �
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 916
Date: a Ja
21412011

Division of Water Quality
Facility Number 1 > l .J - 3 L 0 Division of Soil and Water Conservation
Q Other Agency
Type of Visit: Compliance Inspection 0 Operation Review p Structure Evaluation p Technical Assistance
Reason for Visit: Routine Q Complaint Q Follow-up O Referral 0 Emergency O Other O Denied Access
Date of Visit: = Arrival Time: SG Departure Time: County: LXA(7Li/t/ Region:
Farm Name: TF L112E%l/ 'S p r G Pir/V S Owner Email:
Owner Name: �A /� I p (-A L T i4 i G PC A/ Phone: q10" CQ1q91—!:1 39
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: �} (� c rN
Certified Operator: T4ar6I�r/�
Phone:
Inte rator:
9011
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:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
[Layer
Non -La er
Non-L
Pullets
Other
Poults
Design Current
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 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:
IC9�y8,
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 0 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes [:]No
[:]Yes ❑ No
[:]Yes [] No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: 31 - 3 9 IDateofInspection: ]
Waste Collection & Treatment �(
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes I X1 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 7❑�No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: l r
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
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ 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): C, T'F' (% �C1 ZF Q) _-
13. Soil Type(s): fALA-,_RL J (Lr1_
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ANo
❑ NA
❑ NE
_Required Records _& Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes P No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes 9 No
❑ NA
❑ NE
the appropriate box.
77��
❑WUP ❑Checklists ❑Design Q Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes; check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Waste Application Q Weekly Freeboard ❑ Waste Analysis [] Soil Analysis
❑ Waste "ran
Q Weather Code
Q Rainfall ❑ Stocking [:]Crop Yield Q 120 Minute Inspections Q Monthly and 1" Rainfall Inspections
Q 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: CF1 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 ❑ YesNo ❑ 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 VkNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes '(ANo ❑ 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.
34. 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 LNo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes❑NA ❑ NE
34, Does the facility require a follow-up visit by the same agency? ❑ Yes❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or, any other comments Use drawings.of facility to better explain situations (use additional pages as.necessary).
CP6460 P 0A1 D�-� 1
v.>-A • 1 9
M -511 L I.
1�fa- I .
F }� 0011 15 Gc��- - FC4- // I
Jj- D� -
UpQiq7j�' 1
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 910 _' 4 q f -�34 fp)'� 41
Date:
21412011

Dtvtsign of Water Quality ;�
Facility�;Nuinber 3� �Li hO Division of Soil and Water`Conservahon
r 1 D
Type of Visit 'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /Q Arrival Time: Departure Time: County: tape!_ / Region:
Farm Name: �i-11 tSG � r S 1` 1 C 1`ey S Owner Email:
Owner Name: QanoLA L pN 1 Phone: 914_yM_T��
Mailing Address: �� - �X y a ;1 rCW-Ay,LLC-I,yc,L/P/
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: VANPL4 1141Q0jL_N l.f��+►t iF� Integra or: Q
Certified Operator: �' l�(� Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = n 0 { Longitude: = ° =' = "
sign Current Design Cup
SRine
Capacity gPopulation -Wet Poultry Capacity Popy
❑ Wean to Finish
❑ Layer
❑ Wean to Feeder
❑Non -La er
Feeder to Finish-
❑ Farrow to Wean
..Dry Poultry.",e
❑ Farrow to Feeder
❑ Layers
❑ Farrow to Finish
❑ Gilts
❑ Non -Layers
❑ Boars
❑ Pullets
❑ Turkeys
Other
: ❑ Turkey Poults
❑ Other
_-J.-
❑ 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)
c. What is the estimated volume that reached waters of the State (gallons)?
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Brood
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 V No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
DkNo
❑ NA
❑ NE
❑ Yes 0No ❑ NA ❑ NE
12128104 Continued

Fpcility'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 ElNo ❑ NA ElNE
Structure 1 QQcture 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LAao-cu/ / /—I
Spillway?:
Designed Freeboard (in): 19.5 / g. 5
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes I 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 �ANo ❑ 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) r `
9. Does any part of the waste management system other than the waste structures require ❑ Yes] No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) C-07TJ QAf (57 & R LP
13. Soil type(s) pQ& S 70AI N6 jZF-0C< AU 1 R UU I L_LE
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
D� No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o ❑ NA
to
El
18. Is there a lack of properly operating waste application equipment?
El Yes
❑ NA
❑ NE
Comments'(refer to question #) Explain any YES answers and/or any: recommendations or any other comments ,
':Use drawings of facility to`be"tter explain situations. (use'addifional pages asnecessary)
tom. A .
g�ia/a9 I �-
Reviewer/Inspector Name ANDA C_IPIA 4.S '= Phone: q'/a 1% 739 ,
Reviewer/Inspector Signature: . Date: (f`131/Q
Paget of
12128104 Continued
c c C�

facility Number: — 3 L1 I Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes >1 No ❑ NA ❑ NE
the appropriate box. 0 WUP ❑ Checklists 0 Design 0 Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA El NE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑/aste Transfers/ ❑/ual Certification
0 Rainfall ❑ Stocking El Crop Yield 0 120 Minute Inspections El Monthly and I ° Rain Inspections El 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 allo
❑ Yes kNo
Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
El NA El NE
❑NA El NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
*o
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
`*No
❑ NA
❑ NE
Additional Comments and/or Drawings:
{ 100 T- (. 7 �N �nr o'kX�Lo -,X/d CAca S r►cn^-^-jg - NOT& DOA/ 900
/nV5f E c7 r CW 9-E ppQ-1 7047 f/l G WZ) �D flo C IQU PQ.A -k-W - co" g QA ► Ci/
mil~ ,4SE CET ca4� t QR A ►one DCWC - A S k P L3� D!� IS
S �Xli� i 0
/�iTN. I�MANt�A E1A/Nf�
?LeASE PAX Cory o f 'o9 Sobs AMPLE5 k,�/ C AL-19907) CVV
Page 3 of 3 12,128104

� _ P ,< ,Division of Water Quality � ; � +-
:F ar�l�ty Nuinkier f 3 DrvWon of Soil and Water` Couservanon
Oo ther.Agency � :• �;
(Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit Routine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: / Arrival Time,
Departure Time: C] County: u'V Region:
Farm Name: I-i 1 paw JS ?I c ?Gyy s Owner Email:
Owner Name: ��']Q�E� Phone:-1l11t��'pa�33dco�
Mailing Address:
Physical Address:
Facility Contact: ((�� Title:
Onsite Representative: �ruQ'%�15 17R� c�c �iZA�iroy 104 pEAl Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = = = Longitude: E--] ° El
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & 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 0 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
El Yes El No ❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

1? acility dumber: — Date of Inspection O?
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 14No ❑ 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: C OCR
Spillway?:
Designed Freeboard (in): �• S
Observed Freeboard (in): �Lrj
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 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 VNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes KNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes 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 ;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 WindDriftDrift [I Application Outside of Area
12. Crop type(s) �770%/ J L-1 �j C2l '
13. Soil type(s)
1LL
v
14. Do the receiving crops differ from those designated in the CAW MP? El Yes XNo
15. Does the receiving crop and/or land application site need improvement? ❑ Yes f���,No
N//
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes No
17. Does the facility lack adequate acreage for land application? ❑ Yes ZNo
18. Is there a lack of properly operating waste application equipment? ❑ Yes XNo
❑NA El NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments, (refer to:question;#). Explain any YES answers and/or any_recomrnendatrons or any other comr►ients _.
alise drawtngs of facility to `better explain situations: (usea,add�tianal pages as,necessary): '`
XI
CAQ D nIOT o Gc T �T —
CACb (R [ M S 4l G )4G7) 0 E
C.L L3Q-:�� U07
w) i—L
70 Goy// &CT
F
Reviewer/Inspector Name — 0
Phone: =1!Q —
Reviewer/Inspector Signature:
Date: y1)I�q
Page 2 of 3 12129104 Continued

Facility Number: —3q Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes X 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. Q WUP❑ Checklists 0 Design [3Ma s ❑ Other ` p
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )qNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ 7aste Transfers ❑ Anual Certification
[] Rainfall 0 Stocking 0 Crop Yield El 120 Minute Inspections 0 Monthly and V Rain Inspections [D 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
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes 9V No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes 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 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 , 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 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes �o
❑ NA
❑ NE
Page 3 of 3 12128104

Division of Water Quality
Facility Number] 3 O Division of Soil and Water Conservation /
0 Other Agency �/
Type of Visit )0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit )0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: �� Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative:
�4N CuaTrS Er— integrator: (�(j
Certified Operator: =aNDU gic-'26V Operator Certification Number: 'tq� r o
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 O 0 1 = « Longitude: = o = j = 4i
Swine
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feedej
Farrow to Finish
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
---,ram-,--.—t-•—
❑ NOD-Layet
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 Eleifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stacker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from.a discharge?
❑ Yes � No El ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
oNo
❑ NA
❑ NE
❑ Yes
*o
❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: LAGpn!
Spillway?:
Designed Freeboard (in): % S
Observed Freeboard (in): pL S
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes K10
❑ Yes ❑ No
Structure 5
Cl NA El NE
❑ NA ❑ NE
Structure 6
❑ Yes ONo ❑ NA ❑ NE
❑ Yes Wo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes X No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes RNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ElNE
maintenance or improvement? 14
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
I t . 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?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes d�l No
❑ Yes IQ No
El NA ❑NE
[I NA El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
P No
❑ NA
❑ NE
- 17. Does the facility lack adequate acreage for land application? ❑ Yes
[g No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name _ mp c)iq C p— S Phone:
Reviewer/Inspector Signature: r1 . Date:p�S�
12128104 Continued

Facility Number: 3 ) — 3y Date of Inspection 8�
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 ;I No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 4*,,41 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
J4No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
"mac' No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
.q 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
.� 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
VNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
[INA
❑ 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
KNo
❑ 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
,5�rNo
❑ 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
1� No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
bNo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

'v
Division of Water Quality
Facility Number 3 4f Q Division of Soil and Water Conservation
- - O Other Agency
Type of Visit O�Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
s' I
Date of Visit: 3 3 0 Arrival Time: q.. Departure Time: County: 6/ C--= Region:
Farm Name: Owner Email:
Owner Name: �/7��G P�� Phone:
Mailing Address:
Physical Address:
Facility Contact: _
Onsite Representative:
i
Certified Operator:
Back-up Operator:
Location of Farm:
F
O%/y►®�I Zip
�1 Phone o
ntegrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: c =1 ❑ u Longitude: [= ° = 6
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish k. P 3 2 IST V
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other.
❑ La er
❑ Non -Layer
Dry Poultry
❑ Lavers
❑ 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
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
I
❑ 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 l of 3
❑ Yes ? No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ NA
❑ NE
❑ Yes
IoNo
9f No
❑ NA
❑ NE
12128104 Continued

a
Facility Number: — 3 Date of Inspection✓ 3
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?
Scture I Structure 2 Structure 3 Structure 4
t4
Identifier:-- `2
Spillway?: t9 A)e
Designed Freeboard (in):
❑ Yes VNo
❑ Yes ❑ No
Structure 5
❑NA ❑NE
❑ NA ❑ NE
Structure 6
Observed Freeboard (in): ' 3 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes "ONo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes PNo El NA El 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 PNo ❑ 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 IpJ No [I NA El NE
maintenance/improvement? /
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 1�lNo ❑ NA ❑ NE
❑ Excessive Ponding ElHydraulic Overload ElFrozen Ground ElHeavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN >.10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes O'No
❑ NA
❑ 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 12
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �J 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):
I
Reviewer/Inspector Name I L L'02'9 01 Phone: Zq-
Reviewer/Inspector Signature: Date: 2 &z4L0'Z-_
Page 2 of 3 12128104 Continued

Facility Number: ~l� / -- ?� !� Date of Inspection 3 2
{ T
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 51!
o ❑ NA El 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 ❑ Desig
n El maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. J[J Yes No ❑ NA ❑ NE
Waste Application ElWeekly Freeboard ElWaste Analysis [ISoil Analysis ElWaste'
❑ 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
[I NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El
V
[I NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�No
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
�No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
o
❑ 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
❑ 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
❑ 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:
_
j F�G� S, ��.�✓r ��✓ ��w� �� 219 21 F22,
Page 3 of 3 12128104
1p

0 Division of Water Quality
Facility Number ) 3 O 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
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: y 6 aV Arrival Time: I--L4! ,J Departure Time: County: 1�Ut°i-[L^' Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ?AKjDq =G
Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Latitude: [—] 4 [—] ' ❑ Longitude: = ° = i =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
1 5934--l6
Soo
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other_
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Points
❑ Other
Discharees & 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
i
❑ 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 Ed o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ o
❑ Yes
❑ NA
❑ NE
❑ Yes
LlCo
❑ NA
❑ NE
12128104 Continued

FacilE-� umber: 3{-( Date of Inspection � oL
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 11a No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2Structure 3 Structure 4
Structure 5 Structure 6
Identifier: LA600-0 66^/?i
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 r] 3 7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes O No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
,
ElYes CJ 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 th t, no DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �No El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? ElE� 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 tNo ❑ NA ❑ NE
maintenance or improvement?
Waste ADolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
N
❑ NA ElNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 66T OP4 UEQ,MuOA (G 6 -0 co-s CciC(lrn 6cn_s' -Fce
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
BNo
El NA El NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
,
�N//o
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
2 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
2N
El NA El NE
18. Is there a lack of properly operating waste application equipment?
Yes
ElId
Igo
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name I i ot4xj f Aav G t_ Phone: %r1g-- i
Reviewer/Inspector Signature: Date: Y /2 6a
Page 2 of 3 12128104 Continued

Facihty Number: Date of Inspection
Required Records & Documents /
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
o ❑ NA
❑ NE
the appropriate box.
❑ WUP El Checklists El Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ To ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
/❑
L�'No ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ . ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E oo ❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
[I NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
FN❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ffNo ❑ 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
C?go'
❑ 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
trNo
❑ 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
2'�lo'
❑ 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

Facility Number°; 3
1
Division of Water Quality
0 Division of Soil and Water Conservation
Q Other Agency
Type of Visit (D ,�C�,ommpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: J 05 Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = e = ` = Longitude: = ° = = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
a ❑ Non -La ei
L l Farrow to Wean
i
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey 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
❑ Daia Cow
❑ Daia Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: ED]
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 UNo ❑ NA ❑ NE
El Yes
[:]No
❑NA
ONE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ NA
❑ NE
ElYes
ZUNo
o
❑ NA
❑ NE
12128104 Continued

Facility Number: 3 -- 3 Date of Inspection u�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Rl 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:(..A 6c1Dr.1 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
0 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
ErNo ❑ 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
2: No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
<0 ❑ 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
B No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
Ld No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect 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 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) C o T ci i J i3ER_-*AQ91A LCI) S 41-O Gt.JS SIEGE_rXZL/1 S
13. Soil type(s)
L) V
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
I__I 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
[I NA
El NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
,.,d(No
L� No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
J(No
❑ NA
❑ NE
al.) �Po�.Tc �� •��� u�
a -': u n-L Tr_f�
Reviewer/Inspector Name S A�z ►1L�t _ ffi; y,= Phone: �9+b—'7d.(,
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number. ') -- y Date of Inspection 5 v�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box.
❑ WUP El Checklists El Design [I Maps El Other
❑ Yes E No ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
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 dcrop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
2"NNo
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
2/No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
dNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Q o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
1Vo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
D.No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
LI 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
CJ 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 6y
❑ Yes
UVo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
�/
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
'
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
L o
❑ NA
❑ NE
A'dd:honalCo�nments and/or:Drawings = r��
�..s'`�a,_61
12128104

Type of Visit XCompliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit XRoutine Q Complaint Q Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit: Time:
C Not erational Q Below Threshold
Permitted ❑ Certified © Conditionally Certified © Registered Date Last Operated or Above Threshold: W.
,��% `. / .T /'/✓S County: .
Farm Name: .....,C .... _....___._ .._�._.......
Owner Name: �. ...,lf�. �w. Phone No:
.Mailing Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Location of Farm:
Title:
Apli
Phone No:
Operator Certification Number:
X Swine ❑ Poultry ❑ Cattle Q Horse Latitude • �� �44 Longitude • 4 «
-
Deggn :Current
Desaga Current:]Des gn = Current
Swine
-
_=Po tionPoultr
on'.l.Cattle Po tton
Wean to Feeder
Layer
-
Dairy
Feeder to Finish
fl
❑ Non -Layer
Non -Dairy
Farrow to Wean
-
Farrow to Feeder
Farrow to Finish
�`
E
Total Des><gn Capaak9
[:1 Gilts
t
Boars
Discharges & Stream Impacts
1 _ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/rnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2_ Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes ONo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes j2rNo
❑ Yes J(No
❑ Yes XNo
Structure 6
Identifier:
Freeboard (inches):
12112103
Condnued

r FaciH6 Number,-3/— Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ yes INO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ yes f�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 maintenancerunprovement? ❑ Yes rNo
8. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level 0 Yes /PlNo
elevation markings?
Waste Aaolication
10. Are there any buffers that need maintenanoe!nnprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAI) ❑ Hydraulic Overload _Pozen Gro4o ❑
12. Crop type
13. Do the receiving crops differ vMth those designated in the Certified
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?
Waste
❑ Yes ANo
El Yes 5No
and/or Zut�
Plan (CAWNT)? ❑ Yes No
❑ YesNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes )9No
❑ Yes PrNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ yes XNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes �No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes P110
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes (I(No
Air Quality representative immediately_
❑ Feld Copy ❑ Final Notes
lee", TDie lfo � �iPp�S,
J
Reviewer/Lupector Name ;
Reviewer/iaspector Signature:
Date:
12f] 13 GonUnUed

+ Fa ' Number; Date of Inspection
Required Records &_Documents
21. Fail to have Certificate of Coverage &. General Permit or other Permit readily available? ❑ Yes ONo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes XNo
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes A No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes XNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes ;2fNo
27. Did Reviewer/laspector fail to discuss review/inspection with on -site representative?
❑ Yes )ZfNo
28. Does facility require a follow-up visit by same agency?
❑ Yes XNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes Z No
NI MES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
gfYes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes f&No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes JZNo
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes ONo
34. Did the facility fail to calibrate waste application equipment?
❑ Yes XNo
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes Z14o
❑ Stocking Form Z Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

L
Division of Water Quality
Division of Soil and Water Conservation
Other Agency
Type of Visit A Compliance Inspection Q Operation Review O Lagoon Evaluation I
Reason for Visit Routine O Complaint 0 Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of V isit:
Permitted U Certified 0 Conditionally rtified� D R
Farm Name: egistered
l �`E S
/ �}
Owner Name:
Mailing Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Location of Farm:
rrwn m
Time:
Date Last Operated/oy Above Threshold: _
County:
Phone No:
Phone No:
Operator Certification Number:
Vf Swine ❑ Poultry []Cattle ❑Horse Latitude ' ° OK Longitude ' ��••
Design Current
Design Current Design Current
Swine /C"city Population
Poultry Capacity Population Cattle Ca acity Po ulation
❑ Wean to Feeder
❑ Layer
❑ Dairy
Feeder to Finish
ElNon-Layer
ElNon-Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
El Boars
Total SSLW
r
Number of Lagoons ©
❑ Subsurface Drains Present ❑ La oon Area ❑ 3 ray Field Area
Holding Ponds 1 Solid Traps
10 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 State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: Z
Freeboard (inches):
05103101
❑ Yes OZNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ONO
❑ Yes JVNo
❑ Yes 'P�No
Structure 6
Continued

1
Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application?
El
12. Crop type
13. Do the receiving crops differ with those designated Certified Animal Waste
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
❑ Hy lic%O�erlo)ad
'S6�C��iQ/"
Plan (CAWMP)?
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?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes jZfNo
❑ Yes No
No
❑ Yes,/
❑ Yes ld No
1�
❑ Yes NoNo
C
❑ Yes 01
❑ Yes No\
Yes No
❑ Yes No
❑ Yes /❑ No
❑ Yes ❑ No
❑ Yes ANO
❑ Yes XNO
❑ Yes No
ElYes No
[Yes ❑ No
/❑ Yes N o
❑ Yes �o
❑ Yes /�_"No
❑ Yes o
❑ Yes o
❑ Yes �No
I 0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit. I
Field Copy ❑ Final Notes
11�119WH 11FI-14 X60 ;rW &60MM,9'�- 1�f
ddl�KOZ_ ��eO "'S e-R,4 5_S46-5. //�57
6_1:?OU'11'O Kra'0_5 Z-a 5� r �5f 0
APPMRS o VsrPzsHz
Reviewer/Inspector Name I
Reviewertinspector Signature:
05103101
Date:
Continued

Facility Number: — Date of Inspection lY/ice
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
d; o
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
;No
29.
roads, building structure, and/or public property)
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
o
34.
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
////
o
&No
31.
Do the animals feed storage bins fail to have appropriate cover?
El Yes
32.
Do the Flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ No
'04; &4 y I
fo—A
6 toq"Ik
4�EC c 0 m M F, rn ap S F L --�7-7 A P 1PL-�7 C 4 --r z p^� s QF
OF;. il'o o /a c T-0 r;'LI✓ NA-,) S PRztJc,,,
G�rn
:51Z I- 5AAICC,
3 SrphR k-7E
oo r,-,- R Aix
A
05103101

4 _ - /.;p
AR �waLCY'-CGttSerYBtIOD M--
Type of Visit 10 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: Time:
Facility Number
rO Not O erational 0 Below Threshold
I
�] Permitted ❑ Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold -
Farm Name: County
Owner Name: Phone No:
Mailing Address:
Facility Contact: l Title:
Onsite Representative: &OV
�apFN
Certified Operator:
Location of Farm:
Phone No:
Integrator: 1r� 5
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude 0' 0
Design ' Curren€ ,; Design. :_Current Design. 'Carrent
Slime -
r
Ca acit� "Po utation Potilt C acitr .Po ulation Cattle W Ca achy Po uiatioa
❑ Wean to Feeder ❑ La er r �'❑Da'
Feeder to Finish ❑ Non -Laver J I ❑ Non -Dairy
Farrow to Wean - m-
[] Farrow to Feeder ❑ Other -:
❑ Farrow to Finish Total Design°Capacity
❑ Gilts
❑ Boars - Total SSLW
77
Number of Lagoons = ❑ Subsurface Drains Present ❑ La ooa Area ❑ 5 ray Field Area
Hotdit€g Pons 1 Solid Traps T�= ❑ No Liquid Waste Management System 1
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in-at/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 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Continued

Facility Number: — Date of Inspection
5. Are there anv immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes El No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? [I Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? . ❑ Excessive Pondin; ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type 1f'7"InzljV)/L / IJ—kv}
13. Do the receiving crops differ with those designated in the Certifrid Animal Waste Management Plan (CA WMP)? ❑ Yes ❑ No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25,
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Cammepts.(refer.to question)- E:plaux ariy YES answers and/or_an} recnmmentiattons;or anv.other comments._ -
;_
-: _
Use drawings of.faeilttvfo better ezplarn sifttaitons: (use addtttonai pages'as necessary) Final Notes
- Field Canv
ONTa�uE ---IV dF sG�4���✓ ARM ,
?yam Zoe
�i4T'� ef" ILK 55FG (DSGv�� -
� i
t✓F_
--
Reviewer/Inspector Name _ -
Reviewer/Inspector Signature: Date: 2
05103101 l
Continued

s, _
74P
Facility Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor 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
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No L
❑ Yes
❑ No
❑ Yes
❑ No
Additional: Comments and/or Drawings:C) 1! r2_ "0 //4 9&145 5kz 2 z Cz
��l�QrE,ev�5�T-G�� rD �i✓dFF
TfJL�i�/J �,�'✓i5�!f-� TL�i�'% �1,�._.S�-�✓ S�i}�'J�/ ��i4
72; Z,4&-lro sJ
7oo 1�' ApAovtq,�I_ x:)a^1
70,000 4
/01)0rc,
e�D
0510310I

3 1 3
Date of visit: % O 2- Time: I 1 71 : 325
Facility Number
Not O era 'anal OBelowThreshold
© Permitted © Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: �j-) er,'S County: —
Owner Name: �� Hd e>� Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: get e h
Certified Operator:
Location of Farm:
Phone No:
Integrator: Go In cte e
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude C�' 0 Longitude �' 0
Current Design _ Current` .—Design,Curreent -`
`Ponblation Poultry Caneeity Population Cattle `Cauacitv`''Pouulattoa .=
❑ Wean to Feeder
❑ Feeder to Finish
". ❑ Farrow to Wean
Farrow to Feeder
Gilts
Boats
Number�of it ug�ions � ❑Subsurface Drains Present ❑ La oon Area ❑ Spray Field Area-
Holding~Pands 1 Solid TrapsLiquid+ - -
-W ❑ No Waste System
Discharges & tream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon /pray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gat/min?
d. Does discharge bypass a lagoon system? (If yes. notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure:2 Structure 3 Structure 4 Structure 5
Identifier: _
Freeboard (inches):
05103101
xyes ❑ No
❑ Yes XNo
/yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Continued

4
Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
El Yes
❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
El Yes
El No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Anplication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
❑ No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
24. Does facility require a follow-up visit by same agency?
❑ Yes
IWN0
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
E3 No violations or deficiencies were noted during this visit. You will
receive no further correspondence about this visit.
Comments (refer #o qu+estion #) Eiplain any YES answers andiar a®y
recommendations,or anv other,com_meatsr
Use.drawi©gs of fachsty to better explain sttaahons:(use addthons[. pages iss necessary} =_ : ❑Field Cony ~ (] Final Note--; x}
irlspel4;,o Was elve4cA 1+'i
YCsPonse 4o 41 >CIt�Over-
i✓t 41n,,t 41 e L ser vpA pt n nn
1n1a00s�e Y'Lln o xr ,O! gee •/L. 44 e
Sx? Yc y :
A ►7 : ""tis) Z-J�i fr� B ? t'1 �G -� ZI e L.>OG G� s
Reviewer/Inspector Name
p y
Reviewer/Inspector Signature:
ate:
05103101 ' Continued

w. 10 ._...,,,_ ...._
Facility umber: ,3 —3 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?
Additional Comments -and/or Drawinigs... = _
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
rE�i� �r��P�crGaN r
iV. 7�J [�JvonJ 1zv,9�G,
�6A572S7 y ��,� 1FI oN,g- /f;n1eFZ-0 41too
rZ-OA1r.,-,, 7N72. /7'' � WhP 4�,4.9
yr�
; F/7es'^' za
14,
�G
4Y,o
05103101

Type of Visit compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit .eRoutine O Complaint. O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3 ! Date of Visit:
13 Permitted 0 Certified p Conditionally Certified [3 Registered
Farm Name: �'1 ! 1Ue q �.5 01 �2 �'t S
_.......9 ........................... ...................
Owner Name: ..�'"'� -Th'' 2
.............................. f{°... .............................. ............
Facility Contact:
Title:
8 8 Oj Time: ! 310
Q Not Operational Q Below Threshold
Date Last Operated or Above Threshold: ..................
County: vt�f.... ".'... .............•-................ ....... .....
Phone No:
Phone No:
MailingAddress:•...........................•-....................................................................................... ..........................
, t'` Onsite Representative:.... . ....................... ..g
Certified Operator:
Location of Farm:
Operator Certification Number: ..................... . ...................
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� ��� Longitude •
6 «
Design . Current,`: Design Current _. Desrgri ,- Currerrt
S -Cavacity Po ulad6n Poultry . ..-Capacity : Population Cattle CapaciW.
po ._ tion =_
' ❑ Wean to Feeder ❑ Layer ❑ Dairy
eeder to Finish ❑ Nan -Layer 1 10 Non -Dairy
❑ Farrow to Wean
Farrow to Feeder ❑Other
°x=
Farrow to Finish TOttW Design-CSpa<fty
Gilts
Boars ToW SSLW
Number of i:agoons
m
:-": ❑ Subsurface Drains Present ❑ Lagoon Area ❑Spray Field Area
Holding Ponds / Solid Traps -'
❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes I!rNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes eNo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
0 Yes ff No
c. If discharge is observed. what is the estimated flow in gal/min?
!'1 /q
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes ANo
2. Is there evidence of past discharge from any part of the operation?
❑ Yes ZNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ffNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes ,gNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure S
Structure 6
Identifier: 1 �Z..........................................................................................
.....................................................................................................................
Freeboard (inches): 35
5100
Continued on hack

Facility Number: 3 ( 3c3 Date of Inspection
5. ?kre there any immediate threats to the integrity of any of the structures observed? (pie/ trees, severe erosion,
❑ Yewo
��`"'
seepage, etc.)
6. `Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes B'No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
❑ Yes --o-No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ YesZ'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes__0'90
Waste Application
ld. Are there any buffers that need maintenancetimprovement?
❑ Yes ,,ffNo
11. Is there evidence of over application? ❑ Excessive Ponding 'PAN ❑ Hydraulic Overload
EfYes ❑ No
y�i
12. Crop type Bc.^wlt/Ofe", �ay LCarh LI.J¢ 2r �n►?vq�sotij�egKf� Gu�vrlbwt�
P rear
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes EfNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes ❑ No
b) Does the facility need a wettable acre determination?
❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
15, Does the receiving crop need improvement?
❑ Yes ONO
16. Is there a lack of adequate waste application equipment?
❑ Yes P'No
Required Records & Documents
17, Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes J'No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes .0110
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
..ETYes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ONO
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes [2rNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes [:]'No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss revicw/inspection with on -site representative?
❑ Yes %To
24. Does facility require a follow-up visit by same agency?
❑ Yes ONO
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes No
P. IM4 vii►latitins.oi di fel nd!D$ ftre note#. d06fig this'vjrsjt; • Y60 'wji teb iye �o �u�. . .
correspo deit& about this visit::::: :
Commeabs (refer toWgneshon #) Explaw any YES answers and/or: any recommendations orlany other conitnepts. e
Use dra�ingTof facility to bEtter;eaplain sidiation§ (use_additiooai es_as n - '
_ _... P _ wry) _ .._ _ ..
1J. �r'e is ©Nrraf��l�Ga�1o� o-P 124A) on 41,-e Z•aol peeper r- oh �JYo(ra.rfl
I CG $ iE_ ojC !.$� ?t.s IM01-IGrr em e�iA fvll- AJsol �el-e is� O✓z*'A J;c�M
tJT ��I'�4� �lt� ZOO. GUGvmEity GIfl�O Ol.t 1� �ravt%f .�r113/� ��GJ -
�14� �i qG D�' I• I�� �pJ SRN `°tG/`C Oh e�Gl, QUiI • ��ye zwAli O,
1
Reviewer/Inspector Name
Reviewer/Inspector Signature: -Date: 5100

Odor Issues Facility'Number: 31 - 3� j Date of Inspection � QJ
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 ,ZNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes J'No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes zNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or /
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes XNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ONo
32. Do the flush tanks lack a submerged fill pipe or a permanenUtemporary cover? ❑ Yes ❑ No
Additional:Comments and/orDrawings:
.set-nflei hoed 4o be -4e-S "ed -Faf- alt r;6leY-S ,• Gv,*ren� Te;l 4eJi
Stt.lvs ahl� aPIf sg—V-/z CO,- 41e 6dr-1Vd-J ICeld.
pe-cern" te►tddd -/4a Oqe.sa;l 4d--�..soi-y/6 6e 4,7iktH Ao ervex y /4 ac'-es
orr ImIld. fe sv O Abw -AG aroP e" �CCL ���r'L°1 Cgyp/ �? �le SQ4pIC
/
O�er W 014.
l
4br cqIcvl�►-jao�^s oil -�11P ��2�-2�s are ;YlcorPec�y �-�ke care
I'1 mQ C:ulcv/,q4)ortS .
Svf'e- 4a case q. l�.Jasle gYtai r►s da�e� !N�-1�.;�, 40 da%� 0r
eve4t5 -14e
an �1"C�-ZfS� need �a b� sVr2
Sq,•�•tPl e s 0-1q t'er t �,ne b� s1 s s0 46i r -T ree_O nA1e4
Al e you flake ��,e s� J
�1� e v�� 6� d� s
e 4rO je�e f �'rLow
�.i'
h Eh
°J � 14 W;// be Spi'a 1 �ka� Y7exd bP
A, t� eyfe-6'0 �►'ii21� �e�� .1qy erit�n r`
�✓'o1G-l-; G11 f -
�n�wer ►�jG?S �'Wo Gals✓lq�;a�.s �vf �vt1ilS 4� -�lrp Ga�^'tijl�Vf vne ��
C41 e.4` 4aL-i-s deeSnl f lta v'eG dale -Tics ('.l e;1 44e -2-001 ee' PI oh
p),c+ S-2-q / /I yt5 lh� I �6 &MOL g'- Sq YJ 4e A"., k5 �e k., q'd e
12v't s nz� necri c 6e zv�e o arapoe�` d al c44q e-r afit' 4;Mes
Y � � � r�Go� 1
ftj6�e :. 7GjerP �� currep14i an aV%ne-►1d-.QnPle
Wh�� al{"J'V-f for �v� �ers GL/c,V P�"� 4o �e
4�{re is Yio r"�ix �v r-t q �elfn1 a. C'�OL�i e S�W� f"� GAn be
ff©f
�lGirL�'L/i � ri -��eS� "G✓'4�l qvL,/ �7i1� n'%q' �T��'►� a. � r�r0l,'e"1 d��c r � ,
Q� aPf cQ �s 7-4q A Oad e*4
pt'!n acrc59G ;.s eieVO`t< ,, la `�iiesie Grapes yob lec01 Ja Op4Jr VH tV,��i
c 1 & d; G f l a►t 1,3 j1,1 de -n e �•✓�a a',� volt
'✓►211
--
,.vt,r rt � GL'"'l.e' �Lh7,f � d S a L1l'f` � � .' r
�
r r
5/00

• - ' Division of Water Quality
O Division of Soil and Water Conservation
Q Other Agency-
3
Type of VisitC,o�mpliance Inspection O Operation Review p Lagoon Evaluation
�ti5 Reason for Visit ,routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number Date ur Visit: �'-(]C} Time: 1_ r = Printed on: 7/21/2000
FO Not Operational Q Below Threshold
Pf-Permitted [Certified Q CQonditionally Certified © Registered Date Last Operated or Above Threshold
Farm Name �' 1..�`'p......... County:D...'�......_•....................................._.
�?...... ....•................................................... ....._..._...
OwnerName:.........................._...._........................_.......................................I..................... Phone No:
Facilitv Contact: .............................................................................. Title:
;Mailing Address:.......................................................................................
...
Phone No:
Onsite Representative: LJ t-,� Integrator: �JC3a. �G d
I........I. �."� .......✓.......................................................................... ..._....._....
Certified Operator.
Location of Farm:
Operator Certification Number:
A6
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 9 i Longitude • 4 &C
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Po ulation Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I I ❑ Dairy
eeder to Finish ❑ Non -Layer ' ❑ Non -Dairy
❑ Farrow to Wean 10 ❑ Farrow to Feeder Other
❑ Farrow to Finish Total Design Capacity
❑Gilts 1EE
❑ Boars I Total SSLW
Number of Lagoons I ea- JE1 Subsurface Drains Present ❑ Lag—n Area ID Spray Field Area
Holding Ponds / Solid Traps 1 10 No Liquid Waste Management System
DischaEges & Stream Impact
1. Is any discharge observed from any part of the operation?
❑ Yes
XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance maii-made?
❑ Yes
❑ No
b. If discharge is observed. did it reach Water of the State'' (if yes, notify DWQ)
❑yes
❑ No
c. If dischar�-e is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
❑ Yes
ElNo
2. is there evidence of past discharge from any part of the operation?
❑Yes1Vo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
N:' o
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
XNo
Structure I Structure ? Structure ; Structure 4 Structure 5
Structure 6
Identifier.........................................................................................................................................................
Freeboard (inches):
5100
Continued
on back

Facility N6umber: 31— 3 Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes �No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancefimprovement? KYes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes O(No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes gNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ONO.
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑Yes MNo
12. Crop type G 4—, cL_�ez
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?
Re uired 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?
(i�/ 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. Tail 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 ofthe Certified AWMP?
To A61bitidds :oi, def a n.... were noted during phis"visit: • You will •r. eeeiye trio further ' •
irorreVondeizee ab this .visit` ' ... .
❑ Yes �(No
❑ Yes ONO
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ;�No
❑ Yes tZNo
❑ Yes N1 No
❑ Yes A(No
VYes ❑ No
❑ Yes �yNo
❑ Yes ])�No
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):
❑ Yes XNo
❑ Yes �(No
❑ Yes t<NO
❑ Yes _ZNo
T?) &41 A.
CA
eA
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: ��rt8—C4_ 5/00

Paeilitj; umber: Date of luspection EWE] Printed on. 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge At/or below &Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes Wo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, Yes P�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 KNo
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 3�'No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ro
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes DrNo
Additiorrial Comments:and/or wings:
5100
5100

?Date of Visit: 10-18-2QQQ Time: Printed on: 10/202000
Facility Number 31 34
x. ...,,,.. , , ,¢.,,>�, N.w 0 Not Operational O Below Threshold
Permitted Certified M, Conditionally- Certified Recistered Date Last Operated or Above Threshold:
Count}': DuNi�tt._.._.._.._.._. '
Farm Name: Thi�p�n.s.'ir.Pcxts............................. ................................... ...................... ..... .._.._. W Q.._....
Owner Name: Ban#y---------------------------- Thig3lstt---------------------------------------- Phone No: 47.Q-."2$= 3 1'r_1 9St.-_T(ISl .fhb--.--•--•------
Facility Contact: -- -- - - -- -- -- - - -- Title: -- -- -- - - -- - - - - - -- - Phone No: _ - -- - - -- - - -- --
MailingAddress: PO.B.n.148........................................... ......................................... I........ BcWayilk..N.0.................................. ..................... .28fils..............
Onsite. Representative: .Q.vai ,r...........................--•-.....-_•-------...-.-----•--.......__ Integrator: Ii0`.: xwAfArma__....-.._....---....-_....._.__....__.
Certified Operator: Rawly __ __ Thigpr-n -- -- -- -_ -- -- -- -- -_ -- Operator Certification Number: JL74H __ __ __ ._ __ __ __
Location of Farm:
North of L.ymon. On West side of SR 1801 approx. 0.75 mile South of SR 1809.
2 i = ID Subsurface Drains Present
No Liouid Waste Man
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: 10 Lagoon 0. Spray Field Other
a. If discharge is observed, was the conveyance man -matte?
b. Ndischarge is observed, did it reach Water of the State? (If ves. notify DWQ)
c. If discharge is observed, what is the estimated flow in galimin?
d, Does discharge bypass a lagoon system? (If yes- notify D WQ)
-. is there evidence of past discharge from any part of the operation?
1 Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
AL
El Yes 91 No
F 1 Yes 0- No
4_ is storage capacity (freeboard plus storm storage) less than adequate? Spillway i Yes No
Structure 1 Structure ? Structure 3 Structure 4 Structure 5 Structure 6
Freeboard (inches): - - --4>. - -- - - -- -- -- -- -- -- -- - -- - - - -- - - - -- -- - - - -

Facility Number: 31-34 Date of inspection printed on:
5 _ Are there anv immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10_ Are there -any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
i 0,2012000
❑ Yes
No
❑ Yes
JR: No
Yes
❑ No
❑ Yes
X No
[j Yes
9 No
❑ Yes
ER No
❑ Yes
g-a No
12. Crop type Corn, Soybeans, Wheat Coastal Bermuda (Hay) _ Cucumbers Peppers
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 9- No
14. a) Does the facility lack adequate acreage for land application? Q Yes 19 No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18_ Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WLM, 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?
❑ No violations or deficiencies were noted during this visit. You will receive no further
correspondence about this visit.
❑ Yes No
❑ Yes tK No
❑ Yes Z No
X Yes ❑ No
❑ Yes ® No
❑ Yes 19 No
❑ Yes No
❑ Yes No
❑ Yes 9 No
❑ Yes 9 No
❑ Yes Z No
Repair broken inlet pipe needs to be repaired. J6
A few small leaks from foundation cracks need to be repaired.
B. Need irrigation layout map/design and new aerial map from District office. Recent amendment by Johnny Lanier with
>istrict needs to specify how much acreage can be grown in alternative crops each year.
9. Need soil test for each field in waste plan each year. 2000 sample shows bermuda only and it requires at least a ton/ac
f lime this fall.
10verall, farm and records in good shape. — No copy left on -site — copy to be sent within next week. i , l
Reviewer/inspector Name Dcan Huiikele39 ;-390Q: 22G,:..:......... ...,.. ... ........ ....

uutc:
Facility Number: 31--34 Date of Inspection 10-18-2000 Printed on: 102012000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes � ; No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? [[ Yes No
28, Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation__ asphalt, Yes ; No
roads, building structure. and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, mussing or
or broken fan blade(s), inoperable shutters, etc.) - E] Yes 03 No
31. Do the animals feed storage bins fail to have appropriate cover? [:]Yes [i No
32. "Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes 19 No

A
Q Division of Soil and Water Conservation [3 Other Agency
O'Diviston of Water Quality
a
Routine O Complaint 0 Follow-uR of DW2. inspection O Follow-up of DSWC review O Other
Facility Number
Registered �© Certified (3 Applied for Permit gXermitted
Farm Name: .' .... ...1.1 ... ``� ............................................
r `. ........ .
Owner Name:....°\" .......... Zir`..........................
Date of inspection
Time of Imspection I G ; 24 hr. (hh:mm)
0 Not O erational Date Last Operated:
Count'.
ounty:.......... ..1'........................................................
{.... Phone No: fir
1 C% a� 3� o t
FacilityContact:.............................................................................. Title:..........................
Mailing Address:.d..B. .. ..... n l�ivf�L.Yi* .��4.......0'4�. .....W......
Onsite Representative:... !�:.... �? ` -... ..� 1...........I..
..... ................
Certified Operator-,....... .........
Phone No:..... .................................
........................................ `-c oc .......................... ..........................
Integrator:....?!,�..............`...............................---......----
Operator Certification Number;..........
I, do of Fa
.................................................. ................. ...
Latitude • C " Longitude rW�• 4 "
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes [WNo
2. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: El Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes (3 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes
No
c. If discharge is observed, what is the estimated flow in gal/min? t
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes allo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes 04 No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes 21No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes M 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 No
7/25/97

Facility Number:.3 —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (LagoonsMolding Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: 2-
Freeboard(ft): ........ .....................................................................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
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 ....,��.... W� .............................................................. .......
Structure 5
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?
❑ Yes 12,No
❑ Yes EANo
Structure 6
..............................
....................................
❑ Yes
VNo
❑ Yes
[SrNo
{,Yes
❑ No
R( Yes
❑ No
❑ Yes
.4 No
13- No.violitions'ok deficiencies4e're noted during this:visit. Yoa:v'ill receive-_ira-furttier�_:-
correspoddehbc . 4 out this:visit:: :
N Yes ❑ No
❑ Yes EaNo
❑ Yes iKNo
❑.Yes 29 No
❑ Yes ($ No
❑ Yes ['$No
Ellyes ❑ No
❑ Yes [3:No
❑ Yes 1l No
Yes ❑ No
�6ya SYe�'� �►�� �t� � 1���#i P�.I[r�(P�-5[ � ����. ��- �r-� �ti� w�
per_
�di `\eel �p �` • � L'� �r5 1..,e�.F~. t� `i'i--� � r-�s.�-�- •cam rer�1� �-er�. ' , ►-�11 T, N�
oCf` '� ," N r�cc�-ems W ►1�w �► P 1,ect3 ir.
7/25/97
i Y ��C- `'' • � �` � � � 1 �`'! sC .c r `-�i' Se}�7L- �"] rkr �rh �� off_. h��2 f/J bYPt.t�� �2c_vr 5'f��o �
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:

Di, igion of Soil and Water'Conservation Operation Review
0 Division of Soil and Water Conservation Compliance Inspection
Division of Water Quality = Compliance.Inspection
0 Other,Agency - Operation Review
10 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number 3t 3 Bate of Inspection
lime of Inspection 24 hr. (hh:mm)
19 Permitted 1ACertified E3 Conditionally Certified 13 Registered © Not Operaational Date Last Operated:
FarmN<rme: ....... �M..i-..... � ... k.1 ............................................. ......... County:...... 4kii,..............................................-----............
Owner Name:.. .................. b l-..... ] ��}lG,r...-......-..-............................. Phone No:
Facility Contact:..............................................................................Title:.......
Mailing Address: Qp. ,�
..........1................................................................
Onsite Representative:.............Ew.114.1....�;
......... .
Certified Operator:_ .............:.j......... L,.`......1.Y1 �.1� . ...................
Location of Farm: 1
Phone No:.... .....................:.....
.......... ....lu.ou��,....Nr.............................................. ... ($..........
.......... Integrator: ......�A...........................................................
Operator Certification Number: ..........................................
......................... Q�........ lucs ......la ..... Q.�........ IK.... L. .. Q...7.1.......MW&.......My. .....U........................................
.......................................................................................................................................................................................................................................................................... T
Latitude 0 4 :4 Longitude • 1 44
Design Current
awtne
❑ Wean to Feeder
Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I ❑ Dairy
❑ Non -Layer I Non -Dairy
❑ Other
Total Design Capacity 5-T32,
Total SSLW
Number of Lagoons 7— 1E1 Subsurface Drains Present lin Lagoon Area 10 Spray Field Area
Holding Ponds / Solid Traps JE1 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)? ❑ Yes $bNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. ll' discharge is observed, was the conveyance man-made!. ❑ Yes �0 No
b. If discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State ❑ Yes J4 No
c. If discharge is observed. what is the estimated flow in gal/min? WIN
d. Does discharge bypass a lagoon system? ❑ Yes 1P No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes tj No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate'? ❑ Yes MNo
Structure I Structure 2 Structurc- 3 Structure 4 Structure 5 Structure 6
Identifier: I i-L
Freeboard (inches): ........ �u{..................
1/6/99 Continued on back

baciliiyNumber: 31 — 3 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any pact of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Ponding ❑ Nitrogen 1
12. Crop type ................. 6ennQ34L.................... ar!........ ........ Aftt`r✓
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. Does the facility lack wettable acreage for land application? (footprint)
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 certified operator in responsible charge?
22. Fail to notify regional DWQ of emergency situations as required by.General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss revicw/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
❑_ No.violations.. deficiencies .were noted daring t....v.. .You �rill.retceive nor ftirt�ier .:.:
•0fr.O-spgiidence;about;this;visit..•.•.•... •;•;•;•;•:•;• ;•;.
Z
❑ Yes W No
❑ Yes ,'Q No
® Yes ❑ No
❑ Yes P9 No
❑ Yes A No
❑ Yes 4 No
❑ Yes A No
❑ Yes ED No
❑ Yes fgNo
❑ Yes (A No
❑ Yes JA No
❑ Yes 1A No
Yes ❑ No
j Yes ❑ No
❑ Yes ® No
❑ Yes 19 No
❑ Yes .M No
❑ Yes No
ElYes ;No
Comments. refer to question.4 -Ex lain any YES answers and/or an recommendations or any other comirknts
Use drawings of facility.to better explain situations. (use additional pages as necessary)
7
oGri GM D S 0 r\ • QtkY*- a � 4 will sJ\00ld IX VtwjivW . i3nlct,_ -t-,M �.�k. S�t.1t•J 6,,
19 . w o P 4\e1/1 4 A t f
C11 of gj-- mod. r,l O
�,tC� 5 [A - 4A.
�w4.
Reviewer/Inspector Name
Reviewer/Inspector Signature: ' ,t, r� 1 1� _ Date: U2Vgcg 11/6/99

❑ DSWC Animal Feedlot Operation Review,
�: ` �� � DWQ Animal Feedlot Operation Site Inspectlzon
�� `�� � .� ��>
Routine 0 Complaint 0 Follow-up of DWO inspection O Follow-up of DSWC review 0 Other
Facility Number 3 j 34
13 Registered r Certified 0 Applied for Permit P Permitted
Farm Name: ....... `[�petLS . .. .L' 1..........................................................
Owner Name:
Facility Contact:.........11 .iicp.....................
Mailing Address:......7.49.................
Onsite Representative: ..... ,1. liD�p..�.................
Certified Operator ;........... •}�� ...............
Location of Farm. 1 �
Date of Inspection
Time of Inspection �� 24 hr. (hh:mm)
10 Not Operational I Date Last Operated: ..........................
....... County: ...... 41.ir............................................................
Phone No:._(`jlP.�..��i.%: 34.
Title: .........DLc......................................... Phone No:..��lLt�..��.. ��.�i............
N.c.........1...................:.............. (?.........
...................................... Integrator:.,.., ....... I_ .....................................
......................... Operator Certification Number;-- .1 ......
�.......... !{1.....A........... i►�r�1a.�... ftY......1....r....�.....b�....i~,�.ma,n....... rn.....1�......ra.....
ir
5 .... $4.. •::-GL ......ts........Q.. .r.► 5........a.r ........-rn)eS ... icic......��e......................................:................................................-_......
Latitude ` i <' Longitude 4 .4
Design Current Design Current Design Current..
Swine Capacity Population Poultry Capacity Population Cattle Capacity. Population
❑ Wean to Feeder ❑ Layer JE1 Dairy
153 Feeder to Finish 510 z ICI Non -Layer I0 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW'
Number of Lagoons / Holding Ponds ❑ Subsurface Drains Present ❑ Lagoon Area I0 Spray Field Area
❑ No Liquid Waste Management System k
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes [)d No
2. Is any discharge observed from any part of the operation? ❑ Yes [9 No
Discharge ori�zinated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed. wa,. the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gal/min`.' N
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑Yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes [4 No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes 10 No
7125/97 Continued on back

Facility Number: — 3
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes JZ No
Structures (�Lagoons,11olding Ponds, Flush Pits, etc.)
9. Is storage capacity (Freeboard plus storm storage) less than adequate? ❑ Yes R No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure fi
Identifier:
Freeboard(ft): .1.................. .................................... ................................... .................................... ....................................
....................................
10.
Is seepage observed from any of the structures?
❑ Yes
0 No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
5d No
12.
Do any of the structures need maintenance/improvement?
11711 Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do anof the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
.R No
Waste Applicgtinl)
14.
Is there physical evidence of over application?
❑ Yes
19 No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
` -------...-......tAV15.........................................................................................
Crop type ...........� �Y.YX1JC......................... ..UXsi... ..........-..W.!�.�.....-....
lb.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
WYes
❑ No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
$ No
18.
Does the receiving crop need improvement?
❑ Yes
,R No
19.
Is there a lack of available waste application equipment?
❑ Yes
5j No
20.
Does facility require a follow-up visit by same agency?
Yes
❑ No
21.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
P,No
22-
Does record keeping need improvement?
Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
EKNo
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
U No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
$9 No
0- No.violationsor' deficiencies were noted during this.v_ isit.- .You.will recei've' no' ftirtlier'
correspondence aboiit this-visit:
Cointnents (referFto question #): Explain anv YES answers' and/or aay recommendations or any'other cotntnents t*41
Use drawtn' s Offacfty ta_better ex Lain situateons.: use additional a es as necessa
1L. art, aK as oN ln+ne,tr &-. rnA . wd 56A 6e rcseeOej, I ntur I of IaSoayL ;kouI J to mead, �
f6- Soybew& 00,KW -,N �tfW1 ae-,%jM Por earn. ,GJ� rc"ps io be pfavlw ►„ a4k shpu(d b
Ets,k.Jch Wo.S�erj,���-+itii~R toffyy Ian, 60r4 So�(�i �:s�t�E+ -',, assIs4oa . ]
2�. Gn�tr4p v, ukorx P lfrr►. 0W0 So � i � W0.3k SCghPlt. 0,A4 �Ses S �t4tl� be }-n crr�i Ar � w
S�� ht:[.ora s swolj be (abe(+.t) "J H- �elf� Atmm 6tcs {vas ""SIC VR(-, zatioti P(ar,_
7/25/97
Reviewer/Inspector Name K
Reviewer/Inspector Signature: &;-- LI Date: _I.Q1Q/g7 T`

s
Site Requires Immediate Attention: Ale
Facility No. 1TT
DIVISION OF ENVIRONMENTAL MANAGEMENT
AIVEWAL FEEDLOT OPERATIO S SrM VISITATION RECORD
DATE. , 1995
Time:
Farm Name/Owner: X;f-Alb Li //�
Mailing Address: ";41• Ll i
County: l v/ N
Integrator- !f i✓/�tj
On Site Representative:
Physical
L.
r 7 Phone:
Phone:
9A! '�/ D fl—
Type of Operation: Swine '1/ Poultry Cattle
Design Capacity: 2 - 70-P Number of Animals on Site:
DEM Certification Number: ACE . DEM Certification Number: ACNEW
l
Latitude: ° �� ' 1 Longitude: 7 c'3 Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches Ye r No Actual Freeboard_Ft. Inc es
Was any seepage observed from the lagoon(s)? Yes rW Was any erosion observed?( -Yes r No
Is adequate land available for pray? Yes or No Is the cover crop adequate Ye r No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwelling . 'Ye r No
100 Feet from Wells?/Yes br No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by than -made ditch, flushing system, or other
similar man-made devices? Yes o N If Yes, Please Explain.
Does the facility maintain adequate was a management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments: y _ L 1��T �✓�
.� Inspector Name
cc: Facility Assessment Unit
Use Attachments if Needed.
PA;